Journal articles on the topic 'VTOS centres'
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1
Hughes, Captain Terry. "When is a VTS not a VTS?" Journal of Navigation 62, no. 3 (June 15, 2009): 439–42. http://dx.doi.org/10.1017/s0373463309005396.
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This paper traces the birth and formation of Vessel Traffic Services, examines the rapid growth of such schemes worldwide and notes the tendency for mandatory ship reporting systems to be operated from VTS centres. Questions are asked about this tendency and thoughts are provided.
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Stuurman, Pieter M. "The Development of Inland VTS in the Netherlands." Journal of Navigation 49, no. 3 (September 1996): 289–98. http://dx.doi.org/10.1017/s0373463300013527.
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This paper, and the two following papers, were included in the VTS-96 Symposium held in Rotterdam in April 1996. They are reproduced by kind permission of the Symposium Organizing Committee.In the Netherlands, inland waterways occupy an important position in the transport of goods to and from the hinterland. To guarantee safety at dangerous junctions, VTS-centres have been introduced since 1952. Some years ago an extra dimension was added to some of these VTScentres, namely the promotion of the optimal use of a limited waterway, to guarantee a smooth traffic flow. This is certainly necessary for the river Waal, which can be considered as the aorta to the German hinterland.Automatic data exchange between all inland VTS-centres and the German information centres along the Rhine contributes to a great extent to the operation of the VTS-centres. In case of an accident, appropriate measures can be taken immediately, saving human life and respecting the environment.
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Andiema, Nelly, and Echaune Manasi. "Female Students Participation in Technical Vocational Education and Training in West Pokot County, Kenya." East African Journal of Education Studies 3, no. 1 (April 7, 2021): 61–69. http://dx.doi.org/10.37284/eajes.3.1.314.
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Quality and affordable technical vocational education and training are one of the United Nations Sustainable Development agenda items for ensuring equal access to education for all women and men by the year 2030. This means that all women in the country need to have relevant skills for employment, job creation and entrepreneurship. Data from West Pokot County, Kenya department of technical and vocational education show the number of female students being admitted in vocational training centres for the past five years has remained low. Whereas the government of Kenya has viewed TVET as a critical element of attaining Sustainable Development Goal and Kenya’s Vision 2030 goals, the number of female students graduating from vocational training and being absorbed in the job market remains low. This study looks at enrolment trends for female students in vocational training centres and further examines factors discouraging female students from joining vocational training institutions (VTCs). To collect data, interviews and documentary evidence were used. The respondents for the study involve managers of selected VTCs in West Pokot County. Analysis of data was done through qualitative and quantitative methods. The study found out that the distribution of students in all public VTCs in West Pokot County favoured the male gender over female students. For women enrolled in various programmes, only 45.0% fully completed their programme. It was found out that courses offered in VTCs tend to attract more male students compared to female ones. The distribution of the teaching workforce in VTCs was found to be male-dominated and therefore, female students did not have role models to look up to. The research also found out that majority of girls who were unable to proceed to secondary and tertiary education were not aware of the opportunities available in VTCs in the county. The paper concludes that social-cultural factors, lack of role models and poverty were some of the barriers affecting female students’ participation in vocational education and training. The paper suggests more work needs to be done by all stakeholders to ensure that courses offered in VTCs are attractive to female students, remove social, cultural and physical barriers which prevent female students from enrolling and completing vocational training in West Pokot County, Kenya.
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Audras, Diane, Alex Zhao, Chuck Isgar, and Yucheng Tang. "Virtual teaching assistants: A survey of a novel teaching technology." International Journal of Chinese Education 11, no. 2 (May 2022): 2212585X2211216. http://dx.doi.org/10.1177/2212585x221121674.
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This study centers around virtual teaching assistants (“VTA”) and the potential application of VTAs to reduce the burden on teachers across secondary schools in China exacerbated by the Double Reduction Policy. It seeks to understand how VTAs could be implemented in the classroom while ensuring student and teacher well-being, success, and happiness. Through interviews with fourteen different experts spanning industry, academia, and education, combined with extensive review of the existing literature and ecosystem of VTAs, research shows that VTAs are potentially a major aid in the context of exam review, after school tutoring, automated grading, and student performance reporting. However, they need to be created carefully with an attentive eye towards student support to ensure that the learning experience is not diminished. It must be clearly communicated to all stakeholders that the goal of a VTA is not to replace teachers, but rather to support them such that they can spend more time with students and less time on mundane tasks.
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Wawruch, Ryszard, Jarosław Cydejko, and Marek Dziewicki. "Testing the Quality of Information on Tracked Vessels in a VTS Centre with GNSS." Journal of Navigation 52, no. 2 (May 1999): 252–58. http://dx.doi.org/10.1017/s0373463399008310.
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This paper describes selective tests performed in the areas of Gdansk and Gdynia VTS Centres. The main goal of the tests was to determine the accuracy of position, speed and course estimations measured by shore-based radar VTS tracking systems by using measurements of the same parameters available on board a tracked vessel equipped with GPS and GLONASS receivers. Six DGPS/GPS/GLONASS receivers were installed on board a survey vessel, and all of them recorded the vessel's route simultaneously with two different VTS radars – one at Gdansk and one at Gdynia (20 km apart). All DGPS receivers tracked the same reference station. Presented results show that the radar information can be used by VTS operators to provide navigation assistance within certain limits, but these limits must be understood. A more detailed description of the experiment was presented during the IALA Conference in Hamburg in June 1998.
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OLOMI, DONATH R., and ROSE S. SINYAMULE. "ENTREPRENEURIAL INCLINATIONS OF VOCATIONAL EDUCATION STUDENTS: A COMPARATIVE STUDY OF MALE AND FEMALE TRAINEES IN IRINGA REGION, TANZANIA." Journal of Enterprising Culture 17, no. 01 (March 2009): 103–25. http://dx.doi.org/10.1142/s0218495809000242.
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This study examined entrepreneurial inclinations among vocational training centres (VTCs) using a sample of 508 trainees from 12 VTCs in Iringa region, central Tanzania. A majority of VTC trainees have interest in starting own businesses, motivated primarily by the need to have control over their own lives. While gender and having taken entrepreneurship courses have no significant effects on start-up inclinations, perceived chances of getting a job and background of entrepreneurial family are positively associated with interest in entrepreneurial intention. Results suggest a need to re-examine entrepreneurship training in VET and for policy makers to be careful in promoting entrepreneurship as an alternative career for those unable to secure paid jobs.
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Maingi, Josephine M., Samuel O. Obaki, and Anthony Sang. "Institutional Factors Influencing Acquisition of Vocational Skills by Trainees in Public Vocational Training Centers in Kakamega County-Kenya." World Journal of Education and Humanities 2, no. 1 (October 9, 2019): p15. http://dx.doi.org/10.22158/wjeh.v2n1p15.
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Vocational Training Centers (VTCs) are anchored in the Technical Vocational Education and Training ACT (2013), which emphases on imparting vocational and technical skills in trainees. The purpose of this study was to determine the institutional factors influencing acquisition of vocational skills by trainees in public vocational training centres in Kakamega County. The study adopted a descriptive survey. The target population of the study was 1740 comprising of 60 county polytechnic, 60 county polytechnic principals, 480 instructors and 1200 second year finalist trainees. A sample size of 282 was picked consisting of 18 county polytechnic principals, 144 instructors and 120 second year finalist trainees as the respondents. Stratified random, purposive and simple random sampling was employed. Questionnaires were used to collect data from county polytechnic principals, instructors and trainees. Data were analyzed using both descriptive and inferential statistics. The study established that instructors were inadequate and the existing ones lacked in-service and industrial updates, financial resources were also inadequate to cater for training facilities and payment of more Board of Management instructors, tools and equipment were inadequate and not up to date and this forced instructors to use teacher-centered methods of instructing.
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Okinyi, Rachel. "Internal efficiency of public vocational training centres in Kenya." African Educational Research Journal 9, no. 2 (April 26, 2021): 375–84. http://dx.doi.org/10.30918/aerj.92.21.057.
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The efficiency of educational institutions is critical in the justification of resource allocation and use. However, some developing countries like Kenya face efficiency challenges regarding resource utilisation and the flow of students through the school system at various levels of education and programs. Past research in Kenya has focused more on resource utilisation in public schools. Very few studies have looked at the internal efficiency of public vocational training centres (VTCs). This paper assesses the level of internal efficiency in Kenya's public vocational training institutions through a mixed research design. The findings reveal low levels of internal efficiency as indicated by low enrolment, high dropout and low completion rates in the VTC institutions. The result also shows a low level of tutor utilisation. These results provide vital insights into improving the internal efficiency of public vocational training institutions in developing countries. The study recommends, among other things, subsidisation of examination fees to enhance students' completion rates.
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Aylward, Katie, Anders Johannesson, Reto Weber, Scott N. MacKinnon, and Monica Lundh. "An evaluation of low-level automation navigation functions upon vessel traffic services work practices." WMU Journal of Maritime Affairs 19, no. 3 (June 9, 2020): 313–35. http://dx.doi.org/10.1007/s13437-020-00206-y.
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Abstract The Sea Traffic Management (STM) Validation Project is a European-based initiative with ambitions to improve maritime safety and efficiency through information sharing in real time. The purpose of this paper is to evaluate the “STM services,” which can be categorized as low-level automated functions designed to improve information exchange between ship and shore. Full-scale simulated scenarios were developed and tested on 16 professional vessel traffic service (VTS) operators comparing VTS operations as they are today with the added STM functionality. Data collection involved observations which assessed the frequency and type of interactions between ships and VTS, followed by questionnaires to provide an overall assessment of the user experience. The results indicate that the frequency and method of communication patterns between VTS operators and ships will be affected by the integration of the STM services. Additional access to navigational information could change the role of VTS operators in traffic situations compared with traditional operations. This paper discusses the findings from a socio-technical systems perspective while also addressing the individual STM services and their potential impact on VTS operations. This research provides valuable information for European VTS centers that could be affected by the implementation of e-Navigation and, specifically, the STM services.
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Bruce, Iain, Nicola Harman, Paula Williamson, Stephanie Tierney, Peter Callery, Syed Mohiuddin, Katherine Payne, Elisabeth Fenwick, Jamie Kirkham, and Kevin O’Brien. "The management of Otitis Media with Effusion in children with cleft palate (mOMEnt): a feasibility study and economic evaluation." Health Technology Assessment 19, no. 68 (August 2015): 1–374. http://dx.doi.org/10.3310/hta19680.
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BackgroundCleft lip and palate are among the most common congenital malformations, with an incidence of around 1 in 700. Cleft palate (CP) results in impaired Eustachian tube function, and 90% of children with CP have otitis media with effusion (OME) histories. There are several approaches to management, including watchful waiting, the provision of hearing aids (HAs) and the insertion of ventilation tubes (VTs). However, the evidence underpinning these strategies is unclear and there is a need to determine which treatment is the most appropriate.ObjectivesTo identify the optimum study design, increase understanding of the impact of OME, determine the value of future research and develop a core outcome set (COS) for use in future studies.DesignThe management of Otitis Media with Effusion in children with cleft palate (mOMEnt) study had four key components: (i) a survey evaluation of current clinical practice in each cleft centre; (ii) economic modelling and value of information (VOI) analysis to determine if the extent of existing decision uncertainty justifies the cost of further research; (iii) qualitative research to capture patient and parent opinion regarding willingness to participate in a trial and important outcomes; and (iv) the development of a COS for use in future effectiveness trials of OME in children with CP.SettingThe survey was carried out by e-mail with cleft centres. The qualitative research interviews took place in patients’ homes. The COS was developed with health professionals and parents using a web-based Delphi exercise and a consensus meeting.ParticipantsClinicians working in the UK cleft centres, and parents and patients affected by CP and identified through two cleft clinics in the UK, or through the Cleft Lip and Palate Association.ResultsThe clinician survey revealed that care was predominantly delivered via a ‘hub-and-spoke’ model; there was some uncertainty about treatment strategies; it is not current practice to insert VTs at the time of palate repair; centres were in a position to take part in a future study; and the response rate to the survey was not good, representing a potential concern about future co-operation. A COS reflecting the opinions of clinicians and parents was developed, which included nine core outcomes important to both health-care professionals and parents. The qualitative research suggested that a trial would have a 25% recruitment rate, and although hearing was a key outcome, this was likely to be due to its psychosocial consequences. The VOI analysis suggested that the current uncertainty justified the costs of future research.ConclusionsThere exists significant uncertainty regarding the best management strategy for persistent OME in children with clefts, reflecting a lack of high-quality evidence regarding the effectiveness of individual treatments. It is feasible, cost-effective and of significance to clinicians and parents to undertake a trial examining the effectiveness of VTs and HAs for children with CP. However, in view of concerns about recruitment rate and engagement with the clinicians, we recommend that a trial with an internal pilot is considered.FundingThe National Institute for Health Research Health Technology Assessment programme. This study was part-funded by the Healing Foundation supported by the Vocational Training Charitable Trust who funded trial staff including the study co-ordinator, information systems developer, study statistician, administrator and supervisory staff.
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Świerczyński, Sławomir, and Krzysztof Czaplewski. "M-Estimation as a Tool Supporting a Vessel Traffic Controller in the VTS System." Polish Maritime Research 22, no. 3 (September 1, 2015): 3–13. http://dx.doi.org/10.1515/pomr-2015-0050.
