AbstractObjectiveTo show that limiting dual antiplatelet therapy (DAPT) to six months in patients with event-free ST-elevation myocardial infarction (STEMI) results in a non-inferior clinical outcome ...versus DAPT for 12 months.DesignProspective, randomised, multicentre, non-inferiority trial.SettingPatients with STEMI treated with primary percutaneous coronary intervention (PCI) and second generation zotarolimus-eluting stent.ParticipantsPatients with STEMI aged 18 to 85 that underwent a primary PCI with the implantation of second generation drug-eluting stents were enrolled in the trial. Patients that were event-free at six months after primary PCI were randomised at this time point.InterventionsPatients that were taking DAPT and were event-free at six months were randomised 1:1 to single antiplatelet therapy (SAPT) (ie, aspirin only) or to DAPT for an additional six months. All patients that were randomised were then followed for another 18 months (ie, 24 months after the primary PCI).Main outcome measuresThe primary endpoint was a composite of all cause mortality, any myocardial infarction, any revascularisation, stroke, and thrombolysis in myocardial infarction major bleeding at 18 months after randomisation.ResultsA total of 1100 patients were enrolled in the trial between 19 December 2011 and 30 June 2015. 870 were randomised: 432 to SAPT versus 438 to DAPT. The primary endpoint occurred in 4.8% of patients receiving SAPT versus 6.6% of patients receiving DAPT (hazard ratio 0.73, 95% confidence interval 0.41 to 1.27, P=0.26). Non-inferiority was met (P=0.004 for non-inferiority), as the upper 95% confidence interval of 1.27 was smaller than the prespecified non-inferiority margin of 1.66.ConclusionsDAPT to six months was non-inferior to DAPT for 12 months in patients with event-free STEMI at six months after primary PCI with second generation drug-eluting stents.Trial registrationClinicaltrials.gov NCT01459627.
The Color Pynk is a passionate exploration of Black
femme poetics of survival. Sidelined by liberal feminists and
invisible to mainstream civil rights movements, Black femmes spent
the Trump years ...doing what they so often do best: creating
politically engaged art, entertainment, and ideas. In the first
full-length study of Black queer, cis-, and trans-femininity,
Omise'eke Natasha Tinsley argues that this creative work offers a
distinctive challenge to power structures that limit how we color,
gender, and explore freedom.
Tinsley engages 2017-2020 Black femme cultural production that
colorfully and provocatively imagines freedom in the stark white
face of its impossibility. Looking to the music of Janelle Monáe
and Kelsey Lu, Janet Mock's writing for the television show
Pose , the fashion of Indya Moore and (F)empower, and the
films of Tourmaline and Juliana Huxtable, as well as poetry and
novels, The Color Pynk conceptualizes Black femme as a set
of consciously, continually rescripted cultural and aesthetic
practices that disrupts conventional meanings of race, gender, and
sexuality. There is an exuberant defiance in queer Black
femininity, Tinsley finds-so that Black femmes continue to love
themselves wildly in a world that resists their joy.
Investigation of cerebrospinal fluid (CSF) in the diagnostic work-up in suspected multiple sclerosis (MS) patients has regained attention in the latest version of the diagnostic criteria due to its ...good diagnostic accuracy and increasing issues with misdiagnosis of MS based on over interpretation of neuroimaging results. The hallmark of MS-specific changes in CSF is the detection of oligoclonal bands (OCB) which occur in the vast majority of MS patients. Lack of OCB has a very high negative predictive value indicating a red flag during the diagnostic work-up, and alternative diagnoses should be considered in such patients. Additional molecules of CSF can help to support the diagnosis of MS, improve the differential diagnosis of MS subtypes and predict the course of the disease, thus selecting the optimal therapy for each patient.
