Effect of Direct Oral Anticoagulant, Patient, and Surgery Characteristics on Clinical Outcomes in the Perioperative Anticoagulation Use for Surgery Evaluation Study.

Introduction  The Perioperative Anticoagulation Use for Surgery Evaluation (PAUSE) Study assessed a standardized perioperative management strategy in patients with atrial fibrillation who were taking a direct oral anticoagulant (DOAC) and required an elective surgery or procedure. The aim of this substudy is to analyze the safety of this management strategy across different patient subgroups, according to four presurgical variables: (1) DOAC type and dose, (2) surgery/procedure bleed risk, (3) patient renal function, and (4) age. Methods  Clinical outcomes analyzed included major bleeding (MB), arterial thromboembolism, any bleeding, and any thromboembolism. We used descriptive statistics to summarize clinical outcomes, where the frequency, proportion, and 95% confidence interval were reported. Fisher\u27s exact tests were used for testing the hypothesis of independence between the clinical outcome and patient characteristic, where the test p -values were reported. Results  There were 3,007 patients with atrial fibrillation requiring perioperative DOAC management. There was no significant difference in bleeding or thromboembolic outcomes according to DOAC type/dose regimen, renal function, or patient age. The rate of MB was significantly higher with high bleed risk procedures than low bleed risk procedures in apixaban-treated patients (2.9 vs. 0.59%; p  \u3c 0.01), but not in dabigatran-treated patients (0.88 vs. 0.91%; p  = 1.0) or rivaroxaban-treated patients (2.9 vs. 1.3%; p  = 0.06). The risk for thromboembolism did not differ according to surgery/procedure-related bleed risk. Conclusion  Our results suggest that in DOAC-treated patients who received standardized perioperative management, surgical bleed risk is an important determinant of bleeding but not thromboembolic outcomes, although this finding was not consistent across all DOACs. There were no differences in bleeding and thromboembolism according to DOAC type and dose, renal function, or age

Comprehensive Model of Jumbo Squid Dosidicus gigas Trophic Ecology in the Northern Humboldt Current System

Abstract The jumbo squid Dosidicus gigas plays an important role in marine food webs both as predator and prey. We investigated the ontogenetic and spatiotemporal variability of the diet composition of jumbo squid in the northern Humboldt Current system. For that purpose we applied several statistical methods to an extensive dataset of 3,618 jumbo squid non empty stomachs collected off Peru from 2004 to 2011. A total of 55 prey taxa was identified that we aggregated into eleven groups. Our results evidenced a large variability in prey composition as already observed in other systems. However, our data do not support the hypothesis that jumbo squids select the most abundant or energetic taxon in a prey assemblage, neglecting the other available prey. Indeed, multinomial model predictions showed that stomach fullness increased with the number of prey taxa, while most stomachs with low contents contained one or two prey taxa only. Our results therefore question the common hypothesis that predators seek locally dense aggregations of monospecific prey. In addition D. gigas consumes very few anchovy Engraulis ringens in Peru, whereas a tremendous biomass of anchovy is potentially available. It seems that D. gigas cannot reach the oxygen unsaturated waters very close to the coast, where the bulk of anchovy occurs. Indeed, even if jumbo squid can forage in hypoxic deep waters during the day, surface normoxic waters are then required to recover its maintenance respiration (or energy?). Oxygen concentration could thus limit the co-occurrence of both species and then preclude predator-prey interactions. Finally we propose a conceptual model illustrating the opportunistic foraging behaviour of jumbo squid impacted by ontogenetic migration and potentially constrained by oxygen saturation in surface waters

Performance of a SOA-MZI wavelength converter for label swapping using combined FSK/IM modulation format

This paper presents a theoretical and experimental assessment of the performance of a wavelength converter based on semiconductor optical amplifiers (SOA) in a MZI configuration for optical label swapping. The optical labeling of the signal is based on an FSK/IM combined modulation format for the header/payload, respectively. Experimental results are presented for a signaling scheme with payload data at 10 Gbit/s and an FSK label at 312 Mbit/s. Simulation results and measurements of the chirp properties of converted signals operating at data rates of 2.5 and 10 Gbit/s are presented. Conclusions and design guidelines are presented regarding the implications of the wavelength converter performance on the quality of the label and payload signals for fast packet/burst forwarding in optically labeled switched networks

Analyzing an Abbreviated Dynamics Concept Inventory and Its Role as an Instrument for Assessing Emergent Learning Pedagogies

The Dynamics Concept Inventory (DCI) is a validated assessment tool commonly used to evaluate student growth within core, gateway-level mechanics courses. This research explored the evaluative use of this tool within the context of Freeform – an emergent course system that buttresses active class meetings with blended and collaborative virtual learning environments, themselves founded upon extensive multimedia content and interactive forums – at Purdue University. The paper specifically considers a number of related issues including: (i) the thoughtful development (via expert content validation) and statistical reliability of an abbreviated DCI instrument, which is more amenable to in-class implementation than the much longer full DCI; (ii) the correlation of abbreviated-DCI performance with exam scores and final course grades for a dynamics course using the Freeform framework with an emphasis on both conceptual understanding and traditional problem-solving skills; and (iii) various inter-section performance metrics in a preliminary study on how an implementation of the abbreviated-DCI may help elucidate the impact of the instructor within the Freeform framework. The results of these analyses supported the validity and reliability of the abbreviated DCI tool, and demonstrated its usefulness in a formal research setting. The preliminary study suggested that the Freeform framework might normalize differences in instructor pedagogical choices and student performance across class sections. These findings indicate that the abbreviated DCI holds promise as a research instrument and lay the groundwork for future inquiry into the impact of the Freeform instructional framework on students and instructors alike