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Abstract In order to improve maritime safety and the efficiency of vessel traffic, systems supervising vessel traffic, i.e. VTS (Vessel Traffic Service), started to be created. These systems are aimed to control vessel traffic in waters where traffic congestion, a large concentration of vessels or the presence of navigational hazards creates a risk of collision or stranding. VTS systems constitute maritime safety centres and they must be equipped with appropriate devices in order to be fully functional. Among devices that provide information about vessels are coastal radar stations which are located around a monitored sea area. This kind of spatial arrangement of these stations can be used to simultaneously obtain information about every vessel, but such observations may be fraught with serious errors. Therefore, the estimation methods that are employed and developed in geodesy can be used to improve the accuracy with which a vessel’s position is determined. The Interactive Navigational Structure, i.e. IANS, is an example of how these methods can be applied in navigation; this term has already been introduced into the literature (Czaplewski, 2004). The text below presents the theoretical assumptions underlying the use of IANS as a tool supporting a vessel traffic controller using the VTS system in his/her work. This presentation is supported by a numerical test that was performed in the waters of the Bay of Gdańsk which are covered by the VTS system.
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Levartovsky, A., Y. Barash, S. Ben-Horin, B. Ungar, E. Klang, S. Soffer, and U. Kopylov. "P221 Thromboembolic events in hospitalised patients with inflammatory bowel disease – a large tertiary hospital experience." Journal of Crohn's and Colitis 14, Supplement_1 (January 2020): S253. http://dx.doi.org/10.1093/ecco-jcc/jjz203.350.
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Abstract Background Patients with inflammatory bowel disease (IBD) have a greater risk of venous thromboembolism (VTE) events compared with the general population especially during flares, in both hospitalised and ambulatory patients. Although VTE prophylaxis (thromboprophylaxis) is recommended in hospitalised IBD patients, the implementation is not universal, especially for non-IBD-related hospitalisations. In this study, we aimed to present the rates of VTEs and thromboprophylaxis among hospitalised IBD patients. Methods We created an electronic data repository of all IBD patients who visited the emergency department (ED) of our tertiary medical centre between 2012 and 2018. Data included tabular demographic and clinical variables (reason for referral, VTEs, clinical characteristics, hospitalisation, lab results, treatment and outcome) as well as free-text physician records. For this study, we searched the data repository for VTE cases, using ICD10 coding. Results Overall, there were 7009 ED visits of 2405 patients with IBD, 1556 (64.7%) Crohn's disease and 849 (35.3%) Ulcerative colitis patients. Thromboprophylaxis was administered in 463 hospitalisations (12.4% of IBD-related and 10.9% of non-IBD-related hospitalisations). 1.5% of patients (36/2405) who visited the ED had a new VTE. Thirty patients were diagnosed with a deep vein thrombosis (DVT), two patients with a pulmonary embolism (PE) and six additional patients were diagnosed with both a DVT and PE in the same hospitalisation. Eleven patients had a VTE during a non-IBD-related hospitalisation and six patients during an IBD-related hospitalisation (0.6% vs. 0.3%, respectively, pv = 0.12). Five patients (29.4%) developed VTEs after receiving thromboprophylaxis during hospitalisation. The majority (72.7%) of VTEs diagnosed during a non-IBD-related hospitalisation did not have additional thrombosis-related risk factors. One patient died during hospitalisation and two more patients died in the upcoming 30 days (unrelated to VTEs). Conclusion The rate of thromboprophylaxis in hospitalised IBD patients is low, despite posing life-threatening implications. Thromboprophylaxis should be implemented in IBD patients hospitalised for all indications.
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Bošnjak, Rino, Danko Kezić, Goran Belamarić, and Srećko Krile. "MODELLING OF VTS SUPERVISOR BY ALGORITHM BASED ON PETRI NET: CASE STUDY OF DOVER INCIDENT." Transport 36, no. 4 (November 11, 2021): 305–16. http://dx.doi.org/10.3846/transport.2021.15824.
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The paper deals with collision prevention problem in maritime transport in the area of the narrow canals with predefined routes. The Dover incident, which is analysed and described in the paper, has shown that the control of the passage of ships through the critical areas must be upgraded with an automatic supervising system, which warns the human operator of incorrect ship motion and help the operator to make the right and timely decision. The general idea is to improve the safety of navigation by introduction of automatic collision prevention based on automated supervisor helping to human operator in Vessel Traffic System (VTS) control centre. The VTS supervisor automatically monitors marine traffic by using data from Automatic Radar Plotting Aid (ARPA) radar and others sensors. Such supervisor detects real time and Course Over Ground (COG) of the vessel entering a particular sector, and then estimates the required time for vessel’s passage into another sector. VTS supervisor compares the real time and estimated time of passage of the specific ship through particular sector as a part of surveillance area. In addition, it compares and monitors the deviation of the course during transition of zones (sectors). If significant difference for both values are occurred VTS supervisor triggers a time alarm or a course alarm respectively. In the paper authors have modelled and simulated collision prevention with performed by the alarm actions of VTS supervisor improved with algorithm module based on hybrid Petri net formalism and Visual Object Net ++ tool.
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Ngoc, Duong Van, and Nguyen Tien Dat. "A design in system architecture based on mobile cloud computing for a virtual try-on solution." International Journal of ADVANCED AND APPLIED SCIENCES 9, no. 6 (June 2022): 36–42. http://dx.doi.org/10.21833/ijaas.2022.06.005.
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Cloud computing is an emerging technology in this digital century. It provides an excellent but low-cost source for database storage, computing power, applications, and services through an internet-delivered cloud platform. Thanks to the cost savings in investing and maintaining physical data centers, as well as the stability of Quality of Service (QoS), it has no restrictions on company size or sector for enterprises to shift their operations to a cloud platform. The fashion industry, particularly the fashion e-commerce sector, is a case study in leveraging the cloud platform via a technology called “Virtual try-on” (VTO). VTO solution allows fashion brands to increase the shopping experience, however, requires installing and maintaining a bulky system for implementation. There are different methods and approaches to design architectures using cloud computing, however, there have not been many studies addressing tasks related to machine learning that uses the high Graphics Processing Unit (GPU) encountered in VTO solutions. To design a scheduler that could optimize the system performance while lowering operational expenses in VTO solutions, this research proposes a system to (1) handle synchronous model and asynchronous model separately and clearly, (2) perform multi-layered task processing architecture by hashing task ID and implementing a queue management system. This method would satisfy three major requirements: (1) Avoid complex hardware requirements for users, (2) Ensure the system stability and the ease of horizontal and vertical extension, and (3) Protect user information privacy.
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Reinholz, Danuta, Simona Casati, Ottavio Beratta, and Giorgio Marlani. "Termination of pregnancy in a border region between Switzerland and Italy (2008–2015)." Swiss Medical Weekly 148, no. 2728 (July 12, 2018): w14636. http://dx.doi.org/10.57187/smw.2018.14636.
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In Switzerland, voluntary termination of pregnancy (VTP) can be performed in all public and private hospitals with an obstetrics/gynaecology department. For various reasons, many Italian women use the Swiss healthcare system, in particular in Canton Ticino, a border region adjacent to Italy in the southern part of Switzerland, when they want to have a VTP. In this study, we aimed to illustrate trends in the VTPs in the Canton Ticino between 2008 and 2015 and demonstrate differences between the Swiss women resident in Switzerland (SSR), foreign women resident in Switzerland (FSR) and foreign women resident abroad (FAR), focusing in particular on the Italian women as during this period there were legal changes in Italy. The number of VTPs was constant on a national level (10,924 in 2008, 10,255 in 2015); in contrast, since 2012 the number has progressively decreased (41%) in Ticino, mainly because of the significant reduction in VTPs in women resident in Italy (decrease of 75.7%). In addition, we wanted to evaluate the impact of the pre-VTP counselling at a family planning centre (FPC) on the VTP decision. The high number of pre-VTP consultations suggests that this service is appreciated and helpful. We observed an encouraging trend in changing the decision to have a VTP after the consultation at the FPC, where 12% of the pregnant women decided to continue the pregnancy. Because of its location, the Canton Ticino is an example how availability of certain drugs, methods and laws can influence the cross-border flow of the patients.
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Nanthakumaran, A., H. K. Kadupitiya, S. Devaisy, and W. E. P. Athukorale. "Exploring the village tank cascade systems (VTCSs) in Vavuniya district, Sri Lanka." Journal of Water and Climate Change 13, no. 2 (December 21, 2021): 999–1006. http://dx.doi.org/10.2166/wcc.2021.412.
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Abstract An attempt was made to identify, validate the village tank cascade systems (VTCSs) and study the water flow from one village tank to another in each VTCS in the eight Agrarian Service Centre (ASC) divisions in the Vavuniya district from October 2017 to December 2018. VTCS contribute a significant share of available water resources for the livelihoods of households in the Vavuniya district. The 1:10,000 topographic map of the Survey Department, satellite images and the digital elevation model were used to identify the cascades and flow direction map for the study area using ArcGIS 10.2.2. Among 756 village tanks in the district, 80 VTCSs comprising 514 village tanks were identified, and only 69 cascades were validated in the field. In addition, this study identified 111 isolated village tanks without connecting with other village tanks and 131 abandoned village tanks. Further investigation is recommended to explore the possibilities of increasing the cascade areas in the study area by connecting isolated tanks with VTCSs. Initiation taken towards rehabilitation of cascades would enhance the livelihood of farm households in the Vavuniya district and lead to sustainable water resource management.
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Sadik Aboud, Wajdi, Hayder S. Abd Al-Amir, Aseel A. Alhamdany, and Fahad M. Kadhim. "Overcome uncertainties of vertical take-off and landing aircraft based on optimal sliding mode control." Indonesian Journal of Electrical Engineering and Computer Science 29, no. 2 (February 1, 2023): 703. http://dx.doi.org/10.11591/ijeecs.v29.i2.pp703-714.
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<span>This study aims to design a robust and optimal controller to overcome the problems related to the existence of disturbances and uncertainties during takeoff and landing operations of vertical take-off and landing (VTOL) aircraft. The dynamics are decomposed into two phase’s parts which are the minimum phase and the non-minimum phase. These two-part are controlled by proposing a robust nonlinear controller represented by sliding mode control (SMC). Also, the chattering effect due to the fast-switching surface in SMC is eliminated by utilizing a proposed sigmoid function which acts as the sigmoid function. The controller's main parameters are tuned optimally based on the particle swarm optimization (PSO) algorithm. In addition, the controller guaranteed the system stability based on the Lyapunov and Routh theories. The main output parameter responses represented by the positioning of the centre of mass and angle of rolling are determined with bounded control inputs. The performance of the proposed controller is tested by tracking VTOL parameters to the desired trajectories. The simulated results not only showed a significant tracking trajectory but also system stability guaranteed. In addition, the results showed an improved rate of 72% and 84% compared with those results obtained from the literature.</span>
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Gucma, Lucjan, Andrzej Bąk, and Sylwia Sokołowska. "Stochastic Model of Ships Traffic Capacity and Congestion — Validation by Real Ships Traffic Data on Świnoujście — Szczecin Waterway." Annual of Navigation 24, no. 1 (December 1, 2017): 177–91. http://dx.doi.org/10.1515/aon-2017-0013.
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AbstractPaper presents validation of previously created stochastic ships traffic stream model by the real data of ships delays on Świnoujście — Szczecin waterway. The model is mostly based on Monte Carlo methodology. The model is microscopic which means that each ship’s model is treated as separate object possessing given attributes. As the main parameter of presented validation total waiting (delay) time of ships have been applied. The time of ships delays was possessed from Szczecin VTS centre and compared with the model output.
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Ene, Elena, Karin Nentwich, Phillipp Halbfaß, Kai Sonne, Arthur Berkovitz, and Thomas Deneke. "Effective management of patients with electrical storm – networking and VT unit as essential parts for a successful outcome." Romanian Journal of Cardiology 30, no. 4 (January 4, 2021): 583–88. http://dx.doi.org/10.47803/rjc.2020.30.4.583.
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Ventricular tachycardias (VT) represents worldwide one of the leading causes of sudden cardiac death. The increasing number of implanted ICDs have reduced signifi cantly the number of sudden cardiac deaths SCDs); however recurrent VTs episodes might lead to a rapid deterioration of patient’s clinical status and systolic function. An early intervention after a successful patient stabilization in a dedicated VT unit is mandatory for the mid- and long term prognosis of the patient. Nevertheless, a tight collaboration between general hospitals and highly specialized centers in treatment of patients with electrical storm is essential for an effi cient and successful outcome.
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Burchenal, Margaret K., and Michelle Grohe. "Reimagining School Programs." Visual Arts Research 34, no. 2 (December 1, 2008): 66–75. http://dx.doi.org/10.2307/20715476.
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Abstract Art museums devote enormous resources to supporting K-12 school visit programs, even though there is little research to indicate that single field trips result in significant student learning. The Isabella Stewart Gardner Museum’s education department has taken a different approach, focusing instead on a multiple-visit program that gives students and their teachers extended practice with art discussion using the Visual Thinking Strategies (VTS) approach and conducting a 3-year research project that has shown links between learning to look and critical thinking. This article describes a new model for museum-school collaboration, one that centers on helping students develop their own abilities to look at and interpret art.
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Rizvi, Naiyer A., John L. Marshall, Elizabeth Ness, Michael J. Hawkins, Craig Kessler, Helena Jacobs, Wayne D. Brenckman, et al. "Initial Clinical Trial of Oral TAC-101, a Novel Retinoic Acid Receptor-Alpha Selective Retinoid, in Patients With Advanced Cancer." Journal of Clinical Oncology 20, no. 16 (August 15, 2002): 3522–32. http://dx.doi.org/10.1200/jco.2002.02.090.
