Thromboembolic and neurologic sequelae of discontinuation of an antihyperlipidemic drug during ongoing warfarin therapy

Warfarin and antihyperlipidemics are commonly co-prescribed. Some antihyperlipidemics may inhibit warfarin deactivation via the hepatic cytochrome P450 system. Therefore, antihyperlipidemic discontinuation has been hypothesized to result in underanticoagulation, as warfarin metabolism is no longer inhibited. We quantified the risk of venous thromboembolism (VTE) and ischemic stroke (IS) due to statin and fibrate discontinuation in warfarin users, in which warfarin was initially dose-titrated during ongoing antihyperlipidemic therapy. Using 1999-2011 United States Medicaid claims among 69 million beneficiaries, we conducted a set of bidirectional self-controlled case series studies-one for each antihyperlipidemic. Outcomes were hospital admissions for VTE/IS. The risk segment was a maximum of 90 days immediately following antihyperlipidemic discontinuation, the exposure of interest. Time-varying confounders were included in conditional Poisson models. We identified 629 study eligible-persons with at least one outcome. Adjusted incidence rate ratios (IRRs) for all antihyperlipidemics studied were consistent with the null, and ranged from 0.21 (0.02, 2.82) for rosuvastatin to 2.16 (0.06, 75.0) for gemfibrozil. Despite using an underlying dataset of millions of persons, we had little precision in estimating IRRs for VTE/IS among warfarin-treated persons discontinuing individual antihyperlipidemics. Further research should investigate whether discontinuation of gemfibrozil in warfarin users results in serious underanticoagulation

Wavelength- and material-dependent absorption in GaAs and AlGaAs microcavities

The quality factors of modes in nearly identical GaAs and Al_{0.18}Ga_{0.82}As microdisks are tracked over three wavelength ranges centered at 980 nm, 1460 nm, and 1600 nm, with quality factors measured as high as 6.62x10^5 in the 1600-nm band. After accounting for surface scattering, the remaining loss is due to sub-bandgap absorption in the bulk and on the surfaces. We observe the absorption is, on average, 80 percent greater in AlGaAs than in GaAs and in both materials is 540 percent higher at 980 nm than at 1600nm.Comment: 4 pages, 2 figures, 1 table, minor changes to disucssion of Qrad and Urbach tai

Dry Matter Intake, Milk Performance and Production Efficiency from Spring Calving Dairy Cows Offered Grass-Only, Grass-White Clover and Total Mixed Ration Diets

In pasture-based dairy production systems, dry matter intake (DMI) is one of the main factors curtailing milk production and production efficiency. The inclusion of white clover (Trifolium repens L.) in swards of perennial ryegrass (PRG; Lolium perenne L.) can increase DMI from increased sward nutritive value over a grass-only sward. Feeding a fully balanced TMR diet can enhance milk production as a result of greater DMI and through greater control of feed quality. Therefore, the objective of this study was to determine the relationship between DMI, milk production, and energy efficiencies for dairy cows consuming different diets. A farm systems experiment was conducted from 2015-2021. The three treatments were: TMR (100% confinement; grass silage, maize silage, concentrate), grass-only herbage (GR), or grass-white clover herbage (CL). Dry matter intake was estimated 17 times over the duration of the study, using the n-alkane technique for the GR and CL treatments, and an electronic roughage intake control system for the TMR treatment. Simultaneously, milk production, and production efficiencies were also measured. Significant increases (P \u3c 0.001) in milk production, DMI, and production efficiencies were observed when cows consumed the TMR diet compared with the grazing diets. Greater energy (P \u3c 0.001) was available for milk production after maintenance for the TMR treatment. All treatments had similar energy (148.64 g Unité fourragère lait; UFL) available for milk solids (MS) production after accounting for maintenance. Cows consuming the TMR diet had significantly higher (P \u3c 0.001) daily energy intake (+17%) compared to the pasture-fed cows. Cows grazing the CL swards consumed 1.03 kg greater (P \u3c 0.001) total DMI compared to the GR cows. This translated into greater daily milk (+1.2 kg) and MS (0.12 kg) compared with the GR treatment. The current study highlights the benefits of a TMR and ryegrass/white clover diet for increasing milk production, and energy efficiencies above a grass-only diet

The role of the Intermediate Care Team in detecting and responding to loneliness in older clients

The Intermediate Care Team (ICT) supports patients in their own homes to manage complex needs. They are ideally placed in the community to identify older adults at risk of loneliness. However, little is known about how ICT professionals perceive, detect, or respond to loneliness in their clients. This study explores ICT professional’s attitudes to loneliness in the context of perceived service priorities and their experiences of managing loneliness in their clients. Eight ICT professionals (n=2 physiotherapists, n=3 occupational therapists, n=3 nurses) took part in semi-structured interviews. Data was analysed thematically using framework analysis, applying the Theory of Planned Behaviour as an interpretive framework. ICT professionals believed loneliness was a significant issue for many of their older clients but was a low priority for ICT services. Study participants believed that loneliness often goes undetected because it is an issue that is difficult to measure objectively. Barriers to managing loneliness included high work-load, unsatisfactory referral systems, and lack of close working with social-care and independent sector services. Introducing brief but reliable loneliness assessments into routine practice, receiving training on detecting and managing loneliness, and improving working relationships with social care and independent sector services were highlighted as strategies that could improve the detection and management of loneliness in ICT clients

