Evaluation of an Unfractioned Heparin Pharmacy Dosing Protocol for the Treatment of Venous Thromboembolism in Nonobese, Obese, and Severely Obese Patients

Background: Despite large interpatient variability in dose response, heparin is utilized for treatment of venous thromboembolism (VTE). Current data on the optimal heparin dosing in obese patients are conflicting. Objective: The objective was to evaluate the time and dose required to achieve a therapeutic activated partial thromboplastin time (aPTT) in nonobese, obese, and severely obese patients using a pharmacist-directed heparin dosing protocol. Methods: This was a retrospective cohort study in a single-center community hospital inpatient setting. Adult patients receiving heparin for VTE treatment from July 1, 2013, to July 31, 2015, were evaluated. Patients were categorized into 3 groups: nonobese (BMI \u3c 30 kg/m2), obese (BMI = 30-39.9 kg/m2), and severely obese (BMI ≥ 40 kg/m2). Data on height, weight, initial bolus dose, initial infusion rate, time to therapeutic aPTT, and therapeutic infusion rate were collected. Dosing body weight (DBW) was utilized for patients 20% over their ideal body weight (IBW). The primary outcome was time to therapeutic aPTT. Results: Analysis included 298 patients. Median times to therapeutic aPTT (hours:minutes) in the nonobese, obese, and severely obese were 15:00 (interquartile range [IQR] = 8:05-23:21), 15:40 (IQR = 9:22-25:10), and 15:22 (IQR = 7.54-23:40), respectively (P = 0.506). There was no difference in bleeding among the nonobese (14%), obese (13.9%), or severely obese groups (7.9%; P = 0.453). No adverse thrombotic events occurred during hospitalization. Conclusion: Using a DBW for heparin dosing in patients 20% over their IBW resulted in similar times to therapeutic aPTT and adverse events in the nonobese, obese, and severely obese

Aerodynamic characteristics of rotating wind-driven airfoils

Thesis (B.S.)-- Massachusetts Institute of Technology, Dept. of General Engineering, 1925.by John L. Hosch, Horace E. Weihmiller.B.S

A Model-independent Description of New Physics effects in e+e- to t tbar

We study the potential of a future $e^+e^-$ collider for the search of anomalous gamma t t bar and Z t t bar couplings, assuming that CP-invariance holds. This is done in a model-independent way, considering that all six possible couplings do appear. Two experimental situations are envisaged, with and without electron beam polarization. Observability limits in the form of domains in the 6-dimensional parameter space are established. Illustrations for specific constrained models are also presented and implications for new physics searches are discussed.Comment: 26 pages and 5 figures. e-mail: [email protected]

Flavor changing t -> c l_1^- l_2^+ decay in the general two Higgs doublet model

We study the flavor changing t-> c l_1^- l_2^+ decay in the framework of the general two Higgs doublet model, the so called model III. We predict the branching ratio for l_1=\tau, l_2=\mu at the order of magnitude of BR \sim 10^{-8}.Comment: 12 Pages, 5 Figure

Whole-genome sequencing for One Health surveillance of antimicrobial resistance in conflict zones: a case study of Salmonella spp. and Campylobacter spp. in the West Bank, Palestine

