text:
Thesis - Doctoral
Investigating medication review services provided by community pharmacists
Md Hatah, Ernieda
Cite this item: Md Hatah, E. (2013). Investigating medication review services provided by community pharmacists (Thesis, Doctor of Philosophy). University of Otago. Retrieved from http://hdl.handle.net/10523/4108
Background: In recent years, pharmacists' roles have expanded to include more patient-centred services such as medication review and prescribing. In 2006, the Pharmacy Council of New Zealand proposed a framework for pharmacy services which consisted of four tiers of patient-focussed services. The services were (1) Medicines Provision (2) Medicines Use Review (MUR) (3) Medicines Therapy Assessment (MTA) and (4) Comprehensive Medicines Management (CMM) which may include pharmacist prescribing. These new services were developed with different purposes and aims and were intended to be conducted in close collaboration with general practitioners (GPs).
Aims: This thesis aims to examine medication review services conducted locally and overseas and examine the effects of different types of medication review on the patient care process and patient outcomes. This thesis also aims to explore GPs' perceptions of different types of medication review services and future services such as pharmacist prescribing in New Zealand.
Methods: MUR services that were provided in a locality in New Zealand and conducted from November 2007 until December 2011 were assessed through a retrospective review of MUR patients' records. The services' outcomes were evaluated and factors that may influence the outcomes were investigated using multilevel mixed-effects logistic regression. Types of drug related problems (DRPs) identified by the pharmacists during MUR were categorised according to the DRP classification scheme v6.2 by the Pharmaceutical Care Network Europe (PCNE). In addition, a systematic review and meta-analysis of fee-for-service medication review services was conducted to evaluate the outcomes of the services. The outcomes were also quantified according to types of medication review e.g. MUR vs MTA-like services. Following that, face-to-face, semi-structured interviews were undertaken with GPs from two localities, whose patients had and had not undergone a pharmacist-led MUR service. GPs were asked for their opinions of pharmacists' provision of MUR, MTA and prescribing and some other services and the data were analysed thematically using NVivo 8 and grouped by strengths, weaknesses, opportunities and threats (SWOT) categories.
Results: A total of 353 MUR patients' records were evaluated. MUR was found to improve patients' knowledge, perceptions of, and adherence to medications. Several factors such as gender, ethnicity and duration of engagement with the service were found to predict patients' outcomes. A total of 886 DRPs were identified by pharmacists during the review period. Of this, 160 (18.1%) of the DRPs identified were clinical interventions and were perceived as a MTA level service that went beyond the practice of MUR. From the systematic review and meta-analysis, MTA-like services were found to have a significant impact on patient outcomes by attainment of target clinical biomarkers and reduced hospitalisation but this was not found in MUR-like services. From the interviews, GPs were found to be more accepting of pharmacists providing MUR and MTA but less supportive of pharmacist prescribing. The opportunities for community pharmacists included GPs' openness to work in close collaboration with pharmacists particularly if services were integrated into GPs' practices. The perceived threats to the services included perceptions from the GPs that such services could increase GPs' workloads with limited benefits to patients.
Conclusions: MUR and MTA were found to have different effects on patient outcomes. Although the MUR service in the locality studied had positive effects on patients' knowledge, perceptions of, and adherence to medications, the overview of such services overseas did not report significant results on patients' clinical outcomes. Since the service was not intended to provide the clinical support required by patients, patients who receive only MUR may potentially miss out on optimal care. Although GPs were accepting of both MUR and MTA, they had some concerns about certain aspects of the services. However, GPs' willingness to work collaboratively with pharmacists was seen as an opportunity for optimal medication-related patient-care and could overcome these concerns.
Advisor: Braund, Rhiannon; Tordoff, June; Duffull, Stephen
Degree Name: Doctor of Philosophy
Degree Discipline: School of Pharmacy
Keywords: medication review; pharmacy services; patient-care; pharmaceutical care; community pharmacy services; pharmacists; New Zealand
School of Pharmacy [85]
Thesis - Doctoral [2600]

redpajama_set_name: RedPajamaCommonCrawl


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Gabriela Hearst LLC today announced that it has received a minority investment from LVMH Luxury Ventures, an entity within LVMH focused on investments in iconic brands.
Terms of the investment were not disclosed. The Gabriela Hearst brand was launched in 2015, and reflects Gabriela's commitment to creating a strong, modern collection of luxury ready to wear and accessories that take into consideration where materials come from and who is making them.
In the three years since her brand came to life, Gabriela has received numerous awards and nominations for visionary fashion talent. The LVMH Luxury Ventures investment will be used to support the ongoing expansion of the Gabriela Hearst brand presence around the world.
About Gabriela Hearst: Gabriela honored her family's heritage through the launch of her eponymous label in Fall 2015 after taking over the operations of her father's ranch in Uruguay. She wanted to create a brand that reflects a slower pace and process: where things are made with care and detail, where tradition is more important than trend, where there is a purpose to every piece.
Gabriela's commitment is to make a strong and modern collection without compromising her ethics and key values, taking into consideration where materials come from and who is making them: luxury with a conscience or in other words, "honest luxury".
Gabriela Hearst opened its flagship store at the Carlyle House, on Madison Avenue, in November 2018.
About LVMH Luxury Ventures: Launched in 2017, LVMH Luxury Ventures is an entity within the LVMH Group aimed at taking minority stakes in emerging (but already iconic) brands, with a view to creating value.
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Its second investment was in Stadium Goods, which was subsequently acquired by Farfetch. The investment in Gabriela Hearst is its third.


With most readers only spending less than even half a minute you may be forgiven for thinking that maybe your resume is not that important. In fact, the amount of time that is spent scanning your resume makes it even more important that your MBA resume writing is done very carefully. You have to ensure that your resume is capable of communicating everything that the reader wants to find in that short 20 second window. If it does not then you may find yourself disappointed. The following section will provide you with some simple things that you need to do to ensure that your resume for MBA applications can make you stand out.
Show clear career progression and start with your latest position on your resume. The panel will prefer those applicants that can clearly show that they have received promotions and progressed within their areas of expertise.
Show your achievements. Never list your responsibilities as these are generally obvious from the jobs that you have held. List achievements with the greatest first so these are read first. Use bulleted lists rather than long paragraphs.
Quantify your achievements. Nothing speaks louder than money so if you can provide dollar improvements for your achievements or percentage increases then all the better. In general however, quantify everything about your achievements – How many people were on your team? How quickly did you achieve your goals? What savings/sales / other improvements were made?
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text:
Q: What are database statistics, and how can I benefit from them? I've heard mention of statistics that SQL Server keeps by default. What are they tracking, and how can I use this information to improve my database?

