Do physicians correctly calculate thromboembolic risk scores?: a comparison of concordance between manual and computer‐based calculation of CHADS2 and CHA2DS2‐VASc scores

[Abstract] BACKGROUND: Clinical risk scores, CHADS2 and CHA2 DS2 -VASc scores, are the established tools for assessing stroke risk in patients with atrial fibrillation (AF). AIM: The aim of this study is to assess concordance between manual and computer-based calculation of CHADS2 and CHA2 DS2 -VASc scores, as well as to analyse the patient categories using CHADS2 and the potential improvement on stroke risk stratification with CHA2 DS2 -VASc score. METHODS: We linked data from Atrial Fibrillation Spanish registry FANTASIIA. Between June 2013 and March 2014, 1318 consecutive outpatients were recruited. We explore the concordance between manual scoring and computer-based calculation. We compare the distribution of embolic risk of patients using both CHADS2 and CHA2 DS2 -VASc scores RESULTS: The mean age was 73.8 ± 9.4 years, and 758 (57.5%) were male. For CHADS2 score, concordance between manual scoring and computer-based calculation was 92.5%, whereas for CHA2 DS2 -VASc score was 96.4%. In CHADS2 score, 6.37% of patients with AF changed indication on antithrombotic therapy (3.49% of patients with no treatment changed to need antithrombotic treatment and 2.88% of patients otherwise). Using CHA2 DS2 -VASc score, only 0.45% of patients with AF needed to change in the recommendation of antithrombotic therapy. CONCLUSION: We have found a strong concordance between manual and computer-based score calculation of both CHADS2 and CHA2 DS2 -VASc risk scores with minimal changes in anticoagulation recommendations. The use of CHA2 DS2 -VASc score significantly improves classification of AF patients at low and intermediate risk of stroke into higher grade of thromboembolic score. Moreover, CHA2 DS2 -VASc score could identify 'truly low risk' patients compared with CHADS2 score

The hidden hand of chloride in hypertension

Among the environmental factors that affect blood pressure, dietary sodium chloride has been studied the most, and there is general consensus that increased sodium chloride intake increases blood pressure. There is accruing evidence that chloride may have a role in blood pressure regulation which may perhaps be even more important than that of Na+. Though more than 85 % of Na+ is consumed as sodium chloride, there is evidence that Na+ and Cl− concentrations do not go necessarily hand in hand since they may originate from different sources. Hence, elucidating the role of Cl− as an independent player in blood pressure regulation will have clinical and public health implications in addition to advancing our understanding of electrolyte-mediated blood pressure regulation. In this review, we describe the evidence that support an independent role for Cl− on hypertension and cardiovascular health

Compliance of atrial fibrillation treatment with the ABC pathway in patients with concomitant diabetes mellitus in the Middle East based on the Gulf SAFE registry

Introduction Atrial fibrillation (AF) and diabetes mellitus (DM) constitute a heavy burden on healthcare expenditure due to their negative impact on clinical outcomes in the Middle East. The Atrial fibrillation Better Care (ABC) pathway provides a simple strategy of integrated approach of AF management: A—Avoid stroke; B—Better symptom control; C—Cardiovascular comorbidity risk management. Aims Evaluation of the AF treatment compliance to ABC pathway in DM patients in the Middle East. Assessment of the impact of ABC pathway adherence on all‐cause mortality and the composite outcome of stroke/systemic embolism, all‐cause death and cardiovascular hospitalisations. Methods From 2043 patients in the Gulf SAFE registry, 603 patients (mean age 63; 48% male) with DM were included in an analysis of ABC pathway compliance: A—appropriate use of anticoagulation according to CHA2DS2‐VASc score; B—AF symptoms management according to the European Heart Rhythm Association (EHRA) scale; C—Optimised cardiovascular comorbidities management. Results 86 (14.3%) patients were treated in compliance with the ABC pathway. During 1‐year follow‐up, 207 composite outcome events and 87 deaths occurred. Mortality was significantly lower in the ABC group vs non‐ABC (5.8% vs 15.9%, P = .0014, respectively). On multivariate analysis, ABC compliance was associated with a lower risk of all‐cause death and the composite outcome after 6 months (OR 0.18; 95% CI: 0.42‐0.75 and OR 0.54; 95% Cl: 0.30‐1.00, respectively) and at 1 year (OR 0.30; 95% Cl: 0.11‐0.76 and OR 0.57; 95% Cl: 0.33‐0.97, respectively) vs the non‐ABC group. Conclusions Compliance with the ABC pathway care was independently associated with the reduced risk of all‐cause death and the composite outcome in DM patients with AF, highlighting the importance of an integrated approach to AF management