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PURPOSE: The goals of this study were to determine the safety, toxicity, and pharmacokinetics of TAC-101, a novel synthetic retinoic acid receptor-alpha (RAR-α) selective retinoid, in patients with advanced cancer. PATIENTS AND METHODS: Twenty-nine patients at two centers received oral TAC-101 at doses ranging from 12 to 34 mg/m2/d. Pharmacokinetic sampling was performed on days 1 and 28. RESULTS: The most frequent toxicities were myalgia/arthralgia, fatigue, and triglyceridemia. No dose-limiting toxicities were observed within the first 28 days up to 28 mg/m2. However, seven of 21 patients experienced venous thromboembolic events (VTEs) during TAC-101 treatment. Eight additional patients who received 34 mg/m2 were treated after a hypercoagulable work-up to exclude potential risk factors for VTE, and two of eight patients subsequently experienced VTEs. The maximum tolerated dose was exceeded at 34 mg/m2/d within the first 28 days, with one grade 3 hypertriglyceridemia, two grade 3 myalgia/arthralgia, and one grade 3 fatigue. One patient with advanced non–small-cell lung cancer had a complete response. No other responses were observed. No autoinduction of metabolism was observed with dosing over 28 days. CONCLUSION: This is the first human clinical study with TAC-101, a RAR-α selective retinoid. Musculoskeletal toxicity and hypertriglyceridemia were observed characteristics of previously studied retinoids. The recommended phase II dose is 24 mg/m2 with this treatment schedule. Alternative treatment schedules and prospective evaluation of thrombotic risk will be investigated in subsequent studies.
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Nof, Eyal, Petr Peichl, Predrag Stojadinovic, Martin Arceluz, Philippe Maury, Moshe Katz, Usha B. Tedrow, et al. "HeartMate 3: new challenges in ventricular tachycardia ablation." EP Europace 24, no. 4 (November 17, 2021): 598–605. http://dx.doi.org/10.1093/europace/euab272.
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Abstract Aim To describe clinical characteristics, procedural details, specific challenges, and outcomes in patients with HeartMate3™ (HM3), a left ventricular assist device system with a magnetically levitated pump, undergoing ventricular tachycardia ablation (VTA). Methods and results Data were collected from patients with an HM3 system who underwent VTA in seven tertiary centres. Data included baseline patient characteristics, procedural data, mortality, and arrhythmia-free survival. The study cohort included 19 patients with cardiomyopathy presenting with ventricular tachycardia (VT) (53% with VT storm). Ventricular tachycardias were induced in 89% of patients and a total of 41 VTs were observed. Severe electromagnetic interference was present on the surface electrocardiogram. Hence, VT localization required analysis of intra-cardiac signals or the use of filter in the 40–20 Hz range. The large house pump HM3 design obscured the cannula inflow and therefore multi imaging modalities were necessary to avoid catheter entrapment in the cannula. A total of 32 VTs were mapped and were successfully ablated (31% to the anterior wall, 38% to the septum and only 9% to the inflow cannula region). Non-inducibility of any VT was reached in 11 patients (58%). Over a follow-up of 429 (interquartile range 101–692) days, 5 (26%) patients underwent a redo VT ablation due to recurrent VTA and 2 (11%) patients died. Conclusions Ventricular tachycardia ablation in patients with HM3 is feasible and safe when done in the appropriate setup. Long-term arrhythmia-free survival is acceptable but not well predicted by non-inducibility at the end of the procedure.
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Ying Keat, Raymond Lim, Jestin Nordin, and Mohd Najib Mohd Salleh. "URBAN COMMUTERS’ EXPECTATION LEVELS ON THE e-VTOL VERTICAL AIRPORT DESIGN IN KUALA LUMPUR, MALAYSIA." Malaysian Journal of Sustainable Environment 8, no. 3 (October 26, 2021): 179. http://dx.doi.org/10.24191/myse.v8i3.15895.
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The world’s urban dwellers are rapidly growing by 60.3% over six decades (1960-2019) (The World Bank Group, 2020), and two third of the world’s population is projected to reside in the urban setting by 2050. The same issue occurred in Malaysia, where the shifting from 73% rural to 73% urban population is real (Mohd Hussain, N. H.; Byrd, H.; & Ahmad, N. A., 2017), and this phenomena contributed to the increasing number of population in big cities such as Kuala Lumpur. Therefore, it is expected that the existing challenging traffic congestion will worsen if a better traffic dissemination planning strategy is not developed. Hence, the development of an e-VTOL (electrical vertical take-off landing) vehicle is a possible strategy to ease the urban traffic congestion problem. Serious collaboration among the departments such as planning, engineering, architecture, aviation developers, policy makers, and the sponsors, is important to establish sustainable future urban mobility and connectivity. This study aims to obtain information on the needs and expectations of urban commuters on the development of a vertiport in the city of Kuala Lumpur. A series of surveys involving 157 commuters using public transportation within the city centre, and a case study analysis, were conducted to gain an understanding of the viability of building a vertiport in Kuala Lumpur. Initially, findings show that nearly 50% of the respondents totally agree with the proposed development idea, while approximately 13% are really against this future urban air mobility strategy.
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Holubar, Stefan, Samuel Eisenstein, Liliana Bordeianou, Jeffrey Scow, Christopher Prien, Randolph Steinhagen, Alessandro Fichera, and Tracy Hull. "CURRENT VENOUS THROMBOEMBOLISM CHEMOPROPHYLAXIS PRACTICES AFTER SURGERY FOR IBD: SAVES-IBD TRIAL INITIAL REPORT." Inflammatory Bowel Diseases 28, Supplement_1 (January 22, 2022): S40. http://dx.doi.org/10.1093/ibd/izac015.060.
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Abstract BACKGROUND Despite standard of care chemoprophylaxis, postoperative VTEs occur in ∼4% of IBD patients, and little data on current practices in IBD has been reported. We cultivated a baseline cohort to inform power calculations for a forthcoming prospective, multicenter trial of VTE prophylaxis comparing the efficacy & safety of standard of care vs. aspirin (SAVES-IBD Trial). In this initial report we describe the current standard of care VTE prophylaxis practice patterns in our collaborative. METHODS The National Surgical Quality Improvement Program (NSQIP) IBD Collaborative designed and implemented 6 VTE specific-variables including 1) Inpatient VTE chemoprophylaxis, 2) extended (post-discharge) prophylaxis, 3) length of time on primary prophylaxis, 4) VTE location, and 30-days bleeding requiring 5) transfusion or 6) reoperation. Data was collected prospectively from Sept 2020 – Mar 2021. Patients age >18 undergoing elective or emergent colectomy or proctectomy with a post-op IBD diagnosis were included. Patients with VTE present at admission (n=10, 2.3%) were excluded. RESULTS Over 6-months, 434 patients from 13 centers were accrued; median 22 cases, IQR 18.5 – 28. Demographics: median age 41.5 years, 50% female, median BMI 24.7 kg/m2. Diagnoses: 263 (60.9%) Crohn’s vs. 169 (39%) UC/IBDu, while 359 (82.7%) and 75 (17.3%) patients underwent colectomy and proctectomy, respectively including 69 (15.9%) IPAAs and 256 (59.0%) ileostomies, and 21 (4.8%) emergency cases. IBD Medications: 237 (54.6%) biologics, 233 (53.7%) steroids, 51 (11.8%) immunomodulators. A total of 395 (91.4%) received inpatient chemoprophylaxis including LMWH in 236 (59.7%), UFH in 158 (40.0%), DOAC in 1 (0.3%), and aspirin (none), and no chemoprophylaxis in 37 (8.5%). Extended chemoprophylaxis was utilized in 209 (48.7%) and included LMWH in 179 (85.6%), DOAC in 18 (8.6%), aspirin in 7 (3.3%), and UFH in 5 (2.4%). Overall, bleeding complications occurred in 38 (8.8%) patients with 34 (8.4%) requiring transfusion and 9 (2.1%) needing reoperation. Postoperatively, VTEs were diagnosed in 19 (4.4%) patients. VTE locations: portomesenteric vein thrombosis 8 (42%), upper extremity 3 (15.8%) or lower extremity 3 (15.8%) DVT, pulmonary embolism 2 (10.5%), and other 3 (15.8%). Univariate analysis of risk factors is shown in Table 1. Patients with 0-2 risk factors had a VTE rate of 2.9%, while in those with >2 risk factors, 31.8% developed VTE (p<0.0001). CONCLUSION In this cohort of surgical IBD patients from IBD specialty centers, we observed a 2.3% rate of pre-operative, and a 4.4% rate of post-operative, VTE. These rates have informed the SAVES-IBD power calculations. We also observed that almost half of IBD surgery patients in these centers were prescribed extended chemoprophylaxis, most commonly with enoxaparin, rarely with aspirin. Validation of the prophylaxis variables is in-progress.
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Ramos, Jorge, Yu-Ning Wong, Simon J. Crabb, Guenter Niegisch, Joaquim Bellmunt, Sylvain Ladoire, Syed A. Hussain, et al. "Venous thromboembolism (VTE) risk in patients with localized urinary tract tumors (UTT)." Journal of Clinical Oncology 34, no. 2_suppl (January 10, 2016): 422. http://dx.doi.org/10.1200/jco.2016.34.2_suppl.422.
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422 Background: VTE is common in cancer patients, but there is limited data in patients with UTT. We previously demonstrated that non-urothelial histology, cardiovascular disease (CVD) or CVD risk factors or renal dysfunction increased VTE risk in metastatic UTT. In this study, we assessed the frequency and risk factors for VTE in localized disease. Methods: Data was collected via an electronic data capture platform from 29 centers. Patients diagnosed with < cT2, > N1, or M1 disease at diagnosis were excluded. Patients without a date of diagnosis, last follow up, or VTE data were excluded. Cumulative, unadjusted VTE incidence was calculated from time of diagnosis, excluding VTEs diagnosed in the metastatic setting. Chi-squared analyses were used to assess differences in VTE rates for various patient, therapy, and tumor-related factors. Significant covariates were incorporated into a multivariate, logistic regression model. Results: 1131 patients were eligible for analysis. Perioperative chemotherapy was utilized in 46.9% (530/1131) of patients. 70.8% (801/1131) underwent definitive surgical intervention. There were 64 VTEs (cumulative incidence 5.7%). Treatment with chemotherapy (p = 0.609) or surgery (p = 0.886) did not increase VTE risk. In the univariate analysis, non-urothelial histology (p = 0.025), CVD or CVD risk factors (p = 0.004), renal dysfunction (p = 0.023), and radiation to the primary tumor (p = 0.048) were statistically significant factors. Multivariate analysis demonstrated that non-urothelial histology and CVD or CVD risk factors were associated with increased VTE risk (table). Conclusions: The VTE incidence of 5.7% in localized disease is lower than our previously reported rate in the metastatic setting (8.2%). Consistent with our findings in metastatic UTT, non-urothelial histology and CVD or CVD risk factors increase VTE risk in localized disease. Additional analyses to control for baseline demographics in patients treated with surgery and chemotherapy will be performed. [Table: see text]
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Kim, Do-Yeon, Jung-Sik Jeong, Geonung Kim, Hwa-Young Kim, and Taeho Hong. "Implementation of an Intelligent System for Identifying Vessels Exhibiting Abnormal Navigation Patterns." Journal of Advanced Computational Intelligence and Intelligent Informatics 18, no. 4 (July 20, 2014): 665–71. http://dx.doi.org/10.20965/jaciii.2014.p0665.
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The recent rise in maritime traffic volume, resulted from an increase in international marine trading volumes and the growing popularity of marine leisure activities, has increased the frequency of marine accidents. Vessels exhibiting abnormal navigation patterns (e.g., weaving in and out of courses or rotating in the same position) may have a serious impact on other vessels staying on normal courses. For this reason, ground VTS centers are keeping track of criminal vessels or damaged vessels in tandem with marine police. However, the number of available studies aimed at assisting the identification of seemingly apparent risk factors resulting from human errors has been next to nothing to date. In this respect, this study intends to implement an intelligent system that can identify vessels exhibiting abnormal navigation patterns based on fuzzy inference, in order to assist controllers and mates alike.
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Zeppenfeld, Katja, and Martin J. Schalij. "Current Status and Future Directions of Ventricular Arrhythmia Ablation." European Cardiology Review 6, no. 3 (2010): 77. http://dx.doi.org/10.15420/ecr.2010.6.3.77.
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Ventricular tachycardia (VT) catheter ablation has evolved over the past decade, allowing effective treatment of haemodynamically unstable and epicardial VTs in patients with structural heart disease previously not amenable to ablation. Catheter ablation reduces VT recurrences and thereby implantable cardioverter–defibrillator (ICD) shocks in 67–75% of patients, with a low incidence of procedure-related complications when performed in highly experienced centres. It can be life-saving in patients with electrical storm. Early use of ablation can be considered in selected patients who receive an ICD as an alternative to drug therapy provided that the procedure can be performed safely. Although acute results are promising, outcomes over the long-term are less favourable. An improved understanding of the VT substrate is mandatory for further advancement of a substrate-based ablation approach. Pre-procedural and intra-procedural imaging are likely to contribute to this. Whether catheter ablation will become first-line treatment for VT in structural heart disease and ultimately allow ICD implantation to be avoided in selected patients needs further evaluation.
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Leeman, Marjolijn, Jeannine Huisbrink, Julie M. A. Wijnand, L. Ulas Biter, Serge J. C. Verbrugge, Martin Dunkelgrun, and Jan A. Apers. "Trial protocol: preoperative administration of tranexamic acid in sleeve gastrectomy (PATAS) to reduce haemorrhage rates. A randomised controlled trial." BMJ Open 10, no. 2 (February 2020): e034572. http://dx.doi.org/10.1136/bmjopen-2019-034572.
