Clinical and laboratory practice for lupus anticoagulant testing : an International Society of Thrombosis and Haemostasis Scientific and Standardization Committee survey

Background Current guidelines have contributed to more uniformity in the performance and interpretation of lupus anticoagulant (LA) testing. However, points to reconsider include testing for LA in patients on anticoagulation, cut-off values, and interpretation of results. Objectives The aim of this International Society of Thrombosis and Haemostasis Scientific and Standardization committee (ISTH SSC) questionnaire was to capture the spectrum of clinical and laboratory practice in LA detection, focusing on variability in practice, so that the responses could inform further ISTH SSC recommendations. Methods Members of the ISTH SSC on Lupus Anticoagulant/Antiphospholipid Antibodies and participants of the Lupus Anticoagulant/Antiphospholipid Antibodies Programme of the External quality Control of diagnostic Assays and Tests Foundation were invited to complete a questionnaire on LA testing that was placed on the ISTH website using RedCap, with data tallied using simple descriptive statistics. Results There was good agreement on several key recommendations in the ISTH and other guidelines on LA testing, such as sample processing, principles of testing, choice of tests, repeat testing to confirm persistent positivity and the use of interpretative reporting. However, the results highlight that there is less agreement on some other aspects, including the timing of testing in relation to thrombosis or pregnancy, testing in patients on anticoagulation, cut-off values, and calculation and interpretation of results. Conclusions Although some of the variability in practice in LA testing reflects the lack of substantive data to underpin evidence-based recommendations, a more uniform approach, based on further guidance, should reduce the inter-center variability of LA testing

FPGA based intelligent co-operative processor in memory architecture

Copyright International Association of EngineersIn a continuing effort to improve computer system performance, Processor-In-Memory (PIM) architecture has emerged as an alternative solution. PIM architecture incorporates computational units and control logic directly on the memory to provide immediate access to the data. To exploit the potential benefits of PIM, a concept of Co-operative Intelligent Memory (CIM) was developed by the intelligent system group of University of Hertfordshire, based on the previously developed Co-operative Pseudo Intelligent Memory (CPIM). This paper provides an overview on previous works (CPIM, CIM) and realization of CPIM over two scenarios, cumulative successive addition, and non-cumulative successive addition, using Nexar 2004 EDS tool as a design environment to target device (SPARTAN II, XC2S300E-6PQ208C). The performance (speedup) is then measured against an SISD without significant performance acceleration methods to ensure a speedup assessment obtained against base-line architecture

Validation of a tearing mode locking model using a database of disruptive plasmas at ASDEX Upgrade

An exploratory study is presented that aims at validating a model for mode locking on the basis of a large set of ASDEX Upgrade (AUG) discharges. Not discriminating between plasma configurations, the model allows to estimate the duration of the deceleration phase, as well as the critical mode width for locking. Both quantities are important for the design of disruption avoidance algorithms that aim to affect the MHD mode rotation. It was found that the model successfully described locking of large modes in those cases where the deceleration started in a quasi-stationary phase of the discharge (i.e. with low variability of the global plasma angular momentum prior to mode seeding) and where deceleration took place over temporal intervals comparable to the momentum confinement time. Theoretical braking curves and locking durations predicted with the model were in good quantitative agreement with the experiment. On the other hand, the model failed to reproduce the braking curves of modes appearing towards the end of a transient phase, e.g. during an impurity influx or when approaching the disruptive density limit. It can be concluded that the modes were not the primary cause of the plasma momentum losses within the scope of the model. A modified mode equation of motion is proposed, which accounts for transient variation of the plasma density, e.g. during the development of a MARFE, and its impact on braking predictions is discussed. Furthermore, it was observed that a substantial fraction of modes was rotating at the onset of a major disruptive event. Consequences of this observation on disruption prediction schemes in AUG are examined

Author Correction:Retrospective evaluation of whole exome and genome mutation calls in 746 cancer samples (Nature Communications, (2020), 11, 1, (4748), 10.1038/s41467-020-18151-y)