A: They are used by the query optimiser (whitepaper on MSDN) to track distribution of values in indexes and/or columns.
Your only concern should be to update regularly: just leave the DB engine to do its stuff

A: Statistics simply are a form of dynamic metadata that assists the query optimizer in making better decisions. For example, if there are only a dozen rows in a table, then there's no point going to an index to do a lookup; you will always be better off doing a full table scan. But if that same table grows to a million rows, then you will probably be better off using the index. But if you query that table on a column that only has very few unique values (e.g. it might be a "sex" column containing only "M" or "F"), well actually a FTS might be better that that case because you would need to retrieve the block anyway to build the result set. Now say your table is 99% "M" and only 1% "F", we should FTS in one case or use an index in the other.  Same table, same query, potentially four different query plans depending on the contents of the table. These kinds of things are the "statistics" and they are individual to each database - even two databases with identical table and index structure will have different statistics.
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redpajama_set_name: RedPajamaStackExchange


This handsome brick facade, highlighted with stone accents and a turret-style bay, will bring European style to any neighborhood. Enter to find a well-planned design with heightened ceilings and elegant touches. The great room boasts a wall of windows for great views, and an extended-hearth fireplace framed by built-in shelving. The kitchen features a serving bar that can comfortably seat four. A sloped ceiling defines the dining room, sunny and cheerful with a wall of windows. Exquisite in every detail, the master suite indulges in a spa bath with a step-up tub, a separate shower and a massive walk-in closet. To the far right, a bayed library and a bedroom open to a full hall bath. Basement space can include a recreation room and hobby room, or finish it to suit your needs.
$75.00 A list of building supplies needed to construct the infrastructure of your new house.
$115.00 Choose this option to reverse your plans and to have the text and dimensions readable.


text:
package esiv1

import "time"

/*
200 ok object */
type GetCharactersCharacterIdAgentsResearch200Ok struct {
	/*
	 agent_id integer */
	AgentId int32 `json:"agent_id,omitempty"`
	/*
	 points_per_day number */
	PointsPerDay float32 `json:"points_per_day,omitempty"`
	/*
	 remainder_points number */
	RemainderPoints float32 `json:"remainder_points,omitempty"`
	/*
	 skill_type_id integer */
	SkillTypeId int32 `json:"skill_type_id,omitempty"`
	/*
	 started_at string */
	StartedAt time.Time `json:"started_at,omitempty"`
}

redpajama_set_name: RedPajamaGithub


text:
Kalendarium informatyczne 1941 roku

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 12 maja – pierwsza publiczna prezentacja skonstruowanego przez Konrada Zuse komputera Z3

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 9 września – w Bronxville (stan New York) rodzi się Dennis MacAlistair Ritchie, haker, współtwórca języka C i systemu Unix.

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Kalendarium informatyczne
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redpajama_set_name: RedPajamaWikipedia


text:
« Dwyane Wade keeps shooting hoops during O Canada at Game 3 | Main | Morley Safer says goodbye to 60 Minutes »
Here are a bunch of Canadian films that pass the Bechdel test
I enjoy Canadian film for its propensity of strong writing with realistic characters. Fewer explosions, more dialogue.
My love for strong, realistic dialogue in film gets along well with the Bechdel test, a way to get a sense of where females fall in the importance of a film.
The Bechdel test has 3 basic criteria:
Are there two or more named female characters?
Do they talk with each other?
About something other than a man?
Most films, Canadian or otherwise, definitely fits criteria #1. You might laugh at the idea of named female characters, but you would be surprised that in the credits of some films, women (more than men) have identifiers such as "woman topless on beach" instead of actual names.
Passing the Bechdel test doesn't put the film in some magical feminist utopia. And failing the Bechdel test doesn't mean there aren't strong feminist tones within the film. The Bechdel test is just a guide to steer you away from extremely superfluous films toward films that likely do well with dialogue, plot, and characters.
Sometimes, a film has a strong female character in the lead but not another female character to be the other end of a conversation. The final requirement helps steer away from films where either the women are both going after the man or the sidekick helps her friend get the man by the end of the film.
We aren't saying Canadian films are more likely to pass the Bechdel test. Non-American films are more likely to pass the test than American films but also that the United States supplies with world with so many films that fail the Bechdel test with flying colors.
The criteria can be subject to interpretation. After all, @Krinkle8/Twitter said this, "Someone pointed out that "oh my god, becky, look at her butt" passes the bechdel test and I haven't stopped laughing for a week."
Let's take "Wet Bum" as an example, especially since we've just reviewed the film.
Sam has a "conversation" with Judith, even if Judith doesn't actually answer back. Sam talks with her mom, Mary Ellen, about topics other than a man. Girls in the locker room have conversations with Sam, even if they are about the awkwardness of not changing clothes in the locker room.
A conversation should have words. Does it matter that Sam and Mary Ellen are daughter and mother, after all, female relatives would fit it easier to have conversations that don't involve a man. The locker room conversations are mostly girls talking at each other, or with each other about Sam. All the girls in the film do have names.
The Xavier Dolan Quebecois collection would seemingly pass the Bechdel test with strong female characters. However, "Mommy" barely qualifies, even though a romantic partner isn't the issue. "Tom at the Farm" and "J'ai tué ma mère" talk about a man, though only Sarah of "Tom at the Farm" is interested romantically in the man. As for "Heartbeats" and "Laurence Anyways," I can't honestly recall a conversation with 2 women in either film, though Suzanne Clément's rant against a waitress in the latter film should qualify as an important one-sided conversation.
Lesbian films could pass the Bechdel test if the love interest is a woman, but chances are lesbian films will also have conversations that don't pertain to a romantic partner. "Blue Is the Warmest Colour" has tons of conversations that have nothing to do with romance or sex.
Even with hours for research, we couldn't list all Canadian films that pass the Bechdel test. If the Bechdel test criteria would help you pick out a Canadian film, we have a few suggestions.
Our list is pretty safe. These are mostly films we've seen and discussed where a pair of female named characters have a conversation not about a man.
Ginger Snaps
Wet Bum
Into the Forest
La Passion d'Augustine
Empire of Dirt
Vic and Flo Saw a Bear
Inch'Allah
Take This Waltz (if only the shower scene)
Marion Bridge
When Night is Falling
Tu Dors Nicole
Better Than Chocolate
I am a good person / I am a bad person
Polytechnique
Lost and Delirious
Love in the Sixth
If you have a favorite Canadian film that passes the Bechdel test that we didn't list, feel free to let us know in the comments section.
picture credit: Ginger Snaps film
Posted at 07:00 AM in Canadian society, film, U.S. society | Permalink
Tags: American films, Bechdel, Bechdel test, Better Than Chocolate, Blue Is the Warmest Colour, Cafe de Flore, Canadian film, Canadian films, Cloudburst, Empire of Dirt, female character, female characters, feminist, film, Gabrielle, Ginger Snaps, Heartbeats, Inch'Allah, Into the Forest, J'ai tué ma mère, La Passion d'Augustine, Laurence Anyways, lesbian film, Lost and Delirious, Love in the Sixth, Marion Bridge, Miraculum, Mommy, Polytechnique, Quebecois film, Room, Suzanne Clément, Take This Waltz, The Five Senses, Tom at the Farm, Trigger, Tu Dors Nicole, Vic and Flo Saw a Bear, Ville-Marie, Wet Bum, When Night is Falling, Xavier Dolan


