Purpose of review As thrombus consists of both fibrin and platelets, antithrombotic strategies involve anticoagulants and antiplatelets, alone or in combination. Recent findings Traditionally, unfractionated heparin has been the most commonly used parenteral anticoagulant, but owing to its variable dose response and narrow therapeutic indices, it is being replaced by low molecular weight heparin, fondaparinux, and bivalrudin. New oral factor Xa inhibitors like apixaban and rivaroxaban are still on the horizon, awaiting definite evaluation in ACS, DVT and atrial fibrillation. On the contrary, a dramatic advance in the arena of oral anticoagulants has occurred with the introduction of dabigatran, an oral direct thrombin inhibitor. This agent showed better outcomes than oral vitamin K antagonists in patients with atrial fibrillation. The antiplatelet field has also expanded by the addition of two new agents, prasugrel and ticagrelor. These agents have been tested against clopidogrel, in patients with ACS, with superior efficacy outcomes for both agents and higher bleeding events with prasugrel. Summary Bleeding risk associated with antithrombotics is not only a function of their inherent biochemical properties but also a reflection of how healthcare professionals choose and dose these agents in individual patients.
Use of Wireless communications for Metropolitan Area Network (MAN) in consumer electronics has increased significantly in the recent past. This paper, presents the performance analysis of four different channel coding and interleaving schemes for MIMO-OFDM communications systems. A comparison is done based on the BER, hardware implementation resources requirement, and power dissipation. It also presents a memory-efficient and low-latency interleaver implementation technique for the MIMO-OFDM communication system. It is shown that among the four coding and interleaving schemes studied, the cross-antenna coding and per-antenna interleaving performs the best under all SNR conditions and for all modulation schemes. It is also the best scheme as far as the hardware resource implication and power dissipation are concerned, which are particularly important in the context of consumer electronics. Next, using the proposed interleaver, a MIMO-OFDM based transmitter employing a double data stream 2times2 MIMO spatial multiplexing system is built.
Managing coronary thrombus is a challenging task and requires adequate knowledge of the various antithrombotic agents available. In this article, we will briefly analyze the risk-benefit profile of antithrombotic agents, with critical analysis of the scientific evidence available to support their use. Since thrombus consists of platelets and coagulation cofactors, an effective antithrombotic strategy involves using one anticoagulant with two or more antiplatelet agents. Unfractionated heparin traditionally has been the most commonly used anticoagulant but is fast being replaced by relatively newer agents like LMWH, direct thrombin inhibitors, and Factor Xa inhibitors. In recent years, the antiplatelet landscape has changed significantly with the availability of more potent and rapidly acting agents, like prasugrel and ticagrelor. These agents have demonstrated a sizeable reduction in ischemic outcomes in patients with ACS, who are treated invasively or otherwise, with some concern for an increased bleeding risk. Glycoprotein IIb/IIIa inhibitors have an established role in high risk NSTE ACS patients pretreated with dual antiplatelets, but its role in STEMI patients, treated with invasive approach and dual antiplatelets, has not been supported consistently across the studies. Additionally, in recent years, its place as a directly injected therapy into coronaries has been looked into with mixed results. In conclusion, a well-tailored antithrombotic strategy requires taking into account each patient’s individual risk factors and clinical presentation, with an effort to strike balance between not only preventing ischemic outcomes but also reducing bleeding complications.
Iqbal, Zafar
P. Grigg, Nigel
Govinderaju, K.
Campbell-Allen, Nicola
Purpose - Quality function deployment (QFD) is a methodology to translate the ldquovoice of the customerrdquo into engineering/technical specifications (HOWs) to be followed in designing of products or services. For the method to be effective, QFD practitioners need to be able to accurately differentiate between the final weights (FWs) that have been assigned to HOWs in the house of quality matrix. The paper aims to introduce a statistical testing procedure to determine whether the FWs of HOWs are significantly different and investigate the robustness of different rating scales used in QFD practice in contributing to these differences. Design/methodology/approach - Using a range of published QFD examples, the paper uses a parametric bootstrap testing procedure to test the significance of the differences between the FWs by generating simulated random samples based on a theoretical probability model. The paper then determines the significance or otherwise of the differences between: the two most extreme FWs and all pairs of FWs. Finally, the paper checks the robustness of different attribute rating scales (linear vs non-linear) in the context of these testing procedures. Findings - The paper demonstrates that not all of the differences that exist between the FWs of HOW attributes are in fact significant. In the absence of such a procedure, there is no reliable analytical basis for QFD practitioners to determine whether FWs are significantly different, and they may wrongly prioritise one engineering attribute over another. Originality/value - This is the first article to test the significance of the differences between FWs of HOWs and to determine the robustness of different strength of scales used in relationship matrix.
Given the rapid increase in the consumer use of online services and the increase in competition between firms that compete online, firms are faced with a crucial challenge. Having invested significant resources in transitioning consumers from using offline services to using online services, they now need to understand what drives consumers to choose between competing online services. Our study seeks an exploratory answer to the above challenge. Specifically, we consider, "what role do factors that drive consumers into using online services play in assisting firms better compete in the online space"? This paper explores the above question by quantifying the value that consumers of an online financial service place on having access to in-depth product information, an affordable online service, an easy to use online service, access to offline capabilities, and available marketing promotions. The results reported in this paper are based on a Web-based discrete choice experiment in which 2,209 consumers were asked to compare various online financial service offerings, differing from each other in terms of the relative availability of our critical factors. The results demonstrate that consumer preferences (relative utilities) for various factors of an online financial service are different. Our results enable practicing managers to understand the factors that drive consumer choice when faced with competing online services. We believe that these results have both managerial and research implications for design, management and operations strategy formulation for online services
A novel microwave-assisted process is described for the rapid removal of catalytic
metal and non-desirable carbon impurities in fullerene, single wall, and multiple
wall carbon nanotube preparations. The purification process is carried out
at various programmed pressures, power levels and reaction times in a suspension
of the nanocarbon moieties in the presence of strong acids (for example, a mixture
of sulfuric acid and nitric acid), in weak acids (for example, acetic acid) and
in the presence of chelating agents (for example, EDTA - ethylenediaminetetraacetic
acid). In one embodiment, high metal removal efficiency of 70 to 90 % is observed.
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