Simultaneous optical label erasure and insertion in a single wavelength conversion stage of combined FSK/IM modulated signals

Abstract-We report on optical label swapping of combined frequency-shift keying/intensity modulation (FSK/IM) modulated signals by using a single wavelength conversion stage based on a semiconductor optical amplifier Mach-Zehnder interferometer. Simultaneous FSK label erasure and insertion at a bit rate of 156 Mb/s is successfully achieved for a 10-Gb/s IM payload with transmission over two spans of 40-km standard single-mode fiber

Comparisons between Upper and Lower Extremity Deep Vein Thrombosis : A Review of the RIETE Registry

Publisher Copyright: © SAGE Publications.Background: The outcome of patients with upper extremity deep vein thrombosis (UEDVT) has not been consistently compared with that in patients with lower extremity deep vein thrombosis (LEDVT). Methods: We used the Registro Informatizado de Enfermedad Trombo Embólica (RIETE) registry to compare the outcomes during the course of anticoagulant therapy in patients with UEDVT versus outcomes in patients with LEDVT. Results: As of August 2015, 37,366 patients with acute DVT had been enrolled in RIETE: 35094 (94%) had LEDVT, 1334 (3.6%) non-catheter related UEDVT (672 unprovoked and 662 provoked) and 938 (2.5%) had catheter-related UEDVT. During the course of anticoagulation, patients with unprovoked UEDVT had a higher rate of DVT recurrences (hazard ratio [HR]: 2.22; 95% CI: 1.37-3.43) and a similar rate of PE recurrences or major bleeding than those with unprovoked LEDVT. Patients with non-catheter-related provoked UEDVT had a similar outcome than those with provoked LEDVT. Among patients with UEDVT, those with non-catheter related unprovoked UEDVT had a lower rate of PE recurrences (HR: 0.06; 95% CI: 0-0.35) and major bleeding (HR: 0.20; 95% CI: 0.08-0.46) than those with catheter-related UEDVT or those with non-catheter related provoked UEDVT (HR: 0.10; 95% CI: 0.004-0.60; and 0.22; 95% CI: 0.08-0.52, respectively). On multivariable analysis, any difference had disappeared. Conclusion: During the course of anticoagulation, patients with UEDVT had a similar outcome than those with LEDVT. Among UEDVT patients, there were some differences according to the presence of catheter or additional risk factors for DVT. These differences disappeared after adjusting for potentially confounding variables.publishersversionPeer reviewe

Trasplante de células hematopoyéticas

El trasplante de células hematopoyéticas (TCH) es la infusión de células progenitoras a fin de restablecer la función medular e inmune en pacientes con enfermedades hematológicas malignas y no malignas adquiridas y genéticas. El impacto del TCH se refleja en las alternativas de tratamiento, mayor difusión de la técnica y mejores opciones al paciente.El procedimiento consiste en la obtención de progenitores hematopoyéticos periféricos, mediante las células CD34+ (2- 2.5 x 106/Kg peso); es un excelente predictor de prendimiento del injerto. El trasplante de donante no relacionado, permite tratamiento a pacientes que carecen de donantes familiares histo-idénticos. Otra variante de TCH es el mini-trasplante, utilizando dosis bajas de quimioterapia e inmunosupresores, produciendo menos complicaciones, pero jerarquizando el efecto “injerto sobre tumor”, que permite la remisión de enfermedades neoplásicas hematológicas y no hematológicas, siendo una alternativa en países en vías de desarrollo, por la posibilidad de disminuir costos y complicaciones

Optimal Analysis for the Enhancement in the Thermal Variables Measurement by Smart and Modular Solid State Sensors

The proposed research aims to analyze and optimize the measurement of thermal physical variables during the operation of a hydrogen combustion engine. The optimal measurement of the flow, temperature, pressure, and volume is given over the hydrogen, which is the main fuel of the studied combustion motor. Hence, the success of the measurement is based on the polynomial analysis of the combustion motor operation, which needs nonlinear algorithms to get the optimal correlation of the measured physical variables as well as a high robustness and short response time during the transduction of the measured physical variable, which is achieved as a consequence of the anodic aluminum oxide (AAO) amorphous nanostructures properties that are modular solid state integration of the designed smart sensor. The short response time and high robustness is a good advantage for the designed smart sensor since it gives more time to execute sophisticated algorithms in order to get the optimal physical variables measurement. In fact, the proposed smart sensor keeps the possibility to be modular and solid state for the interaction with the hydrogen fuel as well as recognizing the presence of other molecules mixed in the fluid, which can alarm the user who is able to recognize whether it is joined oxygen or carbon residues. Therefore, the proposed research work toward a good compromise to care for the environment condition based on a cleaner combustion motor operation