Simon N Goodwin has been making games and audio tech for almost 40 years, with British firms like Codemasters, Attention to Detail, and Silicon Studio Ltd, and with multinationals like Amiga, Atari, Creative Labs, DTS, Electronic Arts, Intel, Motorola and Sega. He's also worked extensively in Radio, TV and mass-market technical journalism.
Along the way Simon has pioneered the use of seemingly dead-end 1970s British tech like Ambisonics into Virtual Reality and games like Grand Theft Auto; helped get six games to number 1 in the full-price charts here and abroad, as principal programmer and an experienced sound designer, picked up five patents and a couple of BAFTAs, and written a book, Beep to Boom, to explain himself and hopefully avoid having to keep fixing the same things over and over again.
He's lectured on interactive audio at GDC, the global Game Developer's Conference in San Francisco, and Audio Engineering Society and University events. He advises on past and current EPSRC and AHRC research projects and helped to found the AES's international Audio for Games conference series, a decade ago. He lives in Warwick as an interactive audio tech consultant, specialising in making interesting things happen reliably more than a million times a second.
In this new talk for the AES Midlands Section and the University of Wolverhampton, Faculty of Arts, Simon will break open the 'black box' of game audio runtime systems, identifying the 'objects' in Object Audio and how they're built and managed from psychoacoustic and signal-processing principles, grounding his explanations with practical advice and anecdotes. He will answer questions at the end, which is likely to be even more interesting.


Total War: Warhammer II Dark Elves let's play concludes as Malekith the Witch King launches a wicked attack on his most hated enemy, the High Elves.
As we dive from the campaign game into battle, we see the beating heart of the Dark Elf war machine. Their lust for slaughter is personified in the unique trait Murderous Prowess; as the body-count mounts, the Dark Elves hit fever-pitch and enter a maniac kill-state.
You'll see a wide array of units from the Dark Elf roster, including the sensational flame-spewing Hydra, plus a first look at the Moon Dragon fielded by the High Elves.
In yesterday's campaign let's play, we prepared by steering a Dark Elf Black Ark into support range. Watch as we call down its earth-shaking bombardments on the enemy mid-battle, disrupting and demoralising the High Elf lines.
Total War: WARHAMMER II releases on 28th September 2017 and is available for pre-order now through Steam.
Shortly after the launch of Total War: WARHAMMER II, a gigantic update will be made available to owners of both games, for free. A new combined campaign map will enable players to conquer both the Old and New Worlds as any Race from either base game or any owned DLC Races.


text:
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            } else {
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                ok = writer.write(data, encoding);
            }
        } while (i > 0 && ok);
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            // had to stop early!
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            writer.once('drain', write);
        }
    }
}


Grandpa was my caregiver until I was old enough for school. We had our morning coffee together. He read the sports; I read the comics. He taught me some German, the best time to get cookies so Grandma wouldn't know, and how to roll his cigarettes. He was so proud of me for having them all lined up for him after lunch. Through him, I learned many valuable lessons. I learned cigarettes were bad. I learned what cancer was, what tube feedings were, and the very scary word 'metastasize'. Finally, he taught me how to deal with loss. I was 9 years old.
Decades later, I was a cancer nurse, a patient advocate, and educator. As a cancer nurse, it was my duty to fight with you...to fight with dignity to heal or to fight with dignity to leave. And for years, as I helped people get ready to leave the hospital by applying makeup. I would later learn I was exposing them to the very things that made them sick!
I was angry. Again, I was the little boy who made cigarettes for his Grandpa without understanding the implications. This time though, I had the skills to make a difference.
Since I have also been involved in pharmaceutical research for nearly 20 years, I brought my nursing skills and my research skills together to combat an industry that throws toxic chemicals into a product, slaps a pink ribbon on the box, and betrays the very consumer who thinks they're buying a product with a conscience.
I had to restore balance to this personal equation. So, my first product would be called 'Restoration'.
Essentially, I want all my products to be the most effective, healthy, and organic skin cosmetic it can be. I want it to be something you can feel good about using, look good from using, and can feel safe sharing with others.
My hobby is my crusade. My competition? A goliath. My skin cream was good enough to get into Whole Foods, but they need more products... more product diversification. This will come. What makes me think this?
The Environmental Working Group rates my cream a "1". Water rates a "0".
It's a cream with organic tinctures of Immortelle, Calendula, and Prunella. - long known for their positive effects on skin.
It's infused with Reiki, positive intention, prayer or whatever noun suits your mojo.
The formulary is supported by research published on reputable sites (e.g. National Institute of Health).
Nearly all my 1,500 beta testers say it's a keeper.
My products are formulated with safety in mind - first and foremost.
That means that all products will be 70% organic at minimum. This allows me to say 'organic' on my advertising. Also, it gives me peace of mind.
Unlike other companies, I will not hide chemicals under the guise of 'fragrance'. I also will not fail to reveal all ingredients - another industry dirty secret. I want to be part of the solution - not the problem.
I'm a bass-baritone opera singer who wanted to teach ancient medieval literature. I volunteered my way into patient care, found myself in pharmaceutical research on a dare, and now design databases for Watson Health at IBM. In 2005, I was in a coma, had a dear death experience, and came back to make a difference. One of many lessons learned - don't ignore the bucket list. If you are interested, my bucket list book, The Alchemist's Heir, is available on Amazon.
I've heard it said that our lives are divided into three chapters: learning, earning and returning. I'm living all three at once. My intention is to continue learning how to serve others...to dedicate myself to improving my 'garden patch', to find a path that is both mindful and prosperous, and to find my own personal 'restoration'.