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IntroductionFast-track protocols often include short-term thromboprophylaxis and short length of hospital stay. These treatment strategies may negatively affect the occurrence and diagnosis of postoperative haemorrhage. Over the years, the rates of venous thromboembolic events (VTEs) have decreased, while there seems to be an increase in the occurrence of postoperative haemorrhage. Tranexamic acid (TXA) can potentially lower the incidence of postoperative haemorrhage. This trial aims to investigate whether preoperative administration of TXA reduces the preoperative and postoperative haemorrhage rates in laparoscopic sleeve gastrectomy (LSG).Methods and analysisThis is a single centre double-blind randomised placebo-controlled trial. Patients undergoing an LSG are included after obtaining informed consent. Patients are randomised between two groups: (1) administration of placebo infusion and (2) administration of 1500 mg TXA. In both groups, the infusions will be administered during the induction phase of the procedure. Primary outcome measures are preoperative use of haemostatic clips, postoperative haemoglobin decrease and postoperative haemorrhage. Secondary outcome measure is the rates of VTE.Ethics and disseminationThe protocol version 3 was approved by the medical ethical committee Medical Research Ethics Committees United (MEC-U), Nieuwegein, on 29 July 2019. The trial results will be submitted for publication in a peer-reviewed journal and at conference presentations.Trial registration numberThe Netherlands Trial Registry (NL8029); Pre-results.
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Szlapczynski, Rafal. "Evolutionary Sets of Safe Ship Trajectories Within Traffic Separation Schemes." Journal of Navigation 66, no. 1 (September 12, 2012): 65–81. http://dx.doi.org/10.1017/s0373463312000422.
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The paper presents the continuation of the author's research on Evolutionary Sets of Safe Ship Trajectories (ESoSST) methodology. In an earlier paper (Szlapczynski, 2011) the author described the foundations of this methodology, which used Evolutionary Algorithms (EA) to search for an optimal set of safe trajectories for all the ships involved in an encounter. The methodology was originally designed for open waters or restricted waters when only the standard Convention on the International Regulations for Preventing Collisions at Sea (COLREGS, 1972) rules apply. However, within Traffic Separation Schemes (TSS), where additionally Rule 10 of COLREGS applies, the problem is much more complex and a new solution is needed. This paper introduces the extended ESoSST methodology, with a focus on changes that have to be made to obey Rule 10 and fully support TSS. These changes include detecting and penalizing TSS violations, as well as the pre-processing phase (generating the initial population, which includes predefined TSS-compliant tracks). The methodology has been designed for possible application in Vessel Traffic Service (VTS) centres. Its new mechanisms are presented with details. The examples are included of the results of the computer simulation tests carried out for the Gulf of Gdansk TSS to illustrate the methodology's effectiveness and functional scope.
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Silveira, P. A. M., A. P. Teixeira, and C. Guedes Soares. "Use of AIS Data to Characterise Marine Traffic Patterns and Ship Collision Risk off the Coast of Portugal." Journal of Navigation 66, no. 6 (August 9, 2013): 879–98. http://dx.doi.org/10.1017/s0373463313000519.
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This paper studies the risk of ship collision off the coast of Portugal based on Automatic Identification System (AIS) data, which is recorded and maintained by the Portuguese coastal Vessel Traffic Service (VTS) control centre (CCTMC). Computer programs for decoding, visualization and analysis of the AIS data have been developed. From analysis of the AIS data available, maritime traffic off the coast of Portugal is characterized and a statistical analysis of traffic in the Traffic Separation Schemes is provided. An algorithm has been developed to assess the risk profile and the relative importance of routes associated with ports. A method is proposed to calculate the collision risk from the assessment of the number of collision candidates by estimating future distances between ships based on their previous positions, courses and speeds, and comparing those distances with a defined collision diameter. Values of causation probability suggested in several studies are used to calculate the expected number of collisions in the period of time under investigation based on the number of collision candidates. The results of this study are then compared with the number of collisions that have occurred between 1997–2006, registered and maintained by the Portuguese Maritime Authority.
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Macdonald, John C. "The Australian REEFREP System: A Coastal Vessel Traffic Information Service and Ship Reporting System for the Torres Strait Region and the Inner Route of the Great Barrier Reef." Journal of Navigation 49, no. 3 (September 1996): 299–308. http://dx.doi.org/10.1017/s0373463300013539.
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The new Australian ship reporting system, identifier ‘REEFREP’, will be the core component of a Vessel Traffic Information Service (VTIS) covering the Torres Strait region and the Great Barrier Reef (GBR). It is the first such system to be considered by the International Maritime Organization (IMO) under the terms of the new SOLAS 74 regulation v/8-1, which entered into force on 1 January 1996 and allows for ship reporting systems adopted by the Organization to be made mandatory for all, or certain categories of vessels.The REEFREP system, planned for implementation on 1 January 1997, extends for some 900 n.m. or about 1500 km along the Queensland coastline. It will be a VHF radio-based system with radars covering three selected focal points in the Torres Strait, off Cairns and in the southern approaches to the inner route. The system will provide a capability for a single Ship Reporting Centre to interact with shipping, enabling the provision of improved information on the presence, movements and patterns of shipping in the area and the ability to respond more quickly to an incident or pollution should this occur.An interesting feature and a major factor in the system design is the remoteness of most equipment sites and the limited infrastructure available to support communications and data transmission requiring the application of advanced technology and video transmission, solar power generation and software engineering skills of a high order.
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Annette, Lucy. "G20 Declaration on Health." Impact 2021, no. 8 (October 28, 2021): 67–68. http://dx.doi.org/10.21820/23987073.2021.8.67.
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Health ministers met to discuss global recovery and the G20 Declaration on Health was subsequently published. It sets forth the G20's intentions for achieving global health goals, including tackling the COVID-19 pandemic and fulfilling priorities surrounding healthy and sustainable recovery, One Health resilience, coordinated and collaborative responses and the accessibility of vaccines, therapeutics and diagnostics. A key focus is on collaboration and people-centred preparedness, a need for which was highlighted by the pandemic, as well as strengthening healthcare systems through continuous investment. The Declaration underlines the need to, 'strengthen our collective preparedness to prevent, detect, report, and respond to health emergencies and notably promoting resilience of health systems and communities; to create trust by exchanging reliable information, data and scientific knowledge in a timely manner to develop science- and evidence-informed policies, measures and tools; and to sustain financial support and economic recovery in order to achieve full implementation of the 2019 Political Declaration on Universal Health Coverage (UHC).' A primary commitment for the G20 health ministers is providing 'timely, equitable and global access to safe, affordable and effective COVID-19 vaccines, therapeutics and diagnostics (VTDs).' This includes promoting confidence in vaccines by providing reliable information. Further important elements of the Declaration are whole-society cooperation and cross-border collaboration, as well as the importance of a One Health approach. Concerns that emerged from the meeting were antimicrobial resistance (AMR), food systems and environmental health. Solutions will involve improved surveillance of antimicrobial use and the rise of resistance to new and existing therapeutics.
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Tse, Brandon, Gloria Lim, Michelle Sholzberg, and Katerina Pavenski. "Describing the Point Prevalence and Characteristics of Venous Thromboembolism in Patients with Thrombotic Thrombocytopenic Purpura." Blood 134, Supplement_1 (November 13, 2019): 2381. http://dx.doi.org/10.1182/blood-2019-123081.
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Background: Thrombotic thrombocytopenic purpura (TTP) presents with microangiopathic hemolytic anemia, thrombocytopenia and microvascular thrombosis. Arterial thromboembolic events are relatively common and well-described in these patients. However, the literature describing venous thromboembolism (VTE) in this patient population is scarce and outdated. We hypothesize that patients with TTP are at greater risk for VTE due to the use of central venous catheters and use of solvent-detergent plasma (SDP) for plasma exchange (PLEX). Methods: Eligible patients from a single tertiary care centre were identified through apheresis records, and a retrospective chart review was conducted. The criteria for TTP diagnosis included the presence of accepted clinical/laboratory criteria and ADAMTS13 activity <10%. We considered the diagnosis of VTE if any of the following were present: pulmonary embolism (PE), deep vein thrombosis (DVT) or superficial vein thrombosis (SVT). Data were analyzed using simple descriptive statistics. Institutional research ethics board approval was obtained. Results: We identified 77 consecutive patients with 123 episodes of TTP between January 1, 2008 and December 31, 2018. 51 patients (66%) were female, and 74 (96%) had immune TTP. Standard of care was daily PLEX and high-dose steroids, while rituximab was used for relapsed/refractory disease. In addition, 6 patients received caplacizumab. 13 of the 77 patients (17%) experienced a VTE (14 events: 6 PE, 5 DVT, 3 SVT), all of which were acute and associated with admission for either first presentation or relapse of TTP. None of the VTEs were catheter related. 8/13 patients were female, and all had immune TTP. Median age at diagnosis of VTE was 45 years (IQR: 36.0-56.5 years). 10/14 events were symptomatic; diagnosis was confirmed a median of 1.5 days after VTE symptom onset (IQR: 1-3 days). All patients were treated with PLEX, receiving a median of 17 exchanges (IQR: 10-23 exchanges). In addition, 13/14 TTP episodes were treated with corticosteroids, 9 with rituximab, and no patients received caplacizumab. 8 patients experienced a VTE while receiving daily PLEX; the majority (6/8) were being exchanged with SDP. VTE was diagnosed a median of 13.5 days after initiation of PLEX (IQR: 9.2-23.5 days). At TTP presentation, median platelet count was 11 x 109/L (IQR: 7-16 x 109/L), and median LDH was 894 U/L (IQR: 508-1272 U/L). At VTE diagnosis, the median platelet and LDH levels were 170 x 109/L (IQR: 126-248 x 109/L), and 232 U/L (IQR: 176-254 U/L) respectively. No patients had D-dimer testing at VTE symptom onset or diagnosis. Of the 6 patients with PE, 3 had elevated troponin levels (>0.040 ug/L) at VTE diagnosis. In terms of VTE risk factors, median BMI was 30.0 (IQR: 28.7-32.1); the majority of patients (7/13) were obese (BMI>30). 4/13 patients were active cigarette smokers. No patients had a history of lupus or antiphospholipid antibody syndrome. 2 patients had a past history of VTE, one was associated with a prior TTP episode. Most VTEs (8/14) occurred while patients were not on any pharmacologic thromboprophylaxis. For the remaining patients, dalteparin (3), ASA (2) and rivaroxaban (1) were used. VTE events were treated with direct oral anticoagulants (DOACs) including rivaroxaban and apixaban, in 10 cases. 7 of these patients were started on a DOAC after a brief initial period of low molecular weight or unfractionated heparin, 3 patients were given DOAC as upfront therapy. 4 cases were treated with warfarin (3 bridged with heparin and 1 following rivaroxaban). One distal DVT was not treated. None of the VTEs were fatal. Discussion: The point prevalence of VTE was 17% over one decade amongst patients with TTP; this is higher than previously reported in the literature. Our data also suggests that TTP patients may be at greater risk for VTE compared to general hospitalized medical patients. The majority of affected patients on PLEX were receiving SDP at VTE diagnosis. SDP contains reduced levels of proteins C and S and may have a pro-thrombotic effect. Almost all VTEs occurred after platelet recovery and normalization of hemolytic markers, suggesting a different pathophysiology than arterial thrombosis in this setting. VTE thromboprophylaxis was uncommon since it was often held due to thrombocytopenia and not resumed upon platelet recovery. Our findings suggest the need to implement VTE thromboprophylaxis earlier in patients admitted with TTP. Disclosures Sholzberg: Novartis: Honoraria; Amgen: Honoraria, Research Funding. Pavenski:Ablynx: Honoraria, Research Funding; Alexion: Honoraria, Research Funding; Shire: Honoraria; Octapharma: Research Funding; Bioverativ: Research Funding.
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Li, Ruochen, Cara Doyle, Lara N. Roberts, Kathryn Jane Lang, Emma Gee, Julia Czuprynska, Raj K. Patel, and Roopen Arya. "Screening for Occult Malignancy Following First Unprovoked VTE: A Single Centre Experience." Blood 126, no. 23 (December 3, 2015): 3550. http://dx.doi.org/10.1182/blood.v126.23.3550.3550.
