New Oral Anticoagulants in the Treatment of Pulmonary Embolism: Efficacy, Bleeding Risk, and Monitoring

Anticoagulation therapy is mandatory in patients with pulmonary embolism to prevent significant morbidity and mortality. The mainstay of therapy has been vitamin-K antagonist therapy bridged with parenteral anticoagulants. The recent approval of new oral anticoagulants (NOACs: apixaban, dabigatran, and rivaroxaban) has generated significant interest in their role in managing venous thromboembolism, especially pulmonary embolism due to their improved pharmacokinetic and pharmacodynamic profiles, predictable anticoagulant response, and lack of required efficacy monitoring. This paper addresses the available literature, on-going clinical trials, highlights critical points, and discusses potential advantages and disadvantages of the new oral anticoagulants in patients with pulmonary embolism

Micro Credit And Women's Well Being: Grameen Bank As Compared To Work Force Opportunities in Bangladesh

The purpose of this paper is to explore the ability of a micro credit institution, the Grameen Bank, to use loans to improve the well being of poor women in Bangladesh. Drawing on articles and case studies of Grameen as well as the typically available employment opportunities for women in Bangladesh I will compare micro credit and labor force employment in terms of their ability to improve women's lives. Program success can take many forms including increased income, increased ability to educate children, improved nutrition, increased ability to influence household decisions, etc. For this analysis I have chosen to focus on the following measures: Where are women making their loan investments and in what jobs are they working? How able are women to control the use of their loan money or their work force decisions? How able are women to challenge existing household relations and influence household behavior, specifically in the case of domestic violence? I have chosen the above criteria from secondary data that were readily available on women in Bangladesh with the goal of balancing the criteria among different areas to provide a more complete picture of women's income generation in Bangladesh. The goal of this analysis is to determine how different income generation opportunities for women compare and what this means for policy makers trying to improve the lives of women in Bangladesh. This paper is divided into six main sections, which are then subdivided. The first section is the Introduction. The second, Background, provides information on: the advantages of targeting anti poverty programs towards women, reasons for focusing on economic or income generation projects, and reasons for focusing on micro credit generally and Grameen Bank specifically as a strategy for income generation. This section will also explain the specifics of Grameen Bank and provide information on the status of women in Bangladesh. The third section, Hypothesis, explains my thoughts on Grameen Bank and its ability to improve the lives of women prior to conducting this research. The fourth section, Data and Analysis, will present and discuss secondary data regarding the two types of income generation being compared, micro credit, and work force participation. The fifth section will draw conclusions from these data. Finally, I have developed a list of policy recommendations based on my research for this project. Some apply specifically to Grameen, while others are more general recommendations for micro credit programs at large. Because they do not all pertain directly to the analysis in this paper, I am including them as an appendix rather than as part of the text.Master of City and Regional Plannin

Posing, Candor, and the Realisms of Photographic Portraiture, 1839-1945

This study offers a history of the concept of realism in portrait photography through the examination of a set of categories that have colored photographic practices since the origins of the medium in 1839: the posed and the candid. The first section of this study deals with the practices of posing in early photography, with chapters on the daguerreotype, the carte de visite, and the amateur snapshot photograph. Considering technological advances in conjunction with prevailing cultural mores and aesthetic practices, this section traces the changing cultural meaning of the portrait photograph, the obsolescence of the pose, and the emergence of an "unposed" aesthetic in photography. The second section of this study examines three key photographers and their strategies of photographic representation, all of which involved candid photography: it looks at Erich Salomon's pioneering photojournalism, Humphrey Spender's politicized sociological photography, and Walker Evans' complex maneuvering of the documentary form. Here, the emphasis is on the ways in which the trope of the candid informed these three distinct spheres of photography in the early 20th century, and the ways in which the photographic aesthetic of candor cohered with--or contested--political and cultural developments of the interwar period in Germany, Britain, and the United States

Cost-effectiveness of climate change policies for the United States

This research project applies a hybrid energy-economy model to compare the cost-effectiveness of different climate change mitigation policies for the United States. Five policies are compared: (1) a technology regulation phasing out coal and natural gas generation, (2) Clean Electricity Standard, (3) Corporate Average Fuel Economy Standard, (4) Vehicles Emissions Standard, (5) economy-wide GHG tax. The cost of these policies is estimated using three different methodologies. The first methodology is the techno-economic cost (TEC) measure, representing a ‘bottom-up’ or engineering costing methodology. The second methodology is the perceived private cost (PPC) measure, representing the ‘top-down’ or economist costing methodology. The third methodology uses the previous two methods to make a “best estimate” of welfare costs, called the expected resource cost. Going by the expected resource cost measure, the study finds an economy-wide GHG tax is a quarter of the cost of two policy scenarios that implement tradable performance standards in the electricity and transportation sectors. For the electricity sector policies, the study finds that the clean electricity standard is 50% less costly than a technology regulation phasing out conventional coal and natural gas generation. For the transportation policies, the study finds that the Vehicle Emissions Standard is 15% less costly than the Corporate Average Fuel Economy Standard

The Role of GIS in The Management of Primary Health Care Services

The application of Geographic Information Systems with health has been relatively slow to develop in Australia. The aim of this paper is to show the role that a GIS can play in the management of Divisions of General Practice (GP). We are proposing to use GIS to allow data in General Practice to be analysed visually through desktop mapping as a way of developing a Practice profile. Most of the research projects in this area in western countries are at this stage of development. The favourable conditions in Victoria, Australia (due to the amount of complete digital data bases) allow us to be more ambitious. Thus the aim of the project presented through this paper is not only to reach a visual representation of the spatial health data but to explore the potential of GIS in the following issues:· the combination of health data with other data such as the location and characteristics of private services related with health,· spatial and thematic queries,· sophisticated spatial analyses related with the optimal distribution and location of the practitioners,· simulations regarding the actual and future demand, and · optimal routing Two Divisions of General Practice, one in rural Victoria and one in the metropolitan area of Melbourne, are being used in a pilot study. The data and results presented in this paper are related to these settings

18F-FDG Uptake on PET/CT in Symptomatic versus Asymptomatic Carotid Disease: a Meta-Analysis.

