Extended Thromboprophylaxis with Betrixaban in Acutely Ill Medical Patients

Background Patients with acute medical illnesses are at prolonged risk for venous thrombosis. However, the appropriate duration of thromboprophylaxis remains unknown. Methods Patients who were hospitalized for acute medical illnesses were randomly assigned to receive subcutaneous enoxaparin (at a dose of 40 mg once daily) for 10±4 days plus oral betrixaban placebo for 35 to 42 days or subcutaneous enoxaparin placebo for 10±4 days plus oral betrixaban (at a dose of 80 mg once daily) for 35 to 42 days. We performed sequential analyses in three prespecified, progressively inclusive cohorts: patients with an elevated d-dimer level (cohort 1), patients with an elevated d-dimer level or an age of at least 75 years (cohort 2), and all the enrolled patients (overall population cohort). The statistical analysis plan specified that if the between-group difference in any analysis in this sequence was not significant, the other analyses would be considered exploratory. The primary efficacy outcome was a composite of asymptomatic proximal deep-vein thrombosis and symptomatic venous thromboembolism. The principal safety outcome was major bleeding. Results A total of 7513 patients underwent randomization. In cohort 1, the primary efficacy outcome occurred in 6.9% of patients receiving betrixaban and 8.5% receiving enoxaparin (relative risk in the betrixaban group, 0.81; 95% confidence interval [CI], 0.65 to 1.00; P=0.054). The rates were 5.6% and 7.1%, respectively (relative risk, 0.80; 95% CI, 0.66 to 0.98; P=0.03) in cohort 2 and 5.3% and 7.0% (relative risk, 0.76; 95% CI, 0.63 to 0.92; P=0.006) in the overall population. (The last two analyses were considered to be exploratory owing to the result in cohort 1.) In the overall population, major bleeding occurred in 0.7% of the betrixaban group and 0.6% of the enoxaparin group (relative risk, 1.19; 95% CI, 0.67 to 2.12; P=0.55). Conclusions Among acutely ill medical patients with an elevated d-dimer level, there was no significant difference between extended-duration betrixaban and a standard regimen of enoxaparin in the prespecified primary efficacy outcome. However, prespecified exploratory analyses provided evidence suggesting a benefit for betrixaban in the two larger cohorts. (Funded by Portola Pharmaceuticals; APEX ClinicalTrials.gov number, NCT01583218. opens in new tab.

Composition of Seed Essential Oils of Rhododendron tomentosum

International audienceFor the first time, the chemical composition of the seed essential oil of Rhododendron tomentosum was determined. Forty-seven compounds were identified, comprising 91.7% of the total oil. Palustrol (38.3%) and ledol (27.0%) were the predominant constituents. Some constituents, such as b-pinene oxide, iso-menthyl acetate, nerolidyl acetate, cadalene and guaiazulene were characteristic only for the seeds and were identified for the first time in Rh. Tomentosum oils. For comparison purposes, the essential oil isolated from the shoots of the same plant were analyzed [GC(FID) in combination with RIs, GC-MS and 13C NMR]. More than a half of the oil was comprised of ledol (36.5%) and palustrol (21.0%). Quantitative analysis of ascaridol, a heat-sensitive compound, was carried out by 13C NMR spectroscopy. Indeed, ascaridol undergoes partial thermal isomerization to iso-ascaridol during GC analyses

Towards a framework for customizing the public services

Processes are the primary constituents of public services and as such demand the completeness to achieve the goal of services. Ensuring the completeness of processes is a challenging task because, in recent days, they entail multiple views stemming from distinctive fields. It requires forming teams that combine deep technical and programming knowledge with business experts. These teams of experts are enormously expensive. Besides, increasingly, the public service organizations realize the need to deliver public services more quickly and personalized to the requirements of local communities or citizens. The service organizations may achieve rapid delivery of services either by hiring a team of experts or by using a solution that underpins the local (human) resources that are non IT-experts ti customize the reusable processes that encapsulate services. The former is not an ideal option for many public service organizations owing to the cost. In case of latter, unfortunately, there is no suitable solution available that can guide non IT-experts to customize processes. Thus, it is the aim of this research to deliver a framework that allows non IT-experts to customize the prefabricated and reusable end-to-end processes by parameterizing the services. This customization revolves around the reference guidelines that underpin accommodating multiple-views in a process in a consistent manner