Antimicrobial resistance (AMR) is a critical global concern driven by the overuse, misuse, and/or usage of inadequate antibiotics on humans, animals' agriculture, and as a result of contaminated environments. This study is the first One Health survey in the Middle East that incorporated whole-genome sequencing (WGS) to examine the spread of AMR in Campylobacter spp. and Salmonella spp. This cross-sectional study was conducted to examine the role of AMR at the human-animal-environmental interface and was performed in Ramallah/Al-Bireh and Jerusalem governorates of the central West Bank, Palestine. In 2021 and 2022, a total of 592 samples were collected and analyzed. From a total of 65 Campylobacter jejuni and 19 Salmonella spp. isolates, DNA was extracted for WGS using Oxford Nanopore Technologies MinION platform. We found that the dominant serotypes of C. jejuni and Salmonella enterica were present in chicken manure, chicken meat sold in markets, and feces of asymptomatic farm workers, with high genetic similarities between the isolates regardless of origin. Additionally, our results showed rapid strain turnover in C. jejuni from the same sites between 2021 and 2022. Most of the positive Salmonella spp. samples were multidrug-resistant (MDR) S. enterica serovar Muenchen carrying the plasmid of emerging S. infantis (pESI) megaplasmid, conferring resistance to multiple antibiotics. Our findings highlight the spread of MDR foodborne pathogens from animals to humans through the food chain, emphasizing the importance of a One Health approach that considers the interconnections between human, animal, and environmental health. IMPORTANCE Prior to this study, there existed hardly an integrated human-animal-environmental study of Salmonellosis and Campylobacteriosis and related AMR in Middle Eastern countries. The few existing studies lack robust epidemiological study designs, adequate for a One Health approach, and did not use WGS to determine the circulating serotypes and their AMR profiles. Civil unrest and war in Middle Eastern countries drive AMR because of the breakdown of public health and food security services. This study samples simultaneously humans, animals, and the environment to comprehensively investigate foodborne pathogens in the broiler chicken production chain in Palestine using WGS. We show that identical serotypes of C. jejuni and S. enterica can be found in samples from chicken farms, chicken meat sold in markets, and asymptomatic broiler chicken production workers. The most striking feature is the rapid dynamic of change in the genetic profile of the detected species in the same sampling locations. The majority of positive Salmonella spp. samples are MDR S. enterica serovar Muenchen isolates carrying the pESI megaplasmid. The results demonstrate a close relationship between the S. enterica serovar Muenchen isolates found in our sample collection and those responsible for 40% of all clinical Salmonella spp. isolates in Israel as previously reported, with a sequence identity of over 99.9%. These findings suggest the transboundary spread of MDR S. enterica serovar Muenchen strains from animals to humans through the food chain. The study underscores the importance of combining integrated One Health studies with WGS for detecting environmental-animal-human transmission of foodborne pathogens that could not be detected otherwise. This study showcases the benefits of integrated environmental-animal-human sampling and WGS for monitoring AMR. Environmental samples, which may be more accessible in conflict-torn places where monitoring systems are limited and regulations are weak, can provide an effective AMR surveillance solution. WGS of bacterial isolates provides causal inference of the distribution and spread of bacterial serotypes and AMR in complex social-ecological systems. Consequently, our results point toward the expected benefits of operationalizing a One Health approach through closer cooperation of public and animal health and food safety authorities

Probing Topcolor-Assisted Technicolor from Top-Charm Associated Production at LHC

We propose to probe the topcolor-assisted technicolor (TC2) model from the top-charm associated productions at the LHC, which are highly suppressed in the Standard Model. Due to the flavor-changing couplings of the top quark with the scalars (top-pions and top-Higgs) in TC2 model, the top-charm associated productions can occur via both the s-channel and t-channel parton processes by exchanging a scalar field at the LHC. We examined these processes through Monte Carlo simulation and found that they can reach the observable level at the LHC in quite a large part of the parameter space of the TC2 model.Comment: Version to appear in PRD (Rapid Communication

Single Top Quark Production via FCNC Couplings at Hadron Colliders

We calculate single top-quark production at hadron colliders via the chromo-magnetic flavor-changing neutral current couplings $\bar tcg$ and $\bar tug$. We find that the strength for the anomalous $\bar tcg$ ($\bar tug$) coupling may be probed to $\kappa_c / \Lambda = 0.092 {TeV}^{-1}$ ($\kappa_u / \Lambda = 0.026 {TeV}^{-1}$) at the Tevatron with $2 {fb}^{-1}$ of data and $\kappa_c / \Lambda = 0.013 {TeV}^{-1}$ ($\kappa_u / \Lambda = 0.0061 {TeV}^{-1}$) at the LHC with $10 {fb}^{-1}$ of data. The two couplings may be distinguished by a comparision of the single top signal with the direct top and top decay signals for these couplings.Comment: 18 pages, 6 figures, 3 table

Cystic Echinococcosis: Chronic, Complex, and Still Neglected

Cystic echinococcosis is a most clinically neglected parasitic disease that urgently needs attention. A valuable tool for diagnosing, staging, and following up patients, ultrasound, is readily available. Four management procedures, surgery, percutaneous sterilization techniques, anti-parasitic treatment, and watch & wait, have ‘‘evolved’’ over decades, and been recently summarized, but without adequate comparative evaluation of efficacy, effectiveness, rate of adverse events, relapse rates, and cost. Clinical decision making is on even shakier ground for extrahepatic and extrapulmonary locations, which are rarer and numbers needed to build comparative trials hard to come by. There is an obligation to put at least what we have on an appropriate evidence base by conducting comparative clinical trials at the scale and quality that allow answering these important questions. As one of the expected results, clear criteria for the watch & wait option alone might already save a substantial proportion of patients from unnecessary interventions and save health services money. Difficult chronic diseases clustering in poor rural areas need intelligent, creative approaches, and this one urgently needs operational research incorporating the particularities of resource- poor settings into consideration