Edoxaban for Stroke Prevention

Edoxaban for Stroke Prevention 1. Indication (86words) Edoxaban, a drug part of the direct factor Xa group is licensed on two indications. The first indication, treatment of pulmonary embolism (PE) and deep vein thrombosis (DVT). (1). Treatment is only conducted following the use of parenteral anticoagulants on a minimum 5-day course. Second, prevention of systemic embolism (SE) and stroke in nonvalvular atrial fibrillation (NVAF). Treatment conducted in line with risk factors such as transient ischaemic attack (TIA), diabetes mellitus, congestive heart failure, hypertension, prior stroke, or age>75 years. (2) 2. Design (278) Edoxaban is part of NOAC, which includes apixaban and rivaroxaban. The development of edoxaban is primarily focused on overcoming the drawbacks of warfarin which requires frequent monitoring, unpredictable dosing and interactions with various food and drugs. (3) The API of edoxaban, edoxaban tosilate is accessible in two polymorphic forms, form I and form II with form I being the most thermodynamically stable. The crystalline form I of edoxaban tosilate is synthetically produced with no conversion of forms during the drug manufacturing process. (4) Edoxaban is available in 15, 30 and 60 mg immediate release film coated tablets that disintegrates quickly. Having a relatively long half-life of up to 14 hours, with dose-dependent, linear pharmacokinetic parameters, it is suitable for once a day dosing. Oral bioavailability is approximated to be at 62% and concentration levels reach a steady state within 3 days of oral administration and is unaffected by food. Edoxaban is 50% renally cleared, requiring doses for elderly and renally impaired patients to be reduced. The pharmacodynamics effects are usually produced within 1-2 hours in correspondence to the peak exposure levels of edoxaban. (5) Edoxaban tablets are manufactured from common granulate and are quantitatively proportional when manufactured. API particle sizes are reduced during the final steps of the API manufacturing process utilising milling. The final manufacturing process involves four main stages, fluid bed granulation; blending; tableting and film coating. Final product requires no special storage as it is photostable and is packaged in a PVC and aluminium blister. Storage of edoxaban ranges from 24 months for long and intermediate conditions and as low as 6 months in accelerated conditions. All excipients used in this formulation are compliant to European Pharmacopoeia Standards. (4) Figure 1: Structure of Rivaroxaban, Apixiban and Edoxaban. (6) 3) Safety (199 words) Warfarin is the current GOLD standard indicator for DVT and AF. Large scale pivotal phase II studies have been conducted to compare the safety and efficacy profile of edoxaban and warfarin. The results of studies; ENGAGE AF(7) and Hokusai VTE(8), are tabulated for analysis below in Table 1. Findings of the study place the adverse events (AE) among patients of each drug be well within tolerable range with only mild to moderate events occurring. However, the Treatment-emergent adverse event (TEAE) and serious TEAR were found be higher in warfarin. This is clearly seen in Table 2. Major bleeding is the primary safety endpoint for safety as defined by the International Society on Thrombosis and Haemostasis (ISTH). The ENGANGE AF study showed reduced major bleeding against warfarin with the annualized rate of 3.43% as compared to 2.75% for Edoxaban. Intracranial, major or nonmajor relevant bleeding and fatal bleeding were found to be significantly lower compared to warfarin (p

Solutions in Higher Education Essay -- Education, Training Faculty

Senge’s (1990) characterization of controlling versus learning organizations helps illustrate the challenge Medtech faces in making the shift to a learner-centered college with outcome-based classroom practices. When new and expansive patterns of thinking are nurtured, collective aspiration is set free (1990); however, Harris and Cullen (2008) state that the work environment at many colleges is quite to the contrary. So our questions are the same as stated by Boyer (1987) nearly three decades ago, â€Å"Is it possible for students to become independent, self-directed learners, as well as, how can faculty improve their teaching so as to encourage creativity and critique? For the purpose of this project, I will make the assumption that the answer to the first question is yes, and therefore, deal primarily with the second. â€Å"If we accept the premise that the learner-centered class is a microcosm of the learning organization, then it follows that the professional development of leadership should reflect professional development of teachers (Harris & Cullen, 2008). This can only be accomplished through concrete mechanisms for effecting change. The problem identified for this project stems from Dr. Terry O’Banion’s (2010) statement, â€Å"we cannot assume students are learning†. I identified that existing teaching and assessment often does not achieve the learning objectives required for the courses due to the hiring of faculty who are experts in their field; however, are not trained educators. In the past, tradition dictated that knowledge of the discipline was sufficient for the transmission of knowledge to students; however, this can no longer be taken for granted. The recommended solution is to implement a process for the shift from traditiona... ...the communication to the students will be through the updated syllabi and implementation of new practices in the classroom. Finally, the campus will host an open house on-site for all affiliate partners that include classroom demonstrations that will highlight the new practices. In addition, the presentation will include an explanation on how the new practices benefit the partners with externs and potential employees who have the critical thinking skills required for on the job success. Welsh (n.d.) reflected on a higher education that was static in the mid-twentieth century as he admits that is not so anymore. His charge is that change is necessary today for higher education to remain vibrant. The entire institution must become learner-centered and by initiating incremental steps, immediate rewards, and links to intrinsic motivation we will achieve that vision.

