Journal articles on the topic 'Stadt Dresden'

In dem Dreieck, das Bautzner- und Fischhausstraße bilden, ist der von der Stadt Dresden aus sehr gut erreichbare Teil der Dresdner Heide gelegen. Dieser Waldteil wurde Ende des 19. Jahrhunderts von den Stadtvätern angekauft, als so genannter Waldpark erschlossen und zu Ehren des sächsischen Königs Albertpark getauft. Von der einstigen Nutzung und Bedeutung des Parks für die städtische Bevölkerung zeugen heute hingegen nur noch Fragmente der einstigen Gestaltung.

Das Wirken von Heinrich Schütz in Dresden fällt in die Zeit des sächsischen Kurfürsten Johann Georgs I., unter dessen Herrschaft die Residenzstadt eine hohe soziale Dynamik erlebte. Neben Hof und staatlicher Zentralverwaltung entwickelte sich residenzspezifisch ein auf Luxusprodukte spezialisiertes Handwerk. In Dresden lebten aber auch Menschen ohne Bürgerrecht: Tagelöhner, Söldner und böhmische Exulanten. Kursächsische Landtage brachten im Abstand von einigen Jahren mehrere hundert Mitglieder der gesellschaftlichen Führungsformationen auf einige Monate in die Stadt. Ästhetisch hatte der Dresdner Hof schon vor der Ankunft von Heinrich Schütz durch die Kunst Giovanni Maria Nossenis zum Standard der europäischen Kunstentwicklung aufgeschlossen. Schütz schuf durch seine Musik ein neues ästhetisches Programm der Herrscherrepräsentation, das hinausging über Nossenis Synthese handwerklicher Hofkünste zu einem ikonographischen Programm fürstlicher Selbstdarstellung. (Autor) Quelle: Bibliographie des Musikschrifttums online

Unbegleitet geflüchtete Jugendliche treffen in Deutschland neben anderen Herausforderungen häufig auf Diskriminierung und Rassismus. Die Situation in der Stadt Dresden ist durch die Aktivität der Gruppe Pegida von besonderer Brisanz. Im Rahmen der Studie wurden 50 unbegleitet geflüchtete Jugendliche (15-21 Jahre alt) in Dresden befragt. Untersucht wurde, inwiefern sie rassistische Diskriminierung in Dresden wahrnehmen, welche Umgangsstrategien sie anwenden und wie dies mit ihrem psychischen Wohlergehen zusammenhängt. Die wahrgenommene Diskriminierung wies einen starken negativen Zusammenhang mit ihrem psychischen Wohlergehen auf. Die Wirkung der Umgangsstrategien der Jugendlichen war unterschiedlich: Bei wenig wahrgenommener Diskriminierung konnten einige Strategien das Wohlergehen schützen; war die wahrgenommene Diskriminierung jedoch stark ausgeprägt, waren die Strategien weniger effektiv oder schadeten dies ihremsogar dem Wohlergehen.

Kirch- und Friedhöfe gehören grundsätzlich zu den Werken der Gartenkunst und können Gartendenkmale sein. Die bisherigen praktischen und wissenschaftlichen Untersuchungen beschäftigen sich jedoch im Wesentlichen mit der Dokumentation bedeutender Persönlichkeiten sowie der Erforschung und Erhaltung der baulichen Elemente. Arbeiten zu Gestaltungs- und Bepflanzungskonzepten der Friedhofsanlagen finden sich dagegen eher selten. In den Jahren 2002 bis 2004 wurde schließlich mit der systematischen gartendenkmalpflegerischen Erfassung der historischen Friedhöfe der Stadt Dresden begonnen. Der Beitrag erläutert Grundlegendes zur Friedhofserfassung und wie diese in den letzten Jahren in Sachsen vorangetrieben wurde.

ZusammenfassungUmweltbezogene Gesundheitsvorsorge wird zunehmend ein Thema des öffentlichen Gesundheitsdienstes. Um die gesundheitlichen Auswirkungen des Klimawandels angehen zu können, bedarf es ämterübergreifender Zusammenarbeit. Dies benötigt Voraussetzungen sowohl auf Seiten der Beschäftigten als auch auf Seiten der Verwaltungsstruktur. Das theoretische Konzept des Health in all Policies bildet die Grundlage für das Handeln. Am Beispiel der Stadt Dresden wird beschrieben, wie dies gelingen kann.

AbstractIn studies of memory politics in post-war Germany, the role that music played in responding to the Allied bombing of Dresden on 13–14 February 1945 has been overlooked. This article examines one of the first musical reactions to this traumatic event: Rudolf Mauersberger's mourning motet Wie liegt die Stadt so wüst (How Deserted Lies the City, 1945). I argue that Mauersberger, who served as cantor of the world-famous Kreuzchor from 1930 until his death in 1971, used allegory rather than testimony to formulate a response to the firebombing that resonated with historical customs familiar to the city's residents. When premièred in the bombed-out Kreuzkirche, Mauersberger's music provided a communal setting to confront the effects of the air war, transforming a space of destruction into one of contemplation and mourning. Both his compositional process and the performance transformed rubble (the material aftermath of the attack) into a ruin (an aesthetic object).

Zusammenfassung Städtische Vegetation und Grünräume spielen eine wichtige Rolle im Umgang mit den Folgen des Klimawandels in Städten: Stadtgrün reguliert das Mikroklima in der dicht bebauten, überhitzten Stadt, in Grünflächen kann Wasser versickern und im Überflutungsfall zurückgehalten oder schadensarm abgeleitet werden. Die Erhaltung und Ausweitung des Grünflächenbestandes im Sinne einer grünen Infrastruktur im Siedlungsraum ist daher ein zentraler Bestandteil von kommunalen und regionalen Klimaanpassungsstrategien. Entsprechend werden zahlreiche freiraumplanerische Maßnahmen diskutiert, die zu einer klimawandelgerechten Stadtentwicklung beitragen sollen. Wie kann es gelingen, die verschiedenen Potenziale der grünen Infrastruktur zur Anpassung an die Folgen des Klimawandels im Stadtgefüge zu nutzen und Maßnahmen zur Förderung der grünen Infrastruktur umzusetzen? Im Rahmen der Erstellung des „Integrierten Regionalen Klimaanpassungsprogramms für die Modellregion Dresden" wurden Maßnahmen zur Entwicklung und Gestaltung grüner Infrastruktur formuliert. Aufbauend auf diesen Erfahrungen werden grundlegende planerische Ansätze zur Verankerung und Umsetzung grüner Infrastruktur, die sowohl auf gesamtstädtischer Ebene als auch in Bezug auf einzelne Flächen eine klimawandelgerechte Stadtentwicklung adressieren, vorgestellt.

Dashboards könnten in modernen Krankenhäusern bald häufiger an den Wänden hängen. Sie visualisieren die Prozesse im Krankenhaus. Das könnte viel Zeit sparen, denn knapp die Hälfte ihrer Zeit verplempern Klinikmitarbeiter damit, Informationen zu suchen, schätzt Gerd Dreske, Hersteller einer Dashboard-Lösung.

Nur einen Steinwurf vom berühmten Panorama „Canaletto-Blick“ Dresdens entfernt, fand vom 4. bis 7. September 2019 im Internationalen Congress Center der 47. Kongress der Deutschen Gesellschaft für Rheumatologie (DGRh) statt. Unter den Themenschwerpunkten Autoimmunsystemerkrankungen und Osteoarthrose diskutieren orthopädische und internistische Rheumatologen sowie Kinderheumatologen die aktuellen Herausforderungen der Rheumatologie und neueste wissenschaftliche Ergebnisse. Gastland war in diesem Jahr Tschechien.

ZusammenfassungDurch die Errichtung der innerdeutschen Grenzanlagen 1961 war den ostdeutschen Dermatologen die Teilnahme an Tagungen in der Bundesrepublik, insbesondere auch an den traditionsreichen Kongressen der Deutschen Dermatologischen Gesellschaft (DDG), nicht mehr möglich. In der ehemaligen Deutschen Demokratischen Republik (DDR) mussten eigene Strukturen wie die Gesellschaft für Dermatologie der DDR geschaffen werden, um die entstandene Lücke zu kompensieren. Durch diese Neugründungen wurden von 1964 – 1990 10 zentrale Kongresse und zahlreiche weitere wissenschaftliche und Fortbildungsveranstaltungen zu aktuellen Aspekten des Fachgebietes initiiert. Der letzte zentrale Kongress fand 1990 in Dresden statt, dominiert vom historischen Ereignis der deutschen Wiedervereinigung. Im Rahmen dieser von zahlreichen Teilnehmern aus der Bundesrepublik besuchten Veranstaltung vollzog sich auch die offizielle Wiedervereinigung der deutschen Dermatologen in den traditionsreichen Tagungssälen des 1912 gegründeten Deutschen Hygienemuseums.

