The management of acute venous thromboembolism in clinical practice. Results from the European PREFER in VTE Registry

Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in Europe. Data from real-world registries are necessary, as clinical trials do not represent the full spectrum of VTE patients seen in clinical practice. We aimed to document the epidemiology, management and outcomes of VTE using data from a large, observational database. PREFER in VTE was an international, non-interventional disease registry conducted between January 2013 and July 2015 in primary and secondary care across seven European countries. Consecutive patients with acute VTE were documented and followed up over 12 months. PREFER in VTE included 3,455 patients with a mean age of 60.8 ± 17.0 years. Overall, 53.0 % were male. The majority of patients were assessed in the hospital setting as inpatients or outpatients (78.5 %). The diagnosis was deep-vein thrombosis (DVT) in 59.5 % and pulmonary embolism (PE) in 40.5 %. The most common comorbidities were the various types of cardiovascular disease (excluding hypertension; 45.5 %), hypertension (42.3 %) and dyslipidaemia (21.1 %). Following the index VTE, a large proportion of patients received initial therapy with heparin (73.2 %), almost half received a vitamin K antagonist (48.7 %) and nearly a quarter received a DOAC (24.5 %). Almost a quarter of all presentations were for recurrent VTE, with >80 % of previous episodes having occurred more than 12 months prior to baseline. In conclusion, PREFER in VTE has provided contemporary insights into VTE patients and their real-world management, including their baseline characteristics, risk factors, disease history, symptoms and signs, initial therapy and outcomes

The multifaceted spectrum of liver cirrhosis in older hospitalised patients: Analysis of the REPOSI registry

Background: Knowledge on the main clinical and prognostic characteristics of older multimorbid subjects with liver cirrhosis (LC) admitted to acute medical wards is scarce. Objectives: To estimate the prevalence of LC among older patients admitted to acute medical wards and to assess the main clinical characteristics of LC along with its association with major clinical outcomes and to explore the possibility that well-distinguished phenotypic profiles of LC have classificatory and prognostic properties. Methods: A cohort of 6,193 older subjects hospitalised between 2010 and 2018 and included in the REPOSI registry was analysed. Results: LC was diagnosed in 315 patients (5%). LC was associated with rehospitalisation (age-sex adjusted hazard ratio, [aHR] 1.44; 95% CI, 1.10-1.88) and with mortality after discharge, independently of all confounders (multiple aHR, 2.1; 95% CI, 1.37-3.22), but not with in-hospital mortality and incident disability. Three main clinical phenotypes of LC patients were recognised: relatively fit subjects (FIT, N = 150), subjects characterised by poor social support (PSS, N = 89) and, finally, subjects with disability and multimorbidity (D&M, N = 76). PSS subjects had an increased incident disability (35% vs 13%, P < 0.05) compared to FIT. D&M patients had a higher mortality (in-hospital: 12% vs 3%/1%, P < 0.01; post-discharge: 41% vs 12%/15%, P < 0.01) and less rehospitalisation (10% vs 32%/34%, P < 0.01) compared to PSS and FIT. Conclusions: LC has a relatively low prevalence in older hospitalised subjects but, when present, accounts for worse post-discharge outcomes. Phenotypic analysis unravelled the heterogeneity of LC older population and the association of selected phenotypes with different clinical and prognostic features

Media Representations of LGBT People

LGBT people of color (POC) and White LGBT people have different experiences when it comes to accepting their sexuality and coming out experience, thus affecting their mental health and interactions with the community. The coming out process is a step towards a healthier and happier life, revealing an internal acceptance of oneself while expressing the desire to be open to others. However, LGBT people consider coming out a stressful and emotionally daunting process due to the uncertainty of responses from family, friends, and classmates (Charbonnier & Graziani, 2016). Media representations of LGBT interactions may also influence feelings about the coming out process and affect state levels of anxiety and depression. LGBT participants were randomly assigned to view two videos depicting a positive or negative interaction between LGBT POC or White LGBT people. We predicted that LGBT POC would report higher levels of state anxiety and state depression, lower comfort levels, and decreased outness than White LGBT people. Results showed that LGBT POC reported lower outness scores than White LGBT people. Results also showed that participants reported increased feelings of state anxiety and depression after watching the negative media representation of LGBT interactions; however, this finding may be due to an order effect rather than an effect of the valence of the media content. The results highlight the continued need to study the factors that affect mental well-being and the coming out process in LGBT POC and White LGBT people