Apple Online Store Strategy

GROUP B _Choose three core competencies of Apple Inc. How did these competencies allow Apple to make sense out of the recorded music industry in the early 200’s? How did they set the company up for robust first user advantage? How stable do those advantage seem now? (See Jay Barney’s Looking Inside for Competitive Advantage; Zook’s Finding Your Next Core Business). As the Internet based recorded music segment continues to evolve into other devices, will Apple’s competencies continue to generate advantage versus suc competitors as Research in Motion and Dell Inc.? Apple today is the leading player in the internet music industry with over 6 billion songs downloaded since the launch of its iTunes online music store, which today contains more than 10 million songs. Apple introduced iTunes and its online music store in 2001 when there were several major players, such as Amazon and Napster, competing for the market. However, Apple was able to outperform these co mpetitors with its three main core competencies, software, retailing and branding. In 2003, Apple introduced the iTunes online music store that allowed customers to purchase and download songs directly from the store to their computer through iTunes, and then transfer them directly to their iPods. By that time, most of Apple’s competitors offered their customers songs through subscriptions, however they did not provide customers full control of the songs they purchased, i. e. , songs purchased would be lost once customer no longer subscribed. Apple was able to offer customer a whole new way of selling songs to customers. They allowed customers to buy songs like CDs, cassettes in store and never had their songs lost since there were no subscriptions required. In addition, Apple also allowed the customer to preview the songs they intended to purchase in order to avoid downloading the wrong songs. In order to be able to allow customers to purchase songs for a low cost, Apple managed to negotiate a landmark deal with biggest five music companies in the world, Warner, Universal, BMG, Sony and EMI. Songs offered by Apple were using DRM (Digital Right Management) technology to prevent the songs to be unlimited shared. However, the songs could be used to burn unlimited CDS and transferred to unlimited iPod. Since 2001, Apple had gained tremendous branding reputation for its iPod MP3 players. Since then, it has become the most popular MP3 player in the world. When iTunes online music store was introduced in 2003, Apple had provided an extremely convenient way for legally purchasing songs and transferring them directly to customers’ iPods. Therefore, Apple’s iTunes online music store was widely welcomed and accepted by a large number of customers. Apple was a pioneer in combining online music store and music management in one software that allow customers to conveniently purchase and manage their music. Since iTunes was introduced along with the first iPods, it has been well known for simplicity and user-friendly interface. Therefore, iTunes had largely contributed to the success of Apple’s online music store and the elimination of its competitors. As the internet based recorded music segment continues to evolve into other devices, Apple has taken another new strategies in selling music to customers. In June 2009, Apple has more than 10 million songs in its online music store, and since 2006, Apple started to take DRM off their songs and offer customers DRM-free songs. Eight million songs was DRM-free since June 2009 and Apple has been making effort to offer all of their songs free of DRM. Today, Apple does not have only iPod as their MP3 players, but they also have other devices such as iPhone, iPad and iPod Touch, that can all utilize the iTunes online music store. The introduction of iPhone and iPod Touch has provided Apple an opportunity to expand its iTunes store beyond a simple online music store to become an online entertainment store, which offers numerous varieties of movies, music, TV episodes, games, applications and books. This has made Apple become the leading brand in innovative technology and its brand ranking has been going up in recent years. ITunes itself also has gone through remarkably improvement in order to offer customers a simpler, more interesting and interactive way of browsing the online store. In general, despite intense competitions from other player such as Research in Motion and Dell Inc. , Apple has been able to outperform them and offer customers the most unique and efficient way of purchasing music and other online entertainment contents. This has been proved by growing stock prices, and increasing profit figures since Apple iTunes online music store was introduced in 2003.