The Chrysomelidae of New Caledonia are rich and unique, but insufficiently characterized. New species are being rapidly described, sometimes without careful study of the earlier taxonomic research. Karl M. Heller (Dresden, Germany) described in 1916 seven species of Eumolpinae which are redescribed here to distinguish them from other known species and to provide new information about sexual dimorphism and genitalic structures. New material is used to redefine their distribution. The males of Dematochroma lepros (Heller, 1916) and D. culminicola (Heller, 1916), and the female of D. difficilis (Heller, 1916) are described for the first time. Male and female genitalia are first described for seven and five species, respectively. D. difficilis (Heller, 1916) stat. rev., is revalidated from previous synonymy with D. terastiomerus (Heller, 1916). Lectotypes are designated for D. humboldtiana and D. terastiomerus.

Zusammenfassung: Fragestellung: Die vorliegende Studie untersuchte, ob in einer repräsentativen Stichprobe Achtjähriger Kinder mit Panikstörung gefunden werden und ermittelte die 6-Monats-Prävalenzen der DSM-IV Angststörungen in dieser Altersgruppe. Methode: Eine repräsentative Stichprobe von 826 achtjährigen Schülern der 2. Klassen in Dresden wurde mit einem zweistufigen Vorgehen untersucht. Besondere Sorgfalt wurde auf die Erfassung der Panikstörung gelegt. Die Achtjährigen wurden bereits im Screening persönlich befragt und mit 230 der Kinder fand eine diagnostische Einzeluntersuchung mit einem strukturierten diagnostischen Interview statt. Ergebnisse: Es ergab sich eine Gesamtprävalenz an Angststörungen von 9,5%. Eine Panikstörung konnte nicht gefunden werden, auch keine Agoraphobie. Für die Diagnose einer Agoraphobie fehlte das DSM-IV Diagnosekriterium, daß agoraphobie-typische Situationen gefürchtet oder vermieden werden, weil dort Flucht schwierig oder Hilfe schwer erreichbar wäre. Achtjährige machen diese kognitive Verknüpfung nicht. An einer Spezifischen Phobie in agoraphobischen Situationen leiden 2,5% der Kinder (fast ausschließlich Mädchen). Die Prävalenz der Angststörungen ist bei den Mädchen deutlich höher als bei den Jungen.

This paper seeks to explore the changing importance of blue colours, blue dyes and woad in particular in England in the late Middle Ages and early modern period. It does so by considering six themes — the popularity and fashionability of blue; blue and its significance within the Order of the Garter; blue as a colour worn by the lower social groups and its association with poverty and livery; colour symbolism of blue; blue and court entertainments; blue and the liturgy — but it will start with a review of blue colours and blue dyes.

Abstract Abstract 1173 Background: Among other side effects, hair loss is a frequent complaint in patients receiving anticoagulant therapy with Vitamin-K antagonists (VKA) and sometimes also found in patients receiving low-molecular weight heparin (LMWH). Novel oral anticoagulants (NOAC) such as apixaban, dabigatran or rivaroxaban have been tested in large prospective phase-III trials including over 100.000 patients. Furthermore, after approval more than one million patients have been treated with these novel drugs in daily care. So far, hair loss has not been reported as a side effect of NOAC therapy. Using data from a large monocentric prospective NOAC registry, we evaluated incidence and risk profile of newly reported hair loss in patients receiving dabigatran or rivaroxaban therapy. Objectives: To evaluate the incidence of newly reported hair loss as a potential side effect of NOAC therapy in daily care. Patients and methods: In the district of Saxony, Germany, a network of 200 physicians from private practice and hospitals enrol patients in the prospective NOAC registry. Inclusion criteria are: 1) indication for NOAC anticoagulation >3 month; 2) age > 18 years; 3) written informed consent; 4) availability for follow-up. No Exclusion criteria apply. In the registry, up to 2000 patients will receive prospective follow up (FU) by phone visits at day 30 day and quarterly thereafter to collect efficacy and safety data. Results: Until July 31th 2012, 938 patients were registered. Of these, 730 patients received rivaroxaban for atrial fibrillation (AF) or venous thromboembolism (demographic data in table 1) and 208 received dabigatran for AF. For these patients, current follow up data cumulate to 270.8 patient years of NOAC treatment. During follow-up visits, twelve patients spontaneously reported new hair loss (nine with rivaroxaban, 3 with dabigatran; demographic data in table 1). Therefore, total incidence of newly reported hair loss in our registry is 4.4 per 100 patient years. The mean time between start of NOAC and first report of hair loss was 68±76 days. Despite the fact that all twelve patients were female, uni- and multivariate analysis did not detect any correlation to baseline data including demographic data, co-morbidity or co-medication. Conclusion: In patients receiving long-term NOAC therapy, the incidence of hair loss as a spontaneously reported side effect is around 4.4 per 100 patient years. Before treatment initiation, patients should be informed about this potential side effect. Further data in larger cohorts are necessary to evaluate potential risk factors for hair loss with novel oral anticoagulants. Disclosures: Werth: Bayer Healthcare: Honoraria. Beyer-Westendorf:Bayer Healthcare: Bayer provided a grant to support the NOAC registry in part Other, Honoraria; Boehringer Ingelheim: Boehringer provided a grant to support the NOAC registry in part, Boehringer provided a grant to support the NOAC registry in part Other, Honoraria; Bristol Myers Squibb: Honoraria; Pfizer: Honoraria.

“A harmonious society needs a stronger legal system that wields greater authority.”“He,” the Chinese character for harmony, is now in everyone's mind when thinking about contemporary China. Harmony and other ‘Confucian values’ seem to have penetrated all spheres of Chinese society, from the Communist Party's elite to business leaders and academics. But Confucius is both used and abused: quoting the philosopher at the start of the Olympic Games Opening Ceremony in a kitsch historical extravaganza featuring 3,000 men dressed up as his disciples does not clarify the true political meaning of an increasingly ideologically eclectic regime. On the contrary, it leads, to borrow Claude Lefort's term, to further “complications.” Thus, the interest in the idea of a ‘socialist harmonious society’ stems less from what it holds aloft than from what it hides.

Context:Individuals in the population who are not able to sustain heat and whose body temperature will start rising earlier and at a higher rate than that of others, under the same conditions, are defined as “heat intolerant.”Objectives:The applicability of the heat tolerance test (HTT) in identifying individuals’ tolerance/intolerance to heat is presented.Setting:HTT is performed according to the following protocol: 120 minutes exposure to 40°C and 40% relative humidity in a climatic chamber while walking on a treadmill, dressed in shorts and T-shirt, at a pace of 5 km/h and 2% elevation. Rectal temperature and heart rate are continuously monitored, and sweat rate is calculated.Results and Conclusion:The HTT that is based on controlled exposure to an exercise-heat stress is an applicable and an efficient tool in differentiating between a temporary and permanent state of heat susceptibility.

[No abstract] Opening paragraph: Across the globe, as the sun rises, people begin each day with a routine that marks 21stcentury life as very different from any other century. Before they get dressed, before they are even fully awake, most people start their morning by gazing at rectangular oleophobic panes of illuminated glass. Every day, a new world is painted in millions of individual organic light-emitting diodes which are embedded in a substrate under a layer of glass that is harder and thinner than any previously created. The screen is brighter than any reading surface we have ever known. The first thing we do each morning is to point this blaze of dazzling light straight into our eyes which carries the retina-quality notifications of the digital straight into our foggy brains. Before we are even fully conscious, the digital has disclosed a world to us, a stream of information and data, rivers of news, rivulets of reminders and lists.

Le présent article évoque quelques événements marquants de l’histoire de Documentation et bibliothèques (DB). Il présente ensuite les grandes thématiques qui ont été traitées dans des articles ou des chroniques depuis 1973, dresse un portrait des auteurs et propose quelques réflexions sur l’avenir de la revue. Entre 1973 et 2013, 668 articles et 232 chroniques ont été publiés, répartis dans 163 numéros. Les articles de réflexion et les articles descriptifs constituent 68 % du contenu de la revue. Les thèmes les plus fréquemment abordés sont les milieux, les activités et les services. Six cent soixante-sept auteurs distincts, Québécois dans une proportion de 80 %, ont publié au moins un article dans DB entre 1973 et 2013. La revue est stable et a atteint le stade de la maturité, mais elle doit accroître sa visibilité pour affirmer son identité et assurer sa survie.

As the title suggests, this article will deal not only with the avant-garde and the romantic idea of geniality but also with the much more mundane concept of literary property. Even though the law might seem alien to the lofty ideals of the avant-garde artist, the construction of the creative genius and the birth of copyright will eventually prove to be quite closely connected. But before I move on to the legal part I would like to start with the essentials: with the author, or the artist. The American artist John de Andreas sculpture The Artist and his model from 1980 is probably one of the most revealing pictures of the avant-gardist selfconception ever made. This is a picture of the artist at work, but I will argue it can also be regarded as a legal character. What meets the eye is however very far from the law as we know it. de Andreas sculpture is a self-portrait of the artist at work: a highly naturalistic full-scale portrait of two people. One of them is a naked woman, resting casually on a white socket and looking down on the other who is a fully dressed man. As the title clearly states, the sculpture depicts the classical relation between The Artist and his Model, and it is no coincidence that the artist has a male pronoun and the model a female body. The roles of the artist and his model are traditional stereotypes which we can find in most books on art history - one is an artist and the other is a model; one is a man and the other is a woman; one is dressed and the other one is undressed.