Exempt Students : Hawks, Toads, Nester, and the Hop-Alongs. This group of students is also known as "THE 6".
All students are allowed to have food in c2 during enrichment.
Any student given food by the teacher is allowed to eat that food at their station.
Food and Drinks are not allowed inside room C2 for most students. It does not have to be open or being consumed. Any visible food or drink is considered a violation even if it not open. The definition of room is slightly different for the food and drink policy.
Our classroom has two doors. One door is near the library and is referred to as the library door. The other door is referred to as the main door.
One area is NOT considered inside the room for the food and drink policy. This area is called the "square". This area will be pointed out in class and includes part of the table by the main door of the classroom.
The library door does not have a "square".
The "square" can be used to place food and drink without violating this policy. Students may access the food and drink in this location during work time. I will designate work time. Basically if I am interacting with the whole or part of the class - IT IS NOT WORKTIME.
Going to the square at inappropriate times will result in violation. Appropriate time for to access the square to eat and drink is during DESIGNATED computer work time. This means if you are working at a computer you may eat and drink at the "square". I will designate work time each day. If I fail to indicate work time, ask. Never go to the "square" while I am talking or within the first 10 minutes of class.
Entering the classroom with visible food or drink through the library door and walking to the "Square" is a violation of this policy.
Having any food or drink at a computer station will result in a violation of this policy. It does not matter if the food or drink is opened or closed. It is not allowed at the station in any form.
1st violation - The Hawk will submit the Food Drink Violation form at the time of the incident.
2nd and 3rd - The Hawk will submit the Food Drink Violation form. The student will write their name on the front left board. When the name is removed from the board will depend upon the period the student is in. The only person who can erase the name is the student who who has their name on the board.
3rd Period - erase the name off the board during enrichment.
4th Period - Erase after class and stay 5 minutes.
6th and 7th - The name can be erased after school or during enrichment the next day they are in school.
8th - The student can stay 5 minutes or erase the name during enrichment the next day they are in school.
4th and above - The Hawk will submit the Food Drink Violation form and the student will attend Enrichment the next day or first available day.
Failure to erase your name off the board by the appropriate time will result in being assigned an Enrichment the next day or first available day.
Failure to attend an Enrichment - two Enrichments are assigned. Failure to attend both Enrichments will become an administrative matter with the recommendation of a 1 hour detention with me.
3. Log on the workstation.
5. Go to the schedule.
Other choices may be made available instead of consequence listed above. Possible choice may be Hawk bark, quack track crocker, or cleaning up a computer station. Choices depend upon the instructor.
Only the hawk, nester, toads, and the hop-along are allowed to eat and drink in the classroom at their workstations..


Welcome to my Christmas Redundancy Diary.
Had a lovely Christmas present from my boss; a 'P45'.
Normally we'd just exchange Christmas cards, so this feels rather special.
Although I'm not entirely sure what it is.
Maybe it's a Secret Santa gift and the Secret is the gift rather than the Santa.
And I feel so selfish and unthoughtful now. I bet when I open my gift I'll have wished I'd got something for my boss too.
Anyway, back to the guessing game.
Maybe it's some kind of savings bond?
Or the code to a bank security box?
A seat number? Could it possibly be a trip to the theatre?
Perhaps it's the latest smartphone offering from Samsung?
The room number at some posh snazzy hotel?
Well either way, I'm very excited about my surprise gift.
Only hope it's not too long before all is revealed…….


Edwards Air Force Base personnel gathered at Stripes Lounge to congratulate and celebrate the base's newest master sergeants May 24, 2017.
The 5,166 master sergeants selected Air Force wide represent a 25.61-percent selection rate of eligible technical sergeants. Selectees' average time-in-grade was 3.86 years and time-in-service was 14.36 years.
Master sergeant is the first of the senior noncommissioned officer ranks.


