Outpatient treatment of low-risk venous thromboembolism with monotherapy oral anticoagulation: patient quality of life outcomes and clinician acceptance

BACKGROUND: Oral monotherapy anticoagulation has facilitated home treatment of venous thromboembolism (VTE) in outpatients. OBJECTIVES: The aim of this study was to measure efficacy, safety, as well as patient and physician perceptions produced by a protocol that selected VTE patients as low-risk patients by the Hestia criteria, and initiated home anticoagulation with an oral factor Xa antagonist. METHODS: Patients were administered the Venous Insufficiency Epidemiological and Economic Study Quality of life/Symptoms questionnaire [VEINEs QoL/Sym] and the physical component summary [PCS] from the Rand 36-Item Short Form Health Survey [SF36]). The primary outcomes were VTE recurrence and hemorrhage at 30 days. Secondary outcomes compared psychometric test scores between patients with deep vein thrombosis (DVT) to those with pulmonary embolism (PE). Patient perceptions were abstracted from written comments and physician perceptions specific to PE outpatient treatment obtained from structured survey. RESULTS: From April 2013 to September 2015, 253 patients were treated, including 67 with PE. Within 30 days, 2/253 patients had recurrent DVT and 2/253 had major hemorrhage; all four had DVT at enrollment. The initial PCS scores did not differ between DVT and PE patients (37.2±13.9 and 38.0±12.1, respectively) and both DVT and PE patients had similar improvement over the treatment period (42.2±12.9 and 43.4±12.7, respectively), consistent with prior literature. The most common adverse event was menorrhagia, present in 15% of women. Themes from patient-written responses reflected satisfaction with increased autonomy. Physicians' (N=116) before-to-after protocol comfort level with home treatment of PE increased 48% on visual analog scale. CONCLUSION: Hestia-negative VTE patients treated with oral monotherapy at home had low rates of VTE recurrence and bleeding, as well as quality of life measurements similar to prior reports

Composite absorbing potentials

The multiple scattering interferences due to the addition of several contiguous potential units are used to construct composite absorbing potentials that absorb at an arbitrary set of incident momenta or for a broad momentum interval.Comment: 9 pages, Revtex, 2 postscript figures. Accepted in Phys. Rev. Let

The acceleration and storage of radioactive ions for a neutrino factory

The term beta-beam has been coined for the production of a pure beam of electron neutrinos or their antiparticles through the decay of radioactive ions circulating in a storage ring. This concept requires radioactive ions to be accelerated to a Lorentz gamma of 150 for 6He and 60 for 18Ne. The neutrino source itself consists of a storage ring for this energy range, with long straight sections in line with the experiment(s). Such a decay ring does not exist at CERN today, nor does a high-intensity proton source for the production of the radioactive ions. Nevertheless, the existing CERN accelerator infrastructure could be used as this would still represent an important saving for a beta-beam facility. This paper outlines the first study, while some of the more speculative ideas will need further investigations.Comment: Accepted for publication in proceedings of Nufact02, London, 200

InGaAlAsPN: A Materials System for Silicon Based Optoelectronics and Heterostructure Device Technologies

A new material system is proposed for silicon based opto-electronic and heterostructure devices; the silicon lattice matched compositions of the (In,Ga,Al)-(As,P)N 3-5 compounds. In this nitride alloy material system, the bandgap is expected to be direct at the silicon lattice matched compositions with a bandgap range most likely to be in the infrared to visible. At lattice constants ranging between those of silicon carbide and silicon, a wider bandgap range is expected to be available and the high quality material obtained through lattice matching could enable applications such as monolithic color displays, high efficiency multi-junction solar cells, opto-electronic integrated circuits for fiber communications, and the transfer of existing 3-5 technology to silicon

Effect of Novel Dietary Supplement on Metabolism in \u3cem\u3evitro\u3c/em\u3e and \u3cem\u3ein vivo\u3c/em\u3e

Obesity is an increasingly prevalent and preventable morbidity with multiple behavioral, surgical and pharmacological interventions currently available. Commercial dietary supplements are often advertised to stimulate metabolism and cause rapid weight and/or fat loss, although few well-controlled studies have demonstrated such effects. We describe a commercially available dietary supplement (purportedly containing caffeine, catechins, and other metabolic stimulators) on resting metabolic rate in humans, and on metabolism, mitochondrial content, and related gene expression in vitro. Human males ingested either a placebo or commercially available supplement (RF) in a randomized double-blind placebo-controlled cross-over fashion. Metabolic rate, respiratory exchange ratio, and blood pressure were measured hourly for 3 h post-ingestion. To investigate molecular effects, human rhabdomyosarcoma cells (RD) and mouse myocytes (C2C12) were treated with various doses of RF for various durations. RF enhanced energy expenditure and systolic blood pressure in human males without altering substrate utilization. In myocytes, RF enhanced metabolism, metabolic gene expression, and mitochondrial content suggesting RF may target common energetic pathways which control mitochondrial biogenesis. RF appears to increase metabolism immediately following ingestion, although it is unclear if RF provides benefits beyond those provided by caffeine alone. Additional research is needed to examine safety and efficacy for human weight loss

