Use of Multinational Registries to Assess and Compare Outcomes of Patients with an Acute Coronary Syndrome: A Dissertation

Background Acute coronary syndromes (ACS) are a major cause of mortality and morbidity in the developed world. By 2020, ACS will be the leading cause of morbidity and mortality worldwide, largely due to substantial increases in ACS burden in developing countries. The developing world has been under-represented in international ACS registries. The Arabian Gulf area is a part of the developing world where little is known about the epidemiology of ACS. The first aim of the dissertation is to compare ACS patient characteristics, current practice patterns, and in-hospital outcomes in the Arabian Gulf area to a large multinational sample. Patients with an ACS suffer numerous clinical complications that worsen their prognosis. Cardiogenic shock (CS) is the most serious complication of ACS and the leading cause of in-hospital death. Despite advances in therapies; CS hospital mortality rates continue to exceed 50%. The second aim of the dissertation is to describe the characteristics of patients presenting with ACS complicated by cardiogenic shock, their management, and outcomes in a large multinational sample. In recent years, ACS has been increasingly affecting younger patients. While marked age-related differences have been observed in the risk of developing as well as the prognosis of ACS, few studies however examined time trends in the epidemiology of ACS in young adult patients. The third aim of the dissertation is to examine trends in frequency rates, patient characteristics, treatment practices, and outcomes in young adults hospitalized with an ACS. Methods Data from two large multinational registries of patients hospitalized with an ACS were used for this investigation. Nearly 65,000 patients were enrolled in the Global Registry of Acute Coronary Events (GRACE) between 2000 and 2007, while 6,700 patients participated in the Gulf Registry of Acute Coronary Events (Gulf RACE) in 2007. Results Aim1: Patients in Gulf RACE were significantly younger and were more likely to be male, diabetic, and smoke Compared to GRACE. Patients in Gulf RACE were less likely to receive evidence based therapies. Short-term mortality rates were comparable between the two patient cohorts. Aim2: Compared to patients with no CS, patients with CS were more likely to be older, female, have a history of diabetes, and heart failure. Patients with CS were less likely to receive effective cardiac catheterization and adjunctive cardiac medications. In-hospital case-fatality rate of patients with CS were 59.4%. While in-hospital mortality declines over the study period, incidence rates only showed minor declines. Aim2: Baseline characteristics of patients \u3c 55 years of age did not significantly change, while the use of evidence based therapies increased significantly during the years under study. Rates of short-term adverse outcomes and mortality significantly declined over time. Conclusions We observed marked regional differences in the risk profile, clinical management, and outcomes of patients with an ACS internationally compared to the Arab Middle East. Despite the encouraging trends in the use of evidence based therapies which have likely contributed to the improving trends in the prognosis of ACS, rates of development of ACS, as well as mortality due to ACS complications, remain high

Experiencing Change: Rhythms of Everyday Life Between Continuities and Disruptions

Change is a constant condition of everyday life that we experience and transition through while often maintaining a sense of stability and continuity. But inevitably we come across disruptive changes that call into question the meanings we take for granted and thereby rupture life as we know it. How do those changes affect our rhythms of living? How do we make meaning of the changes and subsequently act upon them? How do individual, social, and environmental changes reciprocally influence one another? These are the guiding questions of this paper. The questions are explored by means of a sociocultural psychological approach to ruptures in the life-course coupled with Lefebvre’s rhythmanalysis. It is argued that those questions can be investigated within five interrelated analytical domains; time, space, the body, social others, and symbolic resources. Rather than primarily emphasizing adaptation to change, the analytical framework’s key focus is meaning-making, looking at how we integrate or resist new rhythms in our lives

Reconsiderando el significado de Hogar en la Rehabilitación: hacia una ciudad histórica sostenible

Despite the significant literature about the meaning of home and the scholars’ research concerning the home environment, the concept of home didn’t filter into the rehabilitation process. The conservation theory and the rehabilitation methodology are still concentrating on the material aspects of the built environment and ignoring the immaterial aspects and meanings. In view of that the dwellings are not only artifacts but they are a livable example of the social structure and behavioral patterns. Understanding the dwellers relationship with their dwellings will be helpful in establishing a connection between the rehabilitation of the historical domestic architecture and the concept of home. This requires reconsidering the theoretical frame work of the rehabilitation process so as to be able to recognize the change in the historical house’s spatial structure and order and to link them to the social structure and pattern of use.A pesar de la gran cantidad de literatura sobre el significado del hogar y las investigaciones hechas por académicos sobre el ambiente del hogar, el concepto de hogar no se filtró en el proceso de rehabilitación. La teoría de la conservación y la metodología de rehabilitación siguen concentrándose en los aspectos materiales del ambiente construido e ignoran los aspectos inmateriales. Tomando en cuenta que las viviendas no son sólo objetos, sino ejemplos de estructuras sociales, y patrones de conducta, el entendimiento de la relación entre habitantes y sus viviendas será de utilidad para establecer una conexión entre la rehabilitación de la arquitectura doméstica histórica y el concepto del hogar. Para ello es necesario reconsiderar el marco de trabajo teórico del proceso de rehabilitación con el fin de ser capaz de reconocer el cambio en la estructura espacial del hogar histórico y el orden, y vincularlos a la estructura social