Cessation of dual antiplatelet therapy and cardiovascular events following acute coronary syndrome

Objective: To assess whether cardiovascular events are increased after cessation of dual antiplatelet therapy (DAPT) following acute coronary syndrome (ACS) and to explore predictors for recurrent events after DAPT cessation during long-term follow-up. Methods: We did a retrospective observational cohort study. We included consecutive people with ACS who were discharged from Scottish hospitals between January 2008 and December 2013 and who received DAPT after discharge followed by antiplatelet monotherapy. The rates of cardiovascular events were assessed during each 90-day period of DAPT treatment and 90-day period after stopping DAPT. Cardiovascular events were defined as a composite of death, ACS, transient ischaemic attack or stroke. Cox regression was used to identify predictors of cardiovascular events following DAPT cessation. Results: 1340 patients were included (62% male, mean age 64.9 (13.0) years). Cardiovascular events occurred in 15.7% (n=211) during the DAPT period (mean DAPT duration 175.1 (155.3) days) and in 16.7% (n=188) following DAPT cessation (mean of 2.7 years follow-up). Independent predictors for a cardiovascular event following DAPT cessation were age (HR 1.07; 95% CI 1.05 to 1.08; p<0.001), DAPT duration (HR 0.997; 95% CI 0.995 to 0.998; p<0.001) and having revascularisation therapy during the index admission (HR 0.58; 95% CI 0.39 to 0.85; p=0.005). Conclusions: The rate of cardiovascular events was not significantly increased in the early period post-DAPT cessation compared with later periods in this ACS population. Increasing age, DAPT duration and lack of revascularisation therapy were associated with increased risk of cardiovascular events during long-term follow-up after DAPT cessation

YOUNG PEOPLE AND LEISURE IN A DEPRIVED URBAN AREA

This thesis reports on a study of the leisure activities of a group of young people aged eleven to sixteen, growing up in a particularly deprived urban area of Plymouth. The analyses are based on data derived from secondary sources, a questionnaire survey, and semi-structured interviews. The fieldwork was conducted between November 1991, and June 1992. Much sociological research into the transition to adulthood has concentrated on the years from sixteen to twenty-one as the years when the most important life changes occur. Thus, the transition to adulthood is seen as part of a process of social and cultural reproduction, taking place through the transition from school to work, the transition to an independent residential unit, and the transition to a family of one's own. This thesis, however, suggests that the transition to adulthood begins much earlier than sixteen, and that this can be illustrated through the changing nature of leisure activities between the ages of eleven and sixteen. This thesis, therefore, is an exploration of the ways in which leisure practices change between the ages of eleven and sixteen, and the significance of those changes for the transition to adulthood, as part of a process of social and cultural reproduction. A distinction is made between home-based activities; out-of-home organised activities; out-of-home unorganised activities; sporting activities; cultural activities; and illegal activities. Here, the evidence suggests that between the ages of eleven and sixteen, there is a general decline in home based activities, and out-of-home organised activities, and a move towards more unstructured, unorganised activities, foUowed by a move towards more adult-oriented leisure activities. These data indicate that the transition to adulthood, as part of a process of social and cultural reproduction, is characterised by a number of informal and less structured changes taking place in young people's lives, prior to the age of sixteen. These are at least as important as the structural changes which take place beyond the age of sixteen. These findings provide case study information on a particular set o f leisure experiences, and relate to wider perspectives on the transition to adulthood

Bayesian Inference of Recursive Sequences of Group Activities from Tracks

We present a probabilistic generative model for inferring a description of coordinated, recursively structured group activities at multiple levels of temporal granularity based on observations of individuals' trajectories. The model accommodates: (1) hierarchically structured groups, (2) activities that are temporally and compositionally recursive, (3) component roles assigning different subactivity dynamics to subgroups of participants, and (4) a nonparametric Gaussian Process model of trajectories. We present an MCMC sampling framework for performing joint inference over recursive activity descriptions and assignment of trajectories to groups, integrating out continuous parameters. We demonstrate the model's expressive power in several simulated and complex real-world scenarios from the VIRAT and UCLA Aerial Event video data sets.Comment: 10 pages, 6 figures, in Proceedings of the 30th AAAI Conference on Artificial Intelligence (AAAI'16), Phoenix, AZ, 201

