Venous thromboembolism in adults screened for Sickle Cell Trait: a population based cohort study with nested case-control analysis

Objective: To determine whether sickle cell carriers (‘sickle cell trait’) have an increased risk of venous thromboembolism (VTE). Design: Cohort study with nested case-control analysis. Setting: General population with data from 609 UK general practices in the Clinical Practice Research Datalink (CPRD). Participants: All individuals registered with a CPRD general practice between 1998 and 2013, with a medical record of screening for sickle cell between 18 and 75 years of age. Main outcomes measures: Incidence of VTE per 10,000 person-years among sickle cell carriers and non-carriers; and adjusted odds ratio (OR) for VTE among sickle cell carriers compared to non-carriers. Results: We included 30,424 individuals screened for sickle cell, with a follow-up time of 179,503 person-years, identifying 55 VTEs in 6,758 sickle cell carriers and 125 VTEs in 23,666 non-carriers. VTE incidence amongst sickle cell carriers (14.9/10,000 person-years; 95% CI: 11.4 to 19.4) was significantly higher than non-carriers (8.8/10,000 person-years; 95% CI: 7.4 to 10.4). Restricting analysis to confirmed non-carriers was non-significant, but performed on a small sample. In the case-control analysis (180 cases matched to 1,775 controls by age and gender), sickle cell carriers remained at increased risk of VTE after adjusting for body mass index, pregnancy, smoking status and ethnicity (OR 1.78, 95% CI: 1.18 to 2.69, p-value 0.006 ), with the greatest risk for pulmonary embolism (OR 2.27, 95% CI: 1.17 to 4.39, p-value 0.011). Conclusions: Although absolute numbers are small, in a general population screened for sickle cell, carriers have a higher incidence and risk of VTE, particularly pulmonary embolism, than non-carriers. Clinicians should be aware of this elevated risk in the clinical care of sickle cell carriers, or when discussing carrier screening, and explicitly attend to modifiable risk factors for VTE in these individuals. More complete primary care coding of carrier status could improve analysis

When I First Met Mary

Portrait of elderly man and woman; Illustration of man and woman dancing around shrubbery; Photograph of Henri Keateshttps://scholarsjunction.msstate.edu/cht-sheet-music/6719/thumbnail.jp

Sea-ice information and forecast needs for industry maritime stakeholders

Profound changes in Arctic sea-ice, a growing desire to utilize the Arctic’s abundant natural resources, and the potential competitiveness of Arctic shipping routes, all provide for increased industry marine activity throughout the Arctic Ocean. This is anticipated to result in further challenges for maritime safety. Those operating in ice-infested waters require various types of information for sea-ice and iceberg hazards. Ice information requirements depend on regional needs and whether the stakeholder wants to avoid ice all together, operate near or in the Marginal Ice Zone, or areas within the ice pack. An insight into user needs demonstrates how multiple spatial and temporal resolutions for sea-ice information and forecasts are necessary to provide information to the marine operating community for safety, planning, and situational awareness. Although ship-operators depend on sea-ice information for tactical navigation, stakeholders working in route and capacity planning can benefit from climatological and long-range forecast information at lower spatial and temporal resolutions where the interest is focused on open-water season. The advent of the Polar Code has brought with it additional information requirements, and exposed gaps in capacity and knowledge. Thus, future satellite data sources should be at resolutions that support both tactical and planning activities

What matters to older people with assisted living needs? A phenomenological analysis of the use and non-use of telehealth and telecare

Telehealth and telecare research has been dominated by efficacy trials. The field lacks a sophisticated theorisation of [a] what matters to older people with assisted living needs; [b] how illness affects people's capacity to use technologies; and [c] the materiality of assistive technologies. We sought to develop a phenomenologically and socio-materially informed theoretical model of assistive technology use. Forty people aged 60–98 (recruited via NHS, social care and third sector) were visited at home several times in 2011–13. Using ethnographic methods, we built a detailed picture of participants' lives, illness experiences and use (or non-use) of technologies. Data were analysed phenomenologically, drawing on the work of Heidegger, and contextualised using a structuration approach with reference to Bourdieu's notions of habitus and field. We found that participants' needs were diverse and unique. Each had multiple, mutually reinforcing impairments (e.g. tremor and visual loss and stiff hands) that were steadily worsening, culturally framed and bound up with the prospect of decline and death. They managed these conditions subjectively and experientially, appropriating or adapting technologies so as to enhance their capacity to sense and act on their world. Installed assistive technologies met few participants' needs; some devices had been abandoned and a few deliberately disabled. Successful technology arrangements were often characterised by ‘bricolage’ (pragmatic customisation, combining new with legacy devices) by the participant or someone who knew and cared about them. With few exceptions, the current generation of so-called ‘assisted living technologies’ does not assist people to live with illness. To overcome this irony, technology providers need to move beyond the goal of representing technology users informationally (e.g. as biometric data) to providing flexible components from which individuals and their carers can ‘think with things’ to improve the situated, lived experience of multi-morbidity. A radical revision of assistive technology design policy may be needed