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Abstract There are clearly demonstrated links between unprovoked venous thromboembolism (VTE) and underlying malignancy. Previous studies have shown an incidence between 3 and 13% of subsequent cancer diagnoses in patients with unprovoked VTE. National guidance issued in the United Kingdom, 2012 recommend that all patients with a first unprovoked VTE are investigated for occult malignancy with a thorough history and examination, full blood count, liver function tests, calcium, chest X-ray and urinalysis with directed investigation of any positive findings. Additionally, abdomino-pelvic CT scans (and mammography in women) should be considered for all patients over 40 years with first unprovoked VTE without positive findings on basic investigations. We retrospectively reviewed all patients diagnosed with unprovoked VTE at King's College Hospital between April 2014 and March 2015, and results were followed up to July 2015. We excluded as provoked VTEs all cases associated with trauma, known malignancy, recent surgery or hospitalisation, prolonged immobilisation, long-haul travel, hormonal therapy, intravenous drug use, pregnancy or the puerperium. We examined extent of investigations performed and reviewed the incidence of occult malignancy in those with a first unprovoked VTE. Over the period of study, 544 patients were objectively diagnosed with pulmonary embolism (PE) or deep vein thrombosis (DVT). Of these, 140 cases were unprovoked in nature. 75/140 (53.6%) were male, with a median age of 56 years (range 22-97). All 140 patients had initial clinical assessment and bloods tests. 113 (80.7%) patients also had chest X-ray screening performed. Of the remaining 27 patients, 4 were not followed up in our centre. 75 (53.6%) patients had tumour markers taken, 74 (52.9%) patients had abdominal imaging (of which 61, 82.4% had CT abdomen and pelvis, remainder ultrasound) and 3 women had mammography. Tumour markers were abnormal in 26/75 (34.7%). Abdominal imaging was abnormal in 33/66 (50.0%) patients without a subsequent diagnosis of malignancy, with 18/66 (27.3%) requiring additional investigation to definitively exclude malignancy. 8/136 (5.9%) cases of occult malignancy were identified (see Table for characteristics). The majority of patients found to have occult malignancy were diagnosed at an advanced stage, with high subsequent mortality rates and minimal opportunity for intervention. Our findings compare favourably with the findings of the SOME trial with a low incidence of occult malignancy and questionable value of routine abdomino-pelvic imaging for otherwise asymptomatic patients with first unprovoked VTE. Such screening is likely to incur anxiety for patients, incidental findings and higher costs without demonstrable patient benefit. Abnormal tumour markers were common and non-specific and should not be performed routinely following unprovoked VTE. Targeted investigation for individuals with suggestive clinical features or abnormalities on baseline bloods, chest X-ray or urinalysis should be considered. Table 1. Characteristics of patients identified with occult malignancy, time to cancer diagnosis, staging of cancer, treatment received, and mortality Cancer Age/Gender VTE Abnormal basic screen# Tumour markers Time to cancer diagnosis (days) Stage/treatment Time to death* (days) Endometrial 52F Distal DVT No Not done 131 T1aM0N0 ¨C surgery (TAH + BSO) N/A Endometrial 57F Distal DVT Yes CA125 3383 0 No formal staging, metastatic disease, no treatment 45 Pancreatic 52M Proximal DVT Yes CA125 2832 17 No formal staging, metastatic disease, no treatment 19 Pancreatic 57M PE Yes CA125 583, CEA 96 20 No formal staging, metastatic disease, no treatment 65 Lung 85F PE Yes Not done 85 T3N1M1a ¨C chemotherapy N/A Lung 81M PE Yes Not done 0 T4N3M1b ¨C for palliation only 49 Ovarian 69F PE Yes CA125 1224, CEA 6 0 No formal staging, metastatic disease, no treatment 16 Unknown primary 97F Proximal DVT Yes AFP 29, CEA 626, CA125 316 1 No formal staging, metastatic disease, for palliation 6 #basic screen includes clinical assessment, renal/liver function, calcium, chest X-ray and urinalysis; *from time of VTE diagnosis Disclosures Arya: Bayer plc: Research Funding.
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Bikdeli, Behnood, David Jiménez, Pablo Demelo-Rodriguez, Francisco Galeano-Valle, José Antonio Porras, Raquel Barba, Cihan Ay, et al. "Venous Thrombosis within 30 Days after Vaccination against SARS-CoV-2 in a Multinational Venous Thromboembolism Registry." Viruses 14, no. 2 (January 18, 2022): 178. http://dx.doi.org/10.3390/v14020178.
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Background: Venous thromboembolism (VTE)—including deep vein thrombosis, pulmonary embolism, and cerebral venous sinus thrombosis (CVST)—may occur early after vaccination against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We sought to describe the site, clinical characteristics, and outcomes of VTE after vaccination against SARS-CoV-2. Methods: In a prospective study using the Registro Informatizado de Enfermedad TromboEmbólica (RIETE) platform, patients with VTE 4–30 days after vaccination against SARS-CoV-2 (1 February 2021 through 30 April 2021) were included. VTE patients recruited from the same centers into RIETE in the same months in 2018–2019 were selected as the reference group. All-cause mortality and major bleeding were the main study outcomes. Results: As of 30 April 2020, 102 patients with post-vaccination VTEs had been identified (28 after adenovirus-based vaccination [ChAdOx1 nCov-19; AstraZeneca] and 74 after mRNA-based vaccination [mRNA-1273; Moderna, and BNT162b2; Pfizer]). Compared with 911 historical controls, patients with VTE after adenovirus-based vaccination more frequently had CVST (10.7% vs. 0.4%, p < 0.001) or thrombosis at multiple sites (17.9% vs. 1.3%, p < 0.001), more frequently had thrombocytopenia (40.7% vs. 14.7%, p < 0.001), and had higher 14-day mortality (14.3% vs. 0.7%; odds ratio [OR]: 25.1; 95% confidence interval [CI]: 6.7–94.9) and major bleeding rates (10.3% vs. 1.0%, OR: 12.03, 95% CI: 3.07–47.13). The site of thrombosis, accompanying thrombocytopenia, and 14-day mortality rates were not significantly different for patients with VTE after mRNA-based vaccination, compared with historical controls. Conclusions: Compared with historical controls, VTE after adenovirus-based vaccination against SARS-CoV-2 is accompanied by thrombocytopenia, occurs in unusual sites, and is associated with worse clinical outcomes.
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Petersen, Pelle Baggesgaard, Christoffer Calov Jørgensen, and Henrik Kehlet. "Venous Thromboembolism despite Ongoing Prophylaxis after Fast-Track Hip and Knee Arthroplasty: A Prospective Multicenter Study of 34,397 Procedures." Thrombosis and Haemostasis 119, no. 11 (October 6, 2019): 1877–85. http://dx.doi.org/10.1055/s-0039-1696686.
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Abstract Introduction Venous thromboembolism (VTE) is a serious complication to total hip and knee arthroplasty (THA/TKA). However, recent publications found low 90-day incidences of VTE with in-hospital only thromboprophylaxis after fast-track THA and TKA, but with a subgroup with VTE despite thromboprophylaxis. Objectives We aimed to investigate in detail the incidence and risk for VTE despite ongoing thromboprophylaxis after fast-track THA and TKA. Materials and Methods This is a prospective unselected multicenter cohort from January 2010 to August 2017. Data on preoperative characteristics were entered into the Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement database (www.FTHK.dk). Length of stay (LOS) and complete 90-day follow-up was obtained from the Danish National Patient Registry and review of medical records. Patients with preoperative use of potent anticoagulants were excluded. Results Of 34,397 procedures, 32 (0.09%, 22.4% of all VTE) had VTE after median 2 (interquartile range: 2–4) days despite ongoing thromboprophylaxis. Twenty-nine (2.1% of LOS > 5 days) occurred with LOS > 5 days and 3 during primary admission with LOS ≤ 5 days. Note that 78% of VTEs despite ongoing thromboprophylaxis occurred without any identifiable pre-VTE complication. Risk factors were age from 81 to 85 years (odds ratio [OR] 6.3 [95% confidence interval: 1.8–22.4], p = 0.005), body mass index (BMI) < 18.5 (OR 11.1 [1.1–109.2], p = 0.040), BMI 35 to 40 (OR 5.1 [1.0–26.2], p = 0.050), and BMI ≥ 40 (OR 21.8 [4.6–103.6], p < 0.001). Conclusion VTE after fast-track THA/TKA occurred after median 2 days in 0.09% (22% of all VTE) despite ongoing thromboprophylaxis. Further investigation of this “high-risk” population might help to improve the optimal choice for patient-specific thromboprophylaxis to further reduce incidence of postoperative VTE.
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Czaplewski, Bartosz, and Krzysztof Czaplewski. "Protection of Visual Data Transmission for Vessel Traffic Systems Using Joint Fingerprinting and Decryption Method Based on Modified Hill Cipher." Annual of Navigation 19, no. 2 (December 1, 2012): 5–17. http://dx.doi.org/10.2478/v10367-012-0014-8.
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Abstract Vessel traffic systems provide a high level of safety on coastal waters due to coastal radar stations and industrial cameras transmitting information to traffic supervision centers, as well. To improve a vessel traffic services is very important to ensure the speed and secrecy for the transmission of video images. The paper presents the basic issues of the multimedia data protection by digital watermarking and fingerprinting methods. Main applications for such digital marking were described in the paper as well as its requirements. Furthermore, the importance of multicast transmission for fingerprinting methods was presented by comparing the scalability of methods using only unicast transmissions and methods using multicast transmissions. The paper also presents the greatest threat to fingerprinting methods, which are attacks performed by more than one pirate. These attacks are called collusion attacks. The criteria that should be followed during identifying rogue users taking part in the collusion attack on the security systems has been presented. The paper also contains description of the extended Hillcast method, which belongs to the group of JFD (Joint Fingerprinting and Decryption) methods. The method provides a cryptographic security and digital fingerprinting of multimedia content, while maintaining high scalability. Main purpose of this method is VoD (Video on Demand) service, but it can also be used in vessel traffic supervision systems, such as VTS and AIS. In the last part of paper, there are results of studies which indicate high resistance to most common collusion attacks. Method proposed by authors can enhance the security of visual data transmission in vessel traffic systems.
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Briggs, John N. "Detection of Marine Radar Targets." Journal of Navigation 49, no. 3 (September 1996): 394–409. http://dx.doi.org/10.1017/s0373463300013618.
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A radar must detect targets before it can display them. Yet manufacturers' data sheets rarely tell us what the products will detect at what range. Many of the bigger radars are Type Approved so we consult the relevant IMO performance standard A 477 (XII). Paraphrasing Section 3.1 of the draft forthcoming revision (NAV 41/6): under normal propagation conditions with the scanner at height of 15 m, in the absence of clutter, the radar is required to give clear indication of an object such as a navigational buoy having a radar cross section area (RCS) of 10 m2 at 2 n.m. and, as examples, coastlines whose ground rises to 60/6 m at ranges of 20/7 n.m., a ship of 5000 tons at any aspect at 7 n.m. and a small vessel 10 m long at 3 n.m.This helps, but suppose we must pick up a 5 m2 buoy at g km? What happens in clutter? Should we prefer S- or X-band? To answer such questions we use equations which define the performance of surveillance radars, but the textbooks and specialist papers containing them often generalize with aeronautical and defence topics, making life difficult for the nonspecialist.This paper attempts a concise and self-contained engineering account of all main factors affecting detection of passive and active targets on civil marine and vessel traffic service (VTS) radars. We develop a set of equations for X- and S-band (3 and 10 cm, centred on 9400 and 3000 MHz respectively), suited for spreadsheet calculation.Sufficient theory is sketched in to indicate where results should be valid. Some simplifications of conventional treatments have been identified.
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Adamski, Alys, Aaron Mark Wendelboe, Thomas L. Ortel, Gary E. Raskob, Nimia Reyes, Ibrahim Saber, Karon Abe, and Michele Beckman. "Risk Factors Associated with 6-Month Recurrent VTE Among Patients in Two Large Population-Based Surveillance Systems." Blood 134, Supplement_1 (November 13, 2019): 3444. http://dx.doi.org/10.1182/blood-2019-126903.
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Introduction The incidence of recurrent venous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), is dependent on multiple patient demographic factors and medical co-morbidities, such as cancer and surgery. We sought to determine risk factors associated with 6-month cumulative incidence of recurrent VTE. Methods A detailed description of the population-based surveillance systems have been previously published (Wendelboe 2015 and Ortel 2019 pending publication). In brief, the Centers for Disease Control and Prevention collaborated with University of Oklahoma Health Science Center and Duke University to establish surveillance systems that utilized active and passive methods to obtain data on all VTE events that occurred within Oklahoma and Durham counties, respectively between April 2012 and March 2014. This is the first report combining data from the two surveillance systems. Eligibility for the current analysis included 1) patients 18 years or older at the time of index VTE 2) no reports of patient death between index VTE and recurrent VTE or within 6 months of index VTE 3) patient data from a hospital system or out-patient clinics associated with a hospital (i.e. individuals treated at non-hospital-based out-patient clinics were excluded due to missing treatment data) 4) and index VTE occurred at least 6 months prior to the end of the surveillance period or a 6-month follow-up data abstraction was performed by the site. Recurrent VTE was defined as 1) VTE (either DVT or PE) in a different location and diagnosed after the index VTE or 2) VTE in the same location and diagnosed greater than 90 days after index VTE. Results During the surveillance period 4,205 patients were diagnosed with an index VTE, of these 2,883 (68.6%) were eligible for analysis. The 6-month incidence of VTE recurrence was 5.8% (n=166). Recurrent VTE events were diagnosed within 3 to 179 days post index VTE. Compared to patients without recurrent VTE, patients with recurrent VTE were more likely to be younger (≤ 60 years of age) and black (Table 1). They were also more likely to have a DVT only as their index VTE, to have a provoked VTE, and to have had a VTE prior to their index VTE; they were less likely to present with symptoms at the time their index VTE was diagnosed. The majority of index DVTs were located in the veins of the lower extremities, however among patients with recurrent DVT there was an increased proportion of index DVTs diagnosed in the upper extremities, other locations, and in more than one location. These differences remained after multivariable adjustment (Table 2). Clinical characteristics of recurrent VTE events are summarized in Table 3. Recurrent VTEs were primarily DVT only (73.5%), located in the lower extremity (52.7%), symptomatic at presentation (73.4%), and were associated with transient provoking factors (50.6%) including hospitalization (41.6%). Several patients (n=25) were hospitalized from the date of their index VTE to the date of VTE recurrence. Use of pharmacologic prophylaxis was high at time of recurrence (33.1%) compared to use at index VTE (12.3%). Discussion Currently, there is no U.S. national VTE surveillance system. Our VTE surveillance results show significant differences in the risk of VTE recurrence according to both patient demographic factors and clinical features of the index VTE. Factors associated with higher recurrence risk include 60 years or younger, black race, and index VTE that was DVT only, asymptomatic, and associated with persistent or transient provoking factors. Fatal recurrent VTEs may not have been identified at time of death, potentially underestimating the VTE recurrence incidence and influence of risk factors. The proportions of recurrent VTE events reported here is similar to the proportions reported in previous cohort studies, indicating that these population-based surveillance systems captured most recurrent VTE events among patients seen within hospital systems for their index VTE. Disclosures Ortel: Instrumentation Laboratories: Consultancy. Raskob:Bayer Healthcare: Consultancy, Honoraria; Daiichi Sankyo: Consultancy, Honoraria; Pfizer: Consultancy, Honoraria; Tetherex: Consultancy; Novartis: Consultancy; Anthos: Consultancy; Janssen R&D, LLC: Consultancy, Honoraria; Boehringer Ingelheim: Consultancy; BMS: Consultancy, Honoraria; Portola: Consultancy; Eli Lilly: Consultancy.