Zusammenfassung: Die Dresdner Kinder-Angst-Studie (DKAS) untersuchte eine repräsentative Stichprobe von 826 Achtjährigen bezüglich Ängstlichkeit der Kinder mittels Selbsteinschätzung sowie mittels Fremdeinschätzung durch Eltern und Lehrerinnen. Mit 230 der Kinder fand zusätzlich eine diagnostische Einzeluntersuchung zur Feststellung klinischer und subklinischer Ängste statt. Die Urteilerübereinstimmung der Ängstlichkeitseinschätzung erwies sich als sehr gering (r = .08 bis r = .15). Mädchen schätzen sich als ängstlicher ein als Jungen und werden auch so eingeschätzt. Auf die Übereinstimmung zwischen Kind und Erwachsenen übt dies jedoch keinen Einfluss aus. Als Faktoren, welche die Übereinstimmung der Ängstlichkeitseinschätzung zwischen Kind und Eltern beeinflussen, konnten Depressivität der Mutter und State-Angst des Kindes in der Befragungssituation identifiziert werden. Angstbelastung oder Schulbildung der Eltern und die schulische Leistungsfähigkeit des Kindes üben keinen Einfluss aus. Die Elterneinschätzung steht in einem signifikanten Zusammenhang mit dem Angst-Diagnose-Status des Kindes. Dies trifft besonders bei der Trennungsangst und der Sozialphobie, nicht aber bei agoraphobischen Ängsten zu. Die Selbsteinschätzung des Kindes weist nur bezüglich Diagnosestatus in subklinischen agoraphobischen Ängsten einen Zusammenhang auf.

Abstract Background : Bleeding is a common complication of oral anticoagulation (OAC). In anticoagulated women of child-bearing potential (WOCBP), increase of menstrual bleeding may be discomforting and severe cases of menorrhagia may require dedicated treatment or even discontinuation of OAC. Since hypermenorrhea seems to be more frequent in patients receiving direct oral anticoagulants (DOAC) compared to classic OAC with vitamin-K antagonists, patterns of menorrhagia need to be studied in daily care cohorts. Patients and methods: Using data from the prospective, non-interventional Dresden NOAC registry and phase-III DOAC trial patients at our site, we evaluated rates, severity and management of vaginal bleeding complications in WOCBP (defined as age ≤55 years and without sterilizing procedures or age >55 years with documented menstrual bleeding). All bleeding complications were centrally adjudicated and classified according to ISTH definition. Annualized rates of vaginal bleeding and hypermenorrhea were calculated as number of bleeding events divided by cumulative days of DOAC exposure divided by 365 days. OAC treatment satisfaction was assessed in all registry patients at every follow-up visit by a simple six-graded scale (ranging from 1=very satisfied to 6=very unsatisfied). To assess impact of vaginal bleeding on quality of live, the first available score after a vaginal bleeding was compared with the last available score of WOCBPs without vaginal bleeding. Results: Until March 31th 2015, 1343 women were enrolled, of which 154 were WOCBPs (mean age 39±12 years; range 14-56). In these patients, OAC consisted of dabigatran (1.3%), rivaroxaban (92.2%), apixaban (5.8%) or edoxaban (0.6%). During follow-up (mean FU duration 24.6 months), 85 female patients reported 107 vaginal bleeding complications, of which 68 occurred in 53 WOCBPs (53 cases of hypermenorrhea and 15 bleedings unrelated to cycle). Table 1 indicates severity of hypermenorrhea and vaginal bleedings unrelated to cycle. According to ISTH definition, 37/68 (54.4%) of the vaginal bleeding in WOCBPs were minor, 25/68 (36.8%) were non-major, clinically relevant (NMCR) and 6/68 (8.8%) major bleeding (classified as "major" due to drop of hemoglobin ≥2g/l in 5 cases and/or transfusion of ≥2 units of red blood cells in 5 cases). In relation to all exposed WOCBPs, the rate of vaginal bleeding events was found to be 0.41 events per exposure year and the rate of hypermenorrhea was found to be 0.32 events per exposure year (median exposure time 243d; 25th/75th percentile 105/674d and median time to first hypermenorrhea 26d; 25th/75th percentile 10/46d). Of the 53 WOCBPs that described vaginal bleeding complications (including hypermenorrhea and cycle-unrelated bleeding), 12/53 (22.6%) experienced a 2nd and 3/53 (5.7%) a 3rd event (figure 1). While bleeding intensity remained stable in most recurrent events, bleeding intensity increased in 6 cases with a 2nd bleeding episode while bleeding intensity remained stable or decreased in all 3 cases with a third episode. In only 16 of the 53 hypermenorrhea events, anatomical causes could be established and 3 of these cases progressed to major bleeding (necessity of at ≥2 units of red blood cells). In contrast, in the 34 hypermenorrhea events without anatomical causes, bleeding intensity was less severe (table 1). Surgical or interventional treatment was necessary in 6/68 (8.8%) vaginal bleeding events. The remaining 62 (91.2%) events were treated conservatively (start or change of hormone therapy, tranexamic acid, OAC dose reduction or temporary interruption). Overall, OAC treatment satisfaction in WOCBP was good (mean score 1.6; 25th/75th percentile 1/2 with data available for 98/154 WOCBPs) and not different in patients with and without vaginal bleeding complications (1.6; 25th/75th percentile 1/2 vs. 1.5; 1/2; p=0.548). Conclusion : Vaginal bleeding and especially hypermenorrhea is a common complication in WOCBPs receiving oral anticoagulation. Only a small proportion of affected patients have underlying anatomical causes for bleeding but these patients often develop more severe bleeding. The majority of cases can be conservatively managed and bleeding intensity rarely increases over time. Overall, the impact of vaginal bleeding complications on treatment satisfaction seems small. Disclosures Marten: Bayer HealthCare: Honoraria. Beyer-Westendorf:Pfizer: Honoraria, Research Funding; Bristol-Myers Squibb: Honoraria, Research Funding; Boehringer Ingelheim: Honoraria, Research Funding; Bayer HealthCare: Honoraria, Research Funding.

A photograph taken in 1896, the year of Miami's incorporation, circulated widely in periodicals of the time, and it came to symbolize the founding of the city in the local and national imagination (figure 1). “That picture has gone all over this country,” one of the men who posed for it recalled, “showing the start of Miami.” In the image seventeen men stand by the mouth of the Miami River, where workers were clearing the ground for the construction of the first tourist hotel, a building owned by a wealthy northern Protestant. For the historian, the carefully posed photograph is illuminating. Most important for the purposes of this essay, it offers hints about power relations in that urban frontier. Note the four white men dressed in their Sunday best who stand behind the workers and observe the scene. They were there that day because John Sewell, the white Baptist who supervised the crew, had hurried down the dirt street to invite "the boys" to get into the historic picture. For Sewell, “the boys” meant white mainline Protestants, each of whom had arrived relatively recently to seek his fortune.

Abstract Background and Objective: Currently, non-VKA oral anticoagulants (NOAC) are replacing vitamin-K antagonists (VKA) in stroke prevention in atrial fibrillation (SPAF). We evaluated characteristics of SPAF patients that are not switched from VKA to NOACs in daily care. Methods: The prospective Dresden NOAC registry stopped enrolment of dabigatran and rivaroxaban patients on February 28, 2013. At that day, participating sites were asked to enrol all VKA patients seen for regular INR testing who remained on VKA and for whom switching to NOAC was not anticipated. VKA patients were followed for one year. Results: In total, 50 physicians registered both SPAF patients on NOAC-therapy (n=709) and on VKA therapy (n=427; table 1). Compared to the NOAC registry cohort, patients that continued VKA therapy more often were male and less often had a history of TIA/stroke, unstable INR values or a history of bleeding complications compared to the NOAC cohort. The mean duration of VKA pre-treatment was 70.7 months (range 1–432 months). For 328 of the 427 VKA patients (62%), the INR documentation was available for at least 6 months backwards and mean TTR (calculated according to Roosendaal) was 72.2% (SD 19.6). Enrolling sites indicated “stable INR” (95.3%), “costs” (6.3%) and “contraindication for NOAC” (2.3%) as the most common reasons to continue with VKA therapy in these patients. As of June 30th 2014, completed FU correlated to 472.42 patient years. At 12 months-FU (completed in 330 pts.), 311 patients (94.2%) were still taking VKA, 13 patients (3.9%) were switched to other anticoagulants and the remaining 6 patients (1.8%) stopped taking anticoagulants completely. Most common reasons for VKA discontinuation were bleeding complications (7/19; 36.8%) and unstable INR (6/19; 31.6%). Conclusion: NOAC-experienced physicians keep around 40% of anticoagulated SPAF patients on VKA, mostly due to the fact INR is considered to be stable or NOAC to be expensive. The mean TTR of 72% indicates that subjective assessment of INR stability is accurate. Patients with a history of stroke or bleeding complications are more likely to be switched from VKA to NOAC. During the following 12 months, less than 6% of the VKA continuers need to stop VKA treatment, indicating that the subjective assessment of the attending physician identifies patients with acceptable VKA treatment persistence. Table 1: characteristics of 1136 patients selected for VKA continuation (n=427), switch to NOAC (n=291) or new start of NOAC (n=418) in 50 private practises enrolling both VKA and NOAC patients into the registry All patientsn=1136 VKAn=427 Switch VKA to NOACn=291 NOAC newn=418 p-value Male, n (%) 52.82 59.02 50.17 48.33 0.0045 Age, years(median; 25th;75th percentile) 75 (70; 80) 74 (70; 79) 75 (70;81) 76 (70;82) 0.210 Mean BMI ± SD (kg/m2) 28.7 ± 4.9 28.68 ± 4.9 29.06 ± 4.9 28.46 ± 4.9 0.272 Chronic heart failure, (%) 41.29 43.56 43.3 37.56 0.149 Arterial hypertension, (%) 88.56 91.8 84.88 87.8 0.013 Diabetes,(%) 41.73 43.33 43.99 38.52 0.244 Coronary artery disease,(%) 23.06 23.65 22.34 22.97 0.916 Prior stroke or systemic embolism,(%) 13.47 8.9 17.53 15.31 0.001 History of bleeding complications (%) 3.79 0.7 7.56 4.31 <0.001 History of unstable INR 7.39 0.7 26.46 n.a. <0.001 Disclosures Beyer-Westendorf: Bayer: Honoraria, Research Funding; Pfizer: Honoraria, Research Funding; Boehringer Ingelheim: Honoraria, Research Funding. Werth:Bayer: Honoraria. Köhler:Bayer: Honoraria. Weiss:Boehringer Ingelheim: Honoraria; Bayer: Honoraria.

