A burst of eight neutrino events a preceding the optical detection of the supernova in the Large Magellanic Cloud has been observed in a large underground water Cherenkov detector. The events span an ...interval of 6 s and have visible energies in the range 20-40 MeV.
This volume is the product of a technical session organized for the 2002 Geological Society of America Annual Meeting in recognition of Isaac Kaplan's many contributions to various fields of ...geochemistry. As Kaplan enters his sixth decade of scientific investigation, it is fair to say that his work has touched or influenced innumerable scientists either directly or indirectly. Readers of this volume are presented with a collection of 29 papers written by former students, post-doctoral researchers, friends and colleagues from countries all over the world (including Sweden, Japan, Taiwan, New Zealand, Australia, Israel and the United States) from the fields of stable isotope, forensic, environmental and petroleum geochemistry, atmospheric chemistry and cosmochemistry. The stable isotope section includes papers investigating climate change, diagenesis, recent sediment and petroleum geochemistry and cosmochemistry problems. The forensic and environmental geochemistry section includes a variety of papers ranging from trace metals in soils to atmospheric CO2 projections. The petroleum geochemistry section includes both basic research and applied geochemistry papers. The ancient and recent sediments section contains papers ranging from carbon flux in modern sediments to Precambrian microfossils. All of the articles together cover a broad range of geochemical studies and represent the diverse and distinguished career of Isaac Kaplan.
Abstract Background Compared with vitamin K antagonists, direct acting oral anticoagulants (DOACs) have fixed dosing, limited drug interactions, and do not require therapeutic drug level monitoring. ...Dose adjustments are recommended for moderate renal dysfunction, low body weight, and select drug interactions. Objectives The aim of our study is to determine if DOAC dose reductions were appropriate based on the manufacturer labeling recommendations for each agent. We also followed patients’ treatment outcomes. Methods We retrospectively reviewed patients administered a DOAC at a reduced dose between January 2011 and August 2014. The primary outcome was adherence to current manufacturer dose recommendations. The secondary outcome measures were the incidence of thromboembolic events or any bleeding episodes, regardless of severity, while on therapy. Results Of 224 patients included in the analysis, 43.3% of patients fit criteria for a dose adjustment according to manufacturer recommendations. Only 3 out of 28 (10.7%) patients treated with apixaban met two out of three clinical criteria required for a dose reduction per manufacturer recommendations. Only 54.7% of rivaroxaban treated patients and 32.2% of dabigatran treated patients had renal insufficiency requiring a dose reduction. Half of our patient population received aspirin therapy, with 6.3% of patients on triple antithrombotic therapy (dual antiplatelet agents plus an anticoagulant). A past medical history significant for bleeding was prevalent in patients treated with a reduced dose DOAC (32.1%, 20.4%, and 25.4% of patients in the apixaban, rivaroxaban, and dabigatran treated groups, respectively). Thromboembolic events occurred in 10.7%, 3.6%, and 5.1% of patients in the apixaban, rivaroxaban, and dabigatran groups, respectively. Frequency of bleeding complications, regardless of severity, was 17.9%, 18.2%, and 23.7% of patients in the apixaban, rivaroxaban, and dabigatran groups, respectively. Conclusion We found that dose-adjusted DOAC therapy was often prescribed in a dose that was lower than package insert recommendations.
A first study of neutron tagging is conducted in Super-Kamiokande, a 50,000 ton water Cherenkov detector. The tagging efficiencies of thermal neutrons are evaluated in a 0.2%
GdCl
3
-water solution ...and pure water. They are determined to be, respectively, 66.7% for events above 3
MeV and 20% with corresponding background probabilities of
2
×
10
-
4
and
3
×
10
-
2
. This newly developed technique may enable water Cherenkov detectors to identify
ν
¯
e
’s from astrophysical sources as well as those produced by commercial reactors via the delayed coincidence scheme.
Clinical uncertainty exists regarding which assay should be designated as the standard monitoring coagulation test for intravenous unfractionated heparin (UFH). Several studies have compared the use ...of activated partial thromboplastin time (aPTT) and antifactor-Xa (anti-Xa) and have come out with varying results. The correlation between these 2 tests varied, markedly from strong to weak. Some have demonstrated that monitoring with anti-Xa heparin assay leads to fewer dose adjustments, resulting in fewer laboratory tests, while others have not. In the current study, we evaluated the correlation between aPTT and anti-Xa values to guide clinical management of UFH, with the intention to develop a new correlation nomogram.