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Kallmes, Kevin, Kathryn Cowie, Nicole Hardy, and Karl Holub. "OP72 Software Tools For Systematic Literature Review In Medicine: A Review And Feature Analysis." International Journal of Technology Assessment in Health Care 38, S1 (December 2022): S27. http://dx.doi.org/10.1017/s0266462322001210.
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IntroductionSystematic reviews (SRs) are central to evaluating therapies but have high costs in time and money. Many software tools exist to assist with SRs, but most tools do not support the full process, and transparency and replicability of SR depends on performing and presenting evidence according to established best practices. In order to provide a basis for comparing between software tools that support SR, we performed a feature-by-feature comparison of SR tools.MethodsWe searched for SR tools by reviewing any such tool listed the Systematic Review Toolbox, previous reviews of SR tools, and qualitative Google searching. We included all SR tools that were currently functional, and required no coding and excluded reference managers, desktop applications, and statistical software. The list of features to assess was populated by combining all features assessed in four previous reviews of SR tools; we also added five features (manual addition, screening automation, dual extraction, living review, and public outputs) that were independently noted as best practices or enhancements of transparency/replicability. Then, two reviewers assigned binary ‘present/absent’ assessments to all SR tools with respect to all features, and a third reviewer adjudicated all disagreements.ResultsOf 53 SR tools found, 29 were excluded, leaving 24 for assessment. Thirty features were assessed across six classes, and the inter-observer agreement was 86 percent. DistillerSR (Evidence Partners; n = 26/30, 87%), Nested Knowledge (Nested Knowledge; n = 25/30, 83%), and EPPI-Reviewer Web (EPPI-Centre; n = 24/30, 80%) support the most features followed by Giotto Compliance (Giotto Compliance; n = 23/30, 77%), LitStream (ICF; n = 22/30, 73%), and SRDB.PRO (VTS Software; n = 21/30, 70%). Seven tools support fewer than half of all features assessed: RobotAnalyst, SyRF, Data Abstraction Assistant, SWIFT-Review, SR-Accelerator, RobotReviewer, and COVID-NMA. Notably, only 10 tools (42%) support direct search, 7 (29%) offer dual extraction, and 13 (54%) offer living/updatable reviews.ConclusionsDistillerSR, EPPI-Reviewer Web, and Nested Knowledge each offer a high density of SR-focused web-based tools. By transparent comparison and discussion regarding SR tool functionality, the medical community can choose among existing software offerings and note the areas of growth needed, most notably in the support of living reviews.
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Meinhardsson, J., R. Klose-Jensen, J. Therkildsen, B. Langdahl, E. M. Hauge, and K. Keller. "POS0133 HIGH-RESOLUTION PERIPHERAL QUANTITATIVE COMPUTED TOMOGRAPHY FOR THE EVALUATION OF BONE EROSIONS OF METATARSOPHALANGEAL JOINTS IN RHEUMATOID ARTHRITIS: A PILOT STUDY." Annals of the Rheumatic Diseases 81, Suppl 1 (May 23, 2022): 293–94. http://dx.doi.org/10.1136/annrheumdis-2022-eular.3589.
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BackgroundBone erosion in rheumatoid arthritis (RA) is most commonly detected in the wrist, metacarpophalangeal (MCP) and metatarsophalangeal (MTP) joints. High-resolution peripheral quantitative computed tomography (HR-pQCT) has successfully been used to quantify bone erosions in the wrist and MCP joints. A recent study highlights that HR-pQCT of only two MCP joints has equal accuracy to detect erosive disease in RA patients compared to conventional radiography (CR) of the hands, wrists, and feet (44 joints)1. However, no study has evaluated the MTP joints by HR-pQCT.ObjectivesTo characterize the localization, size and frequency of erosions in the 4th and 5th MTP joints. Furthermore, to evaluate the sensitivity for the detection of erosion in the 4th and 5th MTP joints by HR-pQCT, compared to CR.MethodsThis single-centre cross-sectional study included 42 patients with established RA (disease duration ≥ 5 years). The right foot was imaged by HR-pQCT in a 2.7 cm long region corresponding to the 4th and 5th MTP joint. Blinded to patient data, the number and volume of bone erosions by HR-pQCT were measured and scored according to the SPECTRA criteria2. CR of 44 joints was evaluated according to the Sharp/van der Heijde (SHS) method.ResultsThe patients (62% women) had a median disease duration of 12 years (interquartile range (IQR): 7 – 20). HR-pQCT of the 4th and 5th MTP joints identified erosions in 38 (90%) patients. The total erosion volume (Vtot) was 2610 mm3 in all quadrants of the 4th and 5th MTP joints. Erosions were most frequently found at the lateral aspect of the 5th metatarsal head (MH), including 1261 mm3 (48%) of Vtot (Figure 1). CR of 44 joints detected erosions in 30 (71%) patients with a median SHS erosion score of 9 (5 – 28). The sensitivity and specificity (95% CI) of classifying patients with erosive RA by HR-pQCT and CR is displayed in Table 1. McNemar’s χ2 test showed a significantly higher sensitivity of patients classified as having erosive RA by HR-pQCT of the 4th and 5th MTP joints than by CR of 44 joints (4.6, p = 0.03).Table 1.Comparing CR and HR-pQCT for classifying patients as having erosive RA, and for identifying erosions in the 4th and 5th MTP joints.Sensitivity & specificity of classifying patients with erosive RA by HR-pQCT when CR of the hands, wrist and feet was used as referenceCRHands, wrists, and feet Erosive RACRHands, wrists, and feetNon-erosive RATotalSensitivity (95% CI)HR-pQCT4th and 5th MTP jointsErosive RA27113890.0 (73.5 – 97.9)Specificity (95% CI)HR-pQCT 4th and 5th MTP joints Non-erosive RA3148.3 (0.2 – 38.5)Total301242Sensitivity & specificity of classifying patients with erosive RA by CR when HR-pQCT was used as referenceHR-pQCT4th and 5th MTP jointsErosive RAHR-pQCT4th and 5th MTP jointsNon-erosive RATotalSensitivity (95% CI)CRHands, wrists, and feetErosive RA2733071.0 (54.1 – 84.6)Specificity (95% CI)CRHands, wrists, and feetNon-erosive RA1111225.0 (0.6 – 80.6)Total38442Conventional Radiography (CR), High-resolution peripheral Quantitative Computed Tomography (HR-pQCT), Metatarsophalangeal (MTP), Rheumatoid Arthritis (RA), Confidence Interval (CI).ConclusionThis is the first study to evaluate erosions with HR-pQCT of the 4th and 5th MTP joints, including a comparison to CR. Erosions were frequent at the lateral aspect of the MTP joints, suggesting that mechanical and biomechanical demands may play a role in the development of erosions in the MTP joints. The superiority of HR-pQCT compared to CR for detecting erosions provide a basis for larger studies assessing bone changes in the MTP joints.References[1]Klose-Jensen, R., et al. Diagnostic accuracy of high-resolution peripheral quantitative computed tomography and X-ray for classifying erosive rheumatoid arthritis. Rheumatology (Oxford) (2021).[2]Barnabe, C., et al. Definition for Rheumatoid Arthritis Erosions Imaged with High Resolution Peripheral Quantitative Computed Tomography and Interreader Reliability for Detection and Measurement. J Rheumatol43, 1935-1940 (2016).Disclosure of InterestsJørgen Meinhardsson: None declared, Rasmus Klose-Jensen: None declared, Josephine Therkildsen: None declared, Bente Langdahl Speakers bureau: UCB, Amgen, Eli Lilly, Gedeon-Richter, Gilead, Astellas, Consultant of: UCB, Amgen, Eli Lilly, Gedeon-Richter, Gilead, Astellas, Grant/research support from: Amgen and Novo Nordisk, Ellen-Margrethe Hauge Speakers bureau: AbbVie, Sanofi, Sobi, MSD, UCB, Consultant of: AbbVie, Sanofi, Sobi, MSD, UCB, Grant/research support from: Novo Nordic Foundation, Danish Rheumatism Association, Danish Regions Medicine Grants, Roche, Novartis, Kresten Keller: None declared
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Sayar, Zara, Anna Weatherill, Stephen Keddie, Jonathan Sive, Michael P. Lunn, Mari Thomas, and Shirley D'Sa. "High Rates of Venous and Arterial Thrombotic Events in POEMS Patients: Results from the UK-Based POEMS Registry, Highlighting the Need for Therapeutic Guidelines." Blood 134, Supplement_1 (November 13, 2019): 714. http://dx.doi.org/10.1182/blood-2019-125639.
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Introduction Arterial and venous events are known to occur in patients with POEMS (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy, Skin changes) syndrome which may also include myeloproliferation, with a reported rate in the literature of around 20%. This is higher than in the myeloma cohort where the VTE rate from the UK Myeloma XI study was reported as 11.8%. The approach to optimum management of thrombosis in POEMS patients remains undefined. Method The UCLH POEMS Registry is a comprehensive tertiary centre-based UK data repository including patients from 1999 to the present. Data were collated from patients referred in for diagnosis or after treatment and included blood results, neurological and general performance status, previous and active venous thromboembolism (VTE) and arterial events and their management. Results Of the 103 patients in the UCLH POEMS Registry, 20 were excluded due to missing data. Of the 83 patients included, median age was 52 years (31-84) and 54 (65%) were male. Mean haemoglobin at diagnosis was 143 g/L (89-190), platelet count 443 x10^9 (194-741), vascular endothelial growth factor (VEGF) 3536 pg/mL (388-15422), creatinine 75 μmol/L (32-168) and albumin 40 g/L (31-50). Performance status was ≥ 3 in 15 patients. Radiotherapy was used as a treatment modality in 21/83 (25%) and 48/83 (52%) patients received autografts. There were 51 outpatient-based chemotherapy regimens prescribed. Lenalidomide and dexamethasone (LD) was the most common prescription 30/51 (59%), followed by cyclophosphamide and dexamethasone in 10/51 (20%), LD plus cyclophosphamide in 3/51 (6%), melphalan and steroids 3/51 (6%), cyclophosphamide, dexamethasone and thalidomide 2/51 (4%), LD plus ixazomib 1/51 (2%), velcade, thalidomide and dexamethasone 1/51 (2%) and carfilzomib with dexamethasone 1/51 (2%). Of these 51 outpatient-based chemotherapy scripts, 30 received documented thromboprophylaxis (TP). Prophylactic low molecular weight heparin (pLMWH) was prescribed most frequently (17/30) with 16 of these patients receiving an immunomodulatory based chemotherapy regimen. Other TP agents used include: aspirin (6/30), treatment dose LMWH (tLMWH) (2/30), rivaroxaban (2/30), warfarin (2/30) and clopidogrel (1/30). Twenty-five patients experienced a total of 35 clinically apparent arterial or venous events. Seven had more than 1 thrombotic event, 2 of which developed both arterial and venous thromboses. Three patients had a prior history of VTE;1 with historic DVT developed pulmonary emboli, and 2 had arterial events after historic VTE. Eleven patients had 14 VTEs including DVT (6/14), PE (4/14) and 4 PICC-associated DVT occurring during melphalan-based autograft. Most VTEs occurred during active disease with median VEGF 2731 (444-5000). Five venous events occurred on chemotherapy, including 4 during a melphalan-based autograft, and 1 on LD. VTE occurred despite prophylactic LMWH in 3 patients (2 unknown). Treatment comprised LMWH (4), warfarin (4), or the direct oral anticoagulants, rivaroxaban (1) and apixaban (1). One patient did not receive treatment for a PICC-associated DVT. Sixteen patients experienced 21 arterial events including stroke (7/21), peripheral vascular disease (6/21), MI (4/21) and microvascular disease (2/21). Most events occurred during active disease with median VEGF 3155 (637-10640). Three occurred on anti-POEMS therapy: one patient (VEGF 4555) developed a second stroke on LD and LMWH prophylaxis; one patient on LD (VEGF 10640) and prophylactic rivaroxaban 10mg developed PVD, and another on melphalan and prednisolone (VEGF 2000-4000) and warfarin for atrial fibrillation (target INR 2.0-3.0) developed PVD. Conclusion The venous and arterial event rate in this cohort at 35/83 (42%) is over double that previously reported. There were more arterial events than venous, and most occurred in a state of active disease and off anti-POEMS therapy (26/35), suggesting that treatment-related risk factors are less of a driver for thrombosis than the disease itself. There was no discernible relationship with thrombocytosis. Thromboprophylaxis is commonly used in POEMS patients receiving outpatient-based chemotherapy with the most common agent being prophylactic LMWH. With the high incidence of arterial events in the presence of active disease, the role for anti-platelet agents or indeed DOACs remains undefined in this patient group. Disclosures Thomas: Sanofi: Membership on an entity's Board of Directors or advisory committees. D'Sa:Janssen: Honoraria, Research Funding.
