Comparison of Long-Term Oral Anticoagulation Therapies Including Newly Approved Reversal Agent for Dabigatran

Anticoagulants are a well-known class of agents essential for the prevention of blood clots, which may further develop into deep vein thrombosis, pulmonary embolism or stroke. Individuals at a high risk of clotting, such as those with atrial fibrillation, multiple risk factors or recent hip/knee surgery, are in need of long-term anticoagulation therapy. The purpose of this review is to highlight the pros and cons for each available anticoagulant as well as discuss pivotal clinical trials that evaluated the safety and efficacy of these agents. Warfarin, the oldest anticoagulant, requires the patient to attend frequent appointments with a health care professional in order to test their international normalized ratio (INR). Newer anticoagulants, including dabigatran, rivaroxaban and apixaban, do not require frequent INR testing and have a quicker onset of action than warfarin, providing convenience for the patient. However, many health care professionals prefer warfarin because the INR may indicate its efficacy, its dosages can be easily changed and it is typically more affordable. Additionally, dabigatran may be chosen because it is the only one of these drugs that has a reversal agent, which can be utilized in the case of major bleeding or emergent surgery. There are many opportunities for pharmacists to impact patient outcomes in the anticoagulation therapy setting. From clinics to the community pharmacy setting, the pharmacist\u27s role in patient counseling and education is crucial in reducing mortality. Additionally, drug development is a growing market as reversal agents are needed for many of these newer anticoagulation therapies

Migrant Labour in Rural Tourism: Continuity and Change

This paper considers the impact of the recession on the availability of migrant labour in the Yorkshire Dales and reassesses how the practice of employing migrant workers, previously explored by the author, has influenced current sources of recruitment. Findings suggest constantly evolving and altering patterns of migration not only shaped by economic and spatial factors but also socially constructed by the interactions of employers and migrants. In particular, results indicate how subjective experiences and judgements made around the use of social networks can recreate as well as transform the specific use of migrant labour in each establishment. © 2014 John Wiley & Sons, Ltd

Employment experiences of Polish migrant workers in the UK hospitality sector.

2010-2011 > Academic research: refereed > Publication in refereed journa

What proportion of riverine nutrients reaches the open ocean?

Globally, rivers deliver significant quantities of nitrogen (N) and phosphorus (P) to the coastal ocean each year. Currently, there are no viable estimates of how much of this N and P escapes biogeochemical processing on the shelf to be exported to the open ocean; most models of N and P cycling assume that either all or none of the riverine nutrients reach the open ocean. We address this problem by using a simple mechanistic model of how a low-salinity plume behaves outside an estuary mouth. The model results in a global map of riverine water residence times on the shelf, typically a few weeks at low latitudes and up to a year at higher latitudes, which agrees well with observations. We combine the map of plume residence times on the shelf with empirical relationships that link residence time to the proportions of dissolved inorganic N (DIN) and P (DIP) exported and use a database of riverine nutrient loads to estimate the global distribution of riverine DIN and DIP supplied to the open ocean. We estimate that 75% of DIN and 80% of DIP reaches the open ocean. Ignoring processing within estuaries yields annual totals of 17 Tg DIN and 1.2 Tg DIP reaching the open ocean. For DIN this supply is about 50% of that supplied via atmospheric deposition, with significant east-west contrasts across the main ocean basins. The main sources of uncertainty are exchange rates across the shelf break and the empirical relationships between nutrient processing and plume residence time

Using dengue epidemics and local weather in Bali, Indonesia to predict imported dengue in Australia.

BACKGROUND: Although the association between dengue in Bali, Indonesia, and imported dengue in Australia has been widely asserted, no study has quantified this association so far. METHODS: Monthly data on dengue and climatic factors over the past decade for Bali and Jakarta as well as monthly data on imported dengue in Australia underwent a three-stage analysis. Stage I: a quasi-Poisson regression with distributed lag non-linear model was used to assess the associations of climatic factors with dengue in Bali. Stage II: a generalized additive model was used to quantify the association of dengue in Bali with imported dengue in Australia with and without including the number of travelers in log scale as an offset. Stage III: the associations of mean temperature and rainfall (two climatic factors identified in stage I) in Bali with imported dengue in Australia were examined using stage I approach. RESULTS: The number of dengue cases in Bali increased with increasing mean temperature, and, up to a certain level, it also increased with increasing rainfall but dropped off for high levels of rainfall. Above a monthly incidence of 1.05 cases per 100,000, dengue in Bali was almost linearly associated with imported dengue in Australia at a lag of one month. Mean temperature (relative risk (RR) per 0.5 °C increase: 2.95, 95% confidence interval (CI): 1.87, 4.66) and rainfall (RR per 7.5 mm increase: 3.42, 95% CI: 1.07, 10.92) in Bali were significantly associated with imported dengue in Australia at a lag of four months. CONCLUSIONS: This study suggests that climatic factors (i.e., mean temperature and rainfall) known to be conducive of dengue transmission in Bali can provide an early warning with 4-month lead time for Australia in order to mitigate future outbreaks of local dengue in Australia. This study also provides a template and framework for future surveillance of travel-related infectious diseases globally

Corporatised Identities ≠ Digital Identities: Algorithmic Filtering on Social Media and the Commercialisation of Presentations of Self

Goffman’s (1959) dramaturgical identity theory requires modification when theorising about presentations of self on social media. This chapter contributes to these efforts, refining a conception of digital identities by differentiating them from ‘corporatised identities’. Armed with this new distinction, I ultimately argue that social media platforms’ production of corporatised identities undermines their users’ autonomy and digital well-being. This follows from the disentanglement of several commonly conflated concepts. Firstly, I distinguish two kinds of presentation of self that I collectively refer to as ‘expressions of digital identity’. These digital performances (boyd 2007) and digital artefacts (Hogan 2010) are distinct, but often confused. Secondly, I contend this confusion results in the subsequent conflation of corporatised identities – poor approximations of actual digital identities, inferred and extrapolated by algorithms from individuals’ expressions of digital identity – with digital identities proper. Finally, and to demonstrate the normative implications of these clarifications, I utilise MacKenzie’s (2014, 2019) interpretation of relational autonomy to propose that designing social media sites around the production of corporatised identities, at the expense of encouraging genuine performances of digital identities, has undermined multiple dimensions of this vital liberal value. In particular, the pluralistic range of authentic preferences that should structure flourishing human lives are being flattened and replaced by commercial, consumerist preferences. For these reasons, amongst others, I contend that digital identities should once again come to drive individuals’ actions on social media sites. Only upon doing so can individuals’ autonomy, and control over their digital identities, be rendered compatible with social media