Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

Discutindo a educação ambiental no cotidiano escolar: desenvolvimento de projetos na escola formação inicial e continuada de professores

A presente pesquisa buscou discutir como a Educação Ambiental (EA) vem sendo trabalhada, no Ensino Fundamental e como os docentes desta escola compreendem e vem inserindo a EA no cotidiano escolar., em uma escola estadual do município de Tangará da Serra/MT, Brasil. Para tanto, realizou-se entrevistas com os professores que fazem parte de um projeto interdisciplinar de EA na escola pesquisada. Verificou-se que o projeto da escola não vem conseguindo alcançar os objetivos propostos por: desconhecimento do mesmo, pelos professores; formação deficiente dos professores, não entendimento da EA como processo de ensino-aprendizagem, falta de recursos didáticos, planejamento inadequado das atividades. A partir dessa constatação, procurou-se debater a impossibilidade de tratar do tema fora do trabalho interdisciplinar, bem como, e principalmente, a importância de um estudo mais aprofundado de EA, vinculando teoria e prática, tanto na formação docente, como em projetos escolares, a fim de fugir do tradicional vínculo “EA e ecologia, lixo e horta”.Facultad de Humanidades y Ciencias de la Educació

STRATEGI PEMASARAN DALAM MEMPERTAHANKAN BISNIS UMKM DI TENGAH PANDEMI COVID-19 (Studi UMKM Buket Bunga Gallery Daisuki Jambi)

Penelitian ini bertujuan untuk mengetahui strategi pemasaran pada UMKM Buket Bunga Gallery Daisuki khususnya bauran pemasaran (Marketing Mix) yang diterapkan UMKM. Penelitian ini menggunakan metode kualitatif, yaitu studi kasus yang menghasilkan data-data deskriptif yang dituangkan dalam kata-kata. Sumber data pada penelitian ini menggunakan teknik Purposive Sampling dan teknik pengumpulan data pada penelitian ini penulis melakukan kunjungan langsung ke UMKM Gallery Daisuki untuk melakukan wawancara pribadi dengan Owner Ibu Rahayu. Dilengkapi dengan data-data penjualan beberapa tahun kebelakang. Peneliti menyimpulkan bahwa ada beberapa pembahasan yaitu Strategi, Kendala dan Solusi. Strategi yang dilakukan Gallery Daisuki yaitu Bauran 4P (Product, Promotion, Price, dan Place). Strategi product berupa inovasi buket masker, strategi promotion berupa potongan harga, strategi price yaitu setiap pembelian buket mendapatkan bonus masker, dan strategi place berupa fleksibilitas dalam pengiriman produk, sehingga dapat mempertahankan dan meningkatkan kualitas produk. Meskipun ada kendala dalam keuangan dan bahan baku tetapi Gallery Daisuki masih bisa menemukan solusi dan alternatifnya yaitu dengan mengelola keuangan dan menggunakan bahan baku secara efisien. Kemudian, solusi UMKM Gallery Daisuki dalam menghadapi COVID-19 adalah dengan menjaga cashflow, inovasi produk, memaksimalkan media sosial dan memaksimalkan layanan antar atau delivery

Perspectives from NHLBI Global Health Think Tank Meeting for late stage (T4) translation research

Almost three-quarters (74%) of all the noncommunicable disease burden is found within low- and middle-income countries. In September 2014, the National Heart, Lung, and Blood Institute held a Global Health Think Tank meeting to obtain expert advice and recommendations for addressing compelling scientific questions for late stage (T4) research—research that studies implementation strategies for proven effective interventions—to inform and guide the National Heart, Lung, and Blood Institute's global health research and training efforts. Major themes emerged in two broad categories: 1) developing research capacity; and 2) efficiently defining compelling scientific questions within the local context. Compelling scientific questions included how to deliver inexpensive, scalable, and sustainable interventions using alternative health delivery models that leverage existing human capital, technologies and therapeutics, and entrepreneurial strategies. These broad themes provide perspectives that inform an overarching strategy needed to reduce the heart, lung, blood, and sleep disorders disease burden and global health disparitie

Search for narrow resonances using the dijet mass spectrum in pp collisions at s√=8 TeV

Results are presented of a search for the production of new particles decaying to pairs of partons (quarks, antiquarks, or gluons), in the dijet mass spectrum in proton-proton collisions at s√=8  TeV. The data sample corresponds to an integrated luminosity of 4.0  fb−1, collected with the CMS detector at the LHC in 2012. No significant evidence for narrow resonance production is observed. Upper limits are set at the 95% confidence level on the production cross section of hypothetical new particles decaying to quark-quark, quark-gluon, or gluon-gluon final states. These limits are then translated into lower limits on the masses of new resonances in specific scenarios of physics beyond the standard model. The limits reach up to 4.8 TeV, depending on the model, and extend previous exclusions from similar searches performed at lower collision energies. For the first time mass limits are set for the Randall–Sundrum graviton model in the dijet channel

Studies on the alcoholysis of poly(3-hydroxybutyrate) and the synthesis of PHB-b-PLA block copolymer for the preparation of PLA/PHB-b-PLA blends

[[abstract]]Molecular interactions, rheological behaviors and microstructures of 1,3:2,4-dibenzylidene-d-sorbitol (DBS)/poly(ethylene glycol) (PEG) organogel-inorganic silica hybrid materials are discussed in this study. DBS can dissolve in low-molecular-weight PEG to form organogels. The self-assembly behavior of these organogels was significantly influenced by the addition of the inorganic silica. The π interactions between the phenyl rings of DBS were not influenced by silica addition; however, the addition of silica affected the intermolecular hydrogen bonding of DBS, which interacts with PEG. The silica more likely interacted with PEG and decreased the intermolecular interactions between DBS and PEG, which resulted in an increase in the self-assembly of DBS. Therefore, the gel formation time and gel dissolution temperature increased as the amount of silica increased, as determined by dynamic rheological instruments. In addition, these organogel systems were all found to exhibit spherulite-like textures under polarized optical microscopy. The addition of silica and the increased DBS self-assembly in PEG resulted in a higher self-assembly temperature of the organogels. The higher temperature resulted in the presence of fewer nucleation sites and larger spherulite sizes in these systems. Small-angle X-ray scattering results demonstrated lamellar packing in these spherulite-like morphologies. Furthermore, the organogels with silica affected the intermolecular hydrogen bonding between DBS and PEG to facilitate the self-assembly of DBS, which resulted in increased diameter sizes of the DBS nanofibrils, as observed using scanning electron microscopy. It was observed that the silica was entrapped within these nanofibrillar networks.[[notice]]補正完