Usefulness of microvolt T-wave alternans for predicting outcome in patients with Chagas disease with implantable cardioverter defibrillators

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Early Oral Ovalbumin Exposure during Maternal Milk Feeding Prevents Spontaneous Allergic Sensitization in Allergy-Prone Rat Pups

There are conflicting data to support the practice of delaying the introduction of allergenic foods into the infant diet to prevent allergy development. This study investigated immune response development after early oral egg antigen (Ovalbumin; OVA) exposure in a rat pup model. Brown Norway (BN) rat pups were randomly allocated into groups: dam reared (DR), DR pups challenged daily (days 4–13) with oral OVA (DR + OVAc), DR pups challenged intermittently (on day 4, 10, 12, and 13) with oral OVA (DR + OVAi), formula-fed pups (FF), and FF pups challenged daily with oral OVA (FF + OVA). Immune parameters assessed included OVA-specific serum IgE, IgG1, and IgA. Ileal and splenic messenger ribonucleic acid (mRNA) expression of transforming growth factor-beta (TGF-β1), mothers against decapentaplegic (Smad) 2/4/7, and forkhead box P3 (Foxp3) were determined. Ileum was stained for TGF-β1 and Smad4. Results. Feeding OVA daily to DR pups maintained systemic and local gut antibody and immunoregulatory marker mRNA responses. Systemic TGF-β1 was lower in DR + OVAi pups compared to DR and DR + OVAc pups. Feeding OVA to FF pups resulted in significantly greater OVA-specific IgE and IgG1, and lower IgA and TGF-β1 and Smad expression compared to DR pups. Conclusions. Early daily OVA exposure in the presence of maternal milk maintains immune markers associated with a regulated immune response, preventing early allergic sensitization

Intentional creation of carbon-rich dark earth soils in the Amazon

Fertile soil known as Amazonian dark earth is central to the debate over the size and ecological impact of ancient human populations in the Amazon. Dark earth is typically associated with human occupation, but it is uncertain whether it was created intentionally. Dark earth may also be a substantial carbon sink, but its spatial extent and carbon inventory are unknown. We demonstrate spatial and compositional similarities between ancient and modern dark earth and document modern Indigenous practices that enrich soil, which we use to propose a model for the formation of ancient dark earth. This comparison suggests that ancient Amazonians managed soil to improve fertility and increase crop productivity. These practices also sequestered and stored carbon in the soil for centuries, and we show that some ancient sites contain as much carbon as the above-ground rainforest biomass. Our results demonstrate the intentional creation of dark earth and highlight the value of Indigenous knowledge for sustainable rainforest management

Kansei Engineering, Kano, & TRIZ for Logistics Service Excellence: Teori dan Aplikasi

Penerapan Kansei Engineering (KE) di sektor layanan (services) khususnya layanan logistik masih terbilang sangat baru. Superioritas dari metode KE ini terletak pada kemampuannya menangkap dan menerjemahkan kebutuhan emosional pelanggan (disebut sebagai Kansei) ke dalam elemen-elemen rancangan layanan. Mengingat perkembangan sektor bisnis layanan logistik di Indonesia yang sangat pesat, penerapan metode KE ini sangatlah tepat dan tentunya mampu memberikan kontribusi praktis yang signifikan. Dengan mempertimbangkan kebutuhan laten dari pelanggan yang cenderung dominan pada kebutuhan dan kepuasan emosional daripada kebutuhan rasionalnya, KE mampu memantapkan posisinya sebagai pendekatan praktis bagi penyedia layanan logistik untuk menentukan atribut-atribut layanan logistik yang perlu diprioritaskan. Untuk memperkuat metodologi serta efisiensi dari penerapan KE, model Kano dan TRIZ (Teoriya Resheniya Izobretatelskikh Zadatch) diintegrasikan ke metodologi KE tersebut. Model Kano mampu menyaring performa layanan ke dalam 3 kategori utama yaitu basic/must-be [M], one-dimensional/linear [O], dan attractive/delighter [A]. Dengan fokus pada kepuasan emosional pelanggan, KE sangat berfokus pada kategori Kano O dan A. Untuk membangkitkan ide-ide perbaikan layanan logistik secara berkesinambungan yang lebih efisien dan tidak menimbulkan kontradiksi, metode TRIZ diutilisasikan sebagai penguat metodologi KE. Dengan kata lain, hasil pengintegrasian beberapa metode tersebut akan digunakan untuk penentuan prioritas atribut layanan logistik mana saja yang akan diperbaiki yang menitikberatkan solusi inovatif yang meminimalkan potensi kontradiksi dan fokus pada kepuasan emosional pelangga