Aaron Belisarius Cosimo Sibthorpe, a village school teacher who wrote the first history of Sierra Leone, was a man of mystery, a magus. So he seems to have seen himself. The dead, he wrote, have vanished into oblivion,Except the historian, that monarch of the past, using his noblest privileges, when he takes a survey of his dominions, has only to touch the ruins and dead bodies with his pen, in order to rebuild the palaces, and resuscitate the men. At his voice, like that of the Deity, the dry bones re-unite, the living flesh again covers them, brilliant dresses again clothe them; and in that immense Jehoshaphat (Joel iii, 2, 12), where the children of three thousand years are collected, his own caprice alone regulates his choice, and he has only to announce the names of those Maroons, or those Settlers he requires, to behold them start forth from their tombs, remove the folds of their grave-clothes with their own hands, and answer like Lazarus to our blessed Saviour, ‘Here am I, Lord! what dost thou want with me?’Here is a powerful, original image. The historian peremptorily calls up the dead from the “immense Jehoshaphat”—the valley where they all lie gathered together to await the judgment of God—choosing anyone he wants, and at his call they are obliged to rise and answer him obediently, as Lazarus answered Jesus. If only for this image Sibthorpe deserves our wonder and gratitude.

Subject area Entrepreneurship. Study level/applicability Postgraduate Management Diploma Masters of Business Administration. Case overview Sakhumzi Restaurant on Vilakazi Street, in Soweto’s Orlando West, had grown exponentially since it opened in October 2001. Vilakazi Street was named after a South African Zulu poet, novelist and educator, Benedict Wallet Vilakazi, who was the first black South African to obtain a PhD in 1946. The street was famous for housing two Nobel Peace Prize laureates – Nelson Mandela and Archbishop Emeritus Desmond Tutu – as well as for being the site of the shooting of Hector Pieterson during the Soweto Uprising. There were two museums in the vicinity that attracted thousands of tourists every year – Mandela House and the Hector Pieterson Memorial and Museum. The founder of Sakhumzi Restaurant, Sakhumzi Maqubela, had no experience of the hospitality industry but, nevertheless, had a “deep appreciation” of customer satisfaction, which he had learnt through his previous job in the banking sector. During the start-up phase of the restaurant, Maqubela immersed himself in books on business, focusing on leadership and communication. From such humble beginnings, the restaurant had become a thriving magnet for the tourist and local markets – tourists enjoyed sampling traditional Soweto fare, and for locals, Sakhumzi offered a culinary “home away from home”. Dressed smartly, Maqubela could be seen every day at his restaurant, mingling with patrons and greeting tour operators warmly. But what worried Maqubela was how to keep growing. Should he open another Sakhumzi? Would it work away from the tourist hub of Vilakazi Street? Or were there other options that he needed to explore? Expected learning outcomes The outcomes are as follows: evaluate the entrepreneurial mindset and how entrepreneurial opportunities are recognised, assess the individual-opportunity fit of an opportunity that is being pursued, navigate the entrepreneurial process, identify sources of entrepreneurial finance, identify and overcome resistance and obstacles to start-ups and growing the venture, rigorously analyse the potential of a new business opportunity/venture and assess the relevance of the practice of entrepreneurship to firms and society. Supplementary materials Teaching notes are available for educators only. Please contact your library to gain login details or email support@emeraldinsight.com to request teaching notes. Subject code CSS 3: Entrepreneurship.

This article is a confession about research trouble and the start of a narrative of research rectification. I begin this article with a review of new materialist theory and methods broadly and specifically those that contribute insight into interviews and photo elicitation such as <em>intra</em>-views and posthuman visual methods. I then detail the research methodology I used for an empirical study conducted last year to look at what young women experience while taking selfies, or images of their face and body to be shared on social media. After this fairly procedural account, I return to my messy research notes and video recordings, and—rather than reread—I re-trace and re-<em>matter</em>-ialize one specific interview with one young woman using new materialist methods (intra-views and reading images horizontally) to reveal data that would otherwise not have been evidenced via my original humanist methods. Re-<em>matter</em>-ializing describes my process as a researcher re-visiting not only the discursive moments, but the <em>affective encounters</em> and the <em>matter</em> of the research assemblage; meaning I move beyond the spoken data to look at how the material-discursive-afffective assemblage or arrangment of the interview room, technologies of data recording, props in the room, and embodied interactions of the participants were entangled in and vital agents in the production of data. In conclusion I detail the benefits of a posthuman re-tracing: 1) an attentiveness to the complex human and non-human agents in a research assemblage, 2) a <em>response-ability</em> or ethical duty of researchers to not reduce the complexity of the phenomena they study, 3) the importance of affect in the research encounter especially in visual methods, and, 4) a questioning of the implicit assumption that—of all steps in a research program—methodology is the least malleable.

Die Vermittlung von Lehre und Forschung des Wissensgebietes Bauwirtschaft, Baubetrieb, Bauverfahrenstechnik und Baumanagement (BBB) hat an den deutschsprachigen Hochschulen in Deutschland, Österreich und der Schweiz (D A CH) in den letzten 30 Jahren eine bemerkenswerte Entfaltung erfahren. Durch die Gründung des BBB-Professorenkreises im Oktober 1986 an der Universität Wuppertal entstand eine Wissensgemeinschaft, die durch Jahrestreffen in ununterbrochener Folge, in diesem Jahr im September zum 30. Mal an der RWTH Aachen, zu einem intensiven Kennenlernen der Kollegen untereinander, dem Vergleichen, der Schaffung von Transparenz, der Orientierung an neuen Entwicklungen und der Bewusstmachung von Schwerpunkten an den einzelnen Hochschulstandorten führte. Wesentliche Hilfestellung bot der BBB-Professorenkreis nach der Wiedervereinigung Deutschlands bei der inhaltlichen Ausgestaltung und Besetzung der BBB-Professuren an den Hochschulstandorten in den neuen Bundesländern. Seit 1990 organisieren auch die wissenschaftlichen Mitarbeiter der BBB-Lehrstühle jährliche BBB-Assistententreffen für den wissenschaftlichen fachlichen Austausch und die Diskussion ihrer Promotions- und Forschungsvorhaben, zuletzt das 26. BBB-Assistententreffen vom 17. bis 19. Juni 2015 an der Universität Stuttgart. &nbsp; Beim BBB-Professorentreffen 2005 in Kassel wurde das Hochschullehrer-Memorandum: „Baubetrieb und Bauwirtschaft – Universitäre Lehre und Forschung“ von F. Berner / H. Hahr, Universität Stuttgart, von den BBB-Professoren verabschiedet [1]. &nbsp; Das „BBB-Memorandum 2015: Aufgaben und Ziele für Baubetrieb, Bauwirtschaft und Baumanagement“ von A. Tautschnig, Universität Innsbruck, R. Osebold, RWTH Aachen, und H.-J. Bargstädt, Bauhaus-Universität Weimar, wird nach Abstimmung im BBB-Professorenkreis im September im Bauingenieur veröffentlicht werden. &nbsp; Seit 2011 finden am Vortag des BBB-Professorentreffens in zweijährigem Turnus Internationale BBB-Kongresse statt, so 2011 an der TU Dresden, 2013 an der TU Darmstadt und am 17. September 2015 der 3. Internationale BBB-Kongress an der RWTH Aachen. &nbsp; Die Schwerpunkte der Lehre umfassen gemäß BBB-Memorandum 2015 im Kernbereich das Planungs- und Baumanagement, die Immobilien- und Bauplanung, die Baubetriebswirtschaft und den Baubetrieb, im Ergänzungsbereich Fächer wie Volkswirtschaftslehre, Immobilienwertermittlung, Portfolio-, Property- und Asset-Management, Schlüsselfertigbau, Bauen im Bestand, Auslandsbau und Arbeitsrecht sowie im interdisziplinären Bereich Baurecht, Unternehmensführung, Rechnungswesen, Projektstudien und Teamarbeit, Fremdsprachen, Verhandlungsführung und Persönlichkeitsentwicklung. &nbsp; Die Schwerpunkte der BBB-Forschungsthemen umfassen im Kernbereich die Projekt- und Unternehmensebene, die Bauverfahrenstechnik und die Immobilienwirtschaft, im Ergänzungsbereich unter anderem Risikomanagement und nachhaltiges Bauen, im interdisziplinären Bereich unter anderem BIM und Lean-Management. &nbsp; Das 1986 in Wuppertal kreierte Logo „BBB“ für Bauwirtschaft, Baubetrieb und Bauverfahrenstechnik hat sich damit zu „BBBplus“ entwickelt mit Bauwirtschaft, Baubetrieb, Baumanagement, Bauverfahrenstechnik, Bauunternehmensführung, Baurecht und Baunutzungsmanagement im Lebenszyklus.

