Outcomes Associated With Oral Anticoagulants Plus Antiplatelets in Patients With Newly Diagnosed Atrial Fibrillation.

Importance: Patients with nonvalvular atrial fibrillation at risk of stroke should receive oral anticoagulants (OAC). However, approximately 1 in 8 patients in the Global Anticoagulant Registry in the Field (GARFIELD-AF) registry are treated with antiplatelet (AP) drugs in addition to OAC, with or without documented vascular disease or other indications for AP therapy. Objective: To investigate baseline characteristics and outcomes of patients who were prescribed OAC plus AP therapy vs OAC alone. Design, Setting, and Participants: Prospective cohort study of the GARFIELD-AF registry, an international, multicenter, observational study of adults aged 18 years and older with recently diagnosed nonvalvular atrial fibrillation and at least 1 risk factor for stroke enrolled between March 2010 and August 2016. Data were extracted for analysis in October 2017 and analyzed from April 2018 to June 2019. Exposure: Participants received either OAC plus AP or OAC alone. Main Outcomes and Measures: Clinical outcomes were measured over 3 and 12 months. Outcomes were adjusted for 40 covariates, including baseline conditions and medications. Results: A total of 24 436 patients (13 438 [55.0%] male; median [interquartile range] age, 71 [64-78] years) were analyzed. Among eligible patients, those receiving OAC plus AP therapy had a greater prevalence of cardiovascular indications for AP, including acute coronary syndromes (22.0% vs 4.3%), coronary artery disease (39.1% vs 9.8%), and carotid occlusive disease (4.8% vs 2.0%). Over 1 year, patients treated with OAC plus AP had significantly higher incidence rates of stroke (adjusted hazard ratio [aHR], 1.49; 95% CI, 1.01-2.20) and any bleeding event (aHR, 1.41; 95% CI, 1.17-1.70) than those treated with OAC alone. These patients did not show evidence of reduced all-cause mortality (aHR, 1.22; 95% CI, 0.98-1.51). Risk of acute coronary syndrome was not reduced in patients taking OAC plus AP compared with OAC alone (aHR, 1.16; 95% CI, 0.70-1.94). Patients treated with OAC plus AP also had higher rates of all clinical outcomes than those treated with OAC alone over the short term (3 months). Conclusions and Relevance: This study challenges the practice of coprescribing OAC plus AP unless there is a clear indication for adding AP to OAC therapy in newly diagnosed atrial fibrillation

Effective interactions and operators in no-core shell model

Solutions to the nuclear many-body problem rely on effective interactions, and in general effective operators, to take into account effects not included in calculations. These include effects due to the truncation to finite model spaces where a numerical calculation is tractable, as well as physical terms not included in the description in the first place. In the no-core shell model (NCSM) framework, we discuss two approaches to the effective interactions based on (i) unitary transformations and (ii) effective field theory (EFT) principles. Starting from a given Hamiltonian, the unitary transformation approach is designed to take into account effects induced by the truncation to finite model spaces in which a numerical calculation is performed. This approach was widely applied to the description of nuclear properties of light nuclei; we review the theory and present representative results. In the EFT approach, a Hamiltonian is always constructed in a truncated model space according to the symmetries of the underlying theory, making use of power counting to limit the number of interactions included in the calculations. Hence, physical terms not explicitly included in the calculation are treated on the same footing with the truncation to a finite model space. In this approach, we review results for both nuclear and trapped atomic systems, for which the effective theories are formally similar, albeit describing different underlying physics. Finally, the application of the EFT method of constructing effective interactions to Gamow shell model is briefly discussed.Comment: 56 pages, 26 figure

Representações às margens do São Gonçalo: o pertencimento e a sustentabilidade na perspectiva da Educação Ambeintal da UFPEL - eestudo de um processo de formação/capacitação dos servidores

