Systematic review and meta-analysis of optimal P2Y₁₂ blockade in dual antiplatelet therapy for patients with diabetes with acute coronary syndrome

Background: Patients with diabetes are at increased risk of acute coronary syndromes (ACS) and their mortality and morbidity outcomes are significantly worse following ACS events, independent of other comorbidities. This systematic review sought to establish the optimum management strategy with focus on P2Y₁₂ blockade in patients with diabetes with ACS. Methods: MEDLINE (1946 to present) and EMBASE (1974 to present) databases, abstracts from major cardiology conferences and previously published systematic reviews were searched to June 2014. Relevant randomised control trials with clinical outcomes for P2Y₁₂ inhibitors in adult patients with diabetes with ACS were scrutinised independently by 2 authors with applicable data was extracted for primary composite end point of cardiovascular death, myocardial infarction (MI) and stroke; enabling calculation of relative risks with 95% CI with subsequent direct and indirect comparison. Results: Four studies studied clopidogrel in patients with diabetes, with two (3122 patients) having primary outcome data showing superiority of clopidogrel against placebo with RR0.84 (95% CI 0.72–0.99). Irrespective of management strategy, the newer agents prasugrel (2 studies) and ticagrelor (1 study) had a lower primary event rate compared with clopidogrel; RR 0.80 (95% CI 0.66 to 0.97) and RR 0.89 (95% CI 0.77 to 1.02), respectively. When ticagrelor was indirectly compared with prasugrel, there was a trend to an improved primary outcome with prasugrel (RR 1.11 (95% CI 0.94 to 1.31)) particularly in those managed with percutaneous coronary intervention (PCI) (RR 1.23 (95% CI 0.95 to 1.59)). Prasugrel demonstrated a statistical superiority with prevention of further MI with RR 1.48 (95% CI 1.11 to 1.97). This was not at the expense of increased major thrombolysis in MI (TIMI) bleeding rates RR 0.94 (95% CI 0.59 to 1.51). Conclusions: This meta-analysis shows the addition of a P2Y₁₂ inhibitor is superior to placebo, with a trend favouring the use of prasugrel in patients with diabetes with ACS, particularly those undergoing PCI

Earthbound Humors: An Ecocritical Approach to Melancholy in As You Like It and Hamlet

Ecocriticism explores the way in which artists interact with, interpret and represent the natural world. The concept of “nature,†according to ecocriticism, goes beyond simply flora and fauna, extending to human nature as well. In Shakespeare\u27s England, a person\u27s nature was determined by his bodily humors, so the melancholy humor particularly lends itself to an ecocritical approach because it is inextricably linked to the natural world. Transcending genre, melancholy is not limited to the green world of comedy but rather appears in tragedy as well. In As You Like It, the melancholy Jaques offers a foil for the forest teeming with sanguine lovers. In Hamlet, however, melancholy becomes a much more bleak and ambiguous quality, raising questions concerning the nature of acting and suicide. In the study of melancholy within As You Like It and Hamlet, an ecocritical perspective offers a unique insight into the way Shakespeare experiences and interacts with the natural world

Earthbound Humors: An Ecocritical Approach to Melancholy in As You Like It and Hamlet

Ecocriticism explores the way in which artists interact with, interpret and represent the natural world. The concept of “nature,†according to ecocriticism, goes beyond simply flora and fauna, extending to human nature as well. In Shakespeare\u27s England, a person\u27s nature was determined by his bodily humors, so the melancholy humor particularly lends itself to an ecocritical approach because it is inextricably linked to the natural world. Transcending genre, melancholy is not limited to the green world of comedy but rather appears in tragedy as well. In As You Like It, the melancholy Jaques offers a foil for the forest teeming with sanguine lovers. In Hamlet, however, melancholy becomes a much more bleak and ambiguous quality, raising questions concerning the nature of acting and suicide. In the study of melancholy within As You Like It and Hamlet, an ecocritical perspective offers a unique insight into the way Shakespeare experiences and interacts with the natural world

Second year college experiences that affect persistence and attrition for first generation and continuing generation students at small, private institutions.

The persistence and attrition of second year college students is a growing concern of colleges and universities as second year college students face some of the greatest challenges (Gahagan & Hunter, 2006; Lemons & Richmond, 1987; Morgan & Davis, 1981; Wilder, 1993). This study examined the factors that predict second year student persistence for students who have enrolled at private institutions in the state of Kentucky. This study reviewed those pre-entry variables that predict persistence beyond the second year. Students were surveyed (during the end of) their fourth semester in college. Spady\u27s (1970b) model of student dropout and Tinto\u27s (1975) model of student departure served as the theoretical foundation for this study. The participants in this study consisted of full-time, second year students who were completing their fourth semester of academic work. This research was a quantitative predictive study that used data collected by administering the Sophomore Experiences Survey via the Internet. This predictive study examined the relationship between predictor variables including pre-college characteristics, scores on the Thriving Quotient in the Sophomore Experiences Survey, and campus experiences and perceptions and the criterion variables of the student\u27s intent to re-enroll after their fourth semester of their second year and intent to graduate from college. Hierarchical logistic regression was used to measure the predictive nature and magnitude of the relationship between the variables in the first five research questions. The sixth and seventh research questions constituted a comparative study. Cross tabulations and chi-square statistics were used to address each of these questions

Characterization and regulation of enzymes responsible for steroid activation : inactivation and bioavailability during the ovulatory process in the mare

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal

Exploring Expertise of Inner City High School Teachers in Integrating Technology

Inner city high school teachers in the Midwest United States lack expertise in integrating technology into their curriculum. The purpose of this basic qualitative study was to explore the experiences of inner city high school teachers in using technology-enhanced instruction to teach 21st-century skills in a public comprehensive high school in the Midwest. The technological pedagogical and content knowledge framework was the conceptual framework used to guide the study because it focuses on how teachers use both content and technological knowledge in their teaching. The research questions addressed inner city teachers’ internal or external barriers that prevented them from integrating technology into classroom instruction and how their digital literacy played a role in integrating technology into the classroom. Data were collected from semistructured interviews with 13 high school teachers who volunteered to participate. The open coding process yielded four themes: teachers struggle with access and currency, teachers reported structural issues that hindered integration, teachers require knowledge about hardware and applications, and teachers require training on integrating existing technologies. Findings may contribute to social change by informing school administrators about providing professional development needs and additional technology training for teachers. Students may benefit if teachers use technology-enhanced instruction to provide students with 21st-century skills which better prepares them for college or career

Challenging the Myth of the Universal Teacher: An Examination of the Experiences of African American Women Post-Secondary Mathematics Teachers

Abstract: This study examines the experiences of a group of African American women mathematics teachers to see what common themes emerge. The findings reveal that the race and gender of these teachers affect their teaching-learning environment

The myth of the universal adult educator: A literature review.

This paper critically evaluates the adult education literature with respect to how it deals with the race and the gender of the teachers as a factor in the teaching-learning environment. The mainstream literature perpetuates the myth of the universal teacher while the narratives of African American women transcend the myth