Dilemmas in anticoagulation and use of inferior vena cava filters in venous thromboembolism; A survey of respiratory physicians, haematologists and medical oncologists and a review of the literature

© The Author(s) 2021. Twenty percent of patients with Cancer Associated Thrombosis receive an inferior vena cava filter annually. Insertion is guided by practice guidelines, which do not specify or discuss the use of inferior vena cava filters in malignancy. Adherence to these guidelines is known to be variable. We aimed to see if there was consistent management of venous thromboembolism among Medical Oncologists/Haematologists and Respiratory Physicians, with respect to inferior vena cava filter use in the setting of suspected and confirmed malignancy. Medical Oncologists, Haematologists and Respiratory Physicians were surveyed with four theoretical cases. Case 1 concerns a patient who develops a pulmonary embolism following spinal surgery. Cases 2 and 4 explore the use of inferior vena cava filters in the setting of malignancy. Case 3 covers the role of inferior vena cava filters in recurrent thrombosis despite systemic anticoagulation. There were 56 responses, 32 (57%) Respiratory Physicians and 24 (43%) Haematologists/Oncologists. Respiratory Physicians were significantly more likely to insert an inferior vena cava filter in case 1 (p = 0.04) whilst Haematologists/Medical Oncologists were more likely to insert an inferior vena cava filter in case 3 (p = 0.03). No significant differences were found in cases 2 and 4. There were significant disparities in terms of type and timing of anticoagulation. Consistency of recommendations with guidelines was variable likely in part because guidelines are themselves inconsistent. The heterogeneity in responses highlights the variations in venous thromboembolism management, especially in Cancer Associated Thrombosis. International Societies should consider addressing inferior vena cava filter use specifically in the setting of Cancer Associated Thrombosis. Collaboration between interested specialities would assist in developing consistent, evidence-based guidelines for the use of inferior vena cava filters in the management of venous thromboembolism

Inferior vena cava filters (IVCFs): A review of uses and application to international guidelines at a single Australian center; implications of venous thromboembolism associated with malignancy

Venous thromboembolism (VTE) is a potentially lethal event. Anticoagulation is the cornerstone of treatment. Inferior vena cava filters (IVCFs) may be used in circumstances when anticoagulation is contraindicated or as an adjunct to anticoagulation. IVCF use is not without controversy due to concerns over their safety profile, differences in guidelines from international societies, and a limited randomized control trial evidence. We retrospectively undertook a review of IVCF use over a three-year period (2014–2016) at our center, which has a large oncology service but no trauma unit. There were 44 patients with successful IVCF insertion and one patient with an unsuccessful attempt. Indications for insertion included: a contraindication to anticoagulation (n¼28); recurrent VTE on anticoagulation (n¼10); and extensive VTE (n¼7). There were 13 retrieval attempts, of which ten were successful. There were five documented IVCF complications (tilting: n¼2, IVC thrombus: n¼3) with one episode of IVCF failure and two episodes of deep vein thrombosis during the follow-up period. Of the patients, 71% had an active malignancy (of whom 71% had metastatic disease). Seventeen patients died due to progressive malignancy during the study period. There were no life-threatening VTEs or IVCF associated mortalities. Adherence with published international guidelines was variable. Patients with malignancy were less likely to undergo IVCF retrieval and had a reduced rate of retrieval success. None of the international guidelines comment on the use of IVCFs in patients with malignancy despite being commonly used. IVCF use may be an underappreciated tool in this group

2,7-Diazabicyclo[2.2.1]heptanes:novel asymmetric access and controlled bridge-opening

La presente investigación está orientada a identificar el impacto que tuvo Cultura PE en los medios digitales, el proyecto fue elaborado, planificado y puesto en marcha con el apoyo del área de Marketing de la Universidad de San Martin de Porres. Cultura PE se llevó a cabo en las calles de Lima, logrando ser conocido y reconocido por la difusión que se le dio en distintos medios, siendo el de mayor impacto el medio digital, en la plataforma de Facebook, con el respaldo de la USMP. El estudio es de enfoque mixto, cuantitativo por cuanto se realizó una encuesta y cualitativo por el análisis de los procesos en el desarrollo del proyecto; es descriptivo, correlacional y explicativo. La muestra con la que contó fue de egresados de la USMP. En esta tesis se demostró que la presencia digital, inversión publicitaria y un contenido de valor pueden cambiar la perspectiva que un usuario tiene frente a una marca, como fue el caso Cultura PE que tuvo impacto la imagen de marca de la USMP