Prospectus, April 1, 1991

https://spark.parkland.edu/prospectus_1991/1005/thumbnail.jp

Fine-mapping identifies multiple prostate cancer risk loci at 5p15, one of which associates with TERT expression

Associations between single nucleotide polymorphisms (SNPs) at 5p15 and multiple cancer types have been reported. We have previously shown evidence for a strong association between prostate cancer (PrCa) risk and rs2242652 at 5p15, intronic in the telomerase reverse transcriptase (TERT) gene that encodes TERT. To comprehensively evaluate the association between genetic variation across this region and PrCa, we performed a fine-mapping analysis by genotyping 134 SNPs using a custom Illumina iSelect array or Sequenom MassArray iPlex, followed by imputation of 1094 SNPs in 22 301 PrCa cases and 22 320 controls in The PRACTICAL consortium. Multiple stepwise logistic regression analysis identified four signals in the promoter or intronic regions of TERT that independently associated with PrCa risk. Gene expression analysis of normal prostate tissue showed evidence that SNPs within one of these regions also associated with TERT expression, providing a potential mechanism for predisposition to disease

John Evans Study Committee Recommendations

With the completion of this report the University of Denver is presented with an opportunity to reflect on our institutional origins, history, and legacy. We have an opportunity to provide a model of transparency, accountability, and transformation for institutions that have directly profited or indirectly benefited from the displacement of the indigenous communities whose lands and histories they occupy. This moment invites us to bend the arc of history away from the clamor of old apologetics that have caused deep wounds for those whose voices have been silenced and toward justice, healing, and peace. This likewise holds for those whose privilege and power has been upheld by historical noise, silence, and intentional omission. This is truly a new horizon and DU should be a change leader illuminating a new path forward: a path of unity, collaboration, and healing for all communities

A Realist Review of How Community-Based Drug Checking Services Could Be Designed and Implemented to Promote Engagement of People Who Use Drugs

With rising numbers of drug-related deaths in the UK and globally, exploration of interventions that seek to reduce drug-related harm is essential. Drug checking services (DCS) allow people to submit drug samples for chemical analysis and receive feedback about the sample, as well as harm reduction advice. The use of DCS is often linked to festival and/or nightlife settings and to so-called ‘recreational’ drug use, but research has also shown the potential of community-based DCS as an intervention serving more varied demographics of people who use drugs, including more marginalised individuals and those experiencing drug dependence. Whilst there is a growing evidence base on the effectiveness of drug checking as a harm reduction intervention, there is still limited evidence of the underlying mechanisms and processes within DCS which may aid implementation and subsequent engagement of people who use drugs. This presents a challenge to understanding why engagement differs across types of DCS, and how best to develop and deliver services across different contexts and for different populations. To explore the contexts and mechanisms which impact engagement in community-based DCS, a realist review was undertaken to synthesise the international evidence for the delivery and implementation of DCS. There were 133 sources included in the review. From these sources the underlying contexts, mechanisms, and outcomes relating to DCS implementation and engagement were developed and refined into seven programme theories. The findings of this review are theoretically novel and hold practical relevance for the design of DCS, with implications for optimisation, tailoring, and implementing services to reach individuals in different settings

Investigation of Asphalt Additives

DTFH-61-84-C-00066The overall objectives of this research were to (l ) identify through laboratory testing, the most promising types of additives or admixtures for reducing rutting and cracking in hot-mixed asphalt pavements, (2) develop guidelines showing how the additives can be incorporated into actual pavements and (3) develop procedures for evaluating additives. Additives selected for evaluation included latex, block copolymer rubber, ethylene vinyl acetate, polyethylene and carbon black. The additives were combined with asphalt cements from two sources with widely differing chemical composition and rheological properties. Asphalts two grades softer than that normally used in hot-mixed asphalt concrete were used with the additives. Binder tests included penetration at two temperatures, viscosity at various temperatures and by various methods, softening point, flash point, specific gravity, rolling thin film oven test, ductility, heat stability, infrared analysis before and after artificial aging, nuclear magnetic resonance, viscoelastic analysis, stress relaxation, and Rostler-Sternberg and Corbett analyses. Energies of interaction between selected asphalts and additives were measured using a microcalorimeter. Paving mixture tests included Hveem and Marshall stabilities, resilient modulus vs. temperature, indirect tension vs. temperature and loading rate, resistance to moisture damage, flexural fatigue, creep/permanent deformation, fracture resistance and fracture healing. The mixture test results were used with the VESYS IV structural subsystem to predict the effects of the additives on pavement- performance, cracking, rutting, and roughness. All additives demonstrated the ability to substantially alter the temperature susceptibility of asphalt concrete mixtures