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Khalil, Ahmed, Daniel Ortolano, Thomas Simunich, Mohamed Saad Eldin, Munawwar Hussain, and Sheetal L. Higbee. "Khorana score as a predictive tool of venous thromboembolism in cancer patients in rural practice." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e24049-e24049. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e24049.
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e24049 Background: The Centers for Disease Control and Prevention (CDC) estimates that 60,000 to 100,000 Americans die from venous thromboembolism (VTE) annually, costing the U.S. healthcare system $7–10 billion each year. VTE is a leading cause of mortality in cancer patients, and risk is particularly elevated in rural areas, where cancer death rates are higher than in metropolitan areas. The Khorana score has been shown to predict VTE incidence before starting treatment and as such identify those patients that would benefit most from VTE prophylaxis. We aimed to replicate the utility of the Khorana score on a rural population of cancer patients to help address VTE in advance. Methods: From our electronic health records system, we extracted data from cancer patients (age ≥ 18 years) who had begun chemotherapy from 2017-January through 2019-August. Patients who were pregnant, had undergone hormonal therapy or major surgeries within three months prior to VTE diagnosis, or had a history of coagulation disorders or VTE prior to starting chemotherapy were excluded. A Khorana score (0—6, interval = 1) was calculated for each prior to their starting chemotherapy and was used for VTE risk stratification, 0 – low; 1,2 – intermediate; ≥3 – high. We hypothesized that VTE occurrence during the first 6 months following the start of treatment would be positively associated with risk category. Results: The 144, mostly female (64%), cancer patients meeting inclusion had a mean age of 75 years (range 48—95) and VTE risk stratification: 10% (15) high, 67% (96) intermediate, and 23% (33) low. In the first 6 months of starting treatment, 6% (9/144) developed VTE, with a prevalence of 20% (3/15) amongst patients stratified as high risk, 5% (5/96) of intermediate, and 3% (1/33) of the low risk group. A linear-by-linear association of the observed Khorana scores with VTE occurrence implies a meaningful positive association between VTE risk stratification by Khorana score and VTE, chi-square (1,144) = 4.018, p = .045. Conclusions: The trend of higher VTE prevalence in intermediate and high risk patients supports the observed positive association between Khorana score VTE risk category and a greater percentage of patients experiencing VTEs with increasing risk. This trend may likely be amplified with application to a larger number of patients. The study limitations include the lack of diversity of organ affection and sample size, specifically upon risk stratification. However, initiating a discussion about the risks and benefits of VTE prophylaxis prior to starting treatment is of outmost importance.
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Louzada, Martha L., Alejandro Lazo-Langner, Marc Carrier, Vi Dao, Jerry Zhang, Marc A. Rodger, Michael J. Kovacs, and Philip Wells. "Patients with Cancer Who Develop a First Venous Thromboembolic Event After Surgery Are at High Risk of Venous Thromboembolism Recurrence During the Anticoagulation Period." Blood 116, no. 21 (November 19, 2010): 4202. http://dx.doi.org/10.1182/blood.v116.21.4202.4202.
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Abstract Abstract 4202 Background: It is unknown whether patients with cancer who develop VTE after a surgical procedure have the same risk of recurrent VTE as clinical patients cancer-associated thrombosis. VTE recurrence risk in non-cancer patients with VTE after surgery is approximately 1% in the 3 months following completion of anticoagulation. It is unknown whether surgical patients with cancer follow the low risk of recurrence as other provoked VTEs or whether they have the high recurrence risk typical of cancer patients. Methods: We performed a post-hoc analysis of a single centre retrospective cohort study conducted at the Thrombosis Unit of the Ottawa Hospital. The charts of patients with cancer and VTE followed from 2002 to 2004 and from 2007 to 2008 were reviewed. We sought to compare the risk of recurrent VTE between patients with cancer who developed a first VTE after major surgery with all other patients with cancer-associated thrombosis. We included patients > or = 18 years of age with active malignancy and objectively diagnosed index VTE [pulmonary embolism (PE), proximal deep venous thrombosis (DVT) of the legs or arms, PE + DVT; unusual site thrombosis]. After the first VTE, all patients received a minimum of 6 months of anticoagulation. In the surgery group, index VTE was considered associated with the intervention if it occurred within the first 3 months after the procedure. Results: 543 patients were included. 121 patients had VTE after surgery and 17 (13.1%) developed a recurrence during therapeutic anticoagulation. Of 422 clinical patients, 61 (14.7%) had a recurrent VTE (Table). The relative risk of recurrent VTE comparing patients who had and who did not have surgery was non-significant (RR= 0.97 (95%CI: 0.587 – 1.574; p= 1.000) suggesting that patients with cancer who undergo surgery have similar risk of developing a recurrent VTE during anticoagulation as patients with cancer-associated VTE who do not undergo surgery. VTE recurrence occurred predominantly within the first 6 months of anticoagulation [Surgery: 9 of 17 patients (52.9 %); no surgery: 45 of 61 (73.7%) patients (p=0.1377)] (Figure). There was no significant difference in VTE recurrence risk according to anticoagulant strategy, tumor site, histology, TNM stage, age or gender between surgery and no surgery groups. Conclusion: Patients with cancer who develop VTE after surgery have similar risk of developing a recurrent VTE during the anticoagulation period as clinical patients with cancer-associated VTE. Disclosures: Rodger: Pfizer: Research Funding; Leo Pharma: Research Funding; Sanofi Aventis: Membership on an entity's Board of Directors or advisory committees, Research Funding; Canadian Institutes of Health Research: Research Funding; Heart and Stroke Foundation: Research Funding.
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Borjas-Howard, James Francis, Casper Rokx, Colette Smit, Ferdinand Wit, Elise Pieterman, Karina Meijer, Bart Rijnders, Wouter Bierman, and Vladimir Tichelaar. "Incidence and Risk Factors for Venous Thrombosis in Human Immunodeficiency Virus (HIV) Infection, Data from the Dutch Athena Cohort Study." Blood 128, no. 22 (December 2, 2016): 271. http://dx.doi.org/10.1182/blood.v128.22.271.271.
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Abstract Introduction HIV-infected patients have an increased risk of venous thrombosis (VT), but the most recently published data are from before 2007 (Rasmussen et al. HIV Med2011). However, since 2008, recommended CD4+ T-cell thresholds for starting combination anti-retroviral therapy (cART) have steadily increased from 200 to the current (2015) recommendation to start cART irrespective of CD4+ count. As the increased risk of VT is predominantly the result of the HIV-associated pro-inflammatory state, we hypothesize that initiation of cART at higher CD4+ T-cell counts might have attenuated the risk of VT over the last decade. However, in contrast and more controversial is the possible prothrombotic effect of certain antiretroviral agents, namely abacavir (ABC) and HIV protease inhibitors (PI). To elucidate this, we assessed the relationship of CD4+ T-cell counts and cART regimens with the risk of VT, using data from the Dutch ATHENA cohort. Methods ATHENA is the Dutch National HIV cohort study, prospectively collecting data of all HIV-infected patients in the Netherlands. As VT is not routinely registered, we developed a strategy of targeted VT case finding through the registered use of anticoagulants (recorded since January 2003). Any anticoagulant use registered in ATHENA led to a review of a patients medical records looking for a VT diagnosis (either confirmed by radiological examination or by clinicians correspondence/ resumes). We confirmed the sensitivity (100% sensitivity) of our search strategy in a pilot study in one participating center and used it to collect VT cases in twelve HIV treatment centers (>70% of all HIV-infected patients in care in the Netherlands). Main outcome was occurrence of a first VT: deep vein thrombosis of the lower/upper extremity (no more distal than popliteal/subclavian vein), pulmonary embolism, splanchnic and/or cerebral VT. Data were analyzed using Cox regression. Covariates of interest were HIV-specific events (coded as CDC-C events), CD4+ & CD8+ T-cell counts, HIV-RNA viral load, use of antiretroviral medication (by class), history of intra-venous drug use and classic VT risk factors (pregnancy, malignancy and hospitalization). Covariates remaining significant after correction for classic VT risk factors (table 1, adjusted), were forced into two fully adjusted models; one excluding (Model 1) and one including hospitalization as a covariate (Model 2). This enabled separation of effects for variables that are not confounded by hospitalization (i.e. in most cases, hospitalization is a consequence- not the cause- of infection/inflammation) and variables potentially confounded by hospitalization (i.e. starting cART during a hospitalization). Results 14,386 eligible patients were included. Median age at inclusion was 40 years, 79% was male. There were 229 VTs during 97,556 years of follow up (2.3 VT per 1000 person years [py]). All classic risk factors introduced were independently associated with VT. HIV specific markers except CD4+/CD8+ T-cell ratio were independently associated with VT, with CD4+ T-cell count category showing a consistent decrease in hazard for VT for each category. The absolute VT risk in patients with CD4+ count >500 was close to that of the general population (1.3 [95%CI 1.0-1.6] versus 1.2 VTs per 1000 py [Silverstein et al, Arch Int Med, 1998]). We did not observe an association between VT and PIs or ABC, but we did for the use of integrase inhibitors (INIs). The effect lost statistical significance after adjustment for hospitalization. Conclusions Overall, HIV-infected patients have a twofold increased risk of VT compared with the general population. This risk declined progressively with increasing CD4+ T-cell counts, from 7.1 to 1.3 VTs per 1000 py for CD4+ T-cell counts >500, thereby approaching the incidence of the general population. Markers for more advanced HIV-disease (higher viral load, AIDS-defining illness) were also associated with an elevated risk of VT. INIs (at that time only raltegravir) were the only antiretroviral agents associated with increased VT risk, with a borderline significance in a fully adjusted model. This association might be due to confounding by indication, as at the time, INIs were mostly used in patients with prior therapy failure or comorbidities. Overall, our findings suggest that the elevated risk in the HIV-infected population is explained by uncontrolled HIV infection and provoking factors. Disclosures Rokx: Virology Education: Honoraria; Janssen-Cilag: Honoraria; Boehringer-Ingelheim: Honoraria; Gilead: Honoraria, Other: travel grants; ViiV Healthcare: Honoraria, Other: travel grant; Merck & Co: Research Funding; MSD: Other: travel grant. Wit:Abbvie: Other: travel grant; Janssen-Cilag: Other: travel grant; ViiV Healthcare: Other: travel grant; MSD: Other: travel grant; Bristol-Myers Squibb: Other: travel grant; Gilead Sciences: Honoraria, Other: travel grant; Boeringer Ingelheim: Other: travel grant. Meijer:Baxter: Research Funding; Bayer: Honoraria, Research Funding; Pfizer: Research Funding; Sanquin: Honoraria, Research Funding; Boehringer Ingelheim: Honoraria; Bristol-Myers Squibb: Honoraria. Rijnders:AbbVie: Membership on an entity's Board of Directors or advisory committees, Other: Travel grants; EUR trust fund: Research Funding; Bristol-Myers Squibb: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel grants; ViiV Healthcare: Other: Travel grants; Gilead Sciences: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel grants, Research Funding; Great Lakes Pharmaceuticals, inc.: Honoraria; Janssen-Cilag: Membership on an entity's Board of Directors or advisory committees, Other: Travel grants; MSD: Membership on an entity's Board of Directors or advisory committees, Other: Travel grants, Research Funding. Bierman:Janssen-Cilag: Other: unrestricted symposium support grant, Research Funding. Tichelaar:Bayer: Other: travel grant; Baxter: Other: travel grant.
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Andrew, Retter J., and Hunt J. Beverley. "Antithrombin Deficiency in Pregnancy." Blood 110, no. 11 (November 16, 2007): 1879. http://dx.doi.org/10.1182/blood.v110.11.1879.1879.
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Abstract Background: During pregnancy untreated antithrombin deficiency is associated with up to a 50% risk of venous thromboembolism (VTE) and a relative risk of pregnancy loss of 2.1 with a 5-fold increase in stillbirths. Thus thromboprophylaxis is widely used, but little data is available to select type, dose & duration of anticoagulation. Method: We performed a retrospective, single centre observational study of our antithrombin deficient pregnancies since 1996. Results: There were 9 pregnancies in 8 women; median age at conception 33 (age-range 19–37). They separated into 3 groups (1) 4 asymptomatic patients diagnosed on family screening. They received unmonitored enoxaparin 40mg until 16 weeks then 40mg BD. (2) 2 with previous VTE, received intermediate dose enoxaparin (1mg/kg), increased to BD at 16 weeks. Monitoring was done to maintain an anti-Xa trough of <0.12 iu/ml and peak <0.8iu.ml. (3) 2 referred after presenting with VTE in pregnancy. They received enoxaparin 1mg/kg BD and the same monitoring These included a known antithrombin deficient woman, referred in her second pregnancy at 26weeks gestation with premature rupture of the membranes and an iliofemoral deep vein thrombosis which developed on enoxaparin 60mg OD. Enoxaparin was increased to 1mg/kg BD and an IVC filter inserted. Despite the filter however she had a pulmonary embolism. The filter was removed after Caesarean section at 31 weeks. Two had sagittal sinus thromboses in the first trimester associated with severe hyperemesis requiring IV fluids. One was our only thromboprophylaxis failure, receiving enoxaparin 40mg OD, she weighed 80Kg. The second presented at 11weeks gestation. She was intolerant of self injecting and so switched to warfarin at 15 weeks until 35 weeks as did one other mother. All mothers had close feto-maternal monitoring with uterine artery Doppler at 24 weeks if possible and then monthly growth scans thereafter. Delivery: Thromboprophylaxis was stopped at labour initiation or 12hrs prior to Caesarean section (3 women) and 50iu/kg of antithrombin concentrate was given. Anticoagulation was restarted 24hrs after delivery. Six weeks enoxaparin post-partum thromboprophylaxis was given or the women converted back to warfarin. Estimated blood loss at delivery was a median of 200ml (range 200–500ml), no transfusions were required. There were no post partum VTEs. Nine births occurred at a median gestation of 38weeks (range 31–41), median birth weight 3045g (range 1420–4120g). One child has West’s syndrome. Conclusion: This is the largest case series on the management of antithrombin deficiency in pregnancy. The combined use of enoxaparin in pregnancy and post partum combined with antithrombin concentrate during labour appears to improve pregnancy outcome and reduce the rate of VTE. Larger studies are required to confirm this finding.