Rhetorically Constructing Immigrants in French and U.S. History Textbooks: A Burkean Analysis

Both France and the U.S. have witnessed extensive immigration in the twentieth century, and today, more than ever since World War II, the world\u27s population is in dramatic flux. Currently almost fifty-four million people worldwide are identified by the Office of the United Nations High Commissioner for Refugees (UNHCR) as displaced people. If and how France and the U.S. should accommodate displaced peoples has agitated political debate in France and the U.S. with conservatively aligned political parties in both countries rejecting calls to resettle displaced peoples in France and the U.S. At the center of this dissertation is the following research question: how are immigrants rhetorically constructed in high school French and U.S. history textbooks? Rhetoric is not just about persuading an audience; it is about using identifications that program the audience not to think, but to automatically believe that one thing is associated with another. In this dissertation I use Kenneth Burke’s rhetoric as identification to examine how immigrants are rhetorically constructed in four high school French history textbooks and two high school American history textbooks, all of which are widely distributed in their respective countries. I disarticulate rhetorical constructions of immigrants in these history textbooks by interrogating the interactions of their political, economic, social, and cultural structures. In Burke’s rhetoric as identification social cohesion and control are realized through apposition and opposition. In the following quotation Burke explains a salient element of his rhetoric as identification: “A is not identical with his colleague, B. But insofar as their interests are joined, A is identified with B. Or he may identify himself with B even when their interests are not joined, if he assumes that they are, or is persuaded to believe so.” Why are so many people in France and the U.S. persuaded that peoples displaced by war and poverty should be locked outside their borders? Through a Burkean analysis, I locate answers to this question in the historical master narrative evidenced in the high school French and U.S. history textbooks selected for this study--a narrative that rhetorically constructs skewed characterizations of immigrants

Carotid plaque detection improves the predictive value of CHA2DS2-VASc score in patients with non-valvular atrial fibrillation::The ARAPACIS Study

BACKGROUND AND AIMS: Vascular disease (VD), as assessed by history of myocardial infarction or peripheral artery disease or aortic plaque, increases stroke risk in atrial fibrillation (AF), and is a component of risk assessment using the CHA2DS2-VASc score. We investigated if systemic atherosclerosis as detected by ultrasound carotid plaque (CP) could improve the predictive value of the CHA2DS2-VASc score. METHODS: We analysed data from the ARAPACIS study, an observational study including 2027 Italian patients with non-valvular AF, in whom CP was detected using Doppler Ultrasonography. RESULTS: VD was reported in 351 (17.3%) patients while CP was detected in 16.6% patients. Adding CP to the VD definition leaded to higher VD prevalence (30.9%). During a median [IQR] follow-up time of 36months, 56 (2.8%) stroke/TIA events were recorded. Survival analysis showed that conventional VD alone did not increase the risk of stroke (Log-Rank: 0.009, p=0.924), while addition of CP to conventional VD was significantly associated to an increased risk of stroke (LR: 5.730, p=0.017). Cox regression analysis showed that VD+CP was independently associated with stroke (HR: 1.78, 95% CI: 1.05-3.01, p=0.0318). Reclassification analysis showed that VD+CP allowed a significant risk reclassification when compared to VD alone in predicting stroke at 36months (NRI: 0.192, 95% CI: 0.028-0.323, p=0.032). CONCLUSIONS: In non-valvular AF patients the addition of ultrasound detection of carotid plaque to conventional VD significantly increases the predictive value of CHA2DS2-VASc score for stroke