Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial.

BACKGROUND: Extracranial carotid and vertebral artery dissection is an important cause of stroke, especially in young people. In some observational studies it has been associated with a high risk of recurrent stroke. Both antiplatelet drugs and anticoagulant drugs are used to reduce risk of stroke but whether one treatment strategy is more effective than the other is unknown. We compared their efficacy in the Cervical Artery Dissection in Stroke Study (CADISS), with the additional aim of establishing the true risk of recurrent stroke. METHODS: We did this randomised trial at hospitals with specialised stroke or neurology services (39 in the UK and seven in Australia). We included patients with extracranial carotid and vertebral dissection with onset of symptoms within the past 7 days. Patients were randomly assigned (1:1) by an automated telephone randomisation service to receive antiplatelet drugs or anticoagulant drugs (specific treatment decided by the local clinician) for 3 months. Patients and clinicians were not masked to allocation, but investigators assessing endpoints were. The primary endpoint was ipsilateral stroke or death in the intention-to-treat population. The trial was registered with EUDract (2006-002827-18) and ISRN (CTN44555237). FINDINGS: We enrolled 250 participants (118 carotid, 132 vertebral). Mean time to randomisation was 3·65 days (SD 1·91). The major presenting symptoms were stroke or transient ischaemic attack (n=224) and local symptoms (headache, neck pain, or Horner's syndrome; n=26). 126 participants were assigned to antiplatelet treatment versus 124 to anticoagulant treatment. Overall, four (2%) of 250 patients had stroke recurrence (all ipsilateral). Stroke or death occurred in three (2%) of 126 patients versus one (1%) of 124 (odds ratio [OR] 0·335, 95% CI 0·006-4·233; p=0·63). There were no deaths, but one major bleeding (subarachnoid haemorrhage) in the anticoagulant group. Central review of imaging failed to confirm dissection in 52 patients. Preplanned per-protocol analysis excluding these patients showed stroke or death in three (3%) of 101 patients in the antiplatelet group versus one (1%) of 96 patients in the anticoagulant group (OR 0·346, 95% CI 0·006-4·390; p=0·66). INTERPRETATION: We found no difference in efficacy of antiplatelet and anticoagulant drugs at preventing stroke and death in patients with symptomatic carotid and vertebral artery dissection but stroke was rare in both groups, and much rarer than reported in some observational studies. Diagnosis of dissection was not confirmed after review in many cases, suggesting that radiographic criteria are not always correctly applied in routine clinical practice. FUNDING: Stroke Association.Hugh S Markus is supported by an NIHR Senior Investigator award and his work is supported by the Cambridge University Hospital Comprehensive Biomedical Research Centre. Adina Feldman was supported by a project grant from the British Heart Foundation (PG/13/30/30005).This is the final published version. It first appeared at http://www.thelancet.com/journals/laneur/article/PIIS1474-4422%2815%2970018-9/abstract

Ripe to be Heard: Worker Voice in the Fair Food Programme

The Fair Food Program (FFP) provides a mechanism through which agricultural workers’ collective voice is expressed, heard and responded to within global value chains. The FFP's model of worker-driven social responsibility presents an alternative to traditional corporate social responsibility. This article identifies the FFP's key components and demonstrates its resilience by identifying the ways in which the issues faced by a new group of migrant workers – recruited through a “guest-worker” scheme – were incorporated and dealt with. This case study highlights the important potential presented by the programme to address labour abuses across transnationalized labour markets while considering early replication possibilities

The pollination dynamics of oilseed rape (Brassica napus L.)

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

"Too young to retire, too bloody old to work": Forest industry restructuring and community response in Port Alberni, British Columbia

British Columbian coastal forest communities have suffered substantial job losses over the last twenty years as the forest products industry has been restructured. One of the most dramatic results has been severe community dislocation. Our paper examines both the economic restructuring and the associated community dislocation that occurred in one such coastal community, Port Alberni on the West Coast of Vancouver Island. The paper is divided into two main sections. The first provides a conceptual framework that interprets the recent restructuring of British Columbia's forest industry as a transition from an older Fordist model of manufacturing to a newer model are based on principles of post-Fordism. The second uses that framework to understand the massive changes occurring in the town, which include severe job loss (more 2600 positions have been lost over the last twenty years), various forms of financial distress, and attempts to assemble alternative local economic strategies of amelioration. Key words: forest economy, British Columbia, industrial restructuring, Fordism, Post-Fordism, single-industry towns, local economic development </jats:p

Stormy weather: cyclones, Harold Innis, and Port Alberni, BC

This paper uses the work of the Canadian economic historian, Harold Innis, to reflect on the nature of resource economies and the single-industry towns that form their backbone. For Innis resource or staple economies are subject to extreme spatial and temporal disruptions that are both creative and destructive. Single-industry towns are on the front line of both that creativity and that destructiveness. They enjoy rapid growth when a new resource is found, but are equally hastily abandoned when resources run out, or prices fall. Innis used the metaphor of the cyclone to depict this pattern of staples accumulation and consequent crisis. This paper will, first, elaborate on Innis's general cyclonic scheme that joins space, time, and staples production, and second, provide a case study of the forest-industry town of Port Alberni, British Columbia, to exemplify his argument.

Street Trees and Intersection Safety

This study and report is about street trees and intersection safety in urban contexts. The study derives from a rather simple, straightforward observation: that on the best tree-lined streets the trees come close to the corners. They do not stop at some distance back from the intersecting street right-of-way. Indeed, in Paris, a city noted for its street trees, if the regular spacing of trees along the street runs short at an intersection, there is likely to be an extra tree placed at the corner. For at least 250 years, the finest of streets the world over have been associated with trees. Elm or oak shaded residential and commercial main streets remain as memories, but seldom as realities, of the best American urbanism. In the automobile age, a real concern with safety has resulted in street tree standards in the United States that dictate long setbacks from intersections, ostensibly geared to achieving unobstructed sight lines for drivers. But are street trees the safety problem they are purported to be? And are other physical, controllable qualities more important for preserving sight lines at intersections

3D-printed microfluidic device with in-line amperometric detection that also enables multi-modal detection

A 3D-printed microfluidic device with amperometric detection employs a parallel-opposed electrode configuration, with threaded electrodes being in contact with the flow stream. This makes downstream detection of ATPviachemiluminescence possible.</p