Intraoperative Platelet and Plasma Improves Survival in Patients Operated for a rAAA: A Follow-up Evaluation

AbstractObjectivesContinued haemorrhage remains a significant contributor to mortality in massively transfused patients. We found that early administration of platelets and plasma reduced mortality from 54% to 36% in rAAA patients. The aim of the present evaluation was to evaluate whether reduced mortality in rAAA patients related to a pro-active transfusion therapy is maintained.DesignSingle-centre observational study.MethodsMortality of patients operated for rAAA 2006–07 was compared to that of patients operated 2004–05 (intervention group; n=50) and 2002–04 (control group, n=82).Results64 consecutive patients with rAAA received, similar to the intervention group, more platelets (5 and 4 vs. 0 units, P<0.05) and plasma (12 and 11 vs. 7 units, P<0.05) intraoperatively and had a higher platelet count (158 and 155 vs. 69×109/L, P<0.0001) upon arrival at the intensive care unit and the 30-day mortality remained reduced (24% and 36% vs. 56%, P<0.01 and P=0.02, respectively) as compared to the control patients.ConclusionsEarly administration of platelets and plasma, together with red blood cells maintained reduced mortality in patients operated for rAAAin a 18 month period

The Influence of Age and Sex on Genetic Associations with Adult Body Size and Shape : A Large-Scale Genome-Wide Interaction Study

Genome-wide association studies (GWAS) have identified more than 100 genetic variants contributing to BMI, a measure of body size, or waist-to-hip ratio (adjusted for BMI, WHRadjBMI), a measure of body shape. Body size and shape change as people grow older and these changes differ substantially between men and women. To systematically screen for age-and/or sex-specific effects of genetic variants on BMI and WHRadjBMI, we performed meta-analyses of 114 studies (up to 320,485 individuals of European descent) with genome-wide chip and/or Metabochip data by the Genetic Investigation of Anthropometric Traits (GIANT) Consortium. Each study tested the association of up to similar to 2.8M SNPs with BMI and WHRadjBMI in four strata (men 50y, women 50y) and summary statistics were combined in stratum-specific meta-analyses. We then screened for variants that showed age-specific effects (G x AGE), sex-specific effects (G x SEX) or age-specific effects that differed between men and women (G x AGE x SEX). For BMI, we identified 15 loci (11 previously established for main effects, four novel) that showed significant (FDR= 50y). No sex-dependent effects were identified for BMI. For WHRadjBMI, we identified 44 loci (27 previously established for main effects, 17 novel) with sex-specific effects, of which 28 showed larger effects in women than in men, five showed larger effects in men than in women, and 11 showed opposite effects between sexes. No age-dependent effects were identified for WHRadjBMI. This is the first genome-wide interaction meta-analysis to report convincing evidence of age-dependent genetic effects on BMI. In addition, we confirm the sex-specificity of genetic effects on WHRadjBMI. These results may providefurther insights into the biology that underlies weight change with age or the sexually dimorphism of body shape.Peer reviewe

A multi-criteria decision approach to decommissioning of offshore oil and gas infrastructure

Thousands of the world's offshore oil and gas structures are approaching obsolescence and will require decommissioning within the next decade. Many nations have blanket regulations requiring obsolete structures to be removed, yet this option is unlikely to yield optimal environmental, societal and economic outcomes in all situations. We propose that nations adopt a flexible approach that allows decommissioning options to be selected from the full range of alternatives (including ‘rigs-to-reefs’ options) on a case-by-case basis. We outline a method of multi-criteria decision analysis (Multi-criteria Approval, MA) for evaluating and comparing alternative decommissioning options across key selection criteria, including environmental, financial, socioeconomic, and health and safety considerations. The MA approach structures the decision problem, forces explicit consideration of trade-offs and directly involves stakeholder groups in the decision process. We identify major decommissioning options and provide a generic list of selection criteria for inclusion in the MA decision process. To deal with knowledge gaps concerning environmental impacts of decommissioning, we suggest that expert opinion feed into the MA approach until sufficient data become available. We conducted a limited trial of the MA decision approach to demonstrate its application to a complex and controversial decommissioning scenario; Platform Grace in southern California. The approach indicated, for this example, that the option ‘leave in place intact’ would likely provide best environmental outcomes in the event of future decommissioning. In summary, the MA approach will allow the environmental, social, and economic impacts of decommissioning decisions to be assessed simultaneously in a transparent manner