Summary Background Rivaroxaban is an oral direct factor Xa inhibitor that has been effective in prevention of venous thromboembolism in patients undergoing elective orthopaedic surgery. However, its ...use after acute coronary syndromes has not been investigated. In this setting, we assessed the safety and efficacy of rivaroxaban and aimed to select the most favourable dose and dosing regimen. Methods In this double-blind, dose-escalation, phase II study, undertaken at 297 sites in 27 countries, 3491 patients stabilised after an acute coronary syndrome were stratified on the basis of investigator decision to use aspirin only (stratum 1, n=761) or aspirin plus a thienopyridine (stratum 2, n=2730). Participants were randomised within each strata and dose tier with a block randomisation method at 1:1:1 to receive either placebo or rivaroxaban (at doses 5–20 mg) given once daily or the same total daily dose given twice daily. The primary safety endpoint was clinically significant bleeding (TIMI major, TIMI minor, or requiring medical attention); the primary efficacy endpoint was death, myocardial infarction, stroke, or severe recurrent ischaemia requiring revascularisation during 6 months. Safety analyses included all participants who received at least one dose of study drug; efficacy analyses were by intention to treat. This study is registered with ClinicalTrials.gov , number NCT00402597. Findings Three patients in stratum 1 and 26 in stratum 2 never received the study drug. The risk of clinically significant bleeding with rivaroxaban versus placebo increased in a dose-dependent manner (hazard ratios HRs 2·21 95% CI 1·25–3·91 for 5 mg, 3·35 2·31–4·87 for 10 mg, 3·60 2·32–5·58 for 15 mg, and 5·06 3·45–7·42 for 20 mg doses; p<0·0001). Rates of the primary efficacy endpoint were 5·6% (126/2331) for rivaroxaban versus 7·0% (79/1160) for placebo (HR 0·79 0·60–1·05, p=0·10). Rivaroxaban reduced the main secondary efficacy endpoint of death, myocardial infarction, or stroke compared with placebo (87/2331 3·9% vs 62/1160 5·5%; HR 0·69, 95% CI 0·50–0·96, p=0·0270). The most common adverse event in both groups was chest pain (248/2309 10·7% vs 118/1153 10·2%). Interpretation The use of an oral factor Xa inhibitor in patients stabilised after an acute coronary syndrome increases bleeding in a dose-dependent manner and might reduce major ischaemic outcomes. On the basis of these observations, a phase III study of low-dose rivaroxaban as adjunctive therapy in these patients is underway. Funding Johnson & Johnson Pharmaceutical Research & Development and Bayer Healthcare AG.
The bacteria that colonize humans and our built environments have the potential to influence our health. Microbial communities associated with seven families and their homes over 6 weeks were ...assessed, including three families that moved their home. Microbial communities differed substantially among homes, and the home microbiome was largely sourced from humans. The microbiota in each home were identifiable by family. Network analysis identified humans as the primary bacterial vector, and a Bayesian method significantly matched individuals to their dwellings. Draft genomes of potential human pathogens observed on a kitchen counter could be matched to the hands of occupants. After a house move, the microbial community in the new house rapidly converged on the microbial community of the occupants’ former house, suggesting rapid colonization by the family’s microbiota.
Thermal inversions have long been predicted to exist in the atmospheres of ultra-hot Jupiters. However, the detection of two species thought to be responsible – titanium oxide and vanadium oxide – ...remains elusive. We present a search for TiO and VO in the atmosphere of the ultra-hot Jupiter WASP-121b (
T
eq
≳ 2400 K), an exoplanet with evidence of VO in its atmosphere at low resolution which also exhibits water emission features in its dayside spectrum characteristic of a temperature inversion. We observed its transmission spectrum with the UV-Visual Echelle Spectrograph at the Very Large Telescope and used the cross-correlation method – a powerful tool for the unambiguous identification of the presence of atomic and molecular species – in an effort to detect whether TiO or VO were responsible for the observed temperature inversion. No evidence for the presence of TiO or VO was found at the terminator of WASP-121b. By injecting signals into our data at varying abundance levels, we set rough detection limits of VO ≲−7.9 and TiO ≲−9.3. However, these detection limits are largely degenerate with scattering properties and the position of the cloud deck. Our results may suggest that neither TiO or VO are the main drivers of the thermal inversion in WASP-121b; however, until a more accurate line list is developed for VO, we cannot conclusively rule out its presence. Future works will consist of a search for other strong optically-absorbing species that may be responsible for the excess absorption in the red-optical.
