The anticoagulation length of therapy and risk of new adverse events in venous thromboembolism (ALTERNATIVE) study: Design and survey results.

The Anticoagulation Length of Therapy and Risk of New Adverse Events In Venous Thromboembolism (ALTERNATIVE) study was designed to compare the benefits and harms of different treatment options for extended treatment of venous thromboembolism (VTE). In this paper, we describe the study cohort, survey data collection, and preliminary results. We identified 39,605 adult patients (age ≥ 18 years) from two large integrated health care delivery systems who were diagnosed with incident VTE and received initial anticoagulation therapy of 3 months or longer. A subset of the cohort (12,737) was invited to participate in a survey. Surveys were completed in English, Spanish or Mandarin via a mailed questionnaire, an online secure web link, or telephone. The survey domains included demographics, personal medical history, anticoagulant treatment history, anticoagulant treatment satisfaction, health-related quality of life and health literacy. A total of 5,017 patients participated in the survey for an overall response rate of 39.4%. The mean (SD) age of the survey respondents was 63.0 (14.5) years and self-reported race was 76.0% White/European, 11.1% Black/African American, and 3.8% Asian/Pacific Islander and 14.0% reported Hispanic ethnicity. Sixty percent of respondents completed the web survey, while 29.0% completed the mail-in paper survey, and 11.0% completed the survey via telephone. The ALTERNATIVE Study will address knowledge gaps by comparing several treatment alternatives for the extended management of VTE so that this information could be used by patients and clinicians to make more informed, patient-centered treatment choices

COVID-19 and Risk of VTE in Ethnically Diverse Populations.

BACKGROUND: Limited existing data suggest that the novel COVID-19 may increase risk of VTE, but information from large, ethnically diverse populations with appropriate control participants is lacking. RESEARCH QUESTION: Does the rate of VTE among adults hospitalized with COVID-19 differ from matched hospitalized control participants without COVID-19? STUDY DESIGN AND METHODS: We conducted a retrospective study among hospitalized adults with laboratory-confirmed COVID-19 and hospitalized adults without evidence of COVID-19 matched for age, sex, race or ethnicity, acute illness severity, and month of hospitalization between January 2020 and August 2020 from two integrated health care delivery systems with 36 hospitals. Outcomes included VTE (DVT or pulmonary embolism ascertained using diagnosis codes combined with validated natural language processing algorithms applied to electronic health records) and death resulting from any cause at 30 days. Fine and Gray hazards regression was performed to evaluate the association of COVID-19 with VTE after accounting for competing risk of death and residual differences between groups, as well as to identify predictors of VTE in patients with COVID-19. RESULTS: We identified 6,319 adults with COVID-19 and 6,319 matched adults without COVID-19, with mean ± SD age of 60.0 ± 17.2 years, 46% women, 53.1% Hispanic, 14.6% Asian/Pacific Islander, and 10.3% Black. During 30-day follow-up, 313 validated cases of VTE (160 COVID-19, 153 control participants) and 1,172 deaths (817 in patients with COVID-19, 355 in control participants) occurred. Adults with COVID-19 showed a more than threefold adjusted risk of VTE (adjusted hazard ratio, 3.48; 95% CI, 2.03-5.98) compared with matched control participants. Predictors of VTE in patients with COVID-19 included age ≥ 55 years, Black race, prior VTE, diagnosed sepsis, prior moderate or severe liver disease, BMI ≥ 40 kg/m2, and platelet count > 217 k/μL. INTERPRETATION: Among ethnically diverse hospitalized adults, COVID-19 infection increased the risk of VTE, and selected patient characteristics were associated with higher thromboembolic risk in the setting of COVID-19

The anticoagulation length of therapy and risk of new adverse events in venous thromboembolism (ALTERNATIVE) study: Design and survey results

The Anticoagulation Length of Therapy and Risk of New Adverse Events In Venous Thromboembolism (ALTERNATIVE) study was designed to compare the benefits and harms of different treatment options for extended treatment of venous thromboembolism (VTE). In this paper, we describe the study cohort, survey data collection, and preliminary results. We identified 39,605 adult patients (age ≥ 18 years) from two large integrated health care delivery systems who were diagnosed with incident VTE and received initial anticoagulation therapy of 3 months or longer. A subset of the cohort (12,737) was invited to participate in a survey. Surveys were completed in English, Spanish or Mandarin via a mailed questionnaire, an online secure web link, or telephone. The survey domains included demographics, personal medical history, anticoagulant treatment history, anticoagulant treatment satisfaction, health-related quality of life and health literacy. A total of 5,017 patients participated in the survey for an overall response rate of 39.4%. The mean (SD) age of the survey respondents was 63.0 (14.5) years and self-reported race was 76.0% White/European, 11.1% Black/African American, and 3.8% Asian/Pacific Islander and 14.0% reported Hispanic ethnicity. Sixty percent of respondents completed the web survey, while 29.0% completed the mail-in paper survey, and 11.0% completed the survey via telephone. The ALTERNATIVE Study will address knowledge gaps by comparing several treatment alternatives for the extended management of VTE so that this information could be used by patients and clinicians to make more informed, patient-centered treatment choices

Estimating informal household food waste in developed countries the case of Australia /

Food waste is a global problem. In Australia alone, it is estimated that households throw away AU$5.2 billion worth of food (AU$616 per household) each year. Developed countries have formal waste management systems that provide measures of food waste. However, much remains unknown about informal food waste disposal routes and volumes outside of the formal system. This article provides indicative metrics of informal food waste by identifying, in detail, five of the dominant informal food waste disposal routes used by Australian households: home composting, feeding scraps to pets, sewer disposal, giving to charity, and dumping or incineration. Informal waste generation rates are then calculated from three primary data sources, in addition to data from previous Australian and UK surveys, using a weighted average method in conjunction with a Monte-Carlo simulation. We find that the average Australian household disposes of 2.6 kgs of food waste per week through informal routes (1.7 kgs via household composting, 0.2 kgs via animals, and 0.6 kgs via sewage). This represents 20% of Australian household food waste flows. Our results highlight that informal food waste is a sizable food waste flow from Australian homes, deserving of greater research and government attention. Our examination of the full extent of food waste by disposal mode provides waste managers and policy makers with clear disposal routes to target for behaviour change and positive environmental outcomes

Estimating informal household food waste in developed countries : the case of Australia

Food waste is a global problem. In Australia alone, it is estimated that households throw away AU$5.2 billion worth of food (AU$616 per household) each year. Developed countries have formal waste management systems that provide measures of food waste. However, much remains unknown about informal food waste disposal routes and volumes outside of the formal system. This article provides indicative metrics of informal food waste by identifying, in detail, five of the dominant informal food waste disposal routes used by Australian households: home composting, feeding scraps to pets, sewer disposal, giving to charity, and dumping or incineration. Informal waste generation rates are then calculated from three primary data sources, in addition to data from previous Australian and UK surveys, using a weighted average method in conjunction with a Monte-Carlo simulation. We find that the average Australian household disposes of 2.6 kgs of food waste per week through informal routes (1.7 kgs via household composting, 0.2 kgs via animals, and 0.6 kgs via sewage). This represents 20% of Australian household food waste flows. Our results highlight that informal food waste is a sizable food waste flow from Australian homes, deserving of greater research and government attention. Our examination of the full extent of food waste by disposal mode provides waste managers and policy makers with clear disposal routes to target for behaviour change and positive environmental outcomes