Impact of COVID-19 on the prescribing pattern of oral anticoagulants for atrial fibrillation after cardiac surgery

Background: Because of logistic challenges associated with the COVID-19 pandemic, direct oral anticoagulants (DOAC) were favored over warfarin in patients presenting postoperative atrial fibrillation (AF) after cardiac surgery in our institution. Considering the limited evidence supporting the use of DOAC in this context, we sought to evaluate the safety and efficacy of this practice change. Methods: A retrospective study was performed with patients from the Quebec City metropolitan area who were hospitalized at the Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval following cardiac surgery and who required oral anticoagulant (OAC) for postoperative AF. The primary objective was to compare the pre- and peri-COVID-19 period for OAC prescribing patterns and the incidence of thrombotic and bleeding events at 3 months post-surgery. The secondary objective was to compare DOAC to warfarin in terms of thrombotic events and bleeding events. Results: A total of 233 patients were included, 142 from the pre-COVID-19 and 91 from the peri-COVID-19 period, respectively. Both groups had equivalent proportions of preoperative AF (48%) and new-onset postoperative AF (52%). The proportion of patients treated with a DOAC increased from 13% pre-COVID-19 to 82% peri-COVID-19. This change in practice was not associated with a significant difference in the incidence of thrombotic or bleeding events 3 months postoperatively. However, compared to DOAC, warfarin was associated with a higher incidence of major bleeding. Only 1 thrombotic event was reported with warfarin, and none were reported with DOAC. Conclusion: This study suggests that DOAC are an effective and safe alternative to warfarin to treat postoperative AF after cardiac surgery and that this practice can be safely maintained

Quantification of levoglucosan and its isomers by High Performance Liquid Chromatography - Electrospray Ionization tandem Mass Spectrometry and its application to atmospheric and soil samples

http://www.atmos-meas-tech-discuss.net/4/4539/2011/amtd-4-4539-2011.htmlInternational audienceThe determination of atmospheric concentrations of levoglucosan and its two isomers, unambiguous tracers of biomass burning emissions, became even more important with the development of wood as renewable energy for domestic heating. Many researches demonstrated the increase during recent years of atmospheric particulate matter load due to domestic biomass combustion in developed countries. Analysis of biomass burning tracers is traditionally performed with Gas Chromatography-Mass Spectrometry (GC-MS) technique after derivatization and requires an organic solvent extraction. A simpler and faster technique using Liquid Chromatography - Electrospray Ionisation - tandem Mass Spectrometry (LC-ESI-MS/MS) was optimized for the analysis of levoglucosan, mannosan and galactosan isomers after an aqueous extraction. This technique allows a good separation between the three compounds in a very reduced time (runtime ~5 min). LOD and LOQ of this method are 30 μg l−1 and 100 μg l−1 respectively, allowing the use of filters from low-volume sampler (as commonly used in routine campaigns). A comparison of simultaneous levoglucosan measurements by GC-MS and LC-ESI-MS/MS for about 50 samples coming from different types of sampling sites and seasons was realized and shows very good agreement between the two methods. Therefore LC-ESI-MS/MS method can be used as an alternative to GC-MS particularly for measurement campaigns in routine where analysis time is important and detection limit is reduced. This paper shows that this method is also applicable to other environmental sample types like soil

Circulating steroid levels as correlates of adipose tissue phenotype in premenopausal women

Background: Obesity-related alterations in the circulating steroid hormone profile remain equivocal in women. Our objective was to identify circulating steroid levels that relate to increased adiposity and altered adipose phenotype in premenopausal women. Materials and methods: In a sample of 42 premenopausal women (age 46±3 years; BMI 27.1±4.2 kg/m2 ), 19 plasma steroids were quantified by ESI-LC-MS/MS. Body composition and fat distribution were assessed by dual-energy X-ray absorptiometry and computed tomography, respectively. Markers of adipose tissue function including adipocyte size distributions, radiological attenuation, and macrophage infiltration were also analyzed in surgically obtained visceral and subcutaneous fat samples. Results: Many negative correlations were observed between adiposity measurements such as BMI, body fat percentage or total abdominal adipose tissue area and plasma levels of androstenedione (r=-0.33 to -0.39, p≤0.04), androsterone (r=-0.30 to -0.38, p≤0.05) and plasma levels of steroid precursor pregnenolone (r=-0.36 to -0.46, p≤0.02). Visceral adipocyte hypertrophy was observed in patients with low pregnenolone concentrations (p<0.05). Visceral adipose tissue radiologic attenuation, a potential marker of adipocyte size, was also positively correlated with pregnenolone levels (r=0.33, p<0.05). Low levels of pregnenolone were related to increased number of macrophages infiltrating visceral and subcutaneous adipose tissue (p<0.05). Conclusion: Plasma levels of androgens and their precursors are lower in women with increased adiposity and visceral adipocyte hypertrophy. Low circulating pregnenolone concentration may represent a marker of adipose tissue dysfunction