A central question in biological water splitting concerns the oxidation states of the manganese ions that comprise the oxygen-evolving complex of photosystem II. Understanding the nature and order of ...oxidation events that occur during the catalytic cycle of five S
states (
= 0-4) is of fundamental importance both for the natural system and for artificial water oxidation catalysts. Despite the widespread adoption of the so-called "high-valent scheme"-where, for example, the Mn oxidation states in the S
state are assigned as III, IV, IV, IV-the competing "low-valent scheme" that differs by a total of two metal unpaired electrons (
III, III, III, IV in the S
state) is favored by several recent studies for the biological catalyst. The question of the correct oxidation state assignment is addressed here by a detailed computational comparison of the two schemes using a common structural platform and theoretical approach. Models based on crystallographic constraints were constructed for all conceivable oxidation state assignments in the four (semi)stable S states of the oxygen evolving complex, sampling various protonation levels and patterns to ensure comprehensive coverage. The models are evaluated with respect to their geometric, energetic, electronic, and spectroscopic properties against available experimental EXAFS, XFEL-XRD, EPR, ENDOR and Mn K pre-edge XANES data. New 2.5 K
Mn ENDOR data of the S
state are also reported. Our results conclusively show that the entire S state phenomenology can only be accommodated within the high-valent scheme by adopting a single motif and protonation pattern that progresses smoothly from S
(III, III, III, IV) to S
(IV, IV, IV, IV), satisfying all experimental constraints and reproducing all observables. By contrast, it was impossible to construct a consistent cycle based on the low-valent scheme for all S states. Instead, the low-valent models developed here may provide new insight into the over-reduced S states and the states involved in the assembly of the catalytically active water oxidizing cluster.
Both stroke and obesity show an increasing incidence worldwide. While obesity is an established risk factor for stroke, its influence on outcome in ischemic stroke is less clear. Many studies suggest ...a better prognosis in obese patients after stroke ("obesity paradox"). This review aims at assessing the clinical outcomes of obese patients after stroke by performing a systematic literature search.
The reviewers searched MEDLINE from inception to December 2015. Studies were eligible if they included outcome comparisons in stroke patients with allocation to body weight.
Twenty-five studies (299'750 patients) were included and none was randomised. Ten of 12 studies (162'921 patients) reported significantly less mortality rates in stroke patients with higher BMI values. Seven of 9 studies (92'718 patients) ascertained a favorable effect of excess body weight on non-fatal outcomes (good clinical outcome, recurrence of vascular events). Six studies (85'042 patients) indicated contradictory results after intravenous thrombolysis (IVT), however. Several methodological limitations were observed in major part of studies (observational study design, inaccuracy of BMI in reflecting obesity, lacking body weight measurement, selection bias, survival bias).
Most observational data indicate a survival benefit of obese patients after stroke, but a number of methodological concerns exist. No obesity paradox was observed in patients after IVT. There is a need for well-designed randomized controlled trials assessing the effects of weight reduction on stroke risk in obese patients.
Extended main-sequence turn-off (eMSTO) regions are a common feature in color-magnitude diagrams of young- and intermediate-age star clusters in the Magellanic Clouds. The nature of eMSTOs remains ...debated in the literature. The currently most popular scenarios are extended star formation activity and ranges of stellar rotation rates. Here we study details of differences in main-sequence turn-off (MSTO) morphology expected from spreads in age versus spreads in rotation rates, using Monte Carlo simulations with the Geneva syclist isochrone models that include the effects of stellar rotation. We confirm a recent finding of Niederhofer et al. that a distribution of stellar rotation velocities yields an MSTO extent that is proportional to the cluster age, as observed. However, we find that stellar rotation yields MSTO crosscut widths that are generally smaller than observed ones at a given age. We compare the simulations with high-quality Hubble Space Telescope data of NGC 1987 and NGC 2249, which are the two only relatively massive star clusters with an age of ∼1 Gyr for which such data is available. We find that the distribution of stars across the eMSTOs of these clusters cannot be explained solely by a distribution of stellar rotation velocities, unless the orientations of rapidly rotating stars are heavily biased toward an equator-on configuration. Under the assumption of random viewing angles, stellar rotation can account for ∼60% and ∼40% of the observed FWHM widths of the eMSTOs of NGC 1987 and NGC 2249, respectively. In contrast, a combination of distributions of stellar rotation velocities and stellar ages fits the observed eMSTO morphologies very well.
Female labor force participation rates in urban India between 1987 and 2011 are surprisingly low and have stagnated since the late 1980s. Despite rising growth, fertility decline, and rising wage and ...education levels, married women's labor force participation hovered around 18 percent. Analysis of five large cross-sectional micro surveys shows that a combination of supply and demand effects have contributed to this stagnation. The main supply side factors are rising household incomes and husband's education as well as the falling selectivity of highly educated women. On the demand side, the sectors that draw in female workers have expanded least, so that changes in the sectoral structure of employment alone would have actually led to declining participation rates.