Esta pesquisa apresenta um estudo acerca das representações socioambientais do servidor técnico administrativo (STA) da Universidade Federal de Pelotas (UFPel). De natureza qualitativa, baseou-se na Teoria das Representações Sociais (TRS), como referencial teórico, e no Discurso do Sujeito Coletivo (DSC), como metodologia para análise dos dados. Teve como objetivos desvelar e compreender a visão, os sentidos, valores e conceitos que embasam os modos de saber/fazer nas relações entre servidor/meio ambiente de trabalho, quanto às questões ambientais que se estabelecem durante suas práticas laborais. O contexto em que se desenvolveu esta abordagem investigativa compreende um espaço/tempo no qual se vivenciam, no âmbito da administração pública, ações na área de gestão de pessoas visando à sensibilização dos gestores públicos para questões ambientais, bem como ao incentivo à qualificação e capacitação do quadro administrativo das Instituições Federais de Ensino Superior (IFES). Nesse sentido, a partir de 2005, a implantação da Gestão Ambiental na UFPel, em consonância com a Política Nacional de Educação Ambiental (PNEA) e Agenda Ambiental na Administração Pública (A3P) vem construindo e implementando ações e metas com o enfoque sustentável nas atividades administrativas, de ensino, pesquisa, extensão e de prestação de serviços. Como instrumentos, para coleta de dados, foram utilizadas seis (6) questões submetidas aos sujeitos nas aulas presenciais durante curso de capacitação em Educação Ambiental, realizado de agosto a novembro de 2010. As questões centrais que permearam o universo investigativo deste estudo transitam pelas noções de pertencimento à Instituição e de sustentabilidade do servidor público em suas práticas diárias. O conhecimento das representações que influenciam as atividades-fim da UFPel permite estabelecer parâmetros e articulações entre aquelas e as práticas cotidianas. Desse modo, oportuniza estratégias e ações mais efetivas dentro do processo permanente de Gestão Ambiental em andamento na Instituição. Como resultado, concluímos, ao longo desse estudo, que as representações de sustentabilidade do coletivo analisado estão permeadas do sentido de pertencimento ao meio ambiente institucional onde convivem e desenvolvem relações socioambientais no desempenho de suas funções. Da mesma forma, está presente a vontade de aprimorar conhecimentos para saber como agir corretamente, ao mesmo tempo que demonstram frustração pela falta de infraestrutura adequada ou a parceria de seus pares e/ou superiores para o desenvolvimento das ações sustentáveis. Desse modo, entende-se como fundamental para a consolidação de uma comunidade universitária cidadã, consciente e comprometida socioambientalmente na construção da sustentabilidade como um todo, uma dimensão educativa que possibilite o fortalecimento dos laços de interação entre os segmentos que compõem o meio ambiente universitário, começando pelo reconhecimento do potencial dos servidores TA em educação das IFES.This research presents a study of the environmental representations server administrative technician (STA), Federal University of Pelotas (UFPel). Qualitative in nature, based on the Social Representations Theory (SRT), as theoretical reference, and the Collective Subject Discourse (CSD), as a methodology for data analysis. Had as objectives uncover and understand the vision, direction, values and concepts that underlie the ways of knowing / doing in relations between server / work environment, as environmental issues that are established during their working practices. The context in which it developed this investigative approach comprises a space / time in which we experience within the public administration actions in the area of people management aimed at raising awareness of environmental issues for public managers, as well as to encourage the training and qualification the administrative framework of Federal Institutions of Higher Education (IFES). Accordingly, from 2005, implementation of Environmental Management in UFPel, in line with the National Policy on Environmental Education (PNEA) and Environmental Agenda in Public Administration (A3P) has been building and implementing actions and goals with a focus on sustainable activities administrative, teaching, research, extension and service. As tools for data collection, we used six (6) questions submitted to the subjects in the classroom during training course in Environmental Education, conducted from August to November 2010. The central issues that permeated the universe investigative study transiting through the notions of belonging to the institution and sustainability of public servants in their daily practices. The knowledge representations that influence activities-end UFPel allows establishing parameters and connections between those and everyday practices.Thus, provides an opportunity more effective actions and strategies within the permanent process of Environmental Management in the Institution. As a result, we conclude, throughout this study, that the representation of sustainability are analyzed permeated the collective sense of belonging to the environment where they live and develop institutional relationships in the environmental performance of their duties. The same manner, this is the desire to enhance knowledge on how to act properly while showing frustration at the lack of adequate infrastructure or partnership of peers and / or superiors to the development of sustainable actions. Thus, it is understood as fundamental to the consolidation of a university community citizen, socially and environmentally conscious and committed to sustainability in construction as a whole, an educational dimension that enables the strengthening of the ties of interaction between the segments that make up the university environment, starting with the recognition of the potential of the servers administrative technician in education of IFES