Structural aspects of on-farm demonstrations: key considerations in the planning and design process

Research on the adoption and diffusion of innovations has consistently confirmed that one of farmers’ most commonly cited sources of information and ideas is other farmers. Demonstrations concern the practical exhibition (and explanation) of how something works and have for long been one of the most important extension techniques. On-farm demonstrations facilitate an effective learning situation for farmers to “See the crops themselves”, “interact with the scientists and extension workers on the field”, and “get doubts clarified themselves”. In the literature concerning on-farm demonstrations, a wide range of structural characteristics are described. These differ according to the actors/networks involved and their roles, the audience/ attendees, the network structure and its characteristics, resources, finances and incentives, and characteristics related to the farm (geographic location, accessibility, etc.). The current paper will elaborate on such structural characteristics and will thus contribute to building a provisional model of the linkages between rationale (goals, objectives, topics), structural factors, functions and results (output, outcomes and impact)

Effects of a prehabilitation program on patients recovery following spinal stenosis surgery: study protocol for a randomized controlled trial

Background Degenerative lumbar spinal stenosis is a prevalent condition in adults over the age of 65 and often leads to deconditioning. Although the benefits of surgery outweigh those of conservative approaches, physical rehabilitation may be used to improve function and to minimize the risk of persistent dysfunction. This study protocol was designed to establish the feasibility of a full-scale randomized controlled trial and to assess the efficacy of an active preoperative intervention program on the improvement of clinical parameters and functional physical capacity in patients undergoing surgery for lumbar spinal stenosis. Methods/Design Forty patients will be recruited and randomly allocated to one of the 2 treatment arms: 6?weeks supervised preoperative rehabilitation program (experimental group) or hospital standard preoperative management (control group). The intervention group will be trained three times per week, with each session aiming to improve strength, muscular endurance, spinal stabilization and cardiovascular fitness. Intensity and complexity of exercises will be gradually increased throughout the sessions, depending on each participant?s individual progress. Primary outcomes are level of low back disability and level of pain. Secondary outcomes include the use of pain medication, quality of life, patient?s global impression of change, lumbar extensor muscles endurance, maximum voluntary contraction of lumbar flexor and extensor muscles, maximum voluntary contraction of knee extensors, active lumbar ranges of motion, walking abilities, and cardiovascular capacity. Both the primary and secondary outcomes will be measured at baseline, at the end of the training program (6?weeks after baseline evaluation for control participants), and at 6?weeks, 3 and 6?months postoperatively. Discussion This study will inform the design of a future large-scale trial. Improvements of physical performances before undergoing lumbar surgery may limit functional limitations occurring after a surgical intervention. Results of this study will provide opportunity to efficiently improve spinal care and advance our knowledge of favorable preoperative strategies to optimize postoperative recovery. Trial registration US National Institutes of Health Clinical Trials registry NCT02258672, 10 February 2014

Feasibility of conducting an active exercise prehabilitation program in patients awaiting spinal stenosis surgery: a randomized pilot study

Prehabilitation is defined as the process of augmenting functional capacity before surgery in preparation for the postoperative phase. This study intends to assess the feasibility of conducting a preoperative intervention program in patients with lumbar spinal stenosis and to report on the piloting of the proposed intervention. Patients were allocated to a 6-week supervised preoperative rehabilitation program or a control group. The intervention included supervised exercise sessions aimed to improve strength, muscular endurance, and spinal stabilization. Outcomes were measured at baseline, 6 weeks later and again 6 weeks, 3 months and 6 months after surgery. Sixty-five percent of admissible participants agreed to take part in the study, of which 5% dropped out before the end of the intervention period. Eighty-eight percent of potential training sessions were delivered without adverse event. Improvements were seen in favour of the experimental group at the preoperative assessment for active ranges of motion, leg pain intensity, lumbar extensor muscle endurance and walking capacities. Results show that slight modifications to the choice of outcome measures would increase feasibility of the main study. The absence of adverse events coupled with positive changes seen in dependant outcome measures warrant the conduct of a full-scale trial assessing the effectiveness of the intervention. © 2019, The Author(s)

Enabling learning in demonstration farms: a literature review

Demonstration farms have a long tradition and have proved to be an effective means of supporting farmers in problem solving at the farm level. The new demands of complex and uncertain agricultural systems call for a renewed understanding of the approaches used and the concepts that underpin them, in particular those relating to farmer learning in the demonstration. A multi-faceted demonstration ‘learning system’ creates different contexts or conditions that enable learning. Of these contexts and conditions, structural and functional characteristics provide a good framework for analysis. This review paper aims to identify the key functional characteristics that enable learning in demonstrations. The paper provides a narrative review which presents, and builds on, the state of the art with respect to the main topic – enabling learning in demonstration farms. It draws on a wide body of literature, firstly with respect to theoretical insights into different forms of learning (single and double loop) and social learning processes, and secondly with respect to the factors that enable learning at programme level (e.g. strategies and approaches) and at farm and event level (e.g. mediation techniques). In doing this, it provides the building blocks for analysing the functional characteristics relevant to enabling learning in demonstrations. It concludes by drawing out the links between the demonstration objective, the functional characteristics and different forms and processes of learning. This work is taken from work in the EU H2020 project AgriDemo-F2F project and complements two other papers in this Special issue which examine the structural enabling environment and the cognitive processes of farm level peer-peer learning. An increased understanding of how learning through demonstration can be enabled in an increasingly complex context will help to develop institutions and programmes that aim to foster innovation in sustainable agriculture

