Extended Thromboprophylaxis with Betrixaban in Acutely Ill Medical Patients

Background Patients with acute medical illnesses are at prolonged risk for venous thrombosis. However, the appropriate duration of thromboprophylaxis remains unknown. Methods Patients who were hospitalized for acute medical illnesses were randomly assigned to receive subcutaneous enoxaparin (at a dose of 40 mg once daily) for 10±4 days plus oral betrixaban placebo for 35 to 42 days or subcutaneous enoxaparin placebo for 10±4 days plus oral betrixaban (at a dose of 80 mg once daily) for 35 to 42 days. We performed sequential analyses in three prespecified, progressively inclusive cohorts: patients with an elevated d-dimer level (cohort 1), patients with an elevated d-dimer level or an age of at least 75 years (cohort 2), and all the enrolled patients (overall population cohort). The statistical analysis plan specified that if the between-group difference in any analysis in this sequence was not significant, the other analyses would be considered exploratory. The primary efficacy outcome was a composite of asymptomatic proximal deep-vein thrombosis and symptomatic venous thromboembolism. The principal safety outcome was major bleeding. Results A total of 7513 patients underwent randomization. In cohort 1, the primary efficacy outcome occurred in 6.9% of patients receiving betrixaban and 8.5% receiving enoxaparin (relative risk in the betrixaban group, 0.81; 95% confidence interval [CI], 0.65 to 1.00; P=0.054). The rates were 5.6% and 7.1%, respectively (relative risk, 0.80; 95% CI, 0.66 to 0.98; P=0.03) in cohort 2 and 5.3% and 7.0% (relative risk, 0.76; 95% CI, 0.63 to 0.92; P=0.006) in the overall population. (The last two analyses were considered to be exploratory owing to the result in cohort 1.) In the overall population, major bleeding occurred in 0.7% of the betrixaban group and 0.6% of the enoxaparin group (relative risk, 1.19; 95% CI, 0.67 to 2.12; P=0.55). Conclusions Among acutely ill medical patients with an elevated d-dimer level, there was no significant difference between extended-duration betrixaban and a standard regimen of enoxaparin in the prespecified primary efficacy outcome. However, prespecified exploratory analyses provided evidence suggesting a benefit for betrixaban in the two larger cohorts. (Funded by Portola Pharmaceuticals; APEX ClinicalTrials.gov number, NCT01583218. opens in new tab.

Cause of Death and Predictors of All-Cause Mortality in Anticoagulated Patients With Nonvalvular Atrial Fibrillation : Data From ROCKET AF

M. Kaste on työryhmän ROCKET AF Steering Comm jäsen.Background-Atrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all-cause mortality may guide interventions. Methods and Results-In the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose-adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all-cause mortality in the 14 171 participants in the intention-to-treat population. The median age was 73 years, and the mean CHADS(2) score was 3.5. Over 1.9 years of median follow-up, 1214 (8.6%) patients died. Kaplan-Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all-cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33-1.70, P= 75 years (hazard ratio 1.69, 95% CI 1.51-1.90, P Conclusions-In a large population of patients anticoagulated for nonvalvular atrial fibrillation, approximate to 7 in 10 deaths were cardiovascular, whereasPeer reviewe

Comparing Newly Built Wetlands in the Atchafalaya Bay, Louisiana and Sacramento-San Joaquin Delta, California

This research investigated patterns in elevation change in newly built wetlands in the Atchafalaya delta, and newly restored wetlands in the Sacramento-San Joaquin River delta. RSETs were used to measure small changes in elevation, and soil cores were processed to examine mineral and organic contributions. Elevation change was highly variable, responding to influences from water level, river discharge, storms and vegetation. Mineral matter consistently added more to the marsh soil through volumetric and gravimetric contributions. Organic contributions were not significantly different across sites, suggesting the type of emergent vegetation at a site may not be the most important factor. Sites with the lowest elevations had the highest rates of positive elevation change. Higher elevation sites were more exposed and had negative rates of elevation change. The findings suggest ideal sites for marsh building are in areas that receive sediment input, are protected from high-energy events, and can support emergent vegetation

