In patients with STEMI and multivessel coronary artery disease undergoing infarct-artery PCI, preventive PCI in noninfarct coronary arteries with major stenoses significantly reduced the risk of adverse cardiovascular events, as compared with PCI limited to the infarct artery. (Funded by Barts and the London Charity; PRAMI Current Controlled Trials number, ISRCTN73028481.).
In the wake of new forms of curricular policy in many parts of the world, teachers are increasingly required to act as agents of change. And yet, teacher agency is under-theorised and often misconstrued in the educational change literature, wherein agency and change are seen as synonymous and positive. This paper addresses the issue of teacher agency in the context of an empirical study of curriculum making in schooling. Drawing upon the existing literature, we outline an ecological view of agency as an effect. These insights frame the analysis of a set of empirical data, derived from a research project about curriculum-making in a school and further education college in Scotland. Based upon the evidence, we argue that the extent to which teachers are able to achieve agency varies from context to context based upon certain environmental conditions of possibility and constraint, and that an important factor in this lies in the beliefs, values and attributes that teachers mobilise in relation to particular situations.3
Background-The mechanisms underlying the variation in collateral formation between patients, even with similar patterns of coronary artery disease, remain unclear. This study investigates whether circulating humoral or cellular factors can provide an insight into this variation. Methods and Results-Thirty patients with isolated left anterior descending coronary artery disease underwent percutaneous coronary intervention with collateral flow index (CFI) determined using a pressure wire. Patients with inadequate (CFI Ͻ0.25) compared with those with adequate (CFI Ն0.25) collateral support had, or tended to have, lower concentrations of coronary sinus growth factors and plasma exerting a weaker effect on endothelial cell migration and angiogenesis in vitro. However, there was an inverse correlation between serum mitogenicity and CFI (rϭϪ0.61, PϽ0.01). No significant differences were detected between the 2 groups in plasma levels of total vascular endothelial growth factor, vascular endothelial growth factor 165 , or placental growth factor. There was a strong positive correlation between numbers of CD34/CD133-positive circulating hemopoietic precursor cells and CFI (rϭ0.75, PϽ0.001). In patients with inadequate, compared with those with adequate, CFI, the numbers of differentiated endothelial progenitor cells (EPCs) appearing in the circulation and in culture were significantly reduced by 75% (PϽ0.05) and 70% (PϽ0.05), respectively. Conclusions-In this study, inadequate coronary collateral development is associated with reduced numbers of circulating EPCs and impaired chemotactic and proangiogenic but not mitogenic activity. These findings are consistent with current efforts to enhance collateral formation by augmentation of circulating EPCs.
BACKGROUNDWhether revascularization by percutaneous coronary intervention (PCI) can improve event-free survival and left ventricular function in patients with severe ischemic left ventricular systolic dysfunction, as compared with optimal medical therapy (i.e., individually adjusted pharmacologic and device therapy for heart failure) alone, is unknown. METHODSWe randomly assigned patients with a left ventricular ejection fraction of 35% or less, extensive coronary artery disease amenable to PCI, and demonstrable myocardial viability to a strategy of either PCI plus optimal medical therapy (PCI group) or optimal medical therapy alone (optimal-medical-therapy group). The primary composite outcome was death from any cause or hospitalization for heart failure. Major secondary outcomes were left ventricular ejection fraction at 6 and 12 months and quality-of-life scores. RESULTSA total of 700 patients underwent randomization -347 were assigned to the PCI group and 353 to the optimal-medical-therapy group. Over a median of 41 months, a primary-outcome event occurred in 129 patients (37.2%) in the PCI group and in 134 patients (38.0%) in the optimal-medical-therapy group (hazard ratio, 0.99; 95% confidence interval [CI], 0.78 to 1.27; P = 0.96). The left ventricular ejection fraction was similar in the two groups at 6 months (mean difference, −1.6 percentage points; 95% CI, −3.7 to 0.5) and at 12 months (mean difference, 0.9 percentage points; 95% CI, −1.7 to 3.4). Quality-of-life scores at 6 and 12 months appeared to favor the PCI group, but the difference had diminished at 24 months. CONCLUSIONSAmong patients with severe ischemic left ventricular systolic dysfunction who received optimal medical therapy, revascularization by PCI did not result in a lower incidence of death from any cause or hospitalization for heart failure.
John Field (2000) has recently argued that there are changes taking place in the practices of governing that have significant implications for lifelong learning. In particular, he points to attempts to mobilize civil society, of which lifelong learning policies may be considered a part. This paper examines this proposition by locating Field's argument within wider debates about governmentality and the attempt to fashion calculating and enterprising selves. Drawing on actor-network theory, the paper then explores some of the ways in which changes in the curriculum associated with lifelong learning contribute to that process. In bringing together the discussion of lifelong learning, governmentality and actor-network theory, the paper provides a framing for researching the effects of policy and, more precisely, the differential ways in which active subjects are mobilized
The aim of this study was to investigate the role of nitric oxide (NO) in a cellular model of early preconditioning (PC) in cultured neonatal rat ventricular myocytes. Cardiomyocytes "preconditioned" with 90 min of stimulated ischemia (SI) followed by 30 min reoxygenation in normal culture conditions were protected against subsequent 6 h of SI. PC was blocked by N(G)-monomethyl-L-arginine monoacetate but not by dexamethasone pretreatment. Inducible nitric oxide synthase (NOS) protein expression was not detected during PC ischemia. Pretreatment (90 min) with the NO donor S-nitroso-N-acetyl-L,L-penicillamine (SNAP) mimicked PC, resulting in significant protection. SNAP-triggered protection was completely abolished by 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one (ODQ) but was unaffected by chelerythrine or the presence of glibenclamide and 5-hydroxydecanoate. With the use of RIA, SNAP treatment increased cGMP levels, which were blocked by ODQ. Hence, NO is implicated as a trigger in this model of early PC via activation of a constitutive NOS isoform. After exposure to SNAP, the mechanism of cardioprotection is cGMP dependent but independent of protein kinase C or ATP-sensitive K(+) channels. This differs from the proposed mechanism of NO-induced cardioprotection in late PC.
Digital technologies in combination with ‘big’ data and predictive analytics are having a significant impact upon professional practices at individual, organisational, national and international levels. The interplay of code, algorithms and big data are increasingly pervasive in the governing, leadership and practices of different professional groups. They are reshaping the relationships between professional grouping and between professionals and their clients/users/students. New forms of accountability and responsibility are emerging as a result of these trends, raising important questions about culpability and decision-making in professional practice. However, to date, despite the introduction of many professional codes on the use of digital data and social media, these issues have received limited examination in research addressing professional education. This article aims to explore some of these trends, how they are manifested in different professions and what might be the educational implications. Our argument is that new digital technologies are reconfiguring professional practice and responsibility, but that the education of professionals has yet to adequately reflect these changes. Digital technologies may therefore be changing the governing of practice rather than simply enhancing the efficiency of practices
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