The original version of this Article omitted from the author list the 9th author Yize Li, who is from the ‘The McDonnell Genome Institute at Washington University, St. Louis, MO 63108, USA and Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO 63108, USA’. This has been corrected in both the PDF and HTML versions of the Article

Experience in conducting research works with masters in the directions of "Environmental engineering and water management"

The main task of higher education institutions is to train highly qualified specialists who are able to carry out scientific research and large-scale interdisciplinary projects. They are well versed not only in their specialty, but also in modern scientific achievements and developments. Tomsk Polytechnic University has vast experience in training such specialists thanks to the development of a system for performing research activities in the learning process. In the learning process, magistrates take part in conferences and competitions at various levels, which motivates specialists to engage in scientific research even after graduation

‘Minimal symptom expression’ in patients with acetylcholine receptor antibody-positive refractory generalized myasthenia gravis treated with eculizumab

Background The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension. Methods Attainment of 'minimal symptom expression' was evaluated using patient-reported outcome measures of gMG symptoms [MG activities of daily living scale (MG-ADL), 15-item MG quality of life questionnaire (MG-QOL15)] at the completion of REGAIN and during the open-label extension. 'Minimal symptom expression' was defined as MG-ADL total score of 0-1 or MG-QOL15 total score of 0-3. Results At REGAIN week 26, more eculizumab-treated patients achieved 'minimal symptom expression' versus placebo [MG-ADL: 21.4% vs 1.7%; difference 19.8%; 95% confidence interval (CI) 8.5, 31.0; p = 0.0007; MG-QOL15: 16.1% vs 1.7%; difference 14.4%; 95% CI 4.3, 24.6; p = 0.0069]. During the open-label extension, the proportion of patients in the placebo/eculizumab group who achieved 'minimal symptom expression' increased after initiating eculizumab treatment and was sustained through 130 weeks of open-label eculizumab (MG-ADL: 1.7 to 27.8%; MG-QOL15: 1.7 to 19.4%). At extension study week 130, similar proportions of patients in the eculizumab/eculizumab and placebo/eculizumab groups achieved 'minimal symptom expression' (MG-ADL: 22.9% and 27.8%, respectively, p = 0.7861; MG-QOL15: 14.3% and 19.4%, respectively, p = 0.7531). The long-term tolerability of eculizumab was consistent with previous reports. Conclusions Patients with AChR+ refractory gMG who receive eculizumab can achieve sustained 'minimal symptom expression' based on patient-reported outcomes. 'Minimal symptom expression' may be a useful tool in measuring therapy effectiveness in gMG

Autoantibodies neutralizing type I IFNs are present in ~4% of uninfected individuals over 70 years old and account for ~20% of COVID-19 deaths

Publisher Copyright: © 2021 The Authors, some rights reserved.Circulating autoantibodies (auto-Abs) neutralizing high concentrations (10 ng/ml; in plasma diluted 1:10) of IFN-alpha and/or IFN-omega are found in about 10% of patients with critical COVID-19 (coronavirus disease 2019) pneumonia but not in individuals with asymptomatic infections. We detect auto-Abs neutralizing 100-fold lower, more physiological, concentrations of IFN-alpha and/or IFN-omega (100 pg/ml; in 1:10 dilutions of plasma) in 13.6% of 3595 patients with critical COVID-19, including 21% of 374 patients >80 years, and 6.5% of 522 patients with severe COVID-19. These antibodies are also detected in 18% of the 1124 deceased patients (aged 20 days to 99 years; mean: 70 years). Moreover, another 1.3% of patients with critical COVID-19 and 0.9% of the deceased patients have auto-Abs neutralizing high concentrations of IFN-beta. We also show, in a sample of 34,159 uninfected individuals from the general population, that auto-Abs neutralizing high concentrations of IFN-alpha and/or IFN-omega are present in 0.18% of individuals between 18 and 69 years, 1.1% between 70 and 79 years, and 3.4% >80 years. Moreover, the proportion of individuals carrying auto-Abs neutralizing lower concentrations is greater in a subsample of 10,778 uninfected individuals: 1% of individuals 80 years. By contrast, auto-Abs neutralizing IFN-beta do not become more frequent with age. Auto-Abs neutralizing type I IFNs predate SARS-CoV-2 infection and sharply increase in prevalence after the age of 70 years. They account for about 20% of both critical COVID-19 cases in the over 80s and total fatal COVID-19 cases.Peer reviewe