text:
Träfflista för sökning "WFRF:(Erlinge David) "
Sökning: WFRF:(Erlinge David)
Erlinge, David, et al. (författare)
Prasugrel 5-mg in the very elderly attenuates platelet inhibition but maintains non-inferiority to prasugrel 10-mg in non-elderly patients: The GENERATIONS trial, a pharmacodynamic and pharmacokinetic study in stable coronary artery disease patients.
Ingår i: Journal of the American College of Cardiology. - : Elsevier. - 0735-1097. ; 62:7, s. 577-583
OBJECTIVES: We assessed pharmacodynamic (PD) response for the reduced prasugrel 5-mg maintenance dose in very elderly (≥75y; VE) patients. BACKGROUND: In TRITON-TIMI 38, prasugrel 10-mg reduced ischemic events versus clopidogrel 75-mg, but increased bleeding in VE patients. METHODS: We examined PD and active-metabolite pharmacokinetics with prasugrel 5-mg and 10-mg and clopidogrel 75-mg in a three-period (12 days each), blinded, cross-over study in VE (n=73, mean 79±3y) or non-elderly (≥45-<65y, NE) (n=82, 56±5y) stable coronary artery disease (CAD) patients on background aspirin. Assays included light transmission aggregometry (LTA), VerifyNow(®) P2Y12 (VN-P2Y12), and VASP. The primary comparison was non-inferiority of maximum platelet aggregation (MPA) comparing the median for prasugrel 5-mg in VE versus the 75th percentile for prasugrel 10-mg in NE, using a prespecified one-sided 97.5% confidence interval for the difference <15%. RESULTS: Prasugrel 5-mg in VE met the primary pharmacodynamic non-inferiority criterion versus prasugrel 10-mg in NE. For prasugrel 5-mg, MPA was significantly lower (mean±SD, 57±14%) than clopidogrel (63±14%) (p<0.001) in VE, but higher than prasugrel 10-mg in NE (46±12%) (p<0.001). PD response by LTA, VN-P2Y12, and VASP during all treatments appeared similar between age cohorts. Prasugrel 5-mg resulted in fewer VE poor responders versus clopidogrel. Rates of mild bleeding were higher with prasugrel 10-mg, but similar for prasugrel 5-mg versus clopidogrel 75-mg. CONCLUSIONS: In aspirin-treated stable CAD patients, prasugrel 5-mg in VE attenuated platelet inhibition while meeting prespecified non-inferiority criterion versus prasugrel 10-mg in NE, with significantly better PD response and fewer poor responders compared to clopidogrel 75-mg in VE.
Prasugrel 5 mg in the Very Elderly Attenuates Platelet Inhibition But Maintains Noninferiority to Prasugrel 10 mg in Nonelderly Patients
Ingår i: Journal of the American College of Cardiology. - : Elsevier. - 0735-1097 .- 1558-3597. ; 62:7, s. 577-583
Objectives This study assessed pharmacodynamic (PD) response to the reduced prasugrel maintenance dose of 5 mg in very elderly (VE) patients (andgt;= 75 years of age). less thanbrgreater than less thanbrgreater thanBackground In the TRITON-TIMI 38 (TRial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet InhibitioN with Prasugrel-Thrombolysis In Myocardial Infarction 38) study prasugrel 10 mg reduced ischemic events versus clopidogrel 75 mg, but increased bleeding in VE patients. less thanbrgreater than less thanbrgreater thanMethods We examined PD and active metabolite pharmacokinetics (PKs) with prasugrel 5 and 10 mg and clopidogrel 75 mg in a 3-period (12 days each) blinded, crossover study in VE (n = 73; mean: 79 +/- 3 years of age) or (n 82) nonelderly (NE) (andgt;= 45 to andlt;65 years of age; mean: 56 +/- 5 years of age) stable coronary artery disease (CAD) patients receiving background aspirin. Assays included light transmission aggregometry (LTA), VerifyNow P2Y12 (VN-P2Y12), and vasodilator-associated stimulated phosphoprotein (VASP). The primary comparison was noninferiority of maximum platelet aggregation (MPA) comparing the median for prasugrel 5 mg in VE versus the 75th percentile for prasugrel 10 mg in NE, using a pre-specified 1-sided 97.5% confidence interval for the difference andlt;15%. less thanbrgreater than less thanbrgreater thanResults Prasugrel 5 mg in VE met the primary PD noninferiority criterion versus prasugrel 10 mg in NE. For prasugrel 5 mg, MPA was significantly lower (57 +/- 14%) than clopidogrel (63 +/- 14%; p andlt; 0.001) in VE but higher than prasugrel 10 mg in NE (46 +/- 12%; p andlt; 0.001). PD response by LTA, VN-P2Y12, and VASP during all treatments appeared similar between age cohorts. Prasugrel 5 mg resulted in fewer VE poor responders than clopidogrel. Rates of mild bleeding were higher with prasugrel 10 mg but similar for prasugrel 5 mg versus clopidogrel 75 mg. less thanbrgreater than less thanbrgreater thanConclusions In aspirin-treated stable CAD patients, prasugrel 5 mg in VE attenuated platelet inhibition while meeting pre-specified noninferiority criterion versus prasugrel 10 mg in NE, with significantly better PD response and fewer poor responders compared to clopidogrel 75 mg in VE. (Comparison of Prasugrel and Clopidogrel in Very Elderly and Non-Elderly Patients With Stable Coronary Artery Disease [GENERATIONS]; NCT01107912)
Reduction in Platelet Reactivity With Prasugrel 5 mg in Low-Body-Weight Patients Is Noninferior to Prasugrel 10 mg in Higher-Body-Weight Patients: Results From the FEATHER Trial.
Ingår i: Journal of the American College of Cardiology. - : Elsevier. - 0735-1097 .- 1558-3597. ; 60:20, s. 2032-2040
OBJECTIVES: The aim of this study was to confirm prior modeling data suggesting that prasugrel 5 mg in low-body-weight (LBW) patients would be noninferior to prasugrel 10 mg in higher-body-weight (HBW) patients as assessed by maximal platelet aggregation (MPA). BACKGROUND: Prasugrel 10 mg reduced ischemic events compared with clopidogrel 75 mg but increased bleeding, particularly in LBW patients. METHODS: In this blinded, 3-period, crossover study in stable patients with coronary artery disease (CAD) taking aspirin, prasugrel 5 and 10 mg and clopidogrel 75 mg were administered to LBW (56.4 ± 3.7 kg; n = 34) and HBW patients (84.7 ± 14.9 kg; n = 38). Assays included light transmission aggregometry (LTA), VerifyNow P2Y12 (VN), and vasodilator-associated stimulated phosphoprotein (VASP) level measured predose and after each 12-day treatment. RESULTS: Median MPA by LTA for prasugrel 5 mg in LBW patients was noninferior to the 75th percentile for prasugrel 10 mg in HBW patients (primary endpoint) and mean MPA was similar, but active metabolite exposure was lowered by 38%. Within LBW patients, prasugrel 5 mg lowered MPA more than clopidogrel (least squares mean difference [95% confidence interval]: -3.7% [-6.72%, -0.69%]) and resulted in lower rates of high on-treatment platelet reactivity (HPR). Within HBW patients, prasugrel 10 mg lowered MPA more than clopidogrel (-16.9% [-22.3%, -11.5%]). Similar results were observed by VN and VASP. Prasugrel 10 mg in LBW patients was associated with more mild to moderate bleeding (mainly bruising) compared with prasugrel 5 mg and clopidogrel. CONCLUSIONS: In aspirin-treated patients with CAD, prasugrel 5 mg in LBW patients reduced platelet reactivity to a similar extent as prasugrel 10 mg in HBW patients and resulted in greater platelet inhibition, lower HPR, and similar bleeding rates compared with clopidogrel. (Comparison of Prasugrel and Clopidogrel in Low Body Weight Versus Higher Body Weight With Coronary Artery Disease [FEATHER]; NCT01107925).
Imran, Mahrukh, et al. (författare)
Methods and results used in the development of a consensus-driven extension to the Consolidated Standards of Reporting Trials (CONSORT) statement for trials conducted using cohorts and routinely collected data (CONSORT-ROUTINE)
Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055 .- 2044-6055. ; 11:4
