Venous thromboembolism in primary nephrotic syndrome - is the risk high enough to justify prophylactic anticoagulation?

Background: The reported incidence of venous thromboembolism (VTE) in patients with nephrotic syndrome (NS) varies widely, as does the approach to prophylactic anticoagulation. We aimed to assess the incidence of VTE in patients with primary NS in order to inform a sample size calculation to determine if a future clinical trial will ever be feasible. Methods: All adults undergoing native renal biopsy for NS between 2008 and 2013 yielding a diagnosis of primary glomerulonephritis were identified. Baseline serum albumin, urine protein:creatinine ratio, estimated glomerular filtration rate, date of biopsy and histological diagnosis were recorded. Episodes of objectively verified VTE were identified using the electronic patient record. Sample size calculations were performed based on 2 independent samples with a dichotomous outcome and to achieve a power of 80% and p < 0.05. Results: Two hundred six patients were included of which 60% were male and mean age at biopsy was 55 years (SD 19). Median follow-up was 2.9 years (interquartile range (IQR) 1.6-4.7). Fourteen (6.8%) patients suffered VTE. Median time to diagnosis of VTE from renal biopsy was 36 days (IQR -22 to 178), with 6 VTEs occurring prior to biopsy and 1 during remission. In a total of 270 patient years of NS, there were 7 VTE that could potentially have been avoided if anticoagulation was given for the duration of NS, that is, 2.6% risk per year of NS; this risk was highest for patients with minimal change nephropathy at 13.3% per year of NS, compared to 0.65% per year of NS for those with idiopathic membranous nephropathy. Assuming a 75% reduction in the incidence of VTE with prophylactic anticoagulation, 972 participants would be required for a future clinical trial to have 80% power. Conclusions: Patients with primary NS are at an increased risk of VTE. The timing of VTE means that only half of episodes would be targeted by prophylactic anticoagulation. Given the low frequency of events, a well-powered clinical trial would be challenging to achieve

Rape and respectability: ideas about sexual violence and social class

Women on low incomes are disproportionately represented among sexual violence survivors, yet feminist research on this topic has paid very little attention to social class. This article blends recent research on class, gender and sexuality with what we know about sexual violence. It is argued that there is a need to engage with classed distinctions between women in terms of contexts for and experiences of sexual violence, and to look at interactions between pejorative constructions of working-class sexualities and how complainants and defendants are perceived and treated. The classed division between the sexual and the feminine, drawn via the notion of respectability, is applied to these issues. This piece is intended to catalyse further research and debate, and raises a number of questions for future work on sexual violence and social class

Comparison of the Oxidation State of Fe in Comet 81P/Wild 2 and Chondritic-Porous Interplanetary Dust Particles

The fragile structure of chondritic-porous interplanetary dust particles (CP- IDPs) and their minimal parent-body alteration have led researchers to believe these particles originate in comets rather than asteroids where aqueous and thermal alteration have occurred. The solar elemental abundances and atmospheric entry speed of CP-IDPs also suggest a cometary origin. With the return of the Stardust samples from Jupiter-family comet 81P/Wild 2, this hypothesis can be tested. We have measured the Fe oxidation state of 15 CP-IDPs and 194 Stardust fragments using a synchrotron-based x-ray microprobe. We analyzed ~300 nanograms of Wild 2 material - three orders of magnitude more material than other analyses comparing Wild 2 and CP-IDPs. The Fe oxidation state of these two samples of material are >2{\sigma} different: the CP-IDPs are more oxidized than the Wild 2 grains. We conclude that comet Wild 2 contains material that formed at a lower oxygen fugacity than the parent body, or parent bodies, of CP-IDPs. If all Jupiter-family comets are similar, they do not appear to be consistent with the origin of CP-IDPs. However, comets that formed from a different mix of nebular material and are more oxidized than Wild 2 could be the source of CP-IDPs.Comment: Earth and Planetary Science Letters, in pres