Homosexuality and Single-Sex Schools

Homosexuality and Single-Sex Schools Unfortunately, for many American students, insults and accusations are part of everyday life. All to often, students, as young as elementary school, are faced with criticism and judgment from their peers, and despite great efforts by many, there are still people in our country who are not the diverse, tolerant people wed like to surround ourselves with on a daily basis. This unfortunate truth means that some students look elsewhere to find supportive and welcoming environments for their middle and high school educations. This is where private school comes into play, as many private schools embrace the many facets of diversity that exist within students, creating vibrant communities unlike what most high school students embrace. However, there is debate among many about the role of single-sex schools when it comes to homosexuality. While some believe that schools that cater to just one gender provide a supportive place for lesbian, gay, bisexual, and transgender (LGBT) students, others believe that these schools  have a hidden side effect: they promote homosexuality. Scientific Studies Surprisingly, there are few scientific studies available to provide conclusive evidence, but no limit to personal opinions. The debate topics include whether or not single-sex schools promote gender stereotypes, if homosexuality is learned or genetic and, particularly, how single-sex schools may impact students if it homosexuality is, in fact, learned. Debate.com has a page dedicated to whether or not single-sex schools promote homosexuality. The outcome of those who have contributed to date shows a majority of debaters (59 percent) feel that single-sex schools do not promote homosexuality. Many single-sex school graduates claim that their experiences, be it high school or even college, were empowering and helped them grow as individuals. Others agree, but say that they discovered their gender identity in that environment because it was the first time they were allowed to experience something different than the stereotypes they grew up with of only male-female couples being acceptable. Unfortunately, for many children stereotypes are all they see in their daily lives and become what they understand simply because they are not exposed to diverse views. Most certainly, no child wants to be intimidated or ostracized simply because they are different. These difference sometimes mean that students are subject to bullying by peers who dont understand or accept them, and these actions can be especially harsh when adults look the other way or are not present. While some claim that single-sex schools promote gender stereotypes, others adamantly disagree, stating that the single-sex school breaks down the stereotypes and better educates students on a more diverse set of viewpoints. The Value of an Open and Affirming Culture What many people dont know is that boys and girls schools often  play to the strengths of students. These open and affirming cultures can provide better support, counseling, and education, empowering students to embrace who they are more than ever. When students can walk around their school community openly without fear of discrimination or bullying, they are able to grow as individuals and achieve more success. Both boys and girls have to deal with their sexuality, understanding their feelings and inclinations mean and how to handle them. If they havent thought of it themselves, the American entertainment industry will certainly put all those gender debates and discussions right under their noses. What any good private school is able to do is to provide some serious mentoring and discussion of issues like teenage sexuality. The tightly wrapped sense of community which most of these schools have makes young people feel comfortable discussing these and other issues. Teens are under enormous stress under normal conditions. Add to the mix worries about sexuality and grades and you potentially have a recipe for extreme measures of dealing with the stress. For some, this can lead to eating disorders, cutting, or even suicide. Heed the warning signs, no matter how insignificant you think they may be, and talk to someone if there are concerns about the physical, mental, or emotional health of a child. If students feel as though they cannot confront their classmates, they should alert an adult and make sure she follows through. Supporting a peer struggling with an issue often means going against their wishes to deal with issues privately in favor of getting help from a qualified individual.   Edited by Stacy Jagodowski

How to envision your future and find success

How to envision your future and find success Any successful person will emphasize the importance of planning, but sometimes we do things in the wrong order. Zingerman’s co-founder Ari Weinzweig dismisses the idea of endlessly scrutinizing the world and then trying to find a niche where your business fits. Watch him advocate for the opposite process: figuring out the life you want for yourself, then bending the world to make it fit. [Source: Daily Fuel]

Hotel Industry in Songdo in South Korea Essay Example | Topics and Well Written Essays - 2000 words

