Risk stratification in non-ST elevation acute coronary syndromes: risk scores, biomarkers and clinical judgment

Undifferentiated chest pain is one of the most common reasons for emergency department attendance and admission to hospitals. Non-ST elevation acute coronary syndrome (NSTE-ACS) is an important cause of chest pain, and accurate diagnosis and risk stratification in the emergency department must be a clinical priority. In the future, the incidence of NSTE-ACS will rise further as higher sensitivity troponin assays are implemented in clinical practice. In this article, we review contemporary approaches for the diagnosis and risk stratification of NSTE-ACS during emergency care. We consider the limitations of current practices and potential improvements. Clinical guidelines recommend an early invasive strategy in higher risk NSTE-ACS. The Global Registry of Acute Coronary Events (GRACE) risk score is a validated risk stratification tool which has incremental prognostic value for risk stratification compared with clinical assessment or troponin testing alone. In emergency medicine, there has been a limited adoption of the GRACE score in some countries (e.g. United Kingdom), in part related to a delay in obtaining timely blood biochemistry results. Age makes an exponential contribution to the GRACE score, and on an individual patient basis, the risk of younger patients with a flow-limiting culprit coronary artery lesion may be underestimated. The future incorporation of novel cardiac biomarkers into this diagnostic pathway may allow for earlier treatment stratification. The cost-effectiveness of the new diagnostic pathways based on high-sensitivity troponin and copeptin must also be established. Finally, diagnostic tests and risk scores may optimize patient care but they cannot replace patient-focused good clinical judgment

National perspectives on climate change adaptation: A panel discussion of climate change adaptation efforts in diverse coastal regions of the United States

Climate change has rapidly emerged as a significant threat to coastal areas around the world. While uncertainty regarding distribution, intensity, and timescale inhibits our ability to accurately forecast potential impacts, it is widely accepted that changes in global climate will result in a variety of significant environmental, social, and economic impacts. Coastal areas are particularly vulnerable to the effects of climate change and the implications of sea-level rise, and coastal communities must develop the capacity to adapt to climate change in order to protect people, property, and the environment along our nation’s coasts. The U.S. coastal zone is highly complex and variable, consisting of several regions that are characterized by unique geographic, economic, social and environmental factors. The degree of risk and vulnerability associated with climate change can vary greatly depending on the exposure and sensitivity of coastal resources within a given area. The ability of coastal communities to effectively adapt to climate change will depend greatly on their ability to develop and implement feasible strategies that address unique local and regional factors. A wide variety of resources are available to assist coastal states in developing their approach to climate change adaptation. However, given the complex and variable nature of the U.S. coastline, it is unlikely that a single set of guidelines can adequately address the full range of adaptation needs at the local and regional levels. This panel seeks to address some of the unique local and regional issues facing coastal communities throughout the U.S. including anticipated physical, social, economic and environmental impacts, existing resources and guidelines for climate change adaptation, current approaches to climate change adaptation planning, and challenges and opportunities for developing adaptation strategies. (PDF contains 4 pages

A study in elimination of boys from high schools

Thesis (M.A.)--University of Kansas, Education, 1915. ; Includes bibliographical references

Assessing societal vulnerability of U.S. Pacific Northwest communities to storm induced coastal change

Progressive increases in storm intensities and extreme wave heights have been documented along the U.S. West Coast. Paired with global sea level rise and the potential for an increase in El Niño occurrences, these trends have substantial implications for the vulnerability of coastal communities to natural coastal hazards. Community vulnerability to hazards is characterized by the exposure, sensitivity, and adaptive capacity of human-environmental systems that influence potential impacts. To demonstrate how societal vulnerability to coastal hazards varies with both physical and social factors, we compared community exposure and sensitivity to storm-induced coastal change scenarios in Tillamook (Oregon) and Pacific (Washington) Counties. While both are backed by low-lying coastal dunes, communities in these two counties have experienced different shoreline change histories and have chosen to use the adjacent land in different ways. Therefore, community vulnerability varies significantly between the two counties. Identifying the reasons for this variability can help land-use managers make decisions to increase community resilience and reduce vulnerability in spite of a changing climate. (PDF contains 4 pages

Expression and regulation of newt simple epithelial keratins in the regenerating limb blastema

The regenerating newt limb blastema expresses a number of molecular markers which are not expressed in the developing limb. Two antibodies which stain most if not all of the mesenchymal cells of the blastema are LPIK and RGE53. In other species these identify keratin 8 and keratin 18, which are usually restricted to simple epithelia. The newt homologues of these keratins, NvK8/18 (Notophthalmus viridescens keratin 8/18) have been cloned. It is shown that whilst NvK8/18 are down-regulated by retinoic acid in the liver, this regulation is not seen in the blastema. However, in cultured limb cells obtained from normal limb muscle (TH4B), RA clearly down-regulates NvK8/K18, there is a decrease in their proliferation and differentiation into myotubes takes place. In contrast NvK8/18 are not directly regulated by RA in cultured blastemal cells (BlHl). In addition retinoic acid neither has a direct effect on the proliferation or differentiation of the BlHl cells. Myogenesis of the BlHl does occur at high cell density. Therefore it is proposed that there are at least two mechanisms of forming muscle in the newt, one is used for repair myogenesis the other for regeneration of muscle. It is further shown that NvK8/18 are only expressed in the regenerating limb when the nerve has entered the limb bud. The nerve does not control NvK8/18 expression, it appears to define a developmental stage whereby the blastemal cells have to express NvK8/18 if regeneration is to proceed. The link between NvK8/18 expression and proliferation appears to be direct. Antisense oligomers targeted against NvK8/18 expressed in either limb or blastemal cells causes a decrease in their proliferation and differentiation is observed. Therefore, it is suggested that one of the first steps in blastemal cell differentiation is the down- regulation of NvK8/18. A model is proposed how NvK8/18 could regulate transcription