The two-dimensional random-bond Ising model, free fermions and the network model

We develop a recently-proposed mapping of the two-dimensional Ising model with random exchange (RBIM), via the transfer matrix, to a network model for a disordered system of non-interacting fermions. The RBIM transforms in this way to a localisation problem belonging to one of a set of non-standard symmetry classes, known as class D; the transition between paramagnet and ferromagnet is equivalent to a delocalisation transition between an insulator and a quantum Hall conductor. We establish the mapping as an exact and efficient tool for numerical analysis: using it, the computational effort required to study a system of width $M$ is proportional to $M^{3}$, and not exponential in $M$ as with conventional algorithms. We show how the approach may be used to calculate for the RBIM: the free energy; typical correlation lengths in quasi-one dimension for both the spin and the disorder operators; even powers of spin-spin correlation functions and their disorder-averages. We examine in detail the square-lattice, nearest-neighbour $\pm J$ RBIM, in which bonds are independently antiferromagnetic with probability $p$, and ferromagnetic with probability $1-p$. Studying temperatures $T\geq 0.4J$, we obtain precise coordinates in the $p-T$ plane for points on the phase boundary between ferromagnet and paramagnet, and for the multicritical (Nishimori) point. We demonstrate scaling flow towards the pure Ising fixed point at small $p$, and determine critical exponents at the multicritical point.Comment: 20 pages, 25 figures, figures correcte

Risk factors for race-day fatality, distal limb fracture and epistaxis in Thoroughbreds racing on all-weather surfaces in Great Britain (2000 to 2013)

The incidence of race-day injuries in Great Britain (GB) is higher on all-weather (AW) surfaces than on turf. However, to date no studies have focused on identifying risk factors for injury specific to AW racing. Therefore, the objective of the current study was to determine risk factors for fatality, distal limb fracture (DLF) and episodes of epistaxis in flat racing Thoroughbreds racing on AW surfaces in GB. Data included all flat racing starts on AW surfaces (n = 258,193) and race-day veterinary events recorded between 2000 and 2013. Information on additional course-level variables was gathered during face-to-face interviews with racecourse clerks. Horse-, race- and course-level risk factors for each outcome were assessed using mixed-effects multivariable logistic regression including horse as a random effect. A classification tree method was used to identify potential interaction terms for inclusion in the models. During the study period, there were 233 fatalities resulting in a fatality incidence of 0.90 per 1000 starts; 245 DLF with a resultant DLF incidence of 0.95 per 1000 starts and 410 episodes of epistaxis resulting in an epistaxis incidence of 1.59 per 1000 starts. Risk factors varied for each outcome, although some factors were similar across models including the going, racing intensity, horse age, age at first race start, horse and trainer performance variables. Generally, older horses and those that had started racing at an older age were at higher risk of an adverse outcome, albeit with an interaction between the two variables in the fatality model. Faster going increased the odds of epistaxis and DLF but not fatality. Increasing race distance increased the odds of fatality but reduced the odds of epistaxis. Epistaxis was associated with type of AW surface (Fibresand versus Polytrack®), but DLF and fatality were not. This study provides further evidence of the association between the risk of race-day injuries and fatalities and current age, age at first start, race distance, going and horse performance. These findings provide the racing industry with information to develop strategies to reduce the occurrence of race-day events on AW surfaces

Professionalism, Golf Coaching and a Master of Science Degree: A commentary

As a point of reference I congratulate Simon Jenkins on tackling the issue of professionalism in coaching. As he points out coaching is not a profession, but this does not mean that coaching would not benefit from going through a professionalization process. As things stand I find that the stimulus article unpacks some critically important issues of professionalism, broadly within the context of golf coaching. However, I am not sure enough is made of understanding what professional (golf) coaching actually is nor how the development of a professional golf coach can be facilitated by a Master of Science Degree (M.Sc.). I will focus my commentary on these two issues