Discrimination as a frame-of-reference effect in overlapping friendship communities of ethnically diverse youth

Objectives: To what extent is the frame of reference of overlapping friendship communities important for young people’s feelings of discrimination and subjective wellbeing? That is, do youth feel better or worse to the extent that they feel less or more discrimination than their friends? Methods: Participants (N=898; Mage=14.13; SDage=3.37; 46% females; 46% Whites; 20% Indigenous; 34% other minorities) were high school students of three ethnically diverse, low SES public schools in New South Wales, Australia. Cross-sectional data were collected to measure felt discrimination, mental health, subjective wellbeing, social support and nominations of close friends. A state-of-the-art method of clustering links was used to identify overlapping friendship communities, and multiple membership multilevel models were run to examine whether community level discrimination moderated the link between individual level discrimination and wellbeing. Results: When the community level discrimination was low, there was no wellbeing related cost or benefit of individual level discrimination. But when the community level discrimination was high, individuals in those communities who themselves felt low discrimination had better wellbeing than individuals who themselves felt high discrimination. Conclusions: We provide evidence for a frame-ofreference effect involving discrimination. Individuals’ relative standing in their friendship communities with high group-level discrimination reliably predicted the individuals’ wellbeing levels, regardless of ethnicity. The results highlight the importance of identifying overlapping friendship communities for understanding the dynamics of discrimination and wellbeing of ethnically diverse youth

Peer victimization : An integrative review and cross-national test of a tripartite model

School victimization issues remain largely unresolved due to over-reliance on unidimensional conceptions of victimization and data from a few developed OECD countries. Thus, support for cross-national generalizability over multiple victimization components (relational, verbal, and physical) is weak. Our substantive–methodological synergy tests the cross-national generalizability of a three-component model (594,196 fifteen-year-olds; nationally -representative samples from 77 countries) compared to competing (unidimensional and two-component) victimization models. We demonstrate the superior explanatory power of the three-component model—goodness-of-fit, component differentiation, and discriminant validity of the three components concerning gender differences, paradoxical anti-bullying attitudes (the Pro-Bully Paradox) whereby victims are more supportive of bullies than of other victims, and multiple indicators of well-being. For example, gender differences varied significantly across the three components, and all 13 well-being indicators were more strongly related to verbal and particularly relational victimization than physical victimization. Collapsing the three components into one or two components undermined discriminant validity. Cross-nationally, systematic differences emerged across the three victimization components regarding country-level means, gender differences, national development, and cultural values. These findings across countries support a tripartite model in which the three components of victimization—relational, verbal, and physical—relate differently to key outcomes. Thus, these findings advance victimization theory and have implications for policy, practice, and intervention. We also discuss directions for further research: the need for simultaneous evaluation of multiple, parallel components of victimization and bullying, theoretical definitions of bullying and victimization and their implications for measurement, conceptual bases of global victimization indices, cyberbullying, anti-bullying policies, and capitalizing on anti-bullying attitudes

Why evidence-based health informatics should have theoretical foundations: Exploring the implications for policy and evaluation

Abstract There is growing recognition that health informatic

Phosphino-Triazole Ligands for Palladium-Catalyzed Cross-Coupling

Twelve 1,5-disubtituted and fourteen 5-substituted 1,2,3-triazole derivatives bearing diaryl or dialkyl phosphines at the 5-position were synthesized and used as ligands for palladium-catalyzed Suzuki–Miyaura cross-coupling reactions. Bulky substrates were tested, and lead-like product formation was demonstrated. The online tool SambVca2.0 was used to assess steric parameters of ligands and preliminary buried volume determination using XRD-obtained data in a small number of cases proved to be informative. Two modeling approaches were compared for the determination of the buried volume of ligands where XRD data was not available. An approach with imposed steric restrictions was found to be superior in leading to buried volume determinations that closely correlate with observed reaction conversions. The online tool LLAMA was used to determine lead-likeness of potential Suzuki–Miyaura cross-coupling products, from which 10 of the most lead-like were successfully synthesized. Thus, confirming these readily accessible triazole-containing phosphines as highly suitable ligands for reaction screening and optimization in drug discovery campaigns

A Divergent Synthetic Approach to Diverse Molecular Scaffolds: Assessment of Lead-Likeness using LLAMA, an Open-Access Computational Tool

Complementary cyclisation reactions of hex-2-ene-1,6-diamine derivatives were exploited in the synthesis of alternative molecular scaffolds. The value of the synthetic approach was analysed using LLAMA, an open-access computational tool for assessing the lead-likeness and novelty of molecular scaffolds