Patient and Physician Perspectives on the Benefits and Risks of Antiplatelet Therapy for Acute Coronary Syndrome.

This article is co-authored by a patient with acute coronary syndrome (ACS) who is receiving long-term antiplatelet therapy in the USA and a cardiologist who routinely treats patients with ACS. The patient describes his experience from diagnosis to the present day and discusses his concerns regarding treatment and management of the condition, including the balance between the benefits and risks of antiplatelet therapy. The patient also describes his work as an advocate for cardiac health. The physician perspective on treating and managing patients with ACS is provided by a cardiologist based in the USA who is and was not involved in this patient's care. The physician reviews the benefits and risks of antiplatelet therapies for the treatment of patients with ACS and discusses his own clinical experience of managing these patients, including how issues such as treatment adherence, as well as the potential inertia to prescribing certain medications that may be seen among physicians, could be overcome.

Antiplatelet therapies are commonly prescribed to patients who have experienced events termed "acute coronary syndrome" (ACS), such as a heart attack, to prevent further cardiovascular events. However, these medicines come with potential risks, such as bleeding. This article provides perspectives from a patient and a cardiologist on managing ACS, and the benefits and risks of antiplatelet therapies. Platelet inhibitors, which aim to prevent blood clots from forming, are the standard treatment for ACS. Different types of platelet inhibitors are used, including treatments known as P2Y12 inhibitors as well as treatments referred to as platelet aggregation inhibitors. Clinical trials have tested different combinations and durations of antiplatelet therapies, and some trials have shown that changing to P2Y12 inhibitor treatment alone after receiving a combination of platelet inhibitors can reduce the risk of cardiovascular events without increasing the risk of bleeding. Treatment guidelines recommend at least 12 months of platelet inhibitors for patients with ACS; however, treatment decisions should be individualized based on the patient's risk profile. Despite the evidence supporting their benefits, some physicians remain reluctant to prescribe potent P2Y12 inhibitors, preferring older, less potent options. Treatment adherence is also challenging, and is influenced by factors such as bleeding, education level, and cost. Improved education about the benefits and risks of antiplatelet therapies may help to address these issues and improve outcomes for patients with ACS. The perspectives of both the patient and the physician contribute to an increased understanding of ACS management and the challenges faced by patients and health care providers.

Refining ambulance clinical response models: The impact on ambulance response and emergency department presentations.

OBJECTIVE: The ambulance service in Victoria, Australia implemented a revised clinical response model (CRM) in 2016 which was designed to increase the diversion of low-acuity Triple Zero (000) calls to secondary telephone triage and reduce emergency ambulance dispatches. The present study evaluates the influence of the revised CRM on emergency ambulance response times and ED presentations. METHODS: A retrospective study of emergency calls for ambulance between 1 January 2015 and 31 December 2018. Ambulance data were linked with ED presentations occurring up to 48 h after contact. Interrupted time series analyses were used to evaluate the impact of the revised CRM. RESULTS: A total of 2 365 529 calls were included. The proportion allocated a Code 1 (time-critical, lights/sirens) dispatch decreased from 56.6 to 41.0% after implementation of the revised CRM. The proportion of calls not receiving an emergency ambulance increased from 10.4 to 19.6%. Interrupted time series analyses demonstrated an improvement in Code 1 cases attended within 15 min (Key Performance Indicator). However, for patients with out-of-hospital cardiac arrest or requiring lights and sirens transport to hospital, there was no improvement in response time performance. By the end of the study period, there was also no difference in the proportion of callers presenting to ED when compared with the estimated proportion assuming the revised CRM had not been implemented. CONCLUSION: The revised CRM was associated with improved Code 1 response time performance. However, there was no improvement in response times for high acuity patients, and no change in the proportion of callers presenting to ED.

Lower Bounds on the Noiseless Worst-Case Complexity of Efficient Global Optimization.

Efficient global optimization is a widely used method for optimizing expensive black-box functions. In this paper, we study the worst-case oracle complexity of the efficient global optimization problem. In contrast to existing kernel-specific results, we derive a unified lower bound for the oracle complexity of efficient global optimization in terms of the metric entropy of a ball in its corresponding reproducing kernel Hilbert space. Moreover, we show that this lower bound nearly matches the upper bound attained by non-adaptive search algorithms, for the commonly used squared exponential kernel and the Matérn kernel with a large smoothness parameter ν. This matching is up to a replacement of d/2 by d and a logarithmic term logRϵ, where d is the dimension of input space, R is the upper bound for the norm of the unknown black-box function, and ϵ is the desired accuracy. That is to say, our lower bound is nearly optimal for these kernels.

The Dragonflies and Damselflies (Insecta: Odonata) of Canada: species list, geographical distribution, status, and conservation ranks.

As of August 2023, 220 species in 57 genera and 10 families of damselflies and dragonflies (Insecta: Odonata) are recorded for Canada. Since the publication of the first edition in 2005, 14 species have been added to the list; one,Neurocordulia obsoleta (Say) has been removed because of a misidentification and another, Sympetrum occidentale, has been to synonymy. Conservation ranks are given for species in all 13 provinces and territories. English and French names for all listed species are included. Literature sources are discussed and presented, as is information on species status and the addition and exclusion of species. Sections on taxonomy and variation, subspecies, presumed hybrids, the introduction of exotic species, notable range extensions and observations, and conservation and protection are also provided.