Approaches to Global Citizenship

James Tully, University of Virginia, describes two different yet overlapping modes of global citizenship which he calls liberal and democratic global citizenship. More information ... Respondent: Louis-Philippe Hodgson, York University, Dept. of Philosoph

Approaches to Global Citizenship

James Tully, University of Virginia, describes two different yet overlapping modes of global citizenship which he calls liberal and democratic global citizenship. More information ... Respondent: Louis-Philippe Hodgson, York University, Dept. of Philosoph

Double-Dose Versus Standard-Dose Clopidogrel According to Smoking Status Among Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention

Background: Prior Studies have suggested better outcomes in smokers compared with nonsmokers receiving clopidogrel (“smoker's paradox”). The impact of a more intensive clopidogrel regimen on ischemic and bleeding risks in smokers with acute coronary syndromes requiring percutaneous coronary interventions remains unclear. Methods and Results: We analyzed 17 263 acute coronary syndrome patients undergoing percutaneous coronary intervention from the CURRENT‐OASIS 7 (Clopidogrel and Aspirin Optimal Dose Usage to Reduce Recurrent Events—Seventh Organization to Assess Strategies in Ischemic Symptoms) trial, which compared double‐dose (600 mg day 1;150 mg days 2–7; then 75 mg daily) versus standard‐dose (300 mg day 1; then 75 mg daily) clopidogrel in acute coronary syndrome patients. The primary outcome was cardiovascular death, myocardial infarction, or stroke at 30 days. Interactions between treatment allocation and smoking status (current smokers versus nonsmokers) were evaluated. Overall, 6394 patients (37.0%) were current smokers. For the comparison of double‐ versus standard‐dose clopidogrel, there were significant interactions in smokers and nonsmokers for the primary outcome (P=0.031) and major bleeding (P=0.002). Double‐ versus standard‐dose clopidogrel reduced the primary outcome among smokers by 34% (hazard ratio [HR] 0.66, 95% confidence interval [CI], 0.50–0.87, P=0.003), whereas in nonsmokers, there was no apparent benefit (HR 0.96, 95% CI, 0.80–1.14, P=0.61). For major bleeding, there was no difference between the groups in smokers (HR 0.77, 95% CI, 0.48–1.24, P=0.28), whereas in nonsmokers, the double‐dose clopidogrel regimen increased bleeding (HR 1.89, 95% CI, 1.37–2.60, P<0.0001). Double‐dose clopidogrel reduced the incidence of definite stent thrombosis in smokers (HR 0.41, 95% CI, 0.24–0.71) and nonsmokers (HR 0.63, 95% CI, 0.42–0.93; P for interaction=0.19). Conclusions: In smokers, a double‐dose clopidogrel regimen reduced major cardiovascular events and stent thrombosis after percutaneous coronary intervention, with no increase in major bleeding. This suggests that clopidogrel dosing in patients with acute coronary syndromes should be personalized, taking into consideration both ischemic and bleeding risk. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT00335452

The Benefits Conferred by Radial Access for Cardiac Catheterization Are Offset by a Paradoxical Increase in the Rate of Vascular Access Site Complications With Femoral Access The Campeau Radial Paradox

AbstractObjectivesThe purpose of this study was to assess whether the benefits conferred by radial access (RA) at an individual level are offset by a proportionally greater incidence of vascular access site complications (VASC) at a population level when femoral access (FA) is performed.BackgroundThe recent widespread adoption of RA for cardiac catheterization has been associated with increased rates of VASCs when FA is attempted.MethodsLogistic regression was used to calculate the adjusted VASC rate in a contemporary cohort of consecutive patients (2006 to 2008) where both RA and FA were used, and compared it with the adjusted VASC rate observed in a historical control cohort (1996 to 1998) where only FA was used. We calculated the adjusted attributable risk to estimate the proportion of VASC attributable to the introduction of RA in FA patients of the contemporary cohort.ResultsA total of 17,059 patients were included. At a population level, the VASC rate was higher in the overall contemporary cohort compared with the historical cohort (adjusted rates: 2.91% vs. 1.98%; odds ratio [OR]: 1.48, 95% confidence interval [CI]: 1.17 to 1.89; p = 0.001). In the contemporary cohort, RA patients experienced fewer VASC than FA patients (adjusted rates: 1.44% vs. 4.19%; OR: 0.33, 95% CI: 0.23 to 0.48; p < 0.001). We observed a higher VASC rate in FA patients in the contemporary cohort compared with the historical cohort (adjusted rates: 4.19% vs. 1.98%; OR: 2.16, 95% CI: 1.67 to 2.81; p < 0.001). This finding was consistent for both diagnostic and therapeutic catheterizations separately. The proportion of VASCs attributable to RA in the contemporary FA patients was estimated at 52.7%.ConclusionsIn a contemporary population where both RA and FA were used, the safety benefit associated with RA is offset by a paradoxical increase in VASCs among FA patients. The existence of this radial paradox should be taken into consideration, especially among trainees and default radial operators