Intraoperative ventilator settings and their association with postoperative pulmonary complications in neurosurgical patients : post-hoc analysis of LAS VEGAS study

Background Limited information is available regarding intraoperative ventilator settings and the incidence of postoperative pulmonary complications (PPCs) in patients undergoing neurosurgical procedures. The aim of this post-hoc analysis of the 'Multicentre Local ASsessment of VEntilatory management during General Anaesthesia for Surgery' (LAS VEGAS) study was to examine the ventilator settings of patients undergoing neurosurgical procedures, and to explore the association between perioperative variables and the development of PPCs in neurosurgical patients. Methods Post-hoc analysis of LAS VEGAS study, restricted to patients undergoing neurosurgery. Patients were stratified into groups based on the type of surgery (brain and spine), the occurrence of PPCs and the assess respiratory risk in surgical patients in Catalonia (ARISCAT) score risk for PPCs. Results Seven hundred eighty-four patients were included in the analysis; 408 patients (52%) underwent spine surgery and 376 patients (48%) brain surgery. Median tidal volume (V-T) was 8 ml [Interquartile Range, IQR = 7.3-9] per predicted body weight; median positive end-expiratory pressure (PEEP) was 5 [3 to 5] cmH(2)0. Planned recruitment manoeuvres were used in the 6.9% of patients. No differences in ventilator settings were found among the sub-groups. PPCs occurred in 81 patients (10.3%). Duration of anaesthesia (odds ratio, 1.295 [95% confidence interval 1.067 to 1.572]; p = 0.009) and higher age for the brain group (odds ratio, 0.000 [0.000 to 0.189]; p = 0.031), but not intraoperative ventilator settings were independently associated with development of PPCs. Conclusions Neurosurgical patients are ventilated with low V-T and low PEEP, while recruitment manoeuvres are seldom applied. Intraoperative ventilator settings are not associated with PPCs

Palliative care competencies for geriatricians across Europe : a Delphi consensus study

Key summary points Aim to develop a set of specific palliative care competencies to be recommended for training at a postgraduate level of geriatricians across Europe. Findings A list of 35 palliative care competencies for geriatricians is now available for implementation in the different European countries. Message Future action are needed to support implementation and evaluation of the recommendations based upon key performance indicators within different health care systems. Purpose Integration of palliative care competencies with geriatric medicine is important for quality of care for older people, especially in the last years of their life. Therefore, knowledge and skills about palliative care for older people should be mandatory for geriatricians. The European Geriatric Medicine Society (EuGMS) has launched a postgraduate curriculum for geriatric medicine recently. Aim Based on this work, the Special Interest Group (SIG) on Palliative care in collaboration with the SIG in Education and Training aimed to develop a set of specific palliative care competencies to be recommended for training at a postgraduate level. Methods Competencies were defined using a modified Delphi technique based upon a Likert like rating scale. A template to kick off the first round and including 46 items was developed based on pre-existing competencies developed in Switzerland and Belgium. Results Three Delphi rounds were necessary to achieve full consensus. Experts came from 12 EU countries. In the first round, the wording of 13 competencies and the content of 10 competencies were modified. We deleted or merged ten competencies, mainly because they were not specific enough. At the end of the 2nd round, one competence was deleted and for three questions the wordings were modified. These modifications had the agreement of the participants during the last round. Conclusion A list of 35 palliative care competencies for geriatricians is now available for implementation in European countries