Pennisetum purpureum (PP) fibres were comprehensively characterised to assess their potential as reinforcing materials in polymer composites. The fibres were treated with 5, 7, 10, 12, and 15% sodium ...hydroxide wt.% concentration for 24h. The fibres were subjected to single fibre tensile tests, thermo-gravimetric analysis (TGA), Fourier transform infrared spectroscopy (FTIR), and scanning electron microscopy (SEM). The average diameter of the untreated fibres was 0.24±0.02mm, and the treated fibres had an average diameter of less than 0.21±0.03mm, yielding a 12–45% reduction in the diameter. The moisture content of the treated fibres decreased as the concentration of the alkali increased. The morphological observation demonstrated that as the alkali concentration increased, the fibre becomes more compressed due to collapse the cellular/lumen structure, the void content decreased, and its surface became rougher. The 5% alkali-treated fibre achieved an average maximum ultimate tensile stress of 141±24MPa. Young's modulus on the other hand, decreased from an average of 5.68±0.14GPa for untreated fibre to only 0.55±0.17GPa as the alkali concentrations increased from 5 to 15%.
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•The treated fibres had an average diameter of less than 0.21±0.03mm.•Moisture content of treated fibres reduced with increased alkaline concentration.•Morphological study shows that the treated fibre's surface became rougher.•The 5% alkali-treated fibre yields average maximum tensile stress of 141±24MPa.
The corrosion properties of high-pressure die cast (HPDC) magnesium-rare earth (RE) based alloys have been studied. Binary additions of La, Ce and Nd to commercially pure Mg were made up to a nominal ...6
wt.%. It was found that the intermetallic phases formed in the eutectic were Mg
12La, Mg
12Ce and Mg
3Nd, respectively. Results indicated that increasing RE alloying additions systematically increased corrosion rates. This was also described in the context of the electrochemical response of Mg–RE intermetallics – which were independently assessed by the electrochemical microcapillary technique.
This study is a discrete effort towards revealing the electrochemical effect of carefully controlled binary alloying additions to magnesium in order to elucidate the microstructure–corrosion relationship more generally for HPDC Mg alloys. Such fundamental information is seen to not only be useful in understanding the corrosion of alloys which presently contain RE additions, but may be exploited in the design of magnesium alloys with more predictable corrosion behaviour. There is a special need to understand this relationship – particularly for magnesium that commonly displays poor corrosion resistance.
Abstract Background Dual antiplatelet therapy (DAPT) is necessary to prevent thrombosis yet increases bleeding after percutaneous coronary intervention (PCI) with drug-eluting stents (DES). ...Antiplatelet monotherapy with a potent P2Y12 receptor antagonist may reduce bleeding while maintaining anti thrombotic efficacy compared with conventional DAPT. Methods TWILIGHT is a randomized, double blind placebo-controlled trial evaluating the comparative efficacy and safety of antiplatelet monotherapy versus DAPT in up to 9000 high-risk patients undergoing PCI with DES. Upon enrollment after successful PCI, all patients will be treated with open label low-dose aspirin (81–100 mg daily) plus ticagrelor (90 mg twice daily) for 3 months. Event-free patients will then be randomized in a double-blind fashion to low-dose aspirin versus matching placebo with continuation of open-label ticagrelor for an additional 12 months. The primary hypothesis is that a strategy of ticagrelor monotherapy will be superior with respect to the primary endpoint of bleeding academic research consortium (BARC) type 2, 3 or 5, while maintaining non-inferiority for ischemic events compared with ticagrelor plus ASA. Conclusions TWILIGHT is the largest study to date that is specifically designed and powered to demonstrate reductions in bleeding with ticagrelor monotherapy versus ticagrelor plus ASA beyond 3 months post-procedure in a high-risk PCI population treated with DES. The trial will provide novel insights with respect to the potential role of ticagrelor monotherapy as an alternative for long-term platelet inhibition in a broad population of patients undergoing PCI with DES.