A conceptual framework to investigate the role of peer learning processes at on-farm demonstrations in the light of sustainable agriculture

Peer-to-peer approaches seem promising in enhancing sustainable agricultural systems. However, the kind of learning processes that underlie peer learning approaches have not been sufficiently studied in farmer-to-farmer settings. To answer the question how peer learning processes can foster farmer learning for sustainable agriculture, we will develop empirical research tools that can give us more insight into these processes as currently occurring in on-farm demonstration settings. In this explorative paper, we explore the common ground on how to design an integrative framework of effective farmer-to-farmer learning processes at on-farm demonstrations in the light of sustainable agriculture. During the in-depth literature search, we focussed on three main subfields in scientific literature addressing effective learning processes: peer assisted learning (PAL) process model, adult learning theory and education for sustainable development (ESD). We link effective learning processes supported by these three subfields with findings from previous research on farmer-to-farmer practices. The comparison of the three subfields led to a conceptual framework with core interacting effective learning processes defined as engagement, interactive knowledge creation and initiated communication, fostering cognitive conflict and critical reflection

Colorectal cancer linkage on chromosomes 4q21, 8q13, 12q24, and 15q22

A substantial proportion of familial colorectal cancer (CRC) is not a consequence of known susceptibility loci, such as mismatch repair (MMR) genes, supporting the existence of additional loci. To identify novel CRC loci, we conducted a genome-wide linkage scan in 356 white families with no evidence of defective MMR (i.e., no loss of tumor expression of MMR proteins, no microsatellite instability (MSI)-high tumors, or no evidence of linkage to MMR genes). Families were ascertained via the Colon Cancer Family Registry multi-site NCI-supported consortium (Colon CFR), the City of Hope Comprehensive Cancer Center, and Memorial University of Newfoundland. A total of 1,612 individuals (average 5.0 per family including 2.2 affected) were genotyped using genome-wide single nucleotide polymorphism linkage arrays; parametric and non-parametric linkage analysis used MERLIN in a priori-defined family groups. Five lod scores greater than 3.0 were observed assuming heterogeneity. The greatest were among families with mean age of diagnosis less than 50 years at 4q21.1 (dominant HLOD = 4.51, α = 0.84, 145.40 cM, rs10518142) and among all families at 12q24.32 (dominant HLOD = 3.60, α = 0.48, 285.15 cM, rs952093). Among families with four or more affected individuals and among clinic-based families, a common peak was observed at 15q22.31 (101.40 cM, rs1477798; dominant HLOD = 3.07, α = 0.29; dominant HLOD = 3.03, α = 0.32, respectively). Analysis of families with only two affected individuals yielded a peak at 8q13.2 (recessive HLOD = 3.02, α = 0.51, 132.52 cM, rs1319036). These previously unreported linkage peaks demonstrate the continued utility of family-based data in complex traits and suggest that new CRC risk alleles remain to be elucidated. © 2012 Cicek et al

Enabling learning in demonstration farms: a literature review

Demonstration farms have a long tradition and have proved to be an effective means of supporting farmers in problem solving at the farm level. The new demands of complex and uncertain agricultural systems call for a renewed understanding of the approaches used and the concepts that underpin them, in particular those relating to farmer learning in the demonstration. A multi-faceted demonstration ‘learning system’ creates different contexts or conditions that enable learning. Of these contexts and conditions, structural and functional characteristics provide a good framework for analysis. This review paper aims to identify the key functional characteristics that enable learning in demonstrations. The paper provides a narrative review which presents, and builds on, the state of the art with respect to the main topic – enabling learning in demonstration farms. It draws on a wide body of literature, firstly with respect to theoretical insights into different forms of learning (single and double loop) and social learning processes, and secondly with respect to the factors that enable learning at programme level (e.g. strategies and approaches) and at farm and event level (e.g. mediation techniques). In doing this, it provides the building blocks for analysing the functional characteristics relevant to enabling learning in demonstrations. It concludes by drawing out the links between the demonstration objective, the functional characteristics and different forms and processes of learning. This work is taken from work in the EU H2020 project AgriDemo-F2F project and complements two other papers in this Special issue which examine the structural enabling environment and the cognitive processes of farm level peer-peer learning. An increased understanding of how learning through demonstration can be enabled in an increasingly complex context will help to develop institutions and programmes that aim to foster innovation in sustainable agriculture