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

Preservation and compensation: The functional neuroanatomy of insight and working memory in schizophrenia

Background: Poor insight in schizophrenia has been theorised to reflect a cognitive deficit that is secondary to brain abnormalities, localized in the brain regions that are implicated in higher order cognitive functions, including working memory (WM). This study investigated WM-related neural substrates of preserved and poor insight in schizophrenia. Method: Forty stable schizophrenia outpatients, 20 with preserved and 20 with poor insight (usable data obtained from 18 preserved and 14 poor insight patients), and 20 healthy participants underwent functional magnetic resonance imaging (fMRI) during a parametric 'n-back' task. The three groups were preselected to match on age, education and predicted IQ, and the two patient groups to have distinct insight levels. Performance and fMRI data were analysed to determine how groups of patients with preserved and poor insight differed from each other, and from healthy participants. Results: Poor insight patients showed lower performance accuracy, relative to healthy participants (p. = 0.01) and preserved insight patients (p. = 0.08); the two patient groups were comparable on symptoms and medication. Preserved insight patients, relative to poor insight patients, showed greater activity most consistently in the precuneus and cerebellum (both bilateral) during WM; they also showed greater activity than healthy participants in the inferior-superior frontal gyrus and cerebellum (bilateral). Group differences in brain activity did not co-vary significantly with performance accuracy. Conclusions: The precuneus and cerebellum function contribute to preserved insight in schizophrenia. Preserved insight as well as normal-range WM capacity in schizophrenia sub-groups may be achieved via compensatory neural activity in the frontal cortex and cerebellum. © 2013 Elsevier B.V.Wellcome Trust, UK; NIHR Birmingham and Black Country CLAHRC, UK; Biomedical Research Centre for Mental Health at the Institute of Psychiatry, King's College London; South London and Maudsley NHS Foundation Trust, UK

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

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

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

Chinese-hamster ovary cell-growth and interferon-production kinetics in stirred batch culture

Recombinant human interferon-gamma production by Chinese hamster ovary cells was restricted to the growth phase of batch cultures in serum-free medium. The specific interferon production rate was highest during the initial period of exponential growth but declined subsequently in parallel with specific growth rate. This decline in specific growth rate and interferon productivity was associated with a decline in specific metabolic activity as determined by the rate of glucose uptake and the rates of lactate and ammonia production. The ammonia and lactate concentrations that had accumulated by the end of the batch culture were not inhibitory to growth. Glucose was exhausted by the end of the growth phase but increased glucose concentrations did not improve the cell yield or interferon production kinetics. Analysis of amino acid metabolism showed that glutamine and asparagine were exhausted by the end of the growth phase, but supplementation of these amino acids did not improve either cell or product yields. When glutamine was omitted from the growth medium there was no cell proliferation but interferon production occurred, suggesting that recombinant protein production can be uncoupled from cell proliferation