Significance of Off-hours in Centralized Primary Percutaneous Coronary Intervention Network

Aim To analyze the efficacy of a regionally organized primary percutaneous coronary intervention (PCI) network at the Heart Center, Semmelweis University Budapest, part of the “Budapest model,” and the factors that influence it. Methods In order to investigate the differences between regular and off-hours patient care in a 24-hour myocardial infarction primary care system, we included 1890 consecutive, unselected patients with ST-segment elevation myocardial infarction and followed them until at least one year. The follow-up was complete for all participants. Results The difference between regular hours and offhours mortality was not significant either after 30 days (8.6% vs 8.8%, respectively) or after 1 year (15.3% vs 14.7%, respectively). The rate of patients with re-infarction, frequency of re-intervention, and major adverse cardiac events, including death, re-infarction, re-intervention, and coronary artery bypass graft surgery, were similar in both patient groups. The time delay between the onset of chest pain and arrival to the clinic was 5.9 ± 5.8 hours (mean ± standard deviation) during regular hours and 5.2 ± 4.6 hours during off-hours (P = 0.235). Direct transport caused significant decrease in the 30-day and 1-year mortality independent of duty time (7.2% vs 9.9%, P = 0.027; 12.6% vs 16.7%, P = 0.028; respectively). Conclusion Centralized primary PCI network of the “Budapest model” achieved the same level of patient care during both off-hours and regular hours

Data on macrofungal diversity from the Danube Delta iosphere Reserve

Despite de fact that the Danube Delta has a great biodiversity with more than 2300 plants and more than 4000 animals registered (http://www.ddbra.ro/rezervatia/deltadunarii/biodiversitate), the study of macromycetes is rather scanty, and the number of macromycetes species found so far in the Reserve is 58. As a result of the mycological investigations done by the authors in 2016 May 7-8 and October 21-22 in the Danube Delta Biosphere Reserve in the Letea Forest, Caraorman Forest and at the forest district’s former premises near C.A. Rosetti, the list of the recorded 130 species is presented, out of which 110 species are documented for the first time in the Danube Delta Biosphere Reserve (DDBR). The number of the macrofungi species that occur in the formentioned Reserve - including the buffer zone from Enisala - has grown to 168. Based on the red list of the romanian macromycetes (Tănase and Pop, 2005) we have found three species in the near threatened category (NT): Helvella acetabulum, Morchella esculenta and Pluteus petasatus, and one species in the vulnerable category (VU): Myriostoma coliforme. A short survey from 1932 to 2012 about the former mycological studies concerning the DDBR is presented, and the nomenclaturally updated list of the 38 species not found by us, but present in the DDBR is given

Significance of Off-hours in Centralized Primary Percutaneous Coronary Intervention Network

Aim To analyze the efficacy of a regionally organized primary percutaneous coronary intervention (PCI) network at the Heart Center, Semmelweis University Budapest, part of the “Budapest model,” and the factors that influence it. Methods In order to investigate the differences between regular and off-hours patient care in a 24-hour myocardial infarction primary care system, we included 1890 consecutive, unselected patients with ST-segment elevation myocardial infarction and followed them until at least one year. The follow-up was complete for all participants. Results The difference between regular hours and offhours mortality was not significant either after 30 days (8.6% vs 8.8%, respectively) or after 1 year (15.3% vs 14.7%, respectively). The rate of patients with re-infarction, frequency of re-intervention, and major adverse cardiac events, including death, re-infarction, re-intervention, and coronary artery bypass graft surgery, were similar in both patient groups. The time delay between the onset of chest pain and arrival to the clinic was 5.9 ± 5.8 hours (mean ± standard deviation) during regular hours and 5.2 ± 4.6 hours during off-hours (P = 0.235). Direct transport caused significant decrease in the 30-day and 1-year mortality independent of duty time (7.2% vs 9.9%, P = 0.027; 12.6% vs 16.7%, P = 0.028; respectively). Conclusion Centralized primary PCI network of the “Budapest model” achieved the same level of patient care during both off-hours and regular hours

Comparison of Safety of RADial comPRESSion Devices: A Multi-Center Trial of Patent Hemostasis following Percutaneous Coronary Intervention from Conventional Radial Access (RAD-PRESS Trial)

Although radial access is the current gold standard for the implementation of percutaneous coronary interventions (PCI), post-procedural radial compression devices are seldom compared with each other in terms of safety or efficacy. Our group aimed to compare a cost effective and potentially green method to dedicated radial compression devices, with respect to access site complications combined in a device oriented complex endpoint (DOCE), freedom from which served as our primary endpoint. Patients undergoing PCI were randomized to receive either the cost effective or a dedicated device, either of which were removed using patent hemostasis. Twenty-four hours after the procedure, radial artery ultrasonography was performed to evaluate the access site. The primary endpoint was assessed using a non-inferiority framework with a non-inferiority margin of five percentage points, which was considered as the least clinically meaningful difference. The cost-effective technique and the dedicated devices were associated with a comparably low rate of complications (freedom from DOCE: 83.3% vs. 70.8%, absolute risk difference: 12.5%, one-sided 95% confidence interval (CI): 1.11%). Composition of the DOCE (i.e., no complication, hematoma, pseudoaneurysm, and radial artery occlusion) and compression time were also assessed in superiority tests as secondary endpoints. Both the cost-effective technique and the dedicated devices were associated with comparably low rates of complications: p = 0.1289. All radial compression devices performed similarly when considering the time to complete removal of the respective device (120.0 (inter-quartile range: 100.0–142.5) for the vial vs. 120.0 (inter-quartile range: 110.0–180) for the dedicated device arm, with a median difference of [95% CI]: 7.0 [−23.11 to 2.00] min, p = 0.2816). In conclusion, our cost-effective method was found to be non-inferior to the dedicated devices with respect to safety, therefore it is a safe alternative to dedicated radial compression devices, as well as seeming to be similarly effective