Major Outcomes in Atrial Fibrillation Patients with One Risk Factor: Impact of Time in Therapeutic Range

BACKGROUND: The benefits and harms of oral anticoagulation (OAC) therapy in patients with only one stroke risk factor (i.e. CHA2DS2-VASc= 1 in males, or 2 in females) has been subject of debate. METHODS: We analysed all patients with only one stroke risk factor from the merged datasets of SPORTIF III and V trials. Anticoagulation control was defined according to time in therapeutic range (TTR). RESULTS: Of the original trial cohort, 1,097 patients had only one stroke risk factor. Stroke/systemic thromboembolic event had an incidence of 0.9 per 100 patient-years, with an incidence of 1.6 per 100 patient-years for all-cause death and 2.3%/patient-years for the composite outcome of stroke/systemic thromboembolic event/all-cause death. There were no significant differences in the risk for stroke/systemic thromboembolic event between sexes, nor between the different stroke risk factors amongst these atrial fibrillation patients with only one stroke risk factor. Cox regression analysis in patients treated with warfarin only found TTR to be inversely associated with stroke/systemic thromboembolic event (p=0.034) and all-cause death (p=0.015). Chronic heart failure was significantly associated with the outcome of all-cause death (p=0.0019) and the composite outcome of stroke/systemic thromboembolic event/all-cause death (p=0.021). There was a significant inverse linear association between TTR and the cumulative risk for both stroke/systemic thromboembolic event and all-cause death (both p<0.001). CONCLUSIONS: In atrial fibrillation patients with only one additional stroke risk factor (i.e. CHA2DS2-VASc= 1 in males or 2 in females), rates of major adverse events (stroke/systemic thromboembolic event, mortality) were high, despite anticoagulation. TTR in warfarin-treated patients was inversely associated with the occurrence of both stroke/systemic thromboembolic event and all-cause death

Desiccation and Preculture Effects on Survival of Encapsulated Zygotic Embryos of Rubber (Hevea Brasiliensis Muel.-Arg) Following Liquid Nitrogen Exposure

The effects of desiccation, sucrose as cryoprotectant and abscisic acid (ABA) as chemical ameliorant on the cryopreservation of Hevea zygotic embryos were evaluated using the alginate encapsulation method. The first part of the study was on the effects of desiccation on the survival of alginate-encapsulated Hevea zygotic embryos following liquid nitrogen exposure. The embryos need to be desiccated to at least 26% moisture content to enable some survival after exposure to liquid nitrogen. Embryos desiccated to moisture content of 14% and 18% gave comparatively higher survival after cryopreservation (42.5% and 47.5% respectively). Encapsulation of the embryos enhanced desiccation tolerance and desiccation was allowed even until 10% moisture content with some survival even though Hevea seeds are known to be recalcitrant. Encapsulation had broaden the window for cryopreservation by allowing the embryos to survive desiccation and cryopreservation at a broader range of moisture content compared to naked embryos done in previous work. However, a very low percentage of embryos developed into normal plantlets. The importance of sucrose preculture for cryopreservation of encapsulated Hevea embryos is also proven in this study. Sucrose preculture at low concentration of 0.3 M improved viability and survival before and after cryopreservation significantly to 70% and 60% respectively. Desiccation and freezing resistance were further enhanced when the encapsulated embryos were precultured on 0 . 5 M sucrose with viability as high as 82% (after cryopreservation). However, after twelve weeks culture, the percentage of survival after cryopreservation was maintained as when precultured on 0.3 M sucrose, with 1 4% and 1 6% moisture levels showing better results (51% and 59% respectively). Preculture with 0.5 M sucrose improved perculture of embryos developed into normal plantlet (as high as 35% and 32% survival before and after cryopreservation). As the concentration of sucrose preculture was increased further to 0.7 M and 0.9 M, the freezing tolerance of the embryos reduced considerably. A very low percentage of normal plantlet was obtained after cryopreservation (3 to 9%). Desiccation tolerance was also slightly reduced as indicated by lower survival before cryopreservation