INTRODUCTION: The role of positron emission tomography (PET)/computed tomography (CT) in the determination of inflammation in arterial disease is not well defined. This can provide information about arterial wall inflammation in atherosclerotic disease, and may give insight into plaque stability. The aim of this review was to perform a meta-analysis of PET/CT with 18F-FDG (fluorodeoxyglucose) uptake in symptomatic and asymptomatic carotid artery disease. METHODS: This was a systematic review, following PRISMA guidelines, which interrogated the MEDLINE database from January 2001 to May 2017. The search combined the terms, "inflammation", "FDG", and "stroke". The search criteria included all types of studies, with a primary outcome of the degree of arterial vascular inflammation determined by 18F-FDG uptake. Analysis involved an inverse weighted variance estimate of pooled data, using a random effects model. RESULTS: A total of 14 articles (539 patients) were included in the meta-analysis. Comparing carotid artery 18F-FDG uptake in symptomatic versus asymptomatic disease yielded a standard mean difference of 0.94 (95% CI 0.58-1.130; p < .0001; I2 = 65%). CONCLUSIONS: PET/CT using 18F-FDG can demonstrate carotid plaque inflammation, and is a marker of symptomatic disease. Further studies are required to understand the clinical implication of PET/CT as a risk prediction tool

Investigating potential future changes in surface water flooding hazard and impact

Increasingly, data from Regional Climate Models (RCMs) are being used to drive hydrological models in order to investigate the potential water-related impacts of climate change, particularly on floods and droughts. Traditionally these climate change assessments have focussed on fluvial flooding, commensurate with coarse resolution (>12km) RCMs. However, high-resolution (1.5km), convection-permitting RCMs are now becoming available and allow impact assessments of Surface Water Flooding (SWF) to be considered. At the same time there has been an increasing demand for more robust and timely real-time forecast and alert information for SWF. In the UK, within the Natural Hazards Partnership (NHP, http://www.naturalhazardspartnership.org.uk/) a real-time Hazard Impact Model (HIM) framework has been developed that includes SWF as one of the hazards chosen for real-time pre-operational trials. The SWF HIM system uses 1km gridded surface runoff estimates from the Grid-to-Grid (G2G) hydrological model to estimate the SWF hazard and links this to detailed inundation model outputs to assess impacts on property, people, transport and infrastructure using a pre-computed Impact Library. Here, a set of Met Office Hadley Centre high resolution (1.5 and 12km) RCM runs have been used to drive the G2G for southern Britain. Results investigating the potential future changes in SWF hazard and property impacts will be presented, including the assessment of the added-value of high-resolution climate model data for hydrological modelling. This research is part of the Hydro-JULES Programme funded by the Natural Environment Research Council

Cutaneous lesions in freshwater turtles (Emydura macquarii krefftii and Myuchelys latisternum) in a rainforest creek in North Queensland, Australia

Freshwater turtles inhabit most rivers and creeks on the east coast of Australia, but some species are only found in specific catchments, which makes them vulnerable to extinction. During annual fieldtrips to Alligator Creek, North Queensland, the resident population of Myuchelys latisternum and Emydura macquarii krefftii in a natural pond, just outside Bowling Green National Park, have been surveyed for a number of years and demographic data recorded against tagged turtles. Rounded, cutaneous lesions on individual animals were first noted in August 2016, three years after the first survey of the population. Turtles living in the upstream sections of the creek were not affected. An initial investigation into the cause of the lesions ruled out pollutants and although the bacterial communities appeared to be different on turtles with lesions, a causative agent was not identified. Attempts to isolate virus in culture was not successful and specific PCRs for ranavirus, papillomavirus, adenovirus and herpesvirus did not identify their presence. Blood biochemical parameters, body condition and activity levels were not significantly different between affected turtles and those without lesions. The turtles in this pond were monitored regularly over the following three years with 249 M. latisternum and 192 E. m. krefftii captured, tagged and released. The prevalence of the lesions fluctuated with season from 0 to 77 and 68% respectively, but did not vary significantly between species or sex in adults. There was a tendency for larger animals to be more likely to have lesions. The position of the lesions on the turtles was mostly on dorsal surfaces, distally on the legs and proximal on the tales of males, indicating that the initial lesion may have been associated with a behaviourally induced trauma. Recaptured animals (n = 43) during this period, provided records of lesion progression over time and while some healed up between capture events, others persisted for up to 24 months. Some turtles were repeatedly captured without lesions. Intra-species aggression associated with seasonal behaviours could potentially be the primary cause of skin trauma, followed by a secondary invasion of an unusual pathogen present in the environment