<p class="1Body">All bacteria utilize RNA polymerase enzyme and transcription activator proteins to regulate gene expression in response to internal or external stress. Some bacterial promoters are regulated with only one transcription factor whilst two or more transcription activators regulate some other promoters. NarL is a transcription activator protein that activates the <em>E. coli yeaR</em> and <em>ogt</em> promoters in response to nitrate and nitrite induction in absence of oxygen. In the present study we have studied <em>ogt1052</em> promoter, which is a derivative of <em>ogt</em> promoter containing only one NarL binding site very close to -35 element. Therefore, it is considered as class II activator dependent promoter just as <em>yeaR</em> promoter. A molecular structure of <em>ogt1052</em> promoter was proposed which suggests that NarL binding site is located in opposite face of DNA that contains Alpha-CTD and sigma domain 4 of RNA polymerase enzyme required for promoter recognition. The aim of the present study was to study and test the suggested molecular model by creating point mutations at -35 element and deletion of one base pair in spacer region, to test whether sigma domain 4 is necessary to bind -35 hexamer in order to start transcription initiation, and to test whether NarL activates the promoter by interaction with Alpha-CTD in the opposite face of the DNA. Based on the result achieved, <em>ogt1052</em> promoter is a class I promoter “dressed” like a class II promoter.</p>

Abstract The purpose of this study was to determine if supplementation of a yeast fermentation product had an effect on the ADG, performance, and meat quality characteristics of Kathadin sheep fed a ryegrass hay based diet in drylot. Twenty-four Katahdin lambs were divided into two groups (male, n = 8; female n = 16) based on weight and gender: a control (CON) and treatment (TRT) used in a repeated block design. The lambs had a BW of 21.5 ± 2.5 kg, and concluded with a finishing weight of 36.3 ± 3.4 kg. Lambs were housed on dirt drylot with shade structures, and offered an ad libitum TMR diet was formulated to be isocaloric and isonitrogenous at 14% CP and was ryegrass hay based, and top dressed with ground corn as a carrier. The TRT received the yeast supplement at a rate of 4/g/h/d. The diet was offered at 2% of the group’s body weight ad libitum. A 1-wk standardization period was conducted before the start of the study to obtain a 5% refusal rate. Orts were collected and recorded, as well as weekly feed samples were collected twice a week, and compiled for a chemical analysis for NDF, ADF, ASH, CP, and ether extract. Temperature and humidity data was also collected throughout the study. Lambs were weighed weekly with a rolling weight being used for the ADG of the lambs. Proc mixed procedures of SAS was used for data analysis. We found no statistical significance in DMI (CON=11.14 ±3.36 kg/d and TRT= 10.89 ±3.55 kg/d per group), and no statistical significance by gender (P < 0.11). There was a statistical significance (P < 0.03), for ADG per group. This suggests that there is a tendency for greater performance and ADG for lambs supplemented with a yeast fermentation product.

Abstract The purpose of this study was to determine if supplementation of a yeast fermentation product had an effect on the ADG, performance, and meat quality characteristics of Katahdin sheep fed a ryegrass hay based diet in drylot. Twenty-four Katahdin lambs were divided into two groups (male, n = 8; female n = 16) based on weight and gender: a control (CON) and treatment (TRT) used in a repeated block design. The lambs had a BW of 21.5 ± 2.5 kg, and concluded with a finishing weight of 36.3 ± 3.4 kg. Lambs were housed on dirt drylot with shade structures, and offered an ad libitum TMR diet was formulated to be isocaloric and isonitrogenous at 14% CP and was ryegrass hay based, and top dressed with ground corn as a carrier. The TRT received the yeast supplement at a rate of 4/g/h/d. The diet was offered at 2% of the group’s body weight ad libitum. A 1-wk standardization period was conducted before the start of the study to obtain a 5% refusal rate. Orts were collected and recorded, as well as weekly feed samples were collected twice a week, and compiled for a chemical analysis for NDF, ADF, ASH, CP, and ether extract. Temperature and humidity data was also collected throughout the study. Lambs were weighed weekly with a rolling weight being used for the ADG of the lambs. Proc mixed procedures of SAS was used for data analysis. We found no statistical significance in DMI (CON=11.14 ±3.36 kg/d and TRT= 10.89 ±3.55 kg/d per group), and no statistical significance by gender (P < 0.11). There was a statistical significance (P < 0.03), for ADG per group. This suggests that there is a tendency for greater performance and ADG for lambs supplemented with a yeast fermentation product.

This paper presents a new form of discretion that deals with subliminal (personal) preferences, which are present in discretionary decision-making (where the mental, cognitive functions of public servants, mixed with their character and “dressed” with sophistic, logically well-explained and legally allowed reasons are present). This paper presents employee discretion that could be a denominator of the public employees’ will to do or not to do something, to give lesser or greater weight to something. The power to choose is hence not only possible in legal frameworks but also outside of them. So far, informal power has been viewed in the law as the illegal one, although there are many informal, especially personal elements involved in the legal decision-making that are never brought to light. This paper offers a promising approach to how decisions can be similar in similar matters, despite their differences in personal backgrounds, cognitive capabilities or emotional variances. This can be done if Bayes’ theorem is used. Probability can here be established based on how much we believe something after we have seen the evidence; this depends not only on what the evidence shows but also on our pre-existing preferences (pre-investigation, prior probability or just a prior) or weights that affect our view on evidence or how much we believed in the evidence from the start. By assessing priors, decision-makers can become more comfortable with probability and uncertainty, and at the same time, the “echo chambers” of unfounded claims can be avoided. This way, subjective preferences could be known to others, while the principles of equality and equity could be raised to a higher level. Further development of employee discretion is based on the same grounds as this type of discretion – on our personal (in)actions.

Background: Health care organizations around the globe have been implementing different strategies aimed at improving their care systems to obtain better patient–physician interaction and resolve underlying issues leading to patient dissatisfaction. In an effort to improve continuity of care inside a network of interdisciplinary teams, the Ministry of Health and Social Services of Québec has implemented the recruitment of pivot nurses in oncology services. Aim: To determine whether continuous nursing care for lung cancer patients, compared with standard care, yields more improvements in terms of patient satisfaction and quality of life. Methods: This study was conducted at the Notre Dame University Hospital in Montreal. Patients were selected from the outpatient admissions' list, three months after the start of their treatment, and divided into two cohorts: the continuity of care (CC) cohort, where patients were followed by a PNO, and the usual care (UC) cohort, who received standard care from the oncology clinic staff. Participants in both groups completed the Princess Margaret Hospital Patient Satisfaction with Doctor Questionnaire (PMH/PSQ-MD), the FACT-L Scale for quality of life assessment and questions evaluating the understanding of their health status and disease. Another ten questions were dressed specifically to the CC in regards to nursing care and the health care system in Quebec. Results: The current study has shown a significant impact of implicating a PNO in the care of patients with advanced lung cancer. Patients in the CC cohort displayed better quality of life assessment scores and expressed higher levels of satisfaction compared with their peers in the UC cohort. Other variables examined revealed an adequate fulfillment of the PNO role as regarded by the participants, except for matters of an intimate nature. Conclusion: The PNO appears to have an substantial role in the care of patients with advanced lung cancer. Continuity of care seems to improve patients' quality of life and satisfaction by reducing the symptom strain experienced by ambulatory patients.