The effect of moisture absorption on untreated and alkaline-treated Napier grass fibre-reinforced polyester composites was evaluated. Under room-temperature immersion, the water absorption behaviour ...of the Napier grass fibre composites conformed to the Fickian diffusion mechanism. Compared with the untreated fibres, the treated fibres absorbed less water due to the removal of lignin and hemicelluloses. The tensile and flexural strength of the Napier grass composites decreased with increased water absorption. SEM analysis showed that the treated Napier grass fibre composites contained fewer fibre pull-outs and splits compared with the untreated composites, which supports the improved performance.
The mechanical properties of Napier grass fibre-reinforced composites were characterised. Napier grass fibres were extracted through water retting process. The effect of alkali-treatment on the ...tensile properties and morphology of the fibres was investigated. The fibres were alkali-treated using NaOH solutions of various concentrations and subjected to single fibre testing. The morphology of the fibres was observed using scanning electron microscopy. The 10% alkali-treated Napier grass fibres yielded the highest strength. To fabricate the polymer composites, Napier grass fibre and polyester resin were used as the reinforcing material and polymer matrix, respectively. The tensile and flexural properties of the composites were studied. In general, up to a certain threshold value, the tensile and flexural strengths of the composites increased as the fibre volume fractions increased, following which, there was a reduction in strength. The maximum tensile and flexural strengths of the composites were obtained at 25% fibre loading.
Eating Disorders Andersen, Arnold E; Mehler, Philip S
2022
eBook
A comprehensive guide on how to diagnose, treat, and care for those with eating disorders.Eating disorders, which include such conditions as anorexia, bulimia, binge eating, and pica, represent a ...challenge to both patients and health care providers alike. For more than 20 years, health care providers have turned to the expert advice found in Eating Disorders to keep up to date with the latest research in the field and to help them provide the best care available for their patients. In this new, thoroughly revised and expanded edition of their best-selling work, Drs. Philip S. Mehler and Arnold E. Andersen provide a user-friendly and comprehensive guide to treating and managing eating disorders for primary care physicians, mental health professionals, worried family members and friends, and nonmedical professionals (such as teachers and coaches). Mehler and Andersen • identify common medical complications faced by people who have eating disorders• answer questions about how to treat both physical and behavioral aspects of eating disorders• discuss serious complications, including cardiac arrhythmia, electrolyte abnormalities, and gastrointestinal problems• incorporate all-new information on avoidant restrictive food intake disorder (ARFID), binge eating disorder, and the role of social media in promoting disordered eating• offer targeted advice for working with specialists• include four new chapters on eating disorders in children and adolescents; atypical anorexia; eating disorders in transgender individuals; and family therapy• feature engaging clinical vignettes • answer a list of common questions practitioners may have in each chapterThe most comprehensive work on the market and the only book that covers eating disorders in transgender individuals, Eating Disorders is a compassionate, evidence-based, and essential guide.Contributors: Arnold E. Andersen, Ovidio Bermudez, Jeana Cost, Meghan Foley, Dennis Gibson, Neville Golden, Sacha Gorell, Jeffrey Hollis, Mori J. Krantz, Daniel Le Grange, Russell Marx, Jennifer McBride, Philip S. Mehler, Leah Puckett, Katherine Sachs, Michael Spaulding-Barclay, Anna Tanner, Nathalia Trees, Jessica Tse, Kenneth Weiner, Patricia Westmoreland
The effect of moisture absorption on the mechanical degradation of hybrid Pennisetum purpureum/glass–epoxy composites was investigated. The hybrid P. purpureum/glass–epoxy composites plates were ...manufactured by the vacuum infusion method using epoxy resin as a matrix. Following 50h of water immersion, the hybrid composite specimens were tested. The moisture content reduced as the glass fibre content increased. The wet and dry hybrid composite specimens were subjected to tensile and flexural tests. The incorporation of the glass fibre into the P. purpureum–epoxy composites enhanced their tensile and flexural strength, as well as their modulus. The tensile and flexural strengths of the hybrid P. purpureum/glass–epoxy composites (24/6–70vol%) were 43 and 60MPa, respectively. However, the tensile and flexural properties significantly degraded under wet conditions. Using field emission scanning electron microscopy (FESEM), morphological analysis was performed to observe the fracture behaviour of the specimens and the effect of water molecules.
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