Context. Observations of nearby starburst and spiral galaxies have revealed that molecular gas is the driver of star formation. However, some nearby low-metallicity dwarf galaxies are actively ...forming stars, but CO, the most common tracer of this reservoir, is faint, leaving us with a puzzle about how star formation proceeds in these environments. Aims. We aim to quantify the molecular gas reservoir in a subset of 6 galaxies from the Herschel Dwarf Galaxy Survey with newly acquired CO data and to link this reservoir to the observed star formation activity. Methods. We present CO(1-0), CO(2-1), and CO(3-2) observations obtained at the ATNF Mopra 22-m, APEX, and IRAM 30-m telescopes, as well as CII 157 mu m and OI 63 mu m observations obtained with the Herschel/PACS spectrometer in the 6 low-metallicity dwarf galaxies: Haro 11, Mrk 1089, Mrk 930, NGC 4861, NGC 625, and UM 311. We derived their molecular gas masses from several methods, including using the CO-to-H sub(2) conversion factor X sub(CO) (both Galactic and metallicity-scaled values) and dust measurements. The molecular and atomic gas reservoirs were compared to the star formation activity. We also constrained the physical conditions of the molecular clouds using the non-LTE code RADEX and the spectral synthesis code Cloudy. Results. We detect CO in 5 of the 6 galaxies, including first detections in Haro 11 (Z ~ 0.4 Zmiddot in circle), Mrk 930 (0.2 Zmiddot in circle), and UM 311 (0.5 Zmiddot in circle), but CO remains undetected in NGC 4861 (0.2Zmiddot in circle). The CO luminosities are low, while CII is bright in these galaxies, resulting in CII/CO(1-0) > or = 10 000. Our dwarf galaxies are in relatively good agreement with the Schmidt-Kennicutt relation for total gas. They show short molecular depletion timescales, even when considering metallicity-scaled X sub(CO) factors. Those galaxies are dominated by their HIgas, except Haro 11, which has high star formation efficiency and is dominated by ionized and molecular gas. We determine the mass of each ISM phase in Haro 11 using Cloudy and estimate an equivalent X sub(CO) factor that is 10 times higher than the Galactic value. Overall, our results confirm the emerging picture that CO suffers from significant selective photodissociation in low-metallicity dwarf galaxies.
Background:
Mental Healthcare Act 2017 (MHCA) came into force on 29 May 2018. Goa State Mental Health Authority (GSMHA) notified the Mental Health Review Board on 8 February 2022, completing the ...important process of implementation of the act. The transition comes with challenges.
Methods:
A qualitative study was conducted with 18 practicing psychiatrists who had worked under Mental Health Act 1987 as well as MHCA 2017 through purposive sampling across Goa. Data was collected through individual interviews; analysis was done by Braune and Clarke’s framework of Thematic Analysis.
Results:
Eighteen psychiatrists participated: 4 private, 3 secondary and 11 from tertiary levels. The themes extracted were work during MHA 1987, transition, and after the implementation of MHCA 2017. Some participants reported difficulties, felt an increase in workload, and had negative emotions, while a few were neutral, indicating mixed perceptions.
Conclusion:
This study highlights the administrative struggles and moral dilemmas faced by psychiatrists in handling the new legislation. It’s imperative that the implementation of new act should be carried out with sufficient resource allocation and monitoring mechanisms.
Maritime Mode of Production Ling, Johan; Earle, Timothy; Kristiansen, Kristian ...
Current anthropology,
10/2018, Letnik:
59, Številka:
5
Journal Article
Recenzirano
Odprti dostop
As exemplified by Viking and Bronze Age societies in northern Europe, we model the political dynamics of raiding, trading, and slaving as a maritime mode of production. It includes political ...strategies to control trade by owning boats and financing excursions, thus permitting chiefs to channel wealth flows and establish decentralized, expansive political networks. Such political institutions often form at the edges of world systems, where chieftains support mobile warriors who were instrumental in seizing and protecting wealth. Particular properties of the maritime mode of production as relevant to Scandinavia are the fusion of agropastoral and maritime modes of production. To exemplify these two sectors, we use the Thy and Tanum cases in which we have been involved in long-term archaeological research. The historic Viking society provides specificity to model the ancestral political society of Bronze Age Scandinavia. Our model helps understand an alternative path to institutional formation in decentralized chiefdoms with low population densities, mobile warriors, and long-distance trading and raiding in valuables, weapons, and slaves.
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