Recombinant hirudin (lepirudin) for the improvement of thrombolysis with streptokinase in patients with acute myocardial infarction Results of the HIT-4 trial

AbstractOBJECTIVESThe purpose of this study was to compare recombinant hirudin and heparin as adjuncts to streptokinase thrombolysis in patients with acute myocardial infarction (AMI).BACKGROUNDExperimental studies and previous small clinical trials suggest that specific thrombin inhibition improves early patency rates and clinical outcome in patients treated with streptokinase.METHODSIn a randomized double-blind, multicenter trial, 1,208 patients with AMI ≤6 h were treated with aspirin and streptokinase and randomized to receive recombinant hirudin (lepirudin, IV bolus of 0.2 mg/kg, followed by subcutaneous (SC) injections of 0.5 mg/kg b.i.d. for 5 to 7 days) or heparin (IV placebo bolus, followed by SC injections of 12,500 IU b.i.d. for 5 to 7 days). A total of 447 patients were included in the angiographic substudy in which the primary end point, 90-min Thrombolysis in Myocardial Infarction (TIMI) flow grade 3 of the infarct-related artery, was evaluated, while the other two-thirds served as “safety group” in which only clinical end points were evaluated. As an additional efficacy parameter the ST-segment resolution at 90 and 180 min was measured in all patients.RESULTSTIMI flow grade 3 was observed in 40.7% in the lepirudin and in 33.5% in the heparin group (p = 0.16), respectively. In the entire study population the proportion of patients with complete ST resolution at 90 min (28% vs. 22%, p = 0.05) and at 180 min (52% vs. 48%, p = 0.18) after start of therapy tended to be higher in the lepirudin group. There was no significant difference in the incidence of hemorrhagic stroke (0.2% vs. 0.3%) or total stroke (1.2% vs. 1.5%), reinfarction rate (4.6% vs. 5.1%) and total mortality rate (6.8% vs. 6.4%) at 30 days, as well as the combined end point of death, nonfatal stroke, nonfatal reinfarction, rescue-percutaneous transluminal coronary angioplasty and refractory angina (22.7 vs. 24.3%) were not statistically different between the two groups.CONCLUSIONSLepirudin as adjunct to thrombolysis with streptokinase did not significantly improve restoration of blood flow in the infarct vessel as assessed by angiography, but was associated with an accelerated ST resolution. There was no increase in the risk of major bleedings with lepirudin compared to heparin

The Ties that Double Bind Us: Career, Emotion and Narrative Coping in Difficult Working Relationships

This article examines through an autoethnographic account how career aspirations and constraints may lead individuals to endure emotionally aversive situations. It presents evidence that individuals in such situations engage in emotion‐focused coping through narrative, illustrated by the author’s autoethnographic narrative of a difficult working relationship which developed into a double bind situation. The paper suggests that narrative coping in response to a double bind can actually serve to reify and prolong such situations. The paper concludes that autoethnographic research does not lend itself to simple organisational solutions. Possible avenues for further research are outlined and discussed

Analysis of the pattern of suprahyoid muscle activity during pharyngeal swallowing of foods by healthy young subjects

We previously developed the TP technique to discriminate between the activity patterns of skeletal muscles. In this study we aim to identify the TP value(s) that can be used to sensitively evaluate the activity patterns of the suprahyoid (SH) muscles during swallowing. We also analyse the effect of food textural properties on the activity patterns of the SH muscle during oral and pharyngeal swallowing. Three test foods consisting of 3%, 6% and 9% of a thickening agent, Mousse-up (MU) were prepared. Their textural properties differed significantly. Swallowing of 9% MU involved a significantly longer average duration than 3% MU. The average T50 value for 6% MU was significantly larger than that for 3% MU. However, the average T20 and T80 values of the test foods did not differ. Thus, the T50 value is particularly suitable for evaluating SH muscle swallowing patterns. Moreover, test foods that vary in their textural properties elicit different durations and patterns of SH muscle activity

Using job strain and organizational justice models to predict multiple forms of employee performance behaviours among Australian policing personnel

The overall purpose of this investigation was to examine the relationship between stress-related working conditions and three forms of employee performance behaviours: in-role behaviours, citizenship behaviours directed at other individuals and citizenship behaviours directed at the organization. The potentially stressful working conditions were based on the job strain model (incorporating job demands, job control and social support) as well as organizational justice theory. A sample of Australian-based police officers (n = 640) took part in this study and the data were collected via a mail-out survey. Multiple regression analyses were undertaken to assess both the strength and the nature of the relationships between the working conditions and employee performance and these analyses included tests for additive, interactional and curvilinear effects. The overall results indicated that a significant proportion of the explained variance in all three outcome measures was attributed to the additive effects of demand, control and support. The level of variance associated with the organizational justice dimensions was relatively small, although there were signs that specific dimensions of justice may provide unique insights into the relationship between job stressors and employee performance. The implications of these and other notable findings are discussed.<br /