Comparing Newly Built Wetlands in the Atchafalaya Bay, Louisiana and Sacramento-San Joaquin Delta, California

This research investigated patterns in elevation change in newly built wetlands in the Atchafalaya delta, and newly restored wetlands in the Sacramento-San Joaquin River delta. RSETs were used to measure small changes in elevation, and soil cores were processed to examine mineral and organic contributions. Elevation change was highly variable, responding to influences from water level, river discharge, storms and vegetation. Mineral matter consistently added more to the marsh soil through volumetric and gravimetric contributions. Organic contributions were not significantly different across sites, suggesting the type of emergent vegetation at a site may not be the most important factor. Sites with the lowest elevations had the highest rates of positive elevation change. Higher elevation sites were more exposed and had negative rates of elevation change. The findings suggest ideal sites for marsh building are in areas that receive sediment input, are protected from high-energy events, and can support emergent vegetation

Beyond ethnocentrism: Towards a global social theory

In this chapter we present the sketch of a global social theory that overcomes the paralyzing opposition between ethnocentrism and relativism by making the cultural situatedness of theory construction its starting point. Avoiding the master-narratives of either a developmental or a transcendental grounding, we aim to reconstruct the agentive resources that allow individual subjects to position themselves critically and reflexively within their cultural and social contexts. Cultural worlds thus emerge as the localized inescapable horizons from within which cultural critique necessarily emerges. Our global social theory develops its formal framework by first grounding itself in hermeneutics, followed by developing an account of how linguistically mediated conceptual schemes pre-structure intercultural dialogue, to eventually arrive at three dimensions of self-reflexivity that are entailed in all meaning-constitution: existential self-reflexivity, dialogical other-reflexivity, and holistic world-reflexivity. We probe our account by engaging Chinese thought and ethics vis-à-vis the relation between self, other, and world-embeddedness. Neo-Confucianism raises concerns vis-à-vis the distinction between social normativity and cosmological ontology, but promises multiple pathways of non-Western modes of conceptualizing the crucial relation between self and being. Irreducible self-reflexivity, egalitarian self-other relations, and interpretive self-awareness present universal marks of our otherwise thoroughly contextual and cultural practices of global self-understanding

Borrelia burgdorferi genospecies detection by RLB hybridization in Ixodes ricinus ticks from different sites of North-Eastern Poland

Introduction. RLB (Reverse Line Blot Hybridization) is a molecular biology technique that might be used for [i]Borrelia burgdorferi [/i]sensu lato (sl) DNA detection with genospecies specification. Among[i] B. burgdorferi[/i] sl genospecies at least 7 are regarded as pathogenic in Europe. objective. The aim of the study was to evaluate the frequency of different [i]Borrelia[/i] genospecies DNA detection in Ixodes ricinus ticks in the endemic area of North-Eastern Poland by using RLB. materials and method. Ixodes ricinus ticks were collected in May – June, from 6 different sites in North-Eastern Poland (Jakubin, Kolno, Grajewo, Suwałki, Siemiatycze, Białowieża) by flagging. Extracted DNA was amplified by polymerase chain reaction (PCR) targeting the intergenic spacer 5S 23S of [i]B. burgdorferi sl.[/i] PCR products were hybridised to 15 different oligonucleotide probes for 9 different [i]Borrelia [/i]genospecies ([i]B. burgdorferi sl, B. burgdorferi ss, B. garinii, B. afzelii, B. valaisiana, B. lusitaniae, B. spielmanii, B. bissettii and B. relapsing[/i] fever-like spirochetes (B. myamotoi)) by RLB. results. [i]Borrelia [/i]genospecies DNA was detected in 205 Ixodes ricinus ticks. Among 14 infected with [i]Borrelia[/i] ticks, 4 were identified as B. garinii and 10 as B. afzelii. Higher numbers of infected ticks were noticed in the eastern part of the research area, where large forest complexes dominate. Nymphs appeared to be the most frequently infected tick stage, which has an epidemiological meaning in the incidence of Lyme borreliosis. conclusions. The study demonstrated that RLB might be easily used in [i]Borrelia[/i] DNA detection with genospecies-identification, and indicated the domination of [i]B. afzelii and B. garinii [/i]in ticks from North-Eastern Poland