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Whereas the beneficial effect of antiplatelet therapy for recurrent stroke prevention has been well established, uncertainties remain regarding the optimal antithrombotic regimen for recently symptomatic carotid stenosis. We sought to explore the approaches of stroke physicians to antithrombotic management of patients with symptomatic carotid stenosis.
Methods:
We employed a qualitative descriptive methodology to explore the decision-making approaches and opinions of physicians regarding antithrombotic regimens for symptomatic carotid stenosis. We conducted semi-structured interviews with a purposive sample of 22 stroke physicians (11 neurologists, 3 geriatricians, 5 interventional-neuroradiologists, and 3 neurosurgeons) from 16 centers on four continents to discuss symptomatic carotid stenosis management. We then conducted thematic analysis on the transcripts.
Results:
Important themes revealed from our analysis included limitations of existing clinical trial evidence, competing surgeon versus neurologist/internist preferences, and the choice of antiplatelet therapy while awaiting revascularization. There was a greater concern for adverse events while using multiple antiplatelet agents (e.g., dual-antiplatelet therapy (DAPT)) in patients undergoing carotid endarterectomy compared to carotid artery stenting. Regional variations included more frequent use of single antiplatelet agents among European participants. Areas of uncertainty included antithrombotic management if already on an antiplatelet agent, implications of nonstenotic features of carotid disease, the role of newer antiplatelet agents or anticoagulants, platelet aggregation testing, and timing of DAPT.
Conclusion:
Our qualitative findings can help physicians critically examine the rationale underlying their own antithrombotic approaches to symptomatic carotid stenosis. Future clinical trials may wish to accommodate identified variations in practice patterns and areas of uncertainty to better inform clinical practice.
In 2011, Guillera [‘A new Ramanujan-like series for
$1/\pi ^2$
’, Ramanujan J.26 (2011), 369–374] introduced a remarkable rational
${}_{7}F_{6}( \frac {27}{64} )$
-series for
${1}/{\pi ^2}$
using the Wilf–Zeilberger (WZ) method, and Chu and Zhang later proved this evaluation using an acceleration method based on Dougall’s
${}_{5}F_{4}$
-sum. Another proof of Guillera’s
${}_{7}F_{6}( \frac {27}{64} )$
-series was given by Guillera in 2018, and this subsequent proof used a recursive argument involving Dougall’s sum together with the WZ method. Subsequently, Chen and Chu introduced a q-analogue of Guillera’s
${}_{7}F_{6}( \frac {27}{64} )$
-series. The many past research articles concerning Guillera’s
${}_{7}F_{6}( \frac {27}{64} )$
-series for
${1}/{\pi ^2}$
naturally lead to questions about similar results for other mathematical constants. We apply a WZ-based acceleration method to prove new rational
${}_{7}F_{6}( \frac {27}{64} )$
- and
${}_{6}F_{5}( \frac {27}{64} )$
-series for
$\sqrt {2}$
.
About one in every four Australian employees is a casual. The casual share has doubled over the past decade and continues to expand. This paper catalogues the growth of casual employment and discusses the characteristics of casual jobs and of those in casual jobs. The key analytical issue discussed is whether casual employment is a transitional employment arrangement on the road towards permanent employment conditions. Alternatively, is it a trap which is associated with job insecurity, low earnings and spells outside of employment? Although the evidence is partial and circumstantial, casual employment is a bridge for some and a trap for others. In particular, for those who wish to beak out of unemployment, casual employment is unlikely to be a transitional point on the road to a permanent job. This finding has important implications for the design of labour market programs.
About a year into Trump’s presidency, I sat on a flight home from Europe next to a twenty-year veteran of the US State Department. I asked him how things were going since Trump’s Secretary of State, Rex Tillerson, had taken charge. He hesitated for a minute but then explained that things weren’t going that well. Neither Trump nor Tillerson listened much to their career civil service professionals. Morale was as low as he’d ever seen it, several senior people had decided to take early retirement, and those remaining were often at odds with administration policies. He also said that because the State Department’s reputation had been tarnished because of Trump’s insulting and often isolationist foreign policies, it was having trouble recruiting young people to work there – a problem, he explained, that was creating a generational vacuum of expertise that would remain for years even after Trump was gone.