E-learning benchmarking survey: A case study of University Utara Malaysia

E-learning has emerged as a new paradigm in today’s education.Many e-learning applications have been developed to meet the increasing demand by education institutions.Previous research mainly focused on a variety of factors that influence the uptake of e-learning.However, very little is known about the quality and the extent of usage of these applications among end users. This study presents results that contain information on the uptake and use of e-learning.The uptake of e-learning is measured by the extent to which different technologies were used by students.A mail survey was conducted to examine the uptake of e-learning among undergraduates.The respondents for this study comprised of 419 respondents representing 16.8% from a random sample size of 2500 students. Thirty four applications available from Universiti Utara Malaysia Learning information system (Learningzone) were grouped into six categories that served as e-learning benchmarks to assess the uptake of e-learning among undergraduates.The results show that accessing for course materials, communications, viewing information are the commonly used applications while helpdesks and support, and link to other centres are least popular among undergraduates

Oil Palm Ash As Solid Catalyst For Palm Oil-based Transesterification To Biodiesel: Optimization By Response Surface Methodology

Biodiesel adalah satu bahan api alternatif untuk enjin diesel yang semakin mendapat perhatian dari segi kesusutan sumber bahan api fosil seluruh duni

Cubic beam elements in practical analysis and design of steel frames

This paper discusses various issues in the use of cubic beam elements for computer structural analysis/design of steel frames. It is pointed out that the concern expressed in recent literature regarding the number of cubic elements required to model a steel member is not justified, and that the inaccuracy of one cubic element in Euler buckling analysis of a simply supported column is largely irrelevant to the second-order elastic analysis/design or advanced analysis of steel frames. The sources of inaccuracy of the cubic element are elucidated. It is also explained that the plastic-zone analysis method is not so inefficient as was previously believed. The spatial cubic element is shown to be capable of accurately accounting for the coupling between axial, flexural and torsional deformation modes. It is concluded that for the purposes of second-order elastic analysis/design and advanced analysis of 2D and 3D steel frames, the well-documented cubic element is a versatile and efficient choice

Limitations of current design procedures for steel members in space frames

The use of more advanced methods of analysis to design steel frames may lead to substantial material savings, in addition to simplicity in the design procedures. However, these benefits do not yet appear to be a powerful incentive for many structural engineers to abandon the familiar linear elastic analysis (LEA) based design procedures, even when dealing with steel structures that are not regular rectangular frames. This paper uses a heuristic example to demonstrate the serious limitations of the LEA based design procedures, whether alignment charts or system buckling analysis is used to determine the effective lengths of the compression members. It is shown that LEA based design procedures may lead to unsafe structures due to their inability to account for bending moment amplification in the rigidly connected tension members of a space frame. Furthermore, there is no allowance for the amplification of axial forces due to changes in the structure geometry, which is significant for the space frame example. Confidence in the system buckling analysis method for determining the effective lengths of compression members, based on linear buckling analysis, is shown to be potentially dangerous for certain types of frames. For the space frame example, the elastic buckling load is overestimated by over 200%. The conservatism inherent in the member capacity check equations specified in steel design standards is also illustrated