Spontaneous cerebellar hemorrhage in a patient taking apixaban

AbstractObjectivesAtrial fibrillation is closely associated with cardioembolic stroke. Until recently, warfarin has been the gold standard for the treatment of atrial fibrillation. Since 2010 the United States Food and Drug Administration has approved three new agents for anticoagulation in patients with atrial fibrillation. The purpose of this case report is to discuss some of the practical implications for using these agents.MethodsA patient taking apixaban presented with a spontaneous cerebellar hemorrhage. While the patient was initially considered a candidate for surgical intervention, the lack of literature addressing surgical intervention in patients on novel anticoagulation clouded the clinical decision-making. The patient was ultimately managed with administration of activated prothrombin complex concentrate, blood pressure control, frequent clinical assessments and airway protection. The patient did not undergo craniotomy for hematoma evacuation.ConclusionsRecent FDA approval of several novel oral anticoagulants for use in patients with atrial fibrillation has resulted in a significant number of patients formerly treated with warfarin being switched to these newer agents. There remains a lack of clear guidelines for the management of hemorrhagic complications. This case report describes one management strategy and highlights the paucity of current evidence to support critical clinical decisions

Caribbean Corals in Crisis: Record Thermal Stress, Bleaching, and Mortality in 2005

BACKGROUND The rising temperature of the world's oceans has become a major threat to coral reefs globally as the severity and frequency of mass coral bleaching and mortality events increase. In 2005, high ocean temperatures in the tropical Atlantic and Caribbean resulted in the most severe bleaching event ever recorded in the basin. METHODOLOGY/PRINCIPAL FINDINGS Satellite-based tools provided warnings for coral reef managers and scientists, guiding both the timing and location of researchers' field observations as anomalously warm conditions developed and spread across the greater Caribbean region from June to October 2005. Field surveys of bleaching and mortality exceeded prior efforts in detail and extent, and provided a new standard for documenting the effects of bleaching and for testing nowcast and forecast products. Collaborators from 22 countries undertook the most comprehensive documentation of basin-scale bleaching to date and found that over 80% of corals bleached and over 40% died at many sites. The most severe bleaching coincided with waters nearest a western Atlantic warm pool that was centered off the northern end of the Lesser Antilles. CONCLUSIONS/SIGNIFICANCE Thermal stress during the 2005 event exceeded any observed from the Caribbean in the prior 20 years, and regionally-averaged temperatures were the warmest in over 150 years. Comparison of satellite data against field surveys demonstrated a significant predictive relationship between accumulated heat stress (measured using NOAA Coral Reef Watch's Degree Heating Weeks) and bleaching intensity. This severe, widespread bleaching and mortality will undoubtedly have long-term consequences for reef ecosystems and suggests a troubled future for tropical marine ecosystems under a warming climate.This work was partially supported by salaries from the NOAA Coral Reef Conservation Program to the NOAA Coral Reef Conservation Program authors. NOAA provided funding to Caribbean ReefCheck investigators to undertake surveys of bleaching and mortality. Otherwise, no funding from outside authors' institutions was necessary for the undertaking of this study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Measurement of hadronic shower punchthrough in magnetic field

The total punchthrough probability of showers produced by negative pions, positive pions, positive kaons and protons, has been measured as a function of depth in an absorber in a magnetic field ranging from 0 to 3 Tesla. The incident particle momentum varied from 10 to 300 GeV/c. The lateral shower development and particle multiplicity at several absorber depths have been determined. The measurements are compared with the predictions of Monte Carlo simulation programs

Demonstration of surface electron rejection with interleaved germanium detectors for dark matter searches