Nigerian films worldwide are the entertainment offerings of the nation, a burgeoning industry with steady increase growth rate and contributing substantially to the GDP of the nation. National symbols are objects, entities and relics representing an idea, concept, character that may be physical, abstract, religious, cultural, and linguistic among others in a sovereign context and beyond. Symbols or objects that connected together may not have anything in common in reality but by association and common agreement, they have come to represent each other in social contexts; a symbol may arbitrarily denote a referent, icon and index. In the case of Nigeria, the National flag, Anthem, Pledge, Currency, language, Coat of arms, National institutions like the National Assembly complex, Federal Capital Territory (FCT), images of past leaders, historical monuments like the Unknown Soldier (representing military men who died in the cause of protecting the nation), dresses are some of these national symbols. Apart from commemorative historical functions, national symbols are also used to represent hard work, credibility or truthfulness, as well as ethnic differentiation, religious affiliation, cultural background, social status, professional orientation, class distinction among others. Theorizing with Gate-keeping and Framing Analysis, this study adopts a content analysis design which is the study of recorded human communications, an objective and systematic analysis of the contents of any document that are manifest. It is often used to investigate the level of presence of a given content in mass communication. The study selected thirty video films between 2010 and 2015 through a systematic sampling with a random start. Content categories include genre of film, type of symbol, setting of symbol, purpose of symbol, cultural implication of symbol, positioning of symbol, symbiotic relations, prominence, and direction of presentation among others. The study presumed that the nation is replete with communicative, symbolic emblems commemorating historical, cultural, religious, social and family landmarks in nationhood but that these items of symbols are minimally represented in the films that stand as cultural products and identity of the nation in the international community. Findings of the study have dire implications for the critical assessment, representation and image or identity of the nation for the past, present and the future.

In connection with the beginnings of the Andria, there have been anecdotes and scholarly theories ever since the time of Suetonius and his sources for the Life of Terence, and they intrigued Donatus in his commentary. Naturally, then, they have developed their own influence in the scholarly tradition. An anecdote recounted by Suetonius, who does not name his source, reports that when Terence delivered his play to the aediles of 166 BCE (who would be producing the comedy at the Megalensian Games), he was ordered (or invited, iussus) to read it first to Caecilius Statius (the current grand old man of Latin Comedy). It happened that Caecilius was dining when Terence appeared, dressed with no distinction and therefore earning the coolness of Caecilius. The old man treated him like a servant and had him seat himself on a stool next to his couch and start reading, so as to disturb his dining as little as possible. However, once Terence began reading his play, after only a few verses, he was invited up to Caecilius' couch and proceeded to read through the remainder of the play to the considerable admiration of his host. Now, scholars have had several things to say about this story. First and most commonly, they have pointed out that good evidence fixes the death of Caecilius in 168, roughly two years before the performance of the Andria; and accordingly this story has no factual substance. Good, there is no reason to try to combat facts: this interesting meeting of Caecilius and Terence never happened. However, we do not need to throw away the Suetonian story as useless trivia. The reason someone devised the story was evidently to bring the older generation of comic poetry into contact with the new and to voice its strong approval of its successor's first product, the Andria. Although Caecilius himself may never have known Terence, the plays of the two were linked by a common impresario, Lucius Ambivius Turpio. The didascaliae to all six plays of Terence credit him with being the producer, and in the so-called second prologue of the Hecyra Ambivius reports that he had troubles producing the plays of Caecilius, as he had recently had with Terence's.

Al inicio del siglo XIX, los países hispanoamericanos obtuvieron su independencia de España. Cuba y Puerto Rico, no obstante, se mantuvieron como parte de la “madre patria” hasta finalizado el siglo XIX. Esto no impidió, sin embargo, que la elite intelectual de estos países repensara la historia y las tradiciones que unían a ambos países con la metrópolis. Aspiraban a encontrar algo que pudiera diferenciarlos de los otros. Como resultado, apareció una literatura étnica importante, altamente contextualizada y muchas veces de naturaleza alegórica que reflejaba la vida de los descendientes de los amerindios en Cuba. En este ensayo, me propongo explorar la forma en que comenzó este proceso, primero con José María Heredia y continuó luego con una de sus discípulas, Gertrudis Gómez de Avellaneda. En sus poemas, escritos en México, Heredia reflexiona sobre “la raza original” de las Antillas y lo hace de una forma que Sigmund Freud solamente podría caracterizar como “luto”; luto y melancolía por la muerte de una persona querida, que se asocia en sus escritos con Cuba. En los años que siguieron, la Avellaneda haría lo mismo. Pero esta vez, los descendientes de la “raza original” reaparecerían vestidos para la pelea, reclamando venganza y mezclados con los deseos y demandas de los esclavos, negros libres y mulatos que los habían reemplazado en los campos de caña. Early in the 19th century, Latin America obtained its independence from Spain. Cuba and Puerto Rico, however, remained part of the “mother land” until the end of that century. That did not prevent their intellectual elite, however, from rethinking the traditional ties between their countries and the metropolis. Their hope was to find something that they could use to differentiate themselves from the others. As a result an important body of ethnic literature appeared, highly contextualized and sometimes allegorical in nature that reflected upon the lives of Amerindians in Cuba. In this essay, I would like to explore the way this process started, first with José María Heredia and continued later on, with Gertrudis Gómez de Avellaneda. In his poems, written in Mexico, Heredia start reflecting on the “original races” of the Caribbean and he does it in a way that Sigmund Freud could have only characterized as “mourning”; mourning and melancholia for the death of a dear person, who becomes associated in his writings with Cuba. In the following years, la Avellaneda will do the same. But in her case, the descendants of the “original race” will reappear dressed for war, claiming vengeance, and interwoven with the desires and demands of the slaves, free blacks and mulattos that have replaced them in the fields.

Abstract Introduction Keeping staff up-to-date on required certifications has always been a gold standard for optimum care of specialty patients in our facility. We currently house a 12-bed American Burn Association(ABA) verified burn unit within this 800-bed hospital. All critical care nurses hired into the Burn Unit are required to obtain Advanced Burn Life Support(ABLS) certification within one year of hire. After the first year, all Burn Unit nurses are required to maintain ABLS certification through renewal. Our hospital currently has seven active ABLS instructors. However, it is difficult to find volunteers willing to have moulage applied and be assessed head-to-toe. Another confounding issue is utilizing additional Burn Unit staff as “scenario patients” causing unfavorable staffing patterns. In March of 2019, we set out to investigate the functionality of high fidelity simulation during ABLS patient assessment performance test outs. Methods Our hospital has a simulation expert that facilitates high fidelity simulations with physician, residents and fellows. We sought out his expertise to understand the feasibility of having a mannequin follow scenario requirements. Both adult and small-child mannequins had the ability. Vital signs could be activated on the monitor screen once an ABLS candidate stated they had assessed the patient. Vital signs could then be adjusted throughout the scenario to coincide accordingly. Both mannequins had the ability to be turned and assessed head-to-toe. Both mannequins were fully dressed at the start of the each scenario, with the expectation each would be fully undressed in proper sequence during the test out.The burns were simulated using mix-and-pour skin effects silicone rubber. The moulage reflected the appropriate degree of burn for each scenario. Results High fidelity simulation has been utilized in our facility for two ABLS courses with great success. ABLS pass rates remain constant. A more realistic setting was obtained when utilizing simulation labs. Further improvements could be made to utilize the simulation’s highest functionality. Conclusions The use of simulation for a variety of burn patient scenarios that represent potential situations allowed learning to occur in a safe and realistic environment. Moving forward, improvement opportunities include utilizing the simulation mannequins and simulation-experts to their fullest capability. An additional component needs to be added prior to test-out, orienting the ABLS candidates to the simulation environment. Applicability of Research to Practice Mixed teaching modalities have been utilized for decades. Simulation has led to more realistic assessments and hands-on learning. There remains a need to merge scenario-based education with simulation-based education to further learners thought process and move from route memorization, to functional knowledge and application.