Donald J. Trump was sworn in as the forty-fifth president of the United States on January 20, 2017. How he won the presidency is the subject of this chapter. It is an important story for us because it foreshadows some of the leadership characteristics that he brought to the White House to launch his attack on the “deep state.” It’s also an important story because Trump’s election reflected a tipping point in American politics – a set of structural conditions and national anxieties that had developed gradually over several decades. Trump benefited from other tipping points once he became president, but this was the one that launched his startling rise to the presidency in the first place. Trump recognized and exploited this unique political opportunity to seize power.1 He was a maven whose inspirational promises and appeal to voters fit the times like a glove, enabling him to pursue his agenda for radical institutional change.
Upon leaving the Constitutional Convention in 1787, Benjamin Franklin is supposed to have been asked whether the framers had given us a monarchy or a republic. As legend has it, Franklin’s reply was short and sweet: “A republic, if you can keep it.” The principal difference between the two is the presence in a republic of free and fair elections – the institutional core of any democracy.
According to the old proverb, “An elephant never forgets.” Indeed, during severe drought in Africa, old elephants have been known to lead the herd to distant watering holes that they remember visiting only as calves sixty years earlier during previous dry spells. It’s ironic, then, that the Republican Party’s mascot is the elephant. The party used to be dedicated to traditional political norms and values, particularly those of civility and compromise.1 It also used to focus on economic and national security issues. Yet thanks to Donald Trump many in the party seem to have forgotten this. As a result, the party has embraced identity politics driven by anger, incivility, intolerance, and divisiveness. Trump alone was not responsible for this shift. For instance, figures like Patrick Buchanan, who twice sought the party’s presidential nomination, former Speaker of the House Newt Gingrich, and one-time vice presidential candidate Sarah Palin had been nudging the party in this direction for years, aided by the right-wing media. But Trump took this to unprecedented extremes that now dominate the party.2 The consequences have been dire.
America’s political institutions are the guardrails preventing our democratic system of government from plunging over the cliff into autocracy. But their durability and strength are not guaranteed, particularly when someone like the president of the United States – perhaps the most powerful person in the world – attacks them. Donald Trump laid siege to these institutions. Except for the Civil War, the damage Trump caused to the country’s guardrails was unprecedented. This book describes what happened and assesses the damage. But it also does something else that’s important.
The day after Donald Trump was elected president in 2016, I attended a panel discussion at the Brookings Institution in Washington DC. The panel included liberals, moderates, and conservatives. The moderator asked them why the election turned out as it did and what the Trump administration was likely to do during the next four years. The panelists offered a lot of different answers, and the debate was lively. But in the end, they all agreed on one thing. Given Trump’s promises to lay siege to the deep state, the next four years might be one of the toughest tests ever for America’s political institutions. They wondered how well the institutional guardrails of American politics and democracy would hold.
Institutions cannot be sustained unless people have enough resources to make them work. That includes political institutions, which is why taxes have been called the “lifeblood” of the state – without them states simply cannot function; their institutional efficacy dwindles.1 Trump understood this. If he wanted to attack the deep state, then cutting its revenue supply and spending was an excellent way to do it. That’s what he tried to do.
To the left of the steps leading up to the US Supreme Court is a massive marble statue of a woman seated and holding a small figurine of a lady who is blindfolded and embracing a set of scales in her arms. The scales represent the Court’s duty to weigh each side of an argument and the blindfold signifies the Court’s responsibility to do so fairly – reminders to all who enter the Court that America’s system of justice is supposed to be impartial and free from bias, political or otherwise. Not so in Trump’s view. He wanted it to serve his personal and political interests and he tried hard to make that happen.
The global trend of urbanization coupled with an increasing awareness of the importance of food systems resilience, has led to an increasing interest in urban agriculture to sustainably feed the rapidly growing urban population and mitigate against food supply chain disruptions. While home and community gardens have been long studied, there has been relatively little empirical research focused specifically on commercial urban agriculture (CUA) operations. The purpose of this study was to characterize commercial urban farms, and to identify their primary barriers to business development and expansion, their perceptions of future opportunities, and their specific informational needs. Because CUA has received relatively less attention in previous empirical research, a qualitative approach was used for this needs assessment to collect rich, contextualized information to help differentiate the specific barriers, opportunities and needs of CUA operations as opposed to their rural counterparts. We conducted semi-structured interviews (n = 29) of CUA producers in Florida. These interviews revealed that CUA operations face many of the same barriers that are common to establishing and growing small farms, with additional barriers due to local government regulations and tensions associated with farming on land that is not traditionally used for agriculture. Despite these difficulties, CUA operators believe their urban location is a key benefit to their operation and they see a variety of opportunities for future business and market expansion.