OBJECTIVES: Randomised controlled trials conducted using cohorts and routinely collected data, including registries, electronic health records and administrative databases, are increasingly used in healthcare intervention research. A Consolidated Standards of Reporting Trials (CONSORT) statement extension for trials conducted using cohorts and routinely collected data (CONSORT-ROUTINE) has been developed with the goal of improving reporting quality. This article describes the processes and methods used to develop the extension and decisions made to arrive at the final checklist.METHODS: The development process involved five stages: (1) identification of the need for a reporting guideline and project launch; (2) conduct of a scoping review to identify possible modifications to CONSORT 2010 checklist items and possible new extension items; (3) a three-round modified Delphi study involving key stakeholders to gather feedback on the checklist; (4) a consensus meeting to finalise items to be included in the extension, followed by stakeholder piloting of the checklist; and (5) publication, dissemination and implementation of the final checklist.RESULTS: 27 items were initially developed and rated in Delphi round 1, 13 items were rated in round 2 and 11 items were rated in round 3. Response rates for the Delphi study were 92 of 125 (74%) invited participants in round 1, 77 of 92 (84%) round 1 completers in round 2 and 62 of 77 (81%) round 2 completers in round 3. Twenty-seven members of the project team representing a variety of stakeholder groups attended the in-person consensus meeting. The final checklist includes five new items and eight modified items. The extension Explanation & Elaboration document further clarifies aspects that are important to report.CONCLUSION: Uptake of CONSORT-ROUTINE and accompanying Explanation & Elaboration document will improve conduct of trials, as well as the transparency and completeness of reporting of trials conducted using cohorts and routinely collected data.
Juszczak, Edmund, et al. (författare)
Introducing the CONsolidated Standards of Reporting Trials (CONSORT) statement for randomised controlled trials (RCTs) using cohorts and routinely collected health data
Ingår i: Trials. - : BMC. - 1745-6215 .- 1745-6215. ; 20:Suppl. 1, s. 131-131
Background: Randomised controlled trials (RCTs) are increasingly being conducted using existing sources of data, such as cohorts, administrative databases, disease registries and electronic health records. RCTs conducted using existing data sources require additional information to be reported. This reporting guideline is an extension of the 2010 version of the Consolidated Standards of Reporting Trials (CONSORT) Statement for RCTs using cohorts and routinely collected health data.Methods: A long-list of potential items for the checklist was identified through two methods: firstly, modifications to the current CONSORT checklist were generated using existing reporting guidelines, including the Reporting of Observational Studies in Epidemiology (STROBE) and REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statements. Secondly, ascoping review of RCTs conducted in the last decade using cohorts and routinely collected health data facilitated the modification and identification of other potential items. Using the long-list, a three-stage Delphi exercise was conducted to assess the importance of each item for inclusion in the final extension checklist, which was finalised at a face-to-face meeting of experts.Results: A long-list of 27 items was created and 125 experts registered for the three-round Delphi exercise (92, 77 and 62 experts participated in each round respectively). Consensus was reached on 21 out of 27 items. The results of the Delphi exercise informed a face-to-face consensus meeting in May 2019; core items to be included in the extension checklist were finalised at this meeting. Corresponding explanations of extensions and new items with examples of good reporting were developed subsequently.Conclusion: The guideline checklist can facilitate transparent reporting of RCTs using cohorts and routinely collected health data, to assist evaluations of rigour and reproducibility, enhance understanding of the methodology, and make the results more useful for clinicians, journal editors, reviewers, guideline authors, and funders.
Khoshnood, Ardavan, et al. (författare)
Effect of oxygen therapy on myocardial salvage in ST elevation myocardial infarction : the randomized SOCCER trial
Ingår i: European Journal of Emergency Medicine. - : Lippincott Williams & Wilkins. - 0969-9546. ; 25:2, s. 78-84
OBJECTIVE: Recent studies suggest that administration of O2 in patients with acute myocardial infarction may have negative effects. With the use of cardiac MRI (CMR), we evaluated the effects of supplemental O2 in patients with ST elevation myocardial infarction (STEMI) accepted for acute percutaneous coronary intervention (PCI).MATERIALS AND METHODS: This study was a randomized-controlled trial conducted at two university hospitals in Sweden. Normoxic STEMI patients were randomized in the ambulance to either supplemental O2 (10 l/min) or room air until the conclusion of the PCI. CMR was performed 2-6 days after the inclusion. The primary endpoint was the myocardial salvage index assessed by CMR. The secondary endpoints included infarct size and myocardium at risk.RESULTS: At inclusion, the O2 (n=46) and air (n=49) patient groups had similar patient characteristics. There were no significant differences in myocardial salvage index [53.9±25.1 vs. 49.3±24.0%; 95% confidence interval (CI): -5.4 to 14.6], myocardium at risk (31.9±10.0% of the left ventricle in the O2 group vs. 30.0±11.8% in the air group; 95% CI: -2.6 to 6.3), or infarct size (15.6±10.4% of the left ventricle vs. 16.0±11.0%; 95% CI: -4.7 to 4.1).CONCLUSION: In STEMI patients undergoing acute PCI, we found no effect of high-flow oxygen compared with room air on the size of ischemia before PCI, myocardial salvage, or the resulting infarct size. These results support the safety of withholding supplemental oxygen in normoxic STEMI patients.
The SOCCER-study: Effects of Oxygen Therapy on Myocardial Salvage in ST Elevation Myocardial Infarction – A Randomized Trial
Konferensbidrag (övrigt vetenskapligt)
Kwakkenbos, Linda, et al. (författare)
CONSORT extension for the reporting of randomised controlled trials conducted using cohorts and routinely collected data (CONSORT-ROUTINE) : checklist with explanation and elaboration
Ingår i: BMJ. British Medical Journal. - : BMJ Publishing Group Ltd. - 1756-1833. ; 373
Randomised controlled trials are increasingly conducted as embedded, nested, or using cohorts or routinely collected data, including registries, electronic health records, and administrative databases, to assess if participants are eligible for the trial and to facilitate recruitment, to deliver an embedded intervention, to collect trial outcome data, or a combination of these purposes. This report presents the Consolidated Standards of Reporting Trials (CONSORT) extension for randomised controlled trials conducted using cohorts and routinely collected data (CONSORT-ROUTINE). The extension was developed to look at the unique characteristics of trials conducted with these types of data with the goal of improving reporting quality in the long term by setting standards early in the process of uptake of these trial designs. The extension was developed with a sequential approach, including a Delphi survey, a consensus meeting, and piloting of the checklist. The checklist was informed by the CONSORT 2010 statement and two reporting guidelines for observational studies, the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and the REporting of studies Conducted using Observational Routinely collected Data (RECORD) statement. The extension includes eight items modified from the CONSORT 2010 statement and five new items. Reporting items with explanations and examples are provided, including key aspects of trials conducted using cohorts or routinely collected data that require specific reporting considerations.
Andell, Pontus, et al. (författare)