Abstract Duration of anticoagulation can be categorised into initial treatment, lasting 3, 6 or 12 months, and long-term treatment beyond 12 months. There is a strong rationale for anticoagulation treatment beyond the acute phase in many patients with venous thromboembolism (VTE), being the risk of recurrent VTE after stopping anticoagulation high, particularly for unprovoked deep vein thrombosis (DVT). Several non-vitamin K antagonist oral anticoagulants (NOACs) have been approved in the acute setting; accumulating evidence suggests continuing treatment with these agents beyond 12 months offers additional benefits to patients with VTE. Apixaban, dabigatran and rivaroxaban have been studied in this setting in a series of phase III extension studies (AMPLIFY-EXT, RE-MEDY and RE-SONATE, and EINSTEIN EXT, respectively). AMPLIFY-EXT evaluated patients who had completed 6-12 months of anticoagulation treatment with apixaban. Patients received either a further 12 months of apixaban at a dose of 2.5 mg or 5 mg twice daily, or placebo. Recurrent VTE or mortality from any cause were 3.8%, 4.2% and 11.6%, respectively (relative risk [95% confidence interval (CI)] vs placebo: 0.33 [0.22-0.48] and 0.66 [0.25-0.53], respectively); for major bleeding, rates were 0.2%, 0.1% and 0.5%, respectively (relative risk [95% CI] vs placebo: 0.49 [0.09-2.64] and 0.25 [0.03-2.24], respectively). In RE-MEDY, patients received either dabigatran (150 mg twice daily) or warfarin for 6-36 months after at least 3 months of prior anticoagulation treatment. Recurrent or fatal VTE occurred in 1.8% of patients treated with dabigatran versus 1.3% of warfarin-treated patients (P=0.01 for non-inferiority); major bleeding rates were lower with dabigatran (0.9% vs 1.8%) but this difference was not statistically significant. In the RE-SONATE study, dabigatran (150 mg twice daily) or placebo was administered for up to 12 months. Recurrent or fatal VTE was significantly lower with dabigatran (0.4% vs 5.6%; P<0.001). Rates of major bleeding were low in both groups (0.3% with dabigatran; no major bleeding episodes occurred in the placebo group); however, for the composite of major or non-major clinically relevant bleeding, the rate was significantly greater with dabigatran (5.3% vs 1.8%; P=0.001). In EINSTEIN EXT, patients who had completed 6-12 months of rivaroxaban or VKA anticoagulation treatment were randomised to receive either rivaroxaban or placebo for 6 or 12 months. Extended rivaroxaban treatment was associated with a significantly lower rate of recurrent VTE (1.3% vs 7.1%, respectively; P<0.001), and there was a moderate, non-significant, increase in the rate of major bleeding complications (0.7% of patients in the rivaroxaban group vs none in the placebo group; P=0.11). The phase III extension studies demonstrate the benefits of extended NOAC use versus treatment cessation, with reduced recurrence rates versus placebo, although associated with a potential moderate increase in bleeding risk; in addition, based on outcomes in patients given placebo, it is clear that not prescribing anticoagulation treatment is not a viable approach. VTE is associated with substantial costs, and recurrent episodes increase costs further. The costs are attributable to hospitalisation, treatment facility and staff and outpatient management. The lack of routine coagulation monitoring needed with use of NOACs may simplify patient management, thereby further reducing the burden on healthcare providers and patients. US and European guidelines advise long-term therapy in certain instances. They support NOAC use where they have been selected as the initial therapy choice and therapy needs to be extended beyond 3 months. In addition to clinical trials of extended anticoagulation, assessment of this therapy in routine clinical practice is essential, in order to confirm whether the results of clinical trials apply to a broad range of patients beyond the highly controlled setting of a clinical study. Phase IV data are now emerging (Dresden Noacs Registry, Xalia Study, Einstein Choice Study, Start Register) and are supportive of the findings from phase III studies. Future studies involving all NOACs will be valuable in determining the safety and effectiveness of long-term NOAC use in a wider patient population. Disclosures Piovella: GlaxoSmithKline: Speakers Bureau; Portola: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; PFIZER/BMS: Speakers Bureau; Bayer: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.