Hotel Industry in Songdo in South Korea - Essay Example So in today's world of business amidst red ocean strategy, it is necessary to adopt appropriate marketing method to promote your business through various tools and techniques in order to attract more and more customers. (Kim and Renee, 2005)1 Singapore which is renowned international business hub known for its world class infrastructure facilities is also a growing tourist destination. In a study, it is identified that hotels of Singapore have adopted and integrated information technology into their marketing strategy which was successfully incorporated the technology into their marketing campaign. (Choon - Chiang Leong, 2001)2 Similarly Songdo International City which is touted as the next Asian business hub is attracting numerous international ventures to start their businesses of all types as the city provides best infrastructure, facilities along with diverse customer base. Songdo International City is planned in such a way that good portion of the place is given for the establishment of hotels only. (http://www.songdo.com) So the industries trying to open their hotel in Songdo city can ask nothing better than this. In order to support the decision of opening a new hotel at Song do and to decide on which strategic ma rketing method to use for the promotion of the hotel, two reputed hotels were selected for the purpose of interview. The present chapter consists of analysis of the interview through comparison of both the hotels strategy of approach towards marketing and how do they manage to attract customers. Data Analysis Rutherford and O'Fallon (2007) states that as strategic marketing is umbrella to lot many marketing methods, but strategic marketing for the hotel industry should be limited to its realms and genesis only. Further the argument of Fetch Waller was also highlighted by Rutherford and O'Fallon stating that definition of marketing should be broadened in order to include all the operational aspects of the hotel. Moreover Waller reiterates illustrated the relationship between marketing and operations as a continuing process without which the hotels cannot remain competitive. As hotels are 24/7 business, it is necessary to evolve , innovate and adopt new marketing strategy each and every time in order to stay in and above the competition. 3 The interviews were conducted in the marketing and sales department of two hotels situated in Songdo City namely 'Ramada' and 'Best Western Premier Songdo Park Hotel'. When asked about the motive behind establishing a hotel in Songdo city, both the personnel representing their respective hotels replied that the place is hub of business and will turn into Asia's next business hub that will attract lots of businesses, which means many more conglomerations, seminars, and other business related activities. (Interviewee Jang and Jang, 2009) So it is clear from the above details that it is a place where most of the business happens and target customers are the business organizations for the present and in near future as well. Regarding difficulties in establishing the business in Song-do, the Ramada hotel representative stated that the hotel is actually a takeover of the already established hotel with little bit of renovation but representative of the Best Western Hotel stated that they had to struggle to get the license for the casinos and other gambling games which limited their targeted customers to only business and tourists as casinos and gambling are not the integral part of the Korean culture. This statement

Cost Management Term Paper Example | Topics and Well Written Essays - 2000 words

Cost Management - Term Paper Example Defense organization of the US government manages many production facilities that operate similar to industries. The chief strategies employed by Defense Department are to reduce permanent positions for staff and workers, outsource some of the jobs and depend more on temporary workers. Authors argue that the organizations have to strike a balance while reducing fixed costs permanently. Elaborating further, they argue that Honda Motor Company reduced permanent engineering staff, which was dedicated to the design functions during 1980s; however, that went against the company when its competitors came out with new designs in automobiles. This eventually resulted into the reduced market share for Honda impacting its profitability. Honda had a great difficulty to catch up with new innovative features that competitors released time to time in the market place. Thus, a strategy to reduce fixed cost may appear lucrative in the beginning but could be detrimental to the future growth. Currentl y, similar situation exists in the Defense Department of the government. ... The impact of fixed cost is huge in any organization. Higher fixed cost compels firms to operate at higher levels of operations and sales volume to meet those fixed costs. That is why in difficult market conditions, the firms with higher fixed costs are often found in trouble. The firms with higher operating leverages are always at risk during unpredictable sales environment. Moreover, sales volatility is rampant in the industries where technology has been changing rapidly. In these kinds of industries, it becomes important to assess fixed-cost involvement and possible sales volume that are achievable. No wonder that many large sized computer firms reduced their fixed-cost commitment in recent years. IBM reduced their permanent staff by 100,000 between 1990 and 1994. Not only that the company outsourced many of its parts and products in these years; that reduced the requirement on plant and machinery to a great extent. This further reduced fixed-cost burden on the company. That is ho w IBM could adapt to changing market environment and survive. That surely is a good strategy in unpredictable and difficult market situation (Ciccotello & Green 1995). Exercising Caution in Reducing Operating Leverage Contrary to this, many private firms have been operating in the industries where market demand of their products is quite steady and predictable. With the predictable sales volume, fixed-cost commitment is easy to make and it makes absolutely no sense to reduce permanent staff compromising the future business prospects and efficiency factors. Authors further emphasize that reducing permanent employees is an expensive preposition and once removed they are very costly