A Universidade na crise da modernidade: Contribuições de Boaventura de Sousa Santos à transição paradigmática

Este estudo apresenta o pensamento de Boaventura Santos e suas contribuições para a pesquisa em educação, com foco na sustentabilidade socioambiental em universidades públicas do sul da América Latina. Assim, trazemos as ideias do autor sobre a transição entre a Regulação e a Emancipação social, pilares do paradigma da ciência moderna; as Epistemologias do Sul e a Ecologia dos Saberes, como proposta para a superação da crise desse paradigma, a partir das demandas do capitalismo e do colonialismo. Da mesma forma sua visão sobre a universidade do século XXI buscando uma aproximação com a temática de nossa tese de doutorado em Educação Ambiental

Disc1 variation leads to specific alterations in adult neurogenesis

Disrupted in schizophrenia 1 (DISC1) is a risk factor for a spectrum of neuropsychiatric illnesses including schizophrenia, bipolar disorder, and major depressive disorder. Here we use two missense Disc1 mouse mutants, described previously with distinct behavioural phenotypes, to demonstrate that Disc1 variation exerts differing effects on the formation of newly generated neurons in the adult hippocampus. Disc1 mice carrying a homozygous Q31L mutation, and displaying depressive-like phenotypes, have fewer proliferating cells while Disc1 mice with a homozygous L100P mutation that induces schizophrenia-like phenotypes, show changes in the generation, placement and maturation of newly generated neurons in the hippocampal dentate gyrus. Our results demonstrate Disc1 allele specific effects in the adult hippocampus, and suggest that the divergence in behavioural phenotypes may in part stem from changes in specific cell populations in the brain

N-Acetylcysteine inhibits platelet-monocyte conjugation in patients with type 2 diabetes with depleted intraplatelet glutathione: a randomised controlled trial

AIMS/HYPOTHESIS: The aim of this study was to determine whether oral dosing with N-acetylcysteine (NAC) increases intraplatelet levels of the antioxidant, glutathione (GSH), and reduces platelet–monocyte conjugation in blood from patients with type 2 diabetes. METHODS: In this placebo-controlled randomised crossover study, the effect of oral NAC dosing on platelet–monocyte conjugation and intraplatelet GSH was investigated in patients with type 2 diabetes (eligibility criteria: men or post-menopausal women with well-controlled diabetes (HbA(1c) < 10%), not on aspirin or statins). Patients (n = 14; age range 43–79 years, HbA(1c) = 6.9 ± 0.9% [52.3 ± 10.3 mmol/mol]) visited the Highland Clinical Research Facility, Inverness, UK on day 0 and day 7 for each arm of the study. Blood was sampled before and 2 h after oral administration of placebo or NAC (1,200 mg) on day 0 and day 7. Patients received placebo or NAC capsules for once-daily dosing on the intervening days. The order of administration of NAC and placebo was allocated by a central office and all patients and research staff involved in the study were blinded to the allocation until after the study was complete and the data fully analysed. The primary outcome for the study was platelet–monocyte conjugation. RESULTS: Oral NAC reduced platelet–monocyte conjugation (from 53.1 ± 4.5% to 42.5 ± 3.9%) at 2 h after administration and the effect was maintained after 7 days of dosing. Intraplatelet GSH was raised in individuals with depleted GSH and there was a negative correlation between baseline intraplatelet GSH and platelet–monocyte conjugation. There were no adverse events. CONCLUSIONS/INTERPRETATION: The NAC-induced normalisation of intraplatelet GSH, coupled with a reduction in platelet–monocyte conjugation, suggests that NAC might help to reduce atherothrombotic risk in type 2 diabetes. FUNDING: Chief Scientist Office (CZB/4/622), Scottish Funding Council, Highlands & Islands Enterprise and European Regional Development Fund. TRIAL REGISTRATION: isrctn.org ISRCTN89304265 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00125-012-2685-z) contains peer-reviewed but unedited supplementary material, which is available to authorised users

