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Secondary prevention through the control or elimination of known risk factors for coronary artery disease (e.g., hyperglycemia in patients with diabetes mellitus, tobacco use, physical inactivity) also should be part of discharge planning.

Long-term anticoagulation with warfarin (Coumadin), a vitamin K antagonist, has been evaluated in recent studies Fendi Satin PointedToe Mules sale shop offer real cheap online pay with visa sale online visit discount purchase ytQd8X
17 of patients with myocardial infarction or unstable angina. Results have been mixed, with some trials 14 , 15 showing benefit from the use of warfarin, when compared with aspirin alone in the prevention of recurrent cardiovascular events, and other trials 16 , 17 (pre-dominantly involving low-intensity warfarin therapy) showing no significant benefit.

The routine use of warfarin in patients with acute coronary syndromes has been limited by the occurrence of bleeding and the need for frequent monitoring. The ACC/AHA guideline Dolce amp; Gabbana LowHeel Metallic Sandals clearance 2014 new choice lowest price for sale sale visa payment XFtdV7
, 2 does not recommend routine use of warfarin after hospitalization in patients with UA/NSTEMI. Warfarin therapy is recommended after acute coronary syndromes in patients with an additional indication for long-term anticoagulation, such as atrial fibrillation or a mechanical prosthetic heart valve. 1 , 2

At the time of hospital discharge, patients should have a clear plan for follow-up with a physician to assess recovery and symptoms and to reinforce secondary preventive measures. Low-risk medically treated patients and revascularized patients usually should be seen within two to six weeks, whereas higher-risk patients should be seen within one to two weeks.

Despite the efforts of hospital staff to adhere to guidelines and evidence-based treatment, or because of temporary contraindications, important therapies may be omitted. Family physicians can provide an invaluable “safety net” to ensure that patients with UA/NSTEMI receive optimal medical care. Therefore, even though all family physicians may not provide acute care for patients with UA/NSTEMI, familiarity with the ACC/AHA guideline will facilitate optimal treatment of patients with UA/NSTEMI and those with a history of this syndrome.

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The authors indicate that they do not have any conflicts of interest. Sources of funding: none reported.

This article is one in a series developed in collaboration with the American Heart Association. Guest editor of the series is Sidney C. Smith, Jr., M.D., Chief Science Officer, American Heart Association, Dallas.

1. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients with Unstable Angina). Accessed online May 11, 2004, at: . ...

Adriana Stan , Mihai Botarel
Adriana Stan Contributor
Adriana Stan is the public relations director of W magazine and a writer on media, culture and technology. She is also the co-founder of the Interesting People in Interesting Times event series and podcast.
More posts by this contributor
Mihai Botarel Contributor
Mihai Botarel is the co-founder of RXM Creative and a writer on society and technology.

As Facebook shapes our access to information , Twitter dictates public opinion and Tinder influences our dating decisions , the algorithms we’ve developed to help us navigate choice are now actively driving every aspect of our lives.

But as we increasingly rely on them for everything from how we seek out news to how we relate to the people around us, have we automated the way we behave? Is human thinking beginning to mimic algorithmic processes? And is the Cambridge Analytica debacle a warning sign of what’s to come — and of happens when algorithms hack into our collective thoughts?

It wasn’t supposed to go this way. Overwhelmed by choice — in products, people and the sheer abundance of information coming at us at all times — we’ve programmed a better, faster, easier way to navigate the world around us. Using clear parameters and a set of simple rules, algorithms help us make sense of complex issues. They’re our digital companions, solving real-world problems we encounter at every step, and optimizing the way we make decisions. What’s the best restaurant in my neighborhood? Google knows it. How do I get to my destination? Apple Maps to the rescue. What’s the latest Trump scandal making the headlines? Facebook may or may not tell you.

Wouldn’t it be nice if code and algorithms knew us so well — our likes, our dislikes, our preferences — that they could anticipate our every need and desire? That way, we wouldn’t have to waste any time thinking about it: We could just read the one article that’s best suited to reinforce our opinions, date whoever meets our personalized criteria and revel in the thrill of familiar surprise. Imagine all the time we’d free up, so we could focus on what truly matters: carefully curating our digital personas and projecting our identities on Instagram.

It was Karl Marx who first said our thoughts are determined by our machinery, an idea that Ellen Ullman references in her 1997 book, Close to the Machine , which predicts many of the challenges we’re grappling with today. Beginning with the invention of the internet, the algorithms we’ve built to make our lives easier have ended up programming the way we behave.