Isoprene oxidation by the gram-negative model bacterium variovorax sp. WS11

Plant-produced isoprene (2-methyl-1,3-butadiene) represents a significant portion of global volatile organic compound production, equaled only by methane. A metabolic pathway for the degradation of isoprene was first described for the Gram-positive bacterium Rhodococcus sp. AD45, and an alternative model organism has yet to be characterised. Here, we report the characterisation of a novel Gram-negative isoprene-degrading bacterium, Variovorax sp. WS11. Isoprene metabolism in this bacterium involves a plasmid-encoded iso metabolic gene cluster which differs from that found in Rhodococcus sp. AD45 in terms of organisation and regulation. Expression of iso metabolic genes is significantly upregulated by both isoprene and epoxyisoprene. The enzyme responsible for the initial oxidation of isoprene, isoprene monooxygenase, oxidises a wide range of alkene substrates in a manner which is strongly influenced by the presence of alkyl side-chains and differs from other well-characterised soluble diiron monooxygenases according to its response to alkyne inhibitors. This study presents Variovorax sp. WS11 as both a comparative and contrasting model organism for the study of isoprene metabolism in bacteria, aiding our understanding of the conservation of this biochemical pathway across diverse ecological niches

Surprise! Infants consider possible bases of generalization for a single input example

Infants have been shown to generalize from a small number of input examples. However, existing studies allow two possible means of generalization. One is via a process of noting similarities shared by several examples. Alternatively, generalization may reflect an implicit desire to explain the input. The latter view suggests that generalization might occur when even a single input example is surprising, given the learner's current model of the domain. To test the possibility that infants are able to generalize based on a single example, we familiarized 9-month-olds with a single three-syllable input example that contained either one surprising feature (syllable repetition, Experiment 1) or two features (repetition and a rare syllable, Experiment 2). In both experiments, infants generalized only to new strings that maintained all of the surprising features from familiarization. This research suggests that surprise can promote very rapid generalization. Infants have been shown to generalize from a small number of input examples. However, existing studies allow two possible means of generalization

Measurement of mitochondrial respiration in permeabilized fish gills

Physiological investigations of fish gills have traditionally been centered on the two principal functions of the gills, gas exchange and ion regulation. Mitochondrion-rich cells (MRCs) are primarily found within the gill filaments of fish, and are thought to proliferate in order to increase the ionoregulatory capacity of the gill in response to environmentally-induced osmotic challenges. However, surprisingly little attention has been paid to the metabolic function of mitochondria within fish gills. Here we describe and validate a simple protocol for the permeabilization of fish gills and subsequent measurement of mitochondrial respiration rates in vitro. Our protocol requires only small tissue samples (8 mg), it exploits the natural structure of fish gills, does not require mechanical separation of the gill tissue (so is relatively quick to perform), and yields accurate and highly reproducible measurements of respiration rates. It offers great potential for the study of mitochondrial function in gills over a wide range of fish sizes and species

2-Vector Spaces and Groupoids

This paper describes a relationship between essentially finite groupoids and 2-vector spaces. In particular, we show to construct 2-vector spaces of Vect-valued presheaves on such groupoids. We define 2-linear maps corresponding to functors between groupoids in both a covariant and contravariant way, which are ambidextrous adjoints. This is used to construct a representation--a weak functor--from Span(Gpd) (the bicategory of groupoids and spans of groupoids) into 2Vect. In this paper we prove this and give the construction in detail.Comment: 44 pages, 5 figures - v2 adds new theorem, significant changes to proofs, new sectio

Risk factors of ischemic stroke and subsequent outcome in hemodialysis patients

Background and purpose: End stage renal disease (ESRD) requiring hemodialysis (HD) carries up to a 10-fold greater risk of stroke than normal renal function. Knowledge concerning risk factors and management strategies derived from the general population may not be applicable to those with ESRD. We studied a large ESRD population to identify risk factors and outcomes for stroke. Methods: All adult patients receiving HD for ESRD from 01/01/2007 to 31/12/2012 were extracted from the electronic patient record. Variables associated with stroke were identified by survival analysis; demographic, clinical, imaging and dialysis related variables were assessed and case-fatality determined. Follow-up was until 31/12/2013. Results: 1382 patients were identified (mean age 60.5 years, 58.5% male). The prevalence of AF was 21.2% and 59.4% were incident HD patients. 160 (11.6%) experienced a stroke during 3471 patient-years of follow-up (95% ischemic). Stroke incidence was 41.5/1000 patient-years in prevalent and 50.1/1000 patient-years in incident HD patients. Factors associated with stroke on regression analysis were prior stroke, diabetes and age at starting renal replacement therapy. AF was not significantly associated with stroke and warfarin did not affect stroke risk in warfarin treated patients. Fatality was 18.8% at 7, 26.9% at 28 and 56.3% 365 days after stroke.<p></p> Conclusions: Incidence of stroke is high in patients with ESRD on HD with high case-fatality. Incident HD patients had the highest stroke incidence. Many, but not all, important risk factors commonly associated with stroke in the general population were not associated with stroke in patients receiving HD