Cancer and thrombosis: Managing the risks and approaches to thromboprophylaxis

Patients with cancer are at increased risk of venous thromboembolism (VTE) compared with patients without cancer. This results from both the prothrombotic effects of the cancer itself and iatrogenic factors, such as chemotherapy, radiotherapy, indwelling central venous devices and surgery, that further increase the risk of VTE. Although cancer-associated thrombosis remains an important cause of morbidity and mortality, it is often underdiagnosed and undertreated. However, evidence is accumulating to support the use of low-molecular-weight heparins (LMWHs) in the secondary prevention of VTE in patients with cancer. Not only have LMWHs been shown to be at least as effective as coumarin derivatives in this setting, but they have a lower incidence of complications, including bleeding, and are not associated with the practical problems of warfarin therapy. Furthermore, a growing number of studies indicate that LMWHs may improve survival among patients with cancer due to a possible antitumor effect. Current evidence suggests that LMWHs should increasingly be considered for the long-term management of VTE in patients with cancer

Mirror Symmetry and Other Miracles in Superstring Theory

The dominance of string theory in the research landscape of quantum gravity physics (despite any direct experimental evidence) can, I think, be justified in a variety of ways. Here I focus on an argument from mathematical fertility, broadly similar to Hilary Putnam's 'no miracles argument' that, I argue, many string theorists in fact espouse. String theory leads to many surprising, useful, and well-confirmed mathematical 'predictions' - here I focus on mirror symmetry. These predictions are made on the basis of general physical principles entering into string theory. The success of the mathematical predictions are then seen as evidence for framework that generated them. I attempt to defend this argument, but there are nonetheless some serious objections to be faced. These objections can only be evaded at a high (philosophical) price.Comment: For submission to a Foundations of Physics special issue on "Forty Years Of String Theory: Reflecting On the Foundations" (edited by G. `t Hooft, E. Verlinde, D. Dieks and S. de Haro)

On Empirical Equivalence and Duality

I argue that, on a judicious reading of two existing criteria--one syntactic and the other semantic--dual theories can be taken to be empirically equivalent. The judicious reading is straightforward, but leads to the surprising conclusion that very different-looking theories can have equivalent empirical content. And thus it shows how a widespread scientific practice, of interpreting duals as empirically equivalent, can be understood by a thus-far unnoticed feature of existing accounts of empirical equivalence

On Empirical Equivalence and Duality

I argue that, on a judicious reading of two existing criteria--one syntactic and the other semantic--dual theories can be taken to be empirically equivalent. The judicious reading is straightforward, but leads to the surprising conclusion that very different-looking theories can have equivalent empirical content. And thus it shows how a widespread scientific practice, of interpreting duals as empirically equivalent, can be understood by a thus-far unnoticed feature of existing accounts of empirical equivalence

Inhibition of N1-Src kinase by a specific SH3 peptide ligand reveals a role for N1-Src in neurite elongation by L1-CAM

In the mammalian brain the ubiquitous tyrosine kinase, C-Src, undergoes splicing to insert short sequences in the SH3 domain to yield N1- and N2-Src. We and others have previously shown that the N-Srcs have altered substrate specificity and kinase activity compared to C-Src. However, the exact functions of the N-Srcs are unknown and it is likely that N-Src signalling events have been misattributed to C-Src because they cannot be distinguished by conventional Src inhibitors that target the kinase domain. By screening a peptide phage display library, we discovered a novel ligand (PDN1) that targets the unique SH3 domain of N1-Src and inhibits N1-Src in cells. In cultured neurons, PDN1 fused to a fluorescent protein inhibited neurite outgrowth, an effect that was mimicked by shRNA targeting the N1-Src microexon. PDN1 also inhibited L1-CAM-dependent neurite elongation in cerebellar granule neurons, a pathway previously shown to be disrupted in Src(−/−) mice. PDN1 therefore represents a novel tool for distinguishing the functions of N1-Src and C-Src in neurons and is a starting point for the development of a small molecule inhibitor of N1-Src

Epidemiology and pathophysiology of cancer-associated thrombosis

Venous thromboembolism (VTE) is a common complication in patients with malignant disease. First recognised by Bouillard in 1823 and later described by Trousseau in 1844, multiple studies have since provided considerable evidence for a clinical association between VTE and cancer. Across all cancers, the risk for VTE is elevated 7-fold; in certain malignancies, the risk for VTE may be increased up to 28-fold. Venous thromboembolism is the second leading cause of death in patients with cancer; among survivors, complications commonly include recurrent VTE and post-thrombotic syndrome, and (more rarely) chronic thromboembolic pulmonary hypertension, which are costly, and have a profound impact on the patient's quality of life. Tumour cells can activate blood coagulation through multiple mechanisms, including production of procoagulant, fibrinolytic, and proaggregating activities, release of proinflammatory and proangiogenic cytokines, and interacting directly with host vascular and blood cells (e.g., endothelial cells, leukocytes, and platelets) through adhesion molecules. Increasing evidence suggests that elements of the haemostatic system also have a direct role in eliciting or enhancing angiogenesis, cell survival, and metastasis. Despite the problem posed by VTE in the setting of cancer, it is evident that a significant number of oncologists do not recognise the link between cancer, its treatment, and thrombogenesis. On 22 May 2009, a group of UK-based physicians met in London, UK, to evaluate recent data on cancer thrombosis. This article (1 of 4) briefly reviews key data on the epidemiology and pathophysiology of VTE as a context for a discussion and consensus statement developed by meeting attendees, on the implications of this information for UK clinical practice

Digital engagement methods for earthquake and fire preparedness:a review

Natural or human-made hazards may occur at any time. Although one might assume that individuals plan in advance for such potentially damaging events, the existing literature indicates that most communities remain inadequately prepared. In the past, research in this area has focused on identifying the most effective ways to communicate risk and elicit preparedness by means of public hazard education campaigns and risk communication programmes. Today, web- and mobile-based technologies are offering new and far-reaching means to inform communities on how to prepare for or cope with extreme events, thus significantly contributing to community preparedness. Nonetheless, their practical efficacy in encouraging proactive hazard preparedness behaviours is not yet proven. Building on behaviour change interventions in the health field and looking in particular at earthquakes and fire hazards, the challenging RISK team has reviewed the currently active websites, Web, and mobile applications that provide information about earthquake and home fire preparedness. The review investigates the type of information provided, the modality of delivery, and the presence of behaviour change techniques in their design. The study proves that most of the digital resources focus on a single hazard and fail to provide context-sensitive information that targets specific groups of users. Furthermore, behaviour change techniques are rarely implemented in the design of these applications and their efficacy is rarely systematically evaluated. Recommendations for improving the design of Web- and mobile-based technologies are made so as to increase their effectiveness and uptake for a multi-hazard approach to earthquake and home fire preparedness