Comparison of Safety of RADial comPRESSion Devices: A Multi-Center Trial of Patent Hemostasis following Percutaneous Coronary Intervention from Conventional Radial Access (RAD-PRESS Trial)

Although radial access is the current gold standard for the implementation of percutaneous coronary interventions (PCI), post-procedural radial compression devices are seldom compared with each other in terms of safety or efficacy. Our group aimed to compare a cost effective and potentially green method to dedicated radial compression devices, with respect to access site complications combined in a device oriented complex endpoint (DOCE), freedom from which served as our primary endpoint. Patients undergoing PCI were randomized to receive either the cost effective or a dedicated device, either of which were removed using patent hemostasis. Twenty-four hours after the procedure, radial artery ultrasonography was performed to evaluate the access site. The primary endpoint was assessed using a non-inferiority framework with a non-inferiority margin of five percentage points, which was considered as the least clinically meaningful difference. The cost-effective technique and the dedicated devices were associated with a comparably low rate of complications (freedom from DOCE: 83.3% vs. 70.8%, absolute risk difference: 12.5%, one-sided 95% confidence interval (CI): 1.11%). Composition of the DOCE (i.e., no complication, hematoma, pseudoaneurysm, and radial artery occlusion) and compression time were also assessed in superiority tests as secondary endpoints. Both the cost-effective technique and the dedicated devices were associated with comparably low rates of complications: p = 0.1289. All radial compression devices performed similarly when considering the time to complete removal of the respective device (120.0 (inter-quartile range: 100.0–142.5) for the vial vs. 120.0 (inter-quartile range: 110.0–180) for the dedicated device arm, with a median difference of [95% CI]: 7.0 [−23.11 to 2.00] min, p = 0.2816). In conclusion, our cost-effective method was found to be non-inferior to the dedicated devices with respect to safety, therefore it is a safe alternative to dedicated radial compression devices, as well as seeming to be similarly effective

East Timor's pursuit of democratic independence

This thesis demonstrates how East Timor achieved statehood by linking independence with democracy. It argues that building a democracy was a consistent goal for some elements of East Timor’s independence movement throughout the transition to statehood. The independence movement committed a future East Timor state to establishing a liberal, multi-party, plural democracy with a particular emphasis on social justice and wealth re-distribution. This pursuit of the twin goals of independence and democracy enabled East Timor to become a sovereign state and this vision of statehood was important for how it instituted new political structures. The interplay between norms of self-determination and democracy is useful for understanding East Timor’s pursuit of sovereign independence. In contemporary International Relations, it has become increasingly recognised that there exists a democratic entitlement in which all people hold rights to internal self-determination and political participation. In essence, East Timor sought to attain the right of self-determination in order to achieve sovereign rights and establish a democracy. There were two key elements to their appeals for self-determination: first, that a unique and identifiable East Timorese ‘nation’ existed and held rights to self-determination under international law; and second, that an East Timorese state would establish a democracy and guarantee human rights. This commitment was important as individual rights to political participation have become international standards that all states are expected to uphold. International and domestic civil society organisations supported the East Timorese independence movement by pressuring governments,lobbying diplomats, holding protests, raising international awareness and providing information of the human rights situation and self-determination in East Timor. These international appeals for democracy, human rights and freedoms in East Timor ultimately led to the referendum on independence in 1999. The United Nations Transitional Administration in East Timor (UNTAET) was mandated to assist East Timor in establishing democracy following the referendum, and there has been considerable literature analysing and evaluating the roles of the UNTAET. However, there has been less attention on the roles of the East Timorese in constructing their political institutions and the relationship between the social and political realms during these processes. East Timorese leaders drafted the constitution, which established key political institutions such as electoral systems and the structure of government, and articulated the nature of citizenship rights and the relationship between the state and society. As such, East Timorese leaders played a considerable role in institutionally structuring the identity of their new state. East Timor’s Constitution outlined a vision of East Timor as a liberal, multi-party, social democracy that guarantees the civil, political and socio-economic rights of its people. The commitment to democracy and human rights demonstrated by political leaders prior and during East Timor’s transition is important for its capacities to consolidate its new political institutions and engender them with political legitimacy. A legitimate political order is one that is sanctioned by the population, thus a widespread, grassroots belief in the validity of democracy as a system of government has assisted East Timor in establishing and maintaining its democratic institutions