Contributions to understanding the genetics and functions of melanin in Ophiostomatoid fungi

The forest products industry plays a critical role in the Canadian economy. In order to remain competitive and profitable, the industry relies on the production of high quality products. However, the aesthetic quality of wood is often compromised by sapstain wood-inhabiting fungi that produce a blue to black discoloration that reduces its value. To develop efficient and environmentally sound control methods, the fundamental nature of the fungal stain has to be deciphered. In this thesis, we examined which genetic factors affected pigmentation and determined one biological function of melanin in the sapstaining Ophiostomatoid fungi. The screening of an insertional mutant library identified 30 Ophiostoma piceae mutants with pigmentation or growth defects. Four pigmentation mutants were further characterized. One mutation in the polyketide synthase gene (PKS1), which encodes an enzyme specific to the melanin biosynthesis pathway, caused albinism while mutations in three other genes only reduced the pigmentation. In the latter, mutations happened in genes that appeared to be involved in the transcriptional regulation of melanin production. These genes were predicted to encode a protein from a MAP kinase signaling pathway, a transcription factor (PIG1), and a protein with unknown function. Additionally, we characterized a spontaneous Ceratocystis resinifera albino mutant (Kasper). Molecular work revealed that the albino phenotype resulted from a single point mutation in the PKS1 gene of the melanin pathway. The results from O. piceae and C. resinifera showed that even if multiple genes are involved in melanin production, a single mutation in the PKS1 gene was enough to induce albinism. Using the mutants described in this study, we found that melanin was involved in the maturation of sexual fruiting bodies. The perithecia from O. piceae and C. resinifera PKS1 mutants had incomplete necks and contained no ascospores. Finally, we assessed the efficiency of Kasper in preventing spruce sapstain in a field trial performed across Canada. Kasper reduced sapstain and was more efficient than Cartapip97, the only sapstain biocontrol agent available commercially. It is anticipated that this information will help both researchers and the forest products industry to develop safe and effective means for controlling sapstain.Forestry, Faculty ofGraduat

Bioresorbable Scaffolds: The Revolution in Coronary Stenting?

Bioresorbable scaffolds (BRS) represent the latest revolution in interventional cardiology. Thanks to their reabsorptive properties, they provide temporary scaffolding that helps stabilizing the plaque and promotes healing, and then disappear, thus restoring a functional endothelium and vasomotion. Several devices have been tested at the preclinical and clinical stage. Here we review the rationale, development, design and clinical data of the BRS platforms, providing a comprehensive review of the literature

Imaging and functional assessment of bioresorbable scaffolds

Bioresorbable vascular scaffolds (BRS) are novel devices designed to provide transient vessel support to drug-delivery capability without the potential long-term limitations of metallic drug-eluting stents. The technology, heralded as the latest revolution in the field of percutaneous coronary intervention, could overcome many of the long-term safety concerns associated with metallic stents and possibly even convey a further clinical benefit. However, despite its theoretical advantages, the safety and efficacy of the first generation BRS remain unclear in all-comer patient populations. Invasive imaging modalities and methodologies were developed to guide BRS implantation and monitor the interaction between the scaffold and the vessel at long-term follow-up. These tools are helpful to avoid some of the pitfalls associated with BRS implantation and may improve the clinical outcome of these devices. The present review aims to report the most recent data regarding multi-imaging modalities as guidance and follow-up of coronary interventions involving the use of BRS

Discussion of Christopher Kutz\u27s \u27Or \u27Emet Lecture: Democratic Holy Wars

Follow-up seminar on Christopher Kutz’s ‘Or ‘Emet Lecture, delivered on Thursday, February 16, 2012. Part of the Legal Philosophy Between State and Transnationalism Seminar Series. Respondents: Louis-Philippe Hodgson, York Philosophy and François Tanguay-Renaud, Osgoode Hall Law School