Dossier "PhénoFinlait : Phénotypage et génotypage pour la compréhension et la maîtrise de la composition fine du lait Avant-propos Le lait est un produit animal complexe à l’origine de multiples valorisations en alimentation humaine : laits de consommation incluant les laits infantiles, fromages, beurres, crèmes, yaourts, desserts et boissons lactées, ingrédient dans une grande diversité de pâtisseries et de plats cuisinés, etc. Il s’agit donc d’un pilier de l’alimentation humaine y compris à l’âge adulte et ce depuis des milliers d’années. Toutefois, les demandes des consommateurs et de la société ont évolué rapidement ces dernières années et les exigences en matière de qualité des produits se sont complexifiées (Le Bihan-Duval et al 2014). Tout d’abord du point de vue du consommateur, en particulier occidental, l’alimentation doit désormais répondre à une diversité d’attentes. A la demande en « quantité » d’après-guerre, se sont en particulier ajoutées des exigences sanitaires, des exigences organoleptiques, de traçabilité du produit, des exigences nutritionnelles, et après une période « nutrition - santé » (Cniel 2011), une exigence croissante de « naturalité ». De plus, du point de vue du citoyen, la qualité intègre l’environnement, le bien-être animal, les conditions de production. Une partie des consommateurs a d’ailleurs évolué vers une stratégie d’achat « responsable » (Cniel 2011). Simultanément, le lait, bien que bénéficiant d’une image traditionnellement et majoritairement favorable à plusieurs titres, est confronté ces dernières années à des remises en causes parfois virulentes (allergies, intolérances, rejet des matières grasses saturées et trans…) qui s’installent probablement durablement dans les rapports des consommateurs avec le lait (Cniel 2011). Malgré ce contexte exigeant et changeant, jusqu’à aujourd’hui, au-delà des quantités totales en matières grasses et protéiques, peu de dispositifs sont disponibles et mis en œuvre pour suivre, qualifier, voire piloter la composition fine du lait « en sortie de ferme ». Le lait a suivi, avec le développement du secteur laitier, un processus de standardisation conformément au principe du « lait apte à toute transformation », devenant une matière première à laquelle l’application de procédés de fabrication variés donne de la valeur. Ce constat est à moduler pour les filières AOP fromagères. La composition fine du lait, en particulier la variabilité des profils en acides gras et en protéines, n’est pas ou peu valorisée, ni au niveau de la production, ni au niveau de la transformation. Dans le contexte actuel, traiter le lait de manière indifférenciée peut être contre-productif, en particulier si l’on reconsidère la richesse intrinsèque de la matière première « lait » et le fait que la composition du produit final reflète largement la composition du lait d’origine (Lucas et al 2006). Le lait « en sortie de ferme » se situe à la charnière entre l’amont et l’aval des filières laitières et, à ce titre, est idéalement placé pour être une source importante de compétitivité et d’adaptabilité des filières laitières dans leur globalité. Le sujet de la composition fine du lait a bien entendu fait l’objet de travaux bien avant que le programme PhénoFinlait ne soit imaginé et mis en œuvre. Ainsi, les liens entre alimentation et profil en acides gras (Chilliard et al 2007, Couvreur et al 2007, Hurtaud et al 2007) ou encore les variants génétiques des lactoprotéines majeures (Grosclaude et al 1987, Grosclaude 1988) ont été étudiés généralement à partir de dispositifs expérimentaux. Ces connaissances ont servi de point de départ et d’assurance sur la faisabilité et l’intérêt d’engager un programme à grande échelle. L’ambition de PhénoFinlait était alors de transposer ces connaissances et hypothèses en élevages privés avec une grande diversité de systèmes d’alimentation et de coupler cela à une analyse conjointe du déterminisme génétique afin d’apporter aux éleveurs et à leurs filières des outils et des réponses globales. De nombreuses nouvelles références étaient bien évidemment à établir, mais l’un des enjeux majeurs portait et porte toujours sur les possibilités de transfert aux filières. Les développements à la fois de la spectrométrie dans l’infra-rouge et de la sélection génomique ont ouvert de nouvelles portes en matière d’accès à la composition fine du lait à coûts réduits et d’analyses de ses déterminants génétiques.Les travaux pionniers de la Faculté Universitaire des Sciences Agronomiques de Gembloux (Soyeurt et al 2006) ont ainsi ouvert la voie à l’estimation de nombreux composants fins du lait à partir d’une exploitation plus fine des données d’absorbance de la lumière dans le Moyen Infra-Rouge (MIR) principalement. Le principe est simple : la spectrométrie MIR, utilisée pour estimer les taux de matière grasse et protéique en routine dans les laboratoires d’analyse du lait, peut aussi être utilisée pour quantifier individuellement certains composants fins. Des modèles de prédiction sont développés à partir d’un jeu d’échantillons caractérisés à la fois à l’aide d’une méthode d’ancrage et par un spectre MIR. Ces modèles sont ensuite appliqués aux données spectrales telles que celles produites dans le cadre des analyses laitières habituelles de paiement du lait à la qualité et de contrôle laitier. Plusieurs dizaines d’acides gras et protéines peuvent ainsi être estimés avec une précision satisfaisante et à un coût additionnel modeste par rapport aux analyses déjà réalisées en routine. Parallèlement, les avancées dans le domaine de la génomique permettent d’analyser et d’exploiter plus rapidement et plus finement le déterminisme génétique des caractères. Là encore, le principe est relativement simple : deséquations d’estimation du potentiel génétique des animaux pour les différents caractères sont établies à partir d’une population de référence (animaux génotypés et caractérisés d’un point de vue phénotypique). Cette population peut être de taille beaucoup plus restreinte que celle nécessaire pour mettre en œuvre une évaluation génétique « classique ». Par ailleurs, les équations produites permettent de déterminer le potentiel génétique d’un animal sans pour autant qu’il dispose lui-même (ou ses descendants) de phénotype mesuré (Robert-Granié et al 2011). L’un des enjeux en sélection est alors de concevoir et de mettre en œuvre des programmes de caractérisation phénotypique de populations de référence, ce que l’on a appelé des programmes de « phénotypage » à plus ou moins grande échelle. Le programme PhénoFinlait est l’un des premiers grands programmes de phénotypage à haut débit (Hocquette et al 2011) avec ses caractéristiques : phénotypage fin sur la composition du lait, dans des systèmes d’élevage caractérisés, en particulier, par l’alimentation, préalable à un génotypage à haut débit des animaux suivis. Face à ces enjeux pour la filière laitière et ces nouvelles potentialités techniques et scientifiques, les filières laitières bovine, caprine et ovine, les acteurs de l’élevage (conseil en élevage et laboratoires d’analyse du lait) et de la génétique (entreprises de sélection et de mise en place d’insémination), les instituts de recherche et de développement (Inra, Institut de l’Elevage, Actalia) et APIS-GENE ont décidé de se constituer en consortium afin d’unifier leurs efforts et de partager leurs compétences et réseaux. Le consortium, avec le soutien financier d’APIS-GENE, de l’ANR, du Cniel, du Ministère de l’Agriculture (fond dédié CASDAR et Action Innovante), de France AgriMer, de France Génétique Elevage, du fond IBiSA et de l’Union Européenne, a initié début 2008 un programme pour :- analyser la composition fine du lait en acides gras et en protéines par des méthodes de routine et des méthodes d’ancrage ultra-résolutives (protéines) ;- appliquer ces méthodes à grande échelle sur une diversité de systèmes et de races représentatives de la diversité de la ferme France afin d’identifier des facteurs influençant la composition fine du lait ;- optimiser la valorisation des ressources alimentaires et génétiques par le conseil en élevage ;- initier une sélection génomique. Au-delà de ces objectifs, le programme PhénoFinlait a été envisagé comme un investissement majeur et collectif pour les filières laitières françaises afin de leur permettre de conserver ou de développer des avantages compétitifs par la possibilité de mieux valoriser la composition fine et demain ultrafine (grâce à des méthodes plus fines encore que la spectrométrie MIR) du lait. Les bases de données et d’échantillons ont ainsi vocation à être exploitées et ré-exploitées pendant plusieurs années au fur et à mesure des demandes des filières et de l’avancée des connaissances et des technologies d’analyse du lait. D’autres pays se mobilisent également sur cette problématique : Pays-Bas, Nouvelle-Zélande, Danemark et Suède, Italie, Belgique, etc. Ce dossier de la revue Inra Productions Animales fait état des principales productions issues à ce jour du programme PhénoFinlait. Il n’a pas vocation à couvrir exhaustivement les résultats produits. En particulier, nous ne présenterons pas systématiquement l’ensemble des résultats pour l’ensemble des espèces, races et composants. Néanmoins, nous nous sommes attachés à présenter à travers trois articles de synthèse et un article conclusif les principales avancées permises par ce programme à partir d’exemples pris dans les différentes filières. Gelé et al, débutent ce dossier par une présentation du programme dans ses différents volets, depuis la détermination des élevages et animaux à suivre jusqu’à la collecte et la conservation d’échantillons (de lait et de sang), en passant par l’enregistrement en routine des spectres MIR, des conditions d’alimentation, le prélèvement d’échantillons de sang puis, plus tard, le génotypage sur des puces pangénomiques. Cet article développe plus particulièrement la méthodologie mise en place pour déterminer la composition du lait en acides gras etprotéines à partir de spectres MIR. Enfin, il dresse un bilan des données collectées, permettant d’actualiser les références sur la caractérisation des troupeaux, des femelles laitières, des régimes alimentaires, et du profil des laits produits dans les trois filières laitières françaises. Legarto et al, présentent ensuite les résultats relatifs à l’influence des facteurs physiologiques (stade de lactation...), alimentaires (à travers des typologies de systèmes d’alimentation), raciaux et saisonniers, sur les profilsen acides gras. Ces résultats mettent en évidence de nombreuses sources de variation de la composition du lait qui pourront être exploitées à différentes échelles : animal, troupeau et bassin de collecte. Enfin, Boichard et al, présentent une synthèse de l’analyse du déterminisme génétique des acides gras d’une part et des protéines d’autre part. Cette synthèse aborde les estimations de paramètres génétiques tels que l’héritabilité et les corrélations génétiques entre caractères de composition fine entre eux, et avec les caractères de production. Ces résultats permettent en particulier de définir les potentialités de sélection ainsi que les liaisons génétiques à considérer. Ces analyses ont aussi permis de mesurer l’importance du choix de l’unité d’expression des teneurs (en pourcentage de la matière grasse ou protéique, ou en pourcentage dans le lait). Dans une dernière partie, cet article présente les analyses de détection de QTL avec une analyse des co-localisations entre races, entre composants et avec des gènes majeurs connus. RéférencesBoichard D., Govignon-Gion A., Larroque H., Maroteau C., Palhière I., Tosser-Klopp G., Rupp R., Sanchez M.P., Brochard M., 2014. Déterminisme génétique de la composition en acides gras et protéines du lait des ruminants. In : PhénoFinlait : Phénotypage et génotypage pour la compréhension et la maîtrise de la composition fine du lait. Brochard M., Boichard D., Brunschwig P., Peyraud J.L. (Eds). Dossier, INRA Prod. Anim., 27, 283-298. Chilliard Y., Glasser F., Ferlay A., Bernard L., Rouel J., Doreau M., 2007. Diet, rumen biohydrogenation, cow and goat milk fat nutritional quality: a review. Eur. J. Lipid Sci. Technol., 109, 828-855. Cniel, 2011. Lait, produits laitiers et société : France 2025 – Prospective collective. Note de synthèse sur les évolutions probables, juillet 2011. Couvreur S., Hurtaud C., Marnet P.G., Faverdin P., Peyraud J.L., 2007. Composition of milk fat from cows selected for milk fat globule size and offered either fresh pasture or a corn silage-based diet. J. Dairy Sci., 90, 392-403. Gelé M., Minery S., Astruc J.M., Brunschwig P., Ferrand M., Lagriffoul G., Larroque H., Legarto J., Martin P., Miranda G., Palhière I., Trossat P., Brochard M., 2014. Phénotypage et génotypage à grande échelle de la composition fine des laits dans les filières bovine, ovine et caprine. In : PhénoFinlait : Phénotypage et génotypage pour la compréhension et la maîtrise de la composition fine du lait. Brochard M., Boichard D., Brunschwig P., Peyraud J.L. (Eds). Dossier, INRA Prod. Anim., 27, 255-268. Grosclaude F., Mahé M.F., Brignon G., Di Stasio L., Jeunet R., 1987. A Mendelian polymorphism underlying quantitative variations of goat αS1-casein. Génét. Sel. Evol., 19, 399-412. Grosclaude F., 1988. Le polymorphisme génétique des principales lactoprotéines bovines. Relations avec la quantité, la composition et les aptitudes fromagères du lait. INRA Prod. Anim., 1, 5-17. Hocquette J.F., Capel C., David V., Guemene D., Bidanel J., Barbezant M., Gastinel P.L., Le Bail P.Y., Monget P., Mormede P., Peyraud J.L., Ponsart C., Guillou F., 2011. Les objectifs et les applications d’un réseau organisé de phénotypage pour les animaux d’élevage. Renc. Rech. Rum., 18, 327-334. Hurtaud C., Peyraud J.L., 2007. Effects of feeding camelina (seeds or meal) on milk fatty acid composition and butter spreadability. J. Dairy Sci., 90, 5134-5145. Le Bihan-Duval E., Talon R., Brochard M., Gautron J., Lefevre F., Larzul C., Baeza E., Hocquette J.F., 2014. Le phénotypage de la qualité des produits : enjeux de société, scientifiques et techniques. In : Phénotypage des animaux d’élevage. Phocas F. (Ed). Dossier, INRA Prod. Anim., 27, 223-234. Legarto L., Gelé M., Ferlay A., Hurtaud C., Lagriffoul G., Palhière I., Peyraud J.L., Rouillé B., Brunschwig P., 2014. Effets des conduites d’élevage sur la composition en acides gras du lait de vache, chèvre et brebis évaluéepar spectrométrie au moyen infrarouge. In : PhénoFinlait : Phénotypage et génotypage pour la compréhension et la maîtrise de la composition fine du lait. Brochard M., Boichard D., Brunschwig P., Peyraud J.L. (Eds).Dossier, INRA Prod. Anim., 27, 269-282. Lucas A., Rock E., Chamba J.F., Verdier-Metz I., Brachet P., Coulon J.B., 2006. Respective effects of milk composition and the cheese-making process on cheese compositional variability in components of nutritionalinterest. Lait, 86, 21-41. Robert-Granié C., Legarra A., Ducrocq V., 2011. Principes de base de la sélection génomique. In : Numéro spécial, Amélioration génétique. Mulsant P., Bodin L., Coudurier B., Deretz S., Le Roy P., Quillet E., Perez J.M. (Eds). INRA Prod. Anim., 24, 331-340. Soyeurt H., Dardenne P., Dehareng F., Lognay G., Veselko G., Marlier M., Bertozzi C., Mayeres P., Gengler N., 2006. Estimating fatty acid content in cow milk using mid-infrared spectrometry. J. Dairy Sci., 89, 3690-3695.