The Influence of Racial Identity Profiles on the Relationship Between Racial Discrimination and Depressive Symptoms

This study examined the association between racial identity profiles, discrimination, and mental health outcomes. African American college students (N = 194) completed measures of racial discrimination, racial identity, college hassles, and depressive symptoms. Four meaningful profiles emerged through a cluster analysis of seven dimensions of racial identity assessed using the Multidimensional Inventory of Black Identity (MIBI). Results suggested racial identity moderates the relation between discrimination and depressive symptoms. Students whose racial identity profile involves the goal of blending with the mainstream and focusing on shared human qualities rather than race as a core ideological concept had a significantly stronger association between racial discrimination and depressive symptoms. The results hold implications for investigating the experience of racial discrimination and conceptualization of racial identity

A Decommissioned LHC Model Magnet as an Axion Telescope

The 8.4 Tesla, 10 m long transverse magnetic field of a twin aperture LHC bending magnet can be utilized as a macroscopic coherent solar axion-to-photon converter. Numerical calculations show that the integrated time of alignment with the Sun would be 33 days per year with the magnet on a tracking table capable of $\pm 5^o$ in the vertical direction and $\pm 40^o$ in the horizontal direction. The existing lower bound on the axion-to-photon coupling constant can be improved by a factor between 50 and 100 in 3 years, i.e., $g_{a\gamma\gamma} \lesssim 9\cdot 10^{-11} GeV^{-1}$ for axion masses $\lesssim$ 1 eV. This value falls within the existing open axion mass window. The same set-up can simultaneously search for low- and high-energy celestial axions, or axion-like particles, scanning the sky as the Earth rotates and orbits the Sun.Comment: Final version, accepted for publication in Nucl. Instr. Meth. A. More information can be found at http://wwwinfo.cern.ch/~collar/SATAN/alvaro.htm

The effectiveness of a low-intensity problem-solving intervention for common adolescent mental health problems in New Delhi, India: protocol for a school-based, individually randomized controlled trial with an embedded stepped-wedge cluster randomized controlled recruitment trial

Background Conduct, anxiety and depressive disorders account for over 75% of the adolescent mental health burden globally. The current protocol will test a low-intensity problem-solving intervention for school-going adolescents with common mental health problems in India. The protocol also tests the effects of a classroom-based sensitization intervention on the demand for counselling services in an embedded recruitment trial. Methods We will conduct a two-arm individually randomized controlled trial in six Government-run secondary schools in New Delhi. The targeted sample is 240 adolescents in grades 9-12 with persistent, elevated mental health symptoms and associated impact. Participants will receive either a brief problem-solving intervention delivered over 3 weeks by lay counsellors (intervention), or enhanced usual care comprised of problem-solving booklets (control). Self-reported adolescent mental health symptoms and idiographic problems will be assessed at 6 weeks (co-primary outcomes) and again at 12 weeks post-randomization. In addition, adolescent-reported impact of mental health difficulties, perceived stress, mental wellbeing and clinical remission, as well as parent-reported adolescent mental health symptoms and impact scores, will be assessed at 6 and 12 weeks post-randomization. We will also complete a parallel process evaluation, including estimations of the costs of delivering the interventions. An embedded recruitment trial will apply a stepped-wedge, cluster (class)-randomized controlled design in 70 classes across the six schools. This will evaluate the added impact of a classroom-based sensitization intervention over school-level recruitment sensitization activities on the primary outcome of referral rate into the host trial (i.e. the proportion of adolescents referred as a function of the total sampling frame in each condition of the embedded recruitment trial). Other outcomes will be the proportion of referrals eligible to participate in the host trial, proportion of self-generated referrals, and severity and pattern of symptoms among referred adolescents in each condition. Power calculations were undertaken separately for each trial. A detailed statistical analysis plan will be developed separately for each trial prior to unblinding. Discussion Both trials were initiated on 20 August 2018. A single research protocol for both trials offers a resource-efficient methodology for testing the effectiveness of linked procedures to enhance uptake and outcomes of a school-based psychological intervention for common adolescent mental health problems

Customer emotions in service failure and recovery encounters

Emotions play a significant role in the workplace, and considerable attention has been given to the study of employee emotions. Customers also play a central function in organizations, but much less is known about customer emotions. This chapter reviews the growing literature on customer emotions in employee–customer interfaces with a focus on service failure and recovery encounters, where emotions are heightened. It highlights emerging themes and key findings, addresses the measurement, modeling, and management of customer emotions, and identifies future research streams. Attention is given to emotional contagion, relationships between affective and cognitive processes, customer anger, customer rage, and individual differences