Monitoring Antiplatelet Therapy in Patients Undergoing Percutaneous Coronary Intervention

Dual antiplatelet therapy with aspirin and thienopyridines is the cornerstone in the treatment of patients with acute coronary syndrome (ACS) and in those undergoing PCI with stent-implantation.However, the magnitude of on-treatment platelet reactivity is not uniform among individuals, due to a multifactorial origin including clinical, pharmacologic and genetic factors. Clopidogrel is a prodrug that requires conversion by hepatic P450 isoenzymes to its active metabolite. Most of the clopidogrel (85%) is hydrolyzed by carboxylase to an inactive carboxylic acid metabolite, whereas the remaining 15% is transformed rapidly into its active metabolite that is able to exert its antiplatelet response by irreversibly inhibiting the binding of adenosinediphosphate (ADP) to the P2Y12 receptor. Recently, paraoxonase-1 (PON1) was identified as the crucial enzyme in clopidogrel bioactivation. Consistent findings across multiple investigations support the association between a lower degree of platelet inhibition, i.e. a high on-treatment platelet reactivity (HPR), and an increased risk for the occurrence of thrombo-ischemic events (Table 1).9-14,14,15,15-27 Multiple factors have been associated with high on-treatment platelet reactivity, among which genetic polymorphisms of cytochrome P450 and of the P2Y12 receptor as well as and drug-drug interactions. Consequently, the monitoring of the magnitude of platelet reactivity has gained widespread attention

Verbal interaction in mathematics lessons in Anglophone Cameroon.

In 2 volsAvailable from British Library Document Supply Centre- DSC:DX177236 / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

The relationship between the perception of own locus of control and aggression of adolescent boys

Aggression is increasingly seen in most parts of South African society. Aggressive behaviour of boys in secondary school often results from frustrations caused by perceived high expectations of others regarding the role, locus of control, and personality of boys. Locus of control plays an important role in a person’s perception concerning a situation and possible reactions to what is happening, or should be happening. A 56-item questionnaire, based on Rotter’s “Locus of control” questionnaire, and the DIAS Scale were used. The questionnaire was completed by 440 boys in Grades 9, 10, and 11. Various factor, item and differential statistical analyses were conducted. Three constructs were identified, i.e. physical, verbal, and indirect aggression. Results indicated that locus of control has a significant influence on verbal and indirect aggression. The differential analysis indicated that contextual variables (language of tuition, age, and grade) play a significant, but not substantial, role in aggression. Furthermore, boys with an internal locus of control are significantly and substantially less aggressive than boys with an external locus of control, with respect to physical, verbal and indirect aggression

Analise van stilistiese en strukturele tegnieke in die laat periode van Robert Muczynski met spesifieke verwysing na sy klavierwerk Desperate Measures (1994)

This dissertation discusses the stylistic and structural properties seen in the late compositional period of Polish-American composer Robert Muczynski. The focus falls mainly on his last piano composition, Desperate Measures. The development of musical style in the USA, the creation and development of neo-classicism alongside several stylistic aspects of Muczynski’s music are amongst the topics investigated in the literature review. In the next chapter the possible periodisation of Muczynski’s oeuvre is discussed with emphasis on the identification of a late period. In chapters 3 and 4 a more detailed discussion of Muczynski’s overall style is presented together with a thorough analysis of his use of form structure and his use of stylistic aspects respectively in his composition Desperate Measures. The dissertation is concluded with the researcher’s definition of Muczynski’s late period as well as a discussion of form structural and stylistic elements in Desperate Measures seen as an example of a composition from said period. With the completion of this dissertation the researcher hopes to increase interest in Muczynski’s music in South Africa and to introduce the composer’s work to a larger group of listeners and performers.Dissertation (MMus (Performing Arts))--University of Pretoria, 2019.MusicMMus (Performing Arts)Unrestricte