Oxygen therapy in suspected acute myocardial infarction and concurrent normoxemic chronic obstructive pulmonary disease : a prespecified subgroup analysis from the DETO2X-AMI trial.
Ingår i: European heart journal. Acute cardiovascular care.. - 2048-8726 .- 2048-8734. ; 9:8, s. 984-992
BACKGROUND: The DETermination of the role of Oxygen in suspected Acute Myocardial Infarction (DETO2X-AMI) trial did not find any benefit of oxygen therapy compared to ambient air in normoxemic patients with suspected acute myocardial infarction. Patients with chronic obstructive pulmonary disease may both benefit and be harmed by supplemental oxygen. Thus we evaluated the effect of routine oxygen therapy compared to ambient air in normoxemic chronic obstructive pulmonary disease patients with suspected acute myocardial infarction.METHODS AND RESULTS: =0.77]); there were no significant treatment-by-chronic obstructive pulmonary disease interactions.CONCLUSIONS: Although chronic obstructive pulmonary disease patients had twice the mortality rate compared to non-chronic obstructive pulmonary disease patients, this prespecified subgroup analysis from the DETO2X-AMI trial on oxygen therapy versus ambient air in normoxemic chronic obstructive pulmonary disease patients with suspected acute myocardial infarction revealed no evidence for benefit of routine oxygen therapy consistent with the main trial's findings.CLINICAL TRIALS REGISTRATION: NCT02290080.
Bergdahl, Andreas, et al. (författare)
Plasticity of TRPC expression in arterial smooth muscle: correlation with store-operated Ca2+ entry.
Ingår i: American Journal of Physiology: Cell Physiology. - : American Physiological Society. - 1522-1563. ; 288:4, s. 872-880
Loss of the smooth muscle contractile phenotype is critical in atherosclerosis and in restenosis after angioplasty, but its early signals are incompletely understood. In this study, we have explored the role of transient receptor potential canonical (TRPC) proteins, which have been suggested to mediate store-operated Ca2+ entry (SOCE). Contractility of rat cerebral arteries in organ culture is preserved for several days, whereas SOCE is increased. In correlation with this increase is that nifedipine-insensitive whole cell current, activated by depletion of intracellular Ca2+ stores, was increased by 50% in cells isolated from arteries cultured for 3 days. TRPC1 and TRPC6 mRNA were more than fivefold increased in cells isolated after organ culture, whereas TRPC3 was decreased. Immunofluorescent staining and/or Western blotting of arteries and isolated cells showed upregulation of TRPC1 and TRPC6 proteins during organ culture. In intact arteries, TRPC4 expression correlated with the amount of endothelium present. Ca2+ addition after store depletion caused a contraction in cultured, but not in freshly dissected, arteries. A polyclonal TRPC1 antibody directed against an extracellular epitope inhibited this contraction by approximately 50%. To investigate the basis of the TRPC upregulation and assess its possible clinical significance, segments of human internal mammary artery were organ cultured for 24 h and then exposed to balloon dilatation in vitro, followed by further culturing for up to 48 h. After dilatation, TRPC1 and TRPC6 mRNA were progressively increased compared with undilated control segments. The results of this study indicate that vascular injury enhances plasticity in TRPC expression, that TRPC expression correlates with cellular Ca2+ handling, and that TRPC1 is a subunit of upregulated store-operated Ca2+ channels.
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The legendary Ibanez TS9 TubeScreamer overdrive pedal is now available in this stunning gold finish. Made in Japan in highly limited numbers, this is the ultimate version of the ultimate overdrive pedal. Now in stock, so secure yours today! We offer fast delivery to the UK and Europe.
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WCHS students and teachers are no strangers to the online applications used to help students learn information. According to Training Magazine, 96.64 percent of students that took an e-learning course received a passing grade. Entertaining online games like Kahoot and Quizlet Live engage students and help them learn by completing multiple choice activities and participating in fun e-learning games can keep students interested in their education. Many online games can help students learn and retain information for tests and quizzes by having students solve a problem, choose the correct answer or just have extra information on a page for students for easy access.
Economics teacher Casey Moeller uses online applications like Quizizz, Kahoot, Quizlet, Schoology and Google applications in her classroom to help students further their education and learn the information they need. They also help teachers know who needs more practice.
"They are tools that help engage students or reinforce the concepts that we are teaching. Some of these also help us collect and analyze student achievement data," Moeller said.
Teachers like Moeller also understand that these tech tools are helpful, but sometimes going "back to the basics" is important, too.
"Writing is one of the best ways to help your brain learn something, so if students are only relying on these to learn, I think it isn't beneficial. Some students might also struggle a little more with organization when taking an exam on the computer. Sometimes kids don't have a method to remember which questions to go back to before submitting," Moeller said.
Senior Allison Wallace is in Moeller's class and uses these applications in her class often to prepare for tests and practice for the future.
"They prepare me for test questions and help me better understand the material," Wallace said.
WCHS E-Learning Coach Christa Rinehold is also aware of the applications teachers use in their classrooms and suggests these to other teachers to help students.
"Peardeck, Padlet, Flipgrid, EdPuzzle, G-suite applications, Quizlet, Kahoot, Quizizz, Canva, Google Classroom and many more," Rinehold said.
Teachers and students benefit from the use of these online applications because they are entertaining and engaging for students. Teachers can see the students' progress and help them review what they see is an overall problem for each individual student or the class.
"Teachers benefit because many of the applications can help track students' progress and comprehension, as well as deliver immediate and more meaningful feedback. Technology integration engages students and creates active learners. No one learns in the same way or at the same pace, but technology can level-set the classroom," said Rinehold.
As e-learning grows, Rinehold says she cannot pick one application that helps students the most, because different students and situations can benefit from different applications and environments.
"I can't pick just one. As the e-learning coach, I love so many of the technology tools available. Certain tools work best in certain situations," Rinehold said.
Rinehold has seen firsthand how these online applications can help make every student an active and engaged student in the classroom, though some teachers do not use these resources enough to help their students.
"Technology can help students become active participants in their learning," Rinehold said.
In these games and applications, the correct answer is shown and used to help students correct their mistakes and make sure they know the correct answer.
"They help by showing you the correct answer, which helps you understand the material," Wallace said.
These online applications used in classes are useful and helpful to teachers to gain progress reports and students understanding of the material for students.
Students can learn new information and review before tests to help themselves improve their grades and their understanding of materials in class. With Chromebooks, students have access to more tools.