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> Educator Resources > Teaching With Documents > Telephone amp; Light Patent Drawings


In 1876 Americans held a Centennial Exhibition in Philadelphia to celebrate the nation's birth 100 years earlier. It was the first world's fair to be held in the United States, and it announced for all to see that the nation had come of age as an industrial power. Over 8 million Americans attended, many traveling the railways that now spanned the continent. Of all the exhibition buildings, Machinery Hall drew the most admiration and wonder. Its displays were powered by the world's largest steam engine. Inside, inventions by two of America's greatest inventors were on display. Alexander Graham Bell exhibited the first telephone, and Thomas Alva Edison presented the automatic telegraph, one of more than 1,000 inventions he would patent in his lifetime. Together their inventions changed American life in ways that still affect us today.

Alexander Graham Bell (1847-1922) was born in Scotland and moved to Boston in 1872 to open a school for teachers of the deaf. He became a U.S. citizen in 1882. His early experiments included ways to improve and use telegraphy. The telegraph conveyed messages through a system of electrical sounds that, when decoded, could be translated into words. It was dependent on skilled technicians and never became a home appliance. Rather, it required you to go to a telegraph office to send or receive a message, or perhaps a messenger did this for you. Bell sought something revolutionary: to transmit not only the sound of the human voice, but audible words. With the telephone, Bell wrote in 1878, "It is possible to connect every man's house, office or factory with a central station, so as to give him direct communication with his neighbors."

Thomas Edison (1847-1931) was born in Ohio and grew up in Michigan. His formal education lasted at most four years, in part because his teachers complained that he asked too many questions. By age 12 he was a newsboy and candy seller on the railways. Working as a telegraph operator gave him some of his early lessons in the uses of electricity. Among Edison's many patents were ones for totally new inventions as well as those that dramatically improved the inventions of others. These included patents for the electric motor, motion picture projector, storage battery, Dictaphone, duplicating machine, typewriter, and phonograph ( his most original). But his most far-reaching achievement was his patent for improving the incandescent lightbulb.

Before the invention of the electric lightbulb, homes were lit by candle, kerosene-oil lamp, or gaslight. All flickered, were fire hazards, and emitted smoke and heat. Other inventors of the day were experimenting with a glass globe that, if emptied of air, could contain a light that would not burn out. But no one could find a suitable filament, or wire. The filament creates light when an electric current passes through it, but it must neither burn out quickly nor melt. Edison solved this problem by using carbonized cotton.

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5. Anthropometric measurements

For anthropometric measurements (weight, height, waist and hip circumference) the following equipment is needed:

Weight should be measured in all participants, except pregnant women, wheelchair bound individuals, or persons who have difficulty standing steady.

Setting up scale at the examination site

The scale should be placed on a hard-floor surface (not on a floor which is carpeted or otherwise covered with soft material). If there is no such floor available, a hard wooden platform should be placed under the scale. A carpenter's level should be used to verify that the surface on which the scale is placed is horizontal.

Calibration of scale

Calibration should occur at the beginning and end of each examining day.

The scale is balanced with both sliding weights at zero and the balance bar aligned. The scale is checked using the standardized weights and calibration is corrected if the error is greater than 0.2 kg. The results of the checking and the recalibrations are recorded in a log book.

Normal weighing procedure

Weighing procedure for heavily overweight persons

If the participant is heavily overweight, i.e. weighs more than the upper limit of the scale, this fact should be noted in the data collection form, together with the upper limit of the scale (see Appendix 5.1 ).

Self-reported weight

Self-reported weights are not acceptable, even if the participant is immobile or refuses to be weighed.

Height should be measured in all participants, except wheelchair bound individuals, persons who have difficulty standing steady or straight, and participants with hairstyle (e.g. Afro or Mowhawk) or head dress (e.g. turban) that prevents proper use of the height measuring equipment.

Setting up stadiometer at the examination site

If the height is measured with the measuring rod attached to the balanced beam scale no further set-up procedures are required, if the scale has been placed properly for weighing. However, it should be verified that the upper part of the measuring rod is straight and vertical (i.e. not bend or curved).

If the height is measured by stadiometer, the height rule is taped vertically to the hard flat wall surface with the base at floor level. The wall may not have a baseboard molding. A carpenter's level is used to check the vertical placement of the rule.

The floor surface next to the height rule must be hard. If no such floor is available, a hard wooden platform should be placed under the base of the height rule. Using the carpenter's level, the surface on which the height rule rests should be checked to be horizontal.

Calibration of height rule

At the beginning and end of each examination day, the height rule should be checked with standardized rods and corrected if the error is greater than 2 mm. The results of the checking and recalibrations are recorded in the log book.

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