A review of High Performance Computing foundations for scientists

The increase of existing computational capabilities has made simulation emerge as a third discipline of Science, lying midway between experimental and purely theoretical branches [1, 2]. Simulation enables the evaluation of quantities which otherwise would not be accessible, helps to improve experiments and provides new insights on systems which are analysed [3-6]. Knowing the fundamentals of computation can be very useful for scientists, for it can help them to improve the performance of their theoretical models and simulations. This review includes some technical essentials that can be useful to this end, and it is devised as a complement for researchers whose education is focused on scientific issues and not on technological respects. In this document we attempt to discuss the fundamentals of High Performance Computing (HPC) [7] in a way which is easy to understand without much previous background. We sketch the way standard computers and supercomputers work, as well as discuss distributed computing and discuss essential aspects to take into account when running scientific calculations in computers.Comment: 33 page

Undergraduate student expectations of university in the United Kingdom: What really matters to them?

Students spend 12 to 14 years in school settings learning in what could be considered a carefully controlled and structured environment. Higher education may not offer the same landscape to students and it appears that many enter with unrealistic conceptions of what is expected of them and are faced with different approaches to aspects of teaching, learning and assessment. This qualitative study explores the perceptions of second-year and final-year students in relation to their expectations whilst studying at university. Focus groups were used across two programmes in one university faculty to ascertain student expectations and what they perceived as important. From the thematic analysis, four areas were highlighted by the students as key to the transition into university these were directed time, non-directed time, support and relationships. Overall these students where positive about the university experience and the levels of support offered to them, particularly noting that working in peer learning groups (PLGs) was beneficial. Issues were raised around the timetabling of face-to-face contact time and the value of the experience and this is an area that needs further research as is understanding the complexity of the students’ lives outside of the institution

Student Expectations: what is university really about?

Students spend 12 to 14 years in school learning in a carefully controlled and structured system. It appears that many students enter university with unrealistic conceptions of what is expected of them in many aspects of teaching and learning, including assessment. Hence, when they reach university they are faced with the challenge of adjusting to radically different styles of teaching, learning and assessment. It follows that this lack of preparedness is key reason why students drop out or take longer to complete their studies. To compound the issue, university teachers may not fully appreciate students' expectations and are unable to anticipate and address these in curriculum development and delivery. Therefore, developing a better understanding of students’ perceptions, expectations and experiences is crucial to being able to deliver programmes of study that support students in the transition from school to university and as they move through their university life. This paper explores the perceptions of Level 5 and Level 6 students on two LJMU programmes in the Faculty of Education, Health and Community with the overarching aim to investigate key aspects of the student experience relating to induction, support and transition. By exploring students’ ideas around key areas we hope to be able to better understand what the student expectation is and identify strategies to bridge any gap that exists between staff and student beliefs

Sensor Integrated Metal Dielectric Filters for Solar-Blind Silicon Ultraviolet Detectors

A filter for electromagnetic radiation including one or more dielectric spacer regions and one or more reflective regions integrated on a semiconductor substrate, the semiconductor substrate including a semiconductor photodetector, such that the filter transmits ultraviolet radiation to the semiconductor photodetector, the ultraviolet radiation having a range of wavelengths, and the filter suppresses transmission of electromagnetic radiation, having wavelengths outside the range of wavelengths, to the semiconductor photodetector

Application of a Self-Similar Pressure Profile to Sunyaev-Zel'dovich Effect Data from Galaxy Clusters

We investigate the utility of a new, self-similar pressure profile for fitting Sunyaev-Zel'dovich (SZ) effect observations of galaxy clusters. Current SZ imaging instruments - such as the Sunyaev-Zel'dovich Array (SZA) - are capable of probing clusters over a large range in physical scale. A model is therefore required that can accurately describe a cluster's pressure profile over a broad range of radii, from the core of the cluster out to a significant fraction of the virial radius. In the analysis presented here, we fit a radial pressure profile derived from simulations and detailed X-ray analysis of relaxed clusters to SZA observations of three clusters with exceptionally high quality X-ray data: A1835, A1914, and CL J1226.9+3332. From the joint analysis of the SZ and X-ray data, we derive physical properties such as gas mass, total mass, gas fraction and the intrinsic, integrated Compton y-parameter. We find that parameters derived from the joint fit to the SZ and X-ray data agree well with a detailed, independent X-ray-only analysis of the same clusters. In particular, we find that, when combined with X-ray imaging data, this new pressure profile yields an independent electron radial temperature profile that is in good agreement with spectroscopic X-ray measurements.Comment: 28 pages, 6 figures, accepted by ApJ for publication (probably April 2009

The EPICure study: association between hemodynamics and lung function at 11 years after extremely preterm birth.

To investigate the relationship between disturbed lung function and large-artery hemodynamics in school-age children born extremely preterm (EP) (at 25 completed weeks of gestation or less)