"Robert Henry is the greatest.
I'm performing in my hometown of Jasper. It's nice to drive 10 minutes to a performance.
Concert manager Suzanne Shull has successfully carried the Casual Classics Concert Series into their 4th season!
New Lebanon Presbyterian Church in Jasper, Tuesday, Sept. 15 at 7:00.


Well, here it is in all its glory. We did the ALS Ice Bucket challenge and had a footloose time doin it! Take a second, watch the video and check out http://www.alsa.org/ to make your own donation.
Alright, so I have to admit, I'm all about supportin anybody who is throwing down some redneck grillin', and Christian Stevenson is no exception. Here's a little interview with this super awesome BBQ redneck!
Bubba Burger Grill – Not so great!
Fantastico Chicken and Bacon thing!
Kind of Good for you Lasagna!


More Like On Instagram Free: The most significant money on Instagram is Likes. When you get even more likes your Instagram post will certainly move higher in the newsfeed. It will also get future posts to move greater instantaneously as this is just how the Instagram newsfeed functions. Instagram shows individuals posts from people they have actually engaged with in the past.
Much more likes get you a variety of various other benefits like more followers and website traffic as people will certainly checkout your entire account if they like just what you share. If prepared appropriately likes could become an important element of your total Instagram method.
Photos are most likely one of the most integral part of your Instagram posts so let's start with them. As you are sharing an image to obtain more likes think of just what drives your followers to such as posts. Take a look at your old posts and analyse them. See which ones got one of the most likes.
If you have a brand-new account or haven't published a lot in the past, you need to check out your rivals' accounts as well as see exactly what they are posting and also what's benefiting them.
When you are certain regarding the sort of photos that obtain likes you can develop comparable ones and also share them.
There are mainly two types of photos you intend to share, photos and created pictures.
If you are sharing the image by itself, you can simply include a filter as well as it will certainly be ready for posting. A research from Track Expert found that for maximum communications you ought to make use of the Mayfair filter or not include one in all as posts without filters perform second-rate.
As well as numerous designed photos like the above. It's good to keep ranging photos and also created photos.
If you desire likes, request for them. Social Bakers found that tweets obtained retweeted much more when individuals asked for retweets.
Thus, if you desire a lot more likes on Instagram you should request for them also.
You can do this by including an easy message like 'Please similar to this post' in the inscription. Putting it as overlay message on the image could aid as well.
A company that regularly releases appealing quotes and also asks people to like them with a message in the caption is Foundr. They have used it to obtain a lot of likes. This has helped them get over a million fans as well.
The aforementioned research from Track Wizard also located that posts with 11 or even more hashtags got one of the most likes on Instagram.
So, you must include at least 11 hashtags whenever you publish. You can include extra, but beware not to place more than 15 as your post could end up looking spammy.
If you are sharing something preferred you can use some hashtags from this listing of 100 finest Instagram hashtags for likes. They work fantastic for posts on general subjects.
But if your posts belong to a niche you ought to use a device like Hashtagify to discover appropriate ones just.
Track Wizard found that posts published between 10 PM as well as 3 AM obtain the most communications.
Thus, if you desire your posts to carry out best, you ought to arrange your post utilizing an excellent Instagram organizing device. I have provided the 7 finest Instagram organizing applications below.
If you have a following on other social media networks it would certainly be a good idea to reshare your Instagram posts into these socials media. They will lead your buddies as well as fans from these accounts into your Instagram account, therefore getting you a lot more likes. Instagram lets you automatically share posts to Tumblr, Twitter And Facebook when you release. You must try it out.
Neil Patel randomly liked images of individuals he really did not comply with as well as discovered that for every 100 likes he made he got back 21.7 likes as well as 6.1 complies with. This technique remained to function even if he really did not comply with these individuals back.
As a result, make it a habit everyday to undergo the prominent Instagram feed as well as the feeds of prominent hashtags as well as like posts you discover amusing or valuable. Quickly you will obtain both likes and also followers.
Like to win competitions are an easy to execute Instagram advertising method to increase interaction. For this competition all you need to do is publish a photo on Instagram and also ask people to such as the post to take part in the contest. As it is a very easy job plenty of individuals will do it. If your involvement is enduring this will certainly be a very easy method to boost it.
For stronger results run a like and tag to win contest where you ask individuals to not just like the post, yet additionally tag a person they know in the comments. Some of the marked individuals will additionally like the post and also tag somebody else.


Base Port This port accepts 2 configurations for communicating with the IMU driver.
delay_between_updates - controls the output speed of messages from the Data Update port.
timeout_after_last_ping - stops sending messages from the Data Update port if nothing has been sent to the Keep-alive port after the specified amount of seconds.
View the defined message here.
Keep-alive Port This driver needs keep-alive messages in order to send data to your application. It's recommended to send an empty string "" because the contents of a keep-alive message are never read.
Error Port Applications can subscribe to this port to receive driver related errors.
Data Update Port Applications can subscribe to this port for IMU data. The output will be a serialized message of type Imu with the following information.