Workshop to scope and preselect indicators for criterion D3C3 under MSFD decision (EU) 2017/848 (WKD3C3SCOPE)

The workshop to scope and preselect indicators for Descriptor 3 criterion 3 under MSFD Commission Decision (EU) 2017/848 (WKD3C3SCOPE) provided a platform for experts from the EU member states and relevant regional bodies to meet and support development and progress the assessment methodology, based on a request by the EC (DGENV). WKD3C3SCOPE is the first of a series of three workshops (WKD3C3THRESHOLDS and WKSIMULD3) to provide guidance in relation to operational indicators for MSFD D3C3. The workshop was organized as a series of presentations with intermittent group discussions. On the first day of the workshop the participants discussed what defines a ‘healthy population structure’ for species with different life history traits (ToR a). During the following days, the group discussed and identified relevant D3C3 indicators (ToR b) and developed criteria to select among the identified D3C3 indicators to allow further testing and setting of thresholds at WKD3C3THRESHOLDS (ToR c). The participants found that overall, healthy fish stocks are characterized by high productivity, wide age and size structuring in the population, and the ability to quickly recover from disturbances. The groups noted that environmental factors, along with stock biomass and fishing pressure, influence the productivity and health of a stock, with environment playing a particularly large role in the recruitment of short-lived stocks. It was suggested that the age structure of a stock might be more relevant for evaluating the health of long-lived stocks. However, it was acknowledged that not all stocks have sufficient data to evaluate all proposed indicators, and a single indicator is unlikely to suffice for all stocks. Data availability, species- specific factors and regional or sub-regional variation are thus also important considerations. In relation to ToR b, the participants presented their work on potential indicators including: recruitment time-series, proportion of fish larger than the mean size of first sexual maturation, F rec/Fbar, length distribution L 90, relative proportion of old fish above A 90, indicators of spawner quality, and SSB/R. A discussion on pros/cons, benefits to the population of high or low indicator values, benefits supported by empirical evidence, applicability to data-poor stocks and benefits supported by simulation/theoretical considerations followed the presentations. Finally, in relation to ToR c, the difficulty emerged in ranking the indicators alone without considering the data used to estimate them and a new set of evaluation criteria for use in WKD3C3THRESHOLDS were defined. Based on the outputs of the meeting a list of indicators to be further evaluated has been drafted, which also emphasizes the stocks for which studies have empirically demonstrated effects on productivity. In addition to the listed indicators, indicators of genetic diversity and proportion of fish with parasite infestation were mentioned but to the knowledge of the participants, widespread data for these are currently not publicly available.info:eu-repo/semantics/publishedVersio

Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism.

BACKGROUND: Whether the oral factor Xa inhibitor edoxaban can be an alternative to warfarin in patients with venous thromboembolism is unclear. METHODS: In a randomized, double-blind, noninferiority study, we randomly assigned patients with acute venous thromboembolism, who had initially received heparin, to receive edoxaban at a dose of 60 mg once daily, or 30 mg once daily (e.g., in the case of patients with creatinine clearance of 30 to 50 ml per minute or a body weight below 60 kg), or to receive warfarin. Patients received the study drug for 3 to 12 months. The primary efficacy outcome was recurrent symptomatic venous thromboembolism. The principal safety outcome was major or clinically relevant nonmajor bleeding. RESULTS: A total of 4921 patients presented with deep-vein thrombosis, and 3319 with a pulmonary embolism. Among patients receiving warfarin, the time in the therapeutic range was 63.5%. Edoxaban was noninferior to warfarin with respect to the primary efficacy outcome, which occurred in 130 patients in the edoxaban group (3.2%) and 146 patients in the warfarin group (3.5%) (hazard ratio, 0.89; 95% confidence interval [CI], 0.70 to 1.13; P<0.001 for noninferiority). The safety outcome occurred in 349 patients (8.5%) in the edoxaban group and 423 patients (10.3%) in the warfarin group (hazard ratio, 0.81; 95% CI, 0.71 to 0.94; P=0.004 for superiority). The rates of other adverse events were similar in the two groups. A total of 938 patients with pulmonary embolism had right ventricular dysfunction, as assessed by measurement of N-terminal pro-brain natriuretic peptide levels; the rate of recurrent venous thromboembolism in this subgroup was 3.3% in the edoxaban group and 6.2% in the warfarin group (hazard ratio, 0.52; 95% CI, 0.28 to 0.98). CONCLUSIONS: Edoxaban administered once daily after initial treatment with heparin was noninferior to high-quality standard therapy and caused significantly less bleeding in a broad spectrum of patients with venous thromboembolism, including those with severe pulmonary embolism. (Funded by Daiichi-Sankyo; Hokusai-VTE ClinicalTrials.gov number, NCT00986154.)