Pulmonary embolism is the third most common cardiovascular disease after myocardial infarction and stroke. The death rate from pulmonary embolism exceeds the death rate from myocardial infarction, ...because myocardial infarction is much easier to detect and to treat. Among survivors of pulmonary embolism, chronic thromboembolic pulmonary hypertension occurs in 2–4 of every 100 patients. Post-thrombotic syndrome of the legs, characterized by chronic venous insufficiency, occurs in up to half of patients who suffer deep vein thrombosis or pulmonary embolism. We have effective pharmacological regimens using fixed low dose unfractionated or low molecular weight heparin to prevent venous thromboembolism among hospitalized patients. There remains the problem of low rates of utilization of pharmacological prophylaxis. The biggest change in our understanding of the epidemiology of venous thromboembolism is that we now believe that deep vein thrombosis and pulmonary embolism share similar risk factors and pathophysiology with atherothrombosis and coronary artery disease.
Warfarin and Vascular Calcification Poterucha, Timothy J., MD; Goldhaber, Samuel Z., MD
The American journal of medicine,
06/2016, Letnik:
129, Številka:
6
Journal Article
Recenzirano
Abstract The vitamin K antagonist, warfarin, is the most commonly prescribed oral anticoagulant. Use of warfarin is associated with an increase in systemic calcification, including in the coronary ...and peripheral vasculature. This increase in vascular calcification is due to inhibition of the enzyme matrix gamma-carboxyglutamate Gla protein (MGP). MGP is a vitamin K-dependent protein that ordinarily prevents systemic calcification by scavenging calcium phosphate in the tissues. Warfarin-induced systemic calcification can result in adverse clinical effects. In this review article, we highlight some of the key translational and clinical studies that associate warfarin with vascular calcification.
A case-control study, examining the effect of first trimester maternal caffeine consumption on low birthweight, was performed in the Kaiser Permanente Medical Care Program. Heavy consumption (greater ...than 3 servings/day) of coffee, cola and greater than 300 mg/day of caffeine from all sources (coffee, tea and cola) was associated with a marginally increased risk of low birthweight. Our data support previous findings of a modest effect of caffeine consumption on fetal growth
Pulmonary embolectomy is often indicated for central pulmonary embolism (PE) with hemodynamic instability, but remains controversial for hemodynamically stable patients with signs of right ...ventricular dysfunction. Because thrombolytic therapy is often contraindicated postoperatively, we reviewed risk factors and outcomes of pulmonary embolectomy for stable and unstable central PE, particularly in the early postoperative period.
Between October 1999 and September 2013, 115 patients underwent pulmonary embolectomy for central, hemodynamically unstable PE (49 of 115, 43%) or hemodynamically stable PE (56 of 115, 49%). Ten operations for alternate indications (right atrial mass, endocarditis) were excluded for comparison analysis, leaving 105 patients.
Mean age was 59 ± 13 years; 46 of 105 patients (44%) had recent surgery (within 5 weeks): orthopedic (12 of 46, 25%), neurosurgery (11 of 46, 24%), or general surgery (10 of 46, 22%). Preoperative demographics did not differ between groups, except for the frequency of cardiopulmonary resuscitation among unstable patients (11 of 49, 22%) versus stable patients (0 of 56, 0%; p < 0.001). Operative mortality for the combined groups was 6.6% (7 of 105): unstable 10.2% (5 of 49) versus stable 3.6% (2 of 56; p = 0.247). Of 11 patients requiring preoperative cardiopulmonary resuscitation, 4 died. Six-month, 1-year, and 3-year survival rates were, respectively, 75%, 68.4%, and 65.8% for unstable PE, and 92.6%, 86.7%, and 80.4% for stable PE (p = 0.018).
This large series of pulmonary embolectomies demonstrates excellent early and late survival rates for patients with stable PE and unstable PE. These findings confirm pulmonary embolectomy as a beneficial therapeutic option for central PE, especially during the postoperative period when thrombolytic therapy is often contraindicated.
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