Leadership = Communication? The relations of leaders' communication styles with leadership styles, knowledge sharing and leadership outcomes

Purpose: The purpose of this study was to investigate the relations between leaders' communication styles and charismatic leadership, human-oriented leadership (leader's consideration), task-oriented leadership (leader's initiating structure), and leadership outcomes. Methodology: A survey was conducted among 279 employees of a governmental organization. The following six main communication styles were operationalized: verbal aggressiveness, expressiveness, preciseness, assuredness, supportiveness, and argumentativeness. Regression analyses were employed to test three main hypotheses. Findings: In line with expectations, the study showed that charismatic and human-oriented leadership are mainly communicative, while task-oriented leadership is significantly less communicative. The communication styles were strongly and differentially related to knowledge sharing behaviors, perceived leader performance, satisfaction with the leader, and subordinate's team commitment. Multiple regression analyses showed that the leadership styles mediated the relations between the communication styles and leadership outcomes. However, leader's preciseness explained variance in perceived leader performance and satisfaction with the leader above and beyond the leadership style variables. Implications: This study offers potentially invaluable input for leadership training programs by showing the importance of leader's supportiveness, assuredness, and preciseness when communicating with subordinates. Originality/value: Although one of the core elements of leadership is interpersonal communication, this study is one of the first to use a comprehensive communication styles instrument in the study of leadership. © 2009 The Author(s)

Right drug, right patient, right time: aspiration or future promise for biologics in rheumatoid arthritis?

Individualising biologic disease-modifying anti-rheumatic drugs (bDMARDs) to maximise outcomes and deliver safe and cost-effective care is a key goal in the management of rheumatoid arthritis (RA). Investigation to identify predictive tools of bDMARD response is a highly active and prolific area of research. In addition to clinical phenotyping, cellular and molecular characterisation of synovial tissue and blood in patients with RA, using different technologies, can facilitate predictive testing. This narrative review will summarise the literature for the available bDMARD classes and focus on where progress has been made. We will also look ahead and consider the increasing use of ‘omics’ technologies, the potential they hold as well as the challenges, and what is needed in the future to fully realise our ambition of personalised bDMARD treatment

Políticas públicas em educação ambiental

O texto apresenta aspectos pertinentes a Educação Ambiental e as Políticas Públicas no contexto da crise ambiental. Trazemos, nesse sentido, reflexões voltadas para a crítica da estrutura socioeconômica capitalista, capaz de gerar alternativas que estimulem a implantação de políticas e programas, dentre as quais a Educação Ambiental seja inserida nas ações dos governos. Consideramos a necessidade de repensar as relações entre a ciência, filosofia e ética no século XX, que apesar dos grandes avanços tecnológicos submete a natureza formas intensas de atrocidade. Nesse contexto histórico, a Educação Ambiental situa-se como um mecanismo de sensibilização, conscientização e mudança de valores que renovem o conjunto de forças sociais capacitando-as a identificar, problematizar e agir em relação às questões socioambientais dentro de uma ética preocupada com a justiça ambiental