The following article appeared in Applied Physics Letters 103.16 (2013): 164105 and may be found at http://scitation.aip.org/content/aip/journal/apl/100/26/10.1063/1.4729825The SuperCDMS experiment in the Soudan Underground Laboratory searches for dark matter with a 9-kg array of cryogenic germanium detectors. Symmetric sensors on opposite sides measure both charge and phonons from each particle interaction, providing excellent discrimination between electron and nuclear recoils, and between surface and interior events. Surface event rejection capabilities were tested with two 210 Pb sources producing ∼130 beta decays/hr. In ∼800 live hours, no events leaked into the 8–115 keV signal region, giving upper limit leakage fraction 1.7 × 10−5 at 90% C.L., corresponding to < 0.6 surface event background in the future 200-kg SuperCDMS SNOLAB experiment.This work is supported in part by the National Science Foundation (Grant Nos. AST-9978911, NSF-0847342, PHY-1102795,NSF-1151869, PHY-0542066, PHY-0503729, PHY-0503629, PHY-0503641, PHY-0504224, PHY-0705052,PHY-0801708, PHY-0801712, PHY-0802575, PHY-0847342, PHY-0855299, PHY-0855525, and PHY-1205898), by the Department of Energy (Contract Nos. DE-AC03-76SF00098, DE-FG02-92ER40701, DE-FG02-94ER40823,DE-FG03-90ER40569, DE-FG03-91ER40618, and DESC0004022),by NSERC Canada (Grant Nos. SAPIN 341314 and SAPPJ 386399), and by MULTIDARK CSD2009-00064 and FPA2012-34694. Fermilab is operated by Fermi Research Alliance, LLC under Contract No. De-AC02-07CH11359, while SLAC is operated under Contract No. DE-AC02-76SF00515 with the United States Department of Energy

Search for dark matter produced in association with bottom or top quarks in √s = 13 TeV pp collisions with the ATLAS detector

A search for weakly interacting massive particle dark matter produced in association with bottom or top quarks is presented. Final states containing third-generation quarks and miss- ing transverse momentum are considered. The analysis uses 36.1 fb−1 of proton–proton collision data recorded by the ATLAS experiment at √s = 13 TeV in 2015 and 2016. No significant excess of events above the estimated backgrounds is observed. The results are in- terpreted in the framework of simplified models of spin-0 dark-matter mediators. For colour- neutral spin-0 mediators produced in association with top quarks and decaying into a pair of dark-matter particles, mediator masses below 50 GeV are excluded assuming a dark-matter candidate mass of 1 GeV and unitary couplings. For scalar and pseudoscalar mediators produced in association with bottom quarks, the search sets limits on the production cross- section of 300 times the predicted rate for mediators with masses between 10 and 50 GeV and assuming a dark-matter mass of 1 GeV and unitary coupling. Constraints on colour- charged scalar simplified models are also presented. Assuming a dark-matter particle mass of 35 GeV, mediator particles with mass below 1.1 TeV are excluded for couplings yielding a dark-matter relic density consistent with measurements

Spontaneous cerebellar hemorrhage in a patient taking apixaban

Objectives: Atrial fibrillation is closely associated with cardioembolic stroke. Until recently, warfarin has been the gold standard for the treatment of atrial fibrillation. Since 2010 the United States Food and Drug Administration has approved three new agents for anticoagulation in patients with atrial fibrillation. The purpose of this case report is to discuss some of the practical implications for using these agents. Methods: A patient taking apixaban presented with a spontaneous cerebellar hemorrhage. While the patient was initially considered a candidate for surgical intervention, the lack of literature addressing surgical intervention in patients on novel anticoagulation clouded the clinical decision-making. The patient was ultimately managed with administration of activated prothrombin complex concentrate, blood pressure control, frequent clinical assessments and airway protection. The patient did not undergo craniotomy for hematoma evacuation. Conclusions: Recent FDA approval of several novel oral anticoagulants for use in patients with atrial fibrillation has resulted in a significant number of patients formerly treated with warfarin being switched to these newer agents. There remains a lack of clear guidelines for the management of hemorrhagic complications. This case report describes one management strategy and highlights the paucity of current evidence to support critical clinical decisions