A systematic review of randomized controlled trials for the prevention of bronchopulmonary dysplasia in infants

Bronchopulmonary dysplasia (BPD) is the most common cause of pulmonary morbidity in premature infants and is associated with life-long morbidities. Developing drugs for the prevention of BPD would improve public health. We sought to determine characteristics of favorable randomized controlled trials (RCTs) of drugs for BPD prevention

Analysis of the impact of dislocation distribution on the breakdown voltage of GaAs-based power varactor diodes

A synchrotron x-ray topography analysis of the impact of the distribution of defects/dislocations on the electrical performance of GaAs power varactor diodes was carried out. Diodes fabricated on or near Liquid Encapsulated Czochralski cellular dislocation networks in the substrate, which are also known to be rich in As precipitates near these cell walls, were observed to have reduced breakdown voltages (VBR). This is consistent with the possibility that the presence of space-charge cylinders surrounding these dislocations gives rise to reduced VBR if they thread a p-n junction; it is also in accord with the possibility that the As precipitates themselves can act as sites for local field enhancement, thus promoting premature avalanche breakdown

Randomized Controlled Trial of Mechanical Thrombectomy Versus Catheter-directed Thrombolysis for Acute Hemodynamically Stable Pulmonary Embolism: Rationale and Design of the PEERLESS Study.

BACKGROUND The identification of hemodynamically stable pulmonary embolism (PE) patients who may benefit from advanced treatment beyond anticoagulation is unclear. However, when intervention is deemed necessary by the PE patient's care team, data to select the most advantageous interventional treatment option are lacking. Limiting factors include major bleeding risks with systemic and locally delivered thrombolytics and the overall lack of randomized controlled trial (RCT) data for interventional treatment strategies. Considering the expansion of the Pulmonary Embolism Response Team (PERT) model, corresponding rise in interventional treatment, and number of thrombolytic and non-thrombolytic catheter-directed devices coming to market, robust evidence is needed to identify the safest and most effective interventional option for patients. METHODS The PEERLESS study (ClinicalTrials.gov identifier: NCT05111613) is a currently enrolling multinational RCT comparing large-bore mechanical thrombectomy (MT) with the FlowTriever System (Inari Medical, Irvine, CA) vs catheter-directed thrombolysis (CDT). A total of 550 hemodynamically stable PE patients with right ventricular (RV) dysfunction and additional clinical risk factors will undergo 1:1 randomization. Up to 150 additional patients with absolute thrombolytic contraindications may be enrolled into a non-randomized MT cohort for separate analysis. The primary endpoint will be assessed at hospital discharge or 7 days post procedure, whichever is sooner, and is a composite of the following clinical outcomes constructed as a hierarchal win ratio: 1) all-cause mortality, 2) intracranial hemorrhage, 3) major bleeding, 4) clinical deterioration and/or escalation to bailout, and 5) intensive care unit admission and length of stay. The first 4 components of the win ratio will be adjudicated by a Clinical Events Committee, and all components will be assessed individually as secondary endpoints. Other key secondary endpoints include all-cause mortality and readmission within 30 days of procedure and device- and drug-related serious adverse events through the 30-day visit. IMPLICATIONS PEERLESS is the first RCT to compare two different interventional treatment strategies for hemodynamically stable PE and results will inform strategy selection after the physician or PERT determines advanced therapy is warranted

Predictors of Positive Cerebrospinal Fluid Cultures in Infants With Bacteremia

BACKGROUND: Meningitis causes substantial morbidity and mortality in hospitalized infants. There is no consensus on the ability of blood cultures to predict results from cerebrospinal fluid (CSF) cultures in hospitalized infants. METHODS: We used the Pediatrix Medical Group database of infants discharged from 333 neonatal intensive care units between 1997 and 2011. We identified all infants with a positive blood culture and a CSF culture obtained within 3 days. We evaluated the odds of a concordant blood-CSF culture pair, controlling for severity of illness, organism type, gestational age, day of blood culture and blood-CSF culture pairing, exposure to CSF-penetrating antibiotics and the presence of a ventriculo-peritoneal shunt. RESULTS: We identified 8839 infants with 9408 blood-CSF culture pairs. Serratia marcescens (24/227, 11%) and Streptococcus pneumoniae (7/64, 11%) had the highest proportion of concordant blood-CSF culture pairs. The presence of a ventriculo-peritoneal shunt, as well as timing of the CSF culture on the same day as the blood culture, were associated with increased odds of blood-CSF culture pair concordance-odds ratio = 3.87 (95% confidence interval; 2.59-5.78) and 6.11 (2.81-13.24), respectively. CONCLUSION: The frequency of blood-CSF culture pair concordance is related to organism type and to the timing of the CSF culture in relation to the blood culture