Chronic substance use and self-harm in a primary health care setting

Background: Chronic substance use (CSU) is associated with health problems, including selfharm, placing a significant burden on health care resources and emergency departments (EDs). This is problematic in low- and middle-income countries like South Africa (SA), where primary care facilitates and emergency departments (EDs) are often poorly resourced. Aim: To investigate the epidemiology of CSU and self-harm and to consider the implications for primary health care service delivery and suicide prevention in SA. Methods: Data were collected from 238 consecutive self-harm patients treated at the emergency department (ED) of an urban hospital in SA. The data were analysed using bivariate and multivariate analyses. Results: Approximately 37% of self-harm patients reported CSU. The patients in the CSU subgroup, compared to other self-harm patients, were more likely to be men (odds ratio[OR] = 8.33, 95% confidence interval [CI] = 3.19–20.9, p < 0.001), to have self-harmed by inflicting damage to their body tissue OR = 4.45, 95% CI = 1.77–11.2, p < 0.01) and to have a history of self-harm (OR = 3.71, 95% CI = 1.44–9.54, p = 0.007). A significantly smaller proportion of CSU patients, compared to other self-harm patients, were referred for psychiatric assessment (OR = 8.05, 95% CI = 4.16–15.7, p < 0.001). Conclusion: The findings of this study confirm that CSU is associated with greater service utilisation and repetition of self-harm among patients in primary health care settings. Treating self-harm as the presenting problem within primary care settings does not necessarily ensure that patients receive the care that they need. It might be helpful to include psychiatric assessments and screening for CSU as an integral component of care for self-harm patients who present in primary health care settings

Substance use and self-harm: a cross-sectional study of the prevalence, correlates and patterns of medical service utilisation among patients admitted to a South African hospital

Abstract Background Substance use is a potentially modifiable risk factor for suicidal behaviour. Little is known about the epidemiology of substance use among self-harm patients in South Africa. This study set out to collect epidemiological data about the prevalence, correlates, and patterns of medical service utilisation among self-harm patients who used substances at the time of self-injury. Methods Data from 238 consecutive self-harm patients treated at an urban hospital in South Africa were analysed using bivariate and multivariate statistics. Results Approximately 20% of patients reported substance use at the time of self-harm. When compared to other self-harm patients, higher rates of patients who had used substances: had depressed levels of consciousness on admission; utilised more medical resources and required longer hospital admissions; cited relationship difficulties and financial concerns as reasons for their self-harm; reported a previous episode of self-harm; and intended to die as a result of their injuries. Although the observed differences were not statistically significant (p > 0.05), the proportional differences were congruent with international literature. Conclusion Acute use of substances among self-harm patients warrants more focused research and clinical attention particularly in the context of reducing utilisation of scarce medical resources

Methode voor pro-actieve signalering van gevaren voor de voedselveiligheid

Dit rapport geeft een aanzet voor een methodische aanpak voor een pro-actief signalerings-systeem voor potentiële gevaren voor de voedselveiligheid. De methode maakt een onderscheid naar de databronnen van de informatie benodigd over zogenaamde indicatoren voor een gevaar als ook naar de mate van detaillering van deze informatie. Met name in-formatie over de traceerbaarheid van een partij (het 'waar' een partij was en het 'wanneer' deze partij daar was) blijkt van belang. De methode wordt toegepast op een tweetal potentiële gevaren, DON in tarwe en chloorprofam op aardappels. De conclusies en aanbevelingen uit deze twee casussen wor-den veralgemeniseerd

South African university students’ experiences of online group cognitive behavioural therapy: Implications for delivering digital mental health interventions to young people

Mental disorders are common among university students. In the face of a large treatment gap, resource constraints and low uptake of traditional in-person psychotherapy services by students, there has been interest in the role that digital mental health solutions could play in meeting students’ mental health needs. This study is a cross-sectional, qualitative inquiry into university students’ experiences of an online group cognitive behavioural therapy (GCBT) intervention. A total of 125 respondents who had participated in an online GCBT intervention completed a qualitative questionnaire, and 12 participated in in-depth interviews. The findings provide insights into how the context in which the intervention took place, students’ need for and expectations about the intervention; and the online format impacted their engagement and perception of its utility. The findings of this study also suggest that, while online GCBT can capitalise on some of the strengths of both digital and in-person approaches to mental health programming, it also suffers from some of the weaknesses of both digital delivery and those associated with in-person therapies