Le « devenir auctorial » d’Ahmadou Kourouma

Toute tentative d’élucidation des moments-clés, supposés être déterminants, dans le devenir d’un écrivain risque de privilégier la biographie de l’auteur en question et de nous éloigner de l’étude analytique de son écriture. L’un des défis inhérents à la notion même d’une genèse auctoriale est celui de savoir comment transposer les méthodes et les outils employés par la génétique textuelle dans cet autre domaine, infiniment plus insaisissable, d’une vie humaine. Conscient de cette difficulté, cet article examine le parcours suivi par Ahmadou Kourouma vers la publication de son premier roman, Les Soleils des indépendances. Le contexte historique dans lequel ce projet d’écriture a vu le jour est esquissé, non pas pour expliquer l’existence du roman, mais pour confirmer l’une des sources majeures de la motivation de son auteur. L’histoire éditoriale du roman est également évoquée, mais sans lui conférer une valeur explicative quelconque. Refusant d’entériner l’opinion exprimée par Kourouma lui-même dans un court article sur le rôle joué par Georges-André Vachon dans la publication de son roman (« Vachon, l’ami qui m’a fait »), l’article s’appuie sur une analyse du modus scribendi de Kourouma et sur une étude des multiples traces matérielles fournies par les archives pour dresser le portrait d’un écrivain, autodidacte certes, mais aussi acharné que méticuleux. Passionné par les dictionnaires et les livres de stylistique, Kourouma souhaitait vivement devenir écrivain et c’est grâce à une pratique scripturale menée sur de longues années, accompagnée d’un questionnement incessant sur sa propre pratique, qu’il a su réaliser ses ambitions

Survey of Extension Professionals\u27 Skill Levels Needed to Practice Public Issues Education

The study discussed here examines Extension professionals\u27 perceived skills to practice Public Issues Education. Extension professionals who responded rated their skills moderately, regardless of years of experience. This is true for all experience levels, with each level of experience having certain skill strengths that might benefit others. Those designing Public Issues Education trainings and curriculum for Extension professionals should not presume that tenure or experience in Extension guarantees high skill levels to effectively practice Public issues Education. Further assessments are needed to determine more precisely what skills and what skill levels are to be included in future trainings

Four Decades of Change in U.S. Public Education: Essays on Teacher Quality and School Finance

Several decades of research in the economics of education have shown that both the quality and quantity of school resources are important for student outcomes. In this dissertation, I present two essays that address changes in both the quality and quantity of resources available to public schools over the past four decades (1960 2000). First, in chapter two I examine how the propensity for high test-scoring females to enter the teaching profession has changed over a forty-year period of occupational desegregation. While it has long been presumed that improved labor market opportunities for women have adversely affected the quality of teachers (over three quarters of whom are female), there is surprisingly little evidence measuring the extent to which this is true. In this essay, I combine data from five longitudinal surveys of high school graduates spanning the years 1957 to 2000 to evaluate this claim. I find that while the test score ranking of the average new female teacher has fallen only slightly over this period, the likelihood that a female in the top decile of her high school class entered teaching has plummeted. Next, in chapter three I examine the impact of rising within school district population heterogeneity and income inequality on local per-pupil expenditure and public school participation rates. Like the nation at large, the populations of school districts in the United States have become significantly more diverse, in (among other dimensions) racial and ethnic background, schooling, and income. Using a merged panel of school district demographics and financial data for 8,700 unified school districts over the 1970 to 2000 period, I look at the effects of this rising heterogeneity on the support for local public schools. I find that rising within-district income inequality is associated with greater per-pupil expenditure, a result consistent with a median voter model in which a lower tax price to the median voter results in greater per-pupil spending. Greater fractionalization in race and educational attainment appears to reduce per-pupil expenditure and increase enrollment in private schools

Regional variation of pull factors for retail sales in Oregon's nonmetropolitan counties 1979, 1982, 1984

The performance of pull factors for total retail sales in Oregon's nonmetropolitan counties during the economic cycle of boom, bust, and recovery of the early 1980s is examined for geographic patterns. One regional pattern and several county patterns are identified and discussed. Counties having the highest and lowest pull factors, and those exhibiting the greatest growth and decline in their pull factors, are examined with regard to the percentage of total retail sales by store group relative to other counties and statewide averages. The potential of the pull factor measure is discussed with regard to its contribution to regional economic analysis

L’avant-texte des Soleils des indépendances

Au moment de sa mort en 2003, l’écrivain ivoirien Ahmadou Kourouma était considéré comme le doyen de la littérature africaine d’expression française. Il jouissait d’une réputation hors pair dans le monde littéraire francophone, qu’il dominait à l’époque autant par son talent original et sa verve linguistique que par le capital moral qu’il avait su accumuler au fil des ans, grâce à ses prises de position souvent courageuses et parfois dangereuses. Auteur de quatre romans, d’une pièce de théâtr..