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Pieters, Willem D., and Raynitchka Tzoneva. "Investigation of an IEC 61850 standard-based process bus implementation of a protection and control scheme for parallelly connected transformers." Journal of Engineering, Design and Technology 19, no. 4 (February 26, 2021): 850–75. http://dx.doi.org/10.1108/jedt-01-2020-0023.
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Purpose This paper aims to focus on the implementation of the International Electrotechnical Commission (IEC) 61850–9-2 standard based process bus with merging units (MUs) and sampled values (SV) to improve the protection and control systems. The digital process interface is important to be included on the process bus level. Design/methodology/approach The IEC 61850–9-2 process bus standard is not extensively used in regard to SV when the IEC 61850 standard is implemented by power utilities. Many protection and control intelligent electronic devices (IEDs) are connected to a substation communication network, routers and switches using fibre-optic linked Ethernet. However, inductive current transformers (CTs) and voltage transformers (VTs) secondary circuits are still hardwired to the IEDs. The paper highlight issues with the copper wires for currents signals and how these issues can be eliminated by using the MUs and the SV protocol. The voltage regulator control IED of each transformer is required to regulate the voltage level of the secondary side bus bar it is connected to. All the regulating IEDs of parallel-connected transformers are required to communicate with each other to share information. They collectively control the bus bar voltage depending on the switching configuration of the parallel transformers. Findings It is shown that process bus information such as the high voltage switchgear status information of primary plant in the yard, can be used to improve the substation protection and control systems. The power transformer protection and voltage regulator control are focused on. Research limitations/implications The deliverables of the research work can be applied in: The Centre for Substation Automation and Energy Management systems of the Department of Electrical Engineering, power utilities and other establishments using power systems and digital substations in the electrical supply industry. The research work on the thesis led to the development of a laboratory test-bench where students can learn and understand the basics of the IEC 61850–9-2 SVs principles. The test-bench components such as the IEDs, real-time digital simulator, standalone MUs and Ethernet equipment can be used for future research applications. The test-bench can be used to demonstrate during course work for students at the University, the basics of digital substations using a process bus network with IEDs, MUs and Ethernet equipment. Practical implications The research work showed where lab equipment is getting outdated and future equipment will be required for research work in IEC 61850–9-2 process bus. Originality/value Power utilities can benefit from implementing the IEC 61850 part 9–2 of the standard and by using MUs and other process interface information in substations. A cost reduction in high voltage equipment, substation installation and commissioning costs and better performance of protection and control system can be achieved.
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Noble, Simon I., Annmarie Nelson, David Fitzmaurice, Marie-Jet Bekkers, Jessica Baillie, Stephanie Sivell, Joanna Canham, et al. "A feasibility study to inform the design of a randomised controlled trial to identify the most clinically effective and cost-effective length of Anticoagulation with Low-molecular-weight heparin In the treatment of Cancer-Associated Thrombosis (ALICAT)." Health Technology Assessment 19, no. 83 (October 2015): 1–94. http://dx.doi.org/10.3310/hta19830.
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BackgroundVenous thromboembolism is common in cancer patients and requires anticoagulation with low-molecular-weight heparin (LMWH). Current data recommend LMWH for anticoagulation as far as 6 months, yet guidelines recommend LMWH beyond 6 months in patients who have ongoing or active cancer. This recommendation, based on expert consensus, has not been evaluated in a clinical study.Objectives(1) To identify the most clinically and cost-effective length of anticoagulation with LMWH in the treatment of cancer-associated thrombosis (CAT); (2) to identify practicalities of conducting a full randomised controlled trial (RCT) with regard to recruitment, retention and outcome measurement; and (3) to explore the barriers for progressing to a full RCT.DesignThe Anticoagulation with Low-molecular-weight heparin In the treatment of Cancer-Associated Thrombosis (ALICAT) trial is a randomised, multicentre, feasibility mixed-methods study with three components: (1) a RCT comparing ongoing LMWH treatment for CAT with cessation of LMWH at 6 months’ treatment (current licensed practice) in patients with locally advanced or metastatic cancer, consulted in three clinical settings (haematology outpatients, oncology outpatients and primary care); (2) a nested qualitative study, including focus groups with clinicians to investigate attitudes for recruiting to the study and identify the challenges of progressing to a full RCT, and semistructured interviews with patients and relatives to explore their attitudes towards participating in the study, and potential barriers and concerns to participation; and (3) a UK-wide survey exercise to develop a classification and enumeration system for the CAT models and pathways of care.SettingA haematology outpatients department, an oncology outpatients department and primary care.ParticipantsPatients with ongoing active or metastatic cancer who have received 6 months of LMWH for CAT.InterventionsOngoing LMWH treatment for CAT versus cessation of LMWH at 6 months’ treatment in patients with locally advanced or metastatic cancer.Main outcome measures(i) The number of eligible patients over 12 months; (ii) the number of recruited patients over 12 months (target recruitment rate of 30% of eligible patients); and (iii) the proportion of randomised participants with recurrent venous thromboembolisms (VTEs) during follow-up.ResultsFollowing several delays in setting up the RCT component of the study, 5 out of 32 eligible patients consented to be randomised to the RCT suggesting progression to a full RCT was not feasible. Reasons for non-consenting were primarily based on a fixed preference for continuing or discontinuing treatment after 6 months of anticoagulation, and a fear of randomisation to their non-preferred option. Views were largely influenced by patients’ initial experience of CAT. Focus groups with clinicians revealed that they would be reticent to recruit to such a study as they had fixed views of best management despite the lack of evidence. Patient pathway modelling suggested that there is a broad heterogeneity of practice with respect to CAT management and co-ordination, with no consensus on which specialty should best manage such cases.ConclusionsThe results of the RCT reflect recruitment from the oncology site only and provide no recruitment data from haematology centres. However, it is unlikely that these other sites would have access to more eligible patients. The management of cancer-associated thrombosis beyond 6 months will remain a clinical challenge. As it is unlikely that a prospective study will successfully recruit, other strategies to accrue relevant data are necessary. Currently the LONGHEVA (Long-term treatment for cancer patients with deep-venous thrombosis or pulmonary embolism) registry is in development to prospectively evaluate this important and common clinical scenario.Study registrationThis study is registered as clinical trials.gov number NCT01817257 and International Standard Randomised Controlled Trial Number (ISRCTN) 37913976.Funding detailsFunding for the ALICAT trial was provided by the Health Technology Assessment programme (10/145/01) in response to a themed funding call. The study was designed in accordance with the initial funding brief and feedback from the review process.
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Abildgaard, Niels, Marie-Christiane Vekemans, Barbara Gamberi, Francesco Di Raimondo, Angel Ramirez Payer, Charalampia Kyriakou, Alain Kentos, et al. "Safety in Patients with Multiple Myeloma Treated with Pomalidomide in a Real-World Setting According to Last Prior Treatment: A European Post-Authorization Safety Study." Blood 132, Supplement 1 (November 29, 2018): 3286. http://dx.doi.org/10.1182/blood-2018-99-111906.
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Abstract BACKGROUND The combination of pomalidomide (POM) and dexamethasone (DEX) for the treatment (Tx) of relapsed or refractory multiple myeloma (RRMM) in patients (pts) who have received ≥ 2 prior Tx regimens, including lenalidomide (LEN) and bortezomib (BORT), was approved in Europe in August 2013. POM-DEX is now a standard Tx for pts with RRMM. These pts are at an increased risk for adverse events (AEs) due to prior exposure to multiple lines of Tx and a high disease burden. The European Union post-authorization safety study (EU PASS; NCT02164955) is a prospective, observational, non-interventional study (method: registry) designed to characterize the safety profile of POM-based Tx in pts with RRMM in a real-world setting. AIM To report the incidence of key AEs with POM-based Tx, such as neutropenia, thrombocytopenia, venous thromboembolism (VTE), peripheral neuropathy (PN), and second primary malignancies (SPMs), in pts with RRMM treated with POM according to the last prior Tx before starting POM Tx in a post-marketing setting. METHODS Pts with symptomatic RRMM initiating POM-based Tx were enrolled at the investigator's discretion. Thromboprophylaxis was administered per local standard practice. AEs were graded according to National Cancer Institute Common Terminology Criteria for Adverse Events (v4.0). The study is ongoing and open for recruitment in centers across Europe. This analysis focused on the safety profile according to the last prior Tx received before starting POM Tx. RESULTS As of July 12, 2018, 596 pts across 100 institutions in 8 European countries were included in the safety population. At the time of data cutoff, Tx was ongoing in 122 pts (20.5%). Median age was 70 yrs (range, 37-92 yrs), with 28.4% of pts aged < 65 yrs, 38.4% between age 65 and 75 yrs, and 33.2% aged ≥ 75 yrs; 54.2% were male. Median time from diagnosis was 4.8 yrs (range, 0.3-26.9 yrs). Median number of prior Txs was 3; 72.1% of pts had ≥ 3 prior lines. Most pts received prior LEN (99.2%) and BORT (99.0%). In 343 pts assessed for Eastern Cooperative Oncology Group performance status (PS), 277 had a PS of 0 or 1 at baseline. Among 595 pts whose prior Tx was entered into the database at the time of data cutoff, the last prior Tx before starting POM was LEN in 340 pts (57.1%), BORT in 134 pts (22.5%), a combination of LEN and BORT in 16 pts (2.7%), and any other drug in 105 pts (17.6%). Tx duration of POM was slightly longer in pts treated with prior BORT than in those treated with prior LEN, with a median Tx duration of 18.7 wks (range, 0.9-150.0 wks) in the LEN group vs 23.7 wks (range, 0.1-148.0 wks) in the BORT group. Across all subgroups, hematologic AEs and infections represented most of all AEs (Table). CONCLUSIONS This ongoing, prospective, non-interventional study in pts with RRMM continues to demonstrate that POM-based Tx is generally well tolerated in the real-world setting and that the safety profile is not impacted by the Tx administered immediately before starting a POM-based Tx. Of all pts included in this trial, more pts were treated with LEN immediately before starting POM than any other drug. This analysis shows that AEs are almost similar in pts treated with LEN or BORT or both or any other drug immediately before starting POM Tx. In addition, the reported VTEs, PNs, and SPMs were generally low in all subgroups. Updated data will be presented at the meeting. Table. Table. Disclosures Abildgaard: Takeda: Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Research Funding. Di Raimondo:Celgene: Honoraria; Takeda: Honoraria, Research Funding. Kueenburg:Celgene Corporation: Consultancy, Honoraria. Rosettani:Celgene International: Employment, Equity Ownership. Bacon:Celgene: Employment. Atiba-Davies:Celgene Corporation: Employment, Equity Ownership. Plesner:Janssen: Consultancy; Celgene: Other: Independent Response Assessment Comittee.
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Mahajerin, Arash, Brian R. Branchford, Julie Jaffray, Brian Vasquez, Amy Stillings, Natalie Laing Smith, Neil A. Goldenberg, and Guy Young. "Children's Hospital-Acquired Thrombosis Database (CHAT): A Multi-Institutional Database for Prospective Identification of Independent Risk Factors." Blood 126, no. 23 (December 3, 2015): 1111. http://dx.doi.org/10.1182/blood.v126.23.1111.1111.
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Abstract Background: Pediatric hospital-acquired venous thromboembolism (HA-VTE) incidence is rising but remains relatively low overall, requiring risk stratification to reduce unnecessary thromboprophylaxis exposure. Large sample sizes are needed for prospective epidemiologic risk factor studies, necessitating collaboration. Objectives: We formed the multi-institutional Children's Hospital-Acquired Thrombosis (CHAT) web-based registry via Research Electronic Data Capture (REDCap) to identify independent HA-VTE risk factors for future clinical risk score development. Methods: This IRB-approved, retrospective chart review reveals HA-VTE risk factors from patients aged 0-21 years who developed diagnostically-validated VTE more than 48 hours after hospital admission, or after central venous line placement, at 3 pediatric hospitals from January 2012 - December 2014. We used descriptive statistics to summarize demographics, medical comorbidities and types of any applicable central lines for the initial 373 patients entered into the database, as well as characteristics of the VTEs themselves and associated laboratory testing. Further analysis is currently underway utilizing matched controls and logistic regression to identify specific odds ratios for independent risk factors. Results: The median length of time to VTE diagnosis was 9 with interquartile range (IQR) of day 4-18, 35.3% of VTE occurred in a critical care unit, and 21% were incidentally found. The distribution of VTE included deep vein thromboses (DVT) of the arms/legs (81.1%) followed by cerebral sinus venous thrombosis (7.3%), pulmonary embolism (5.4%), DVT of the abdomen (4%), and intracardiac DVT (4%) with some overlap due to patients with multiple, separate, concurrent VTE events. Demographic characteristics of the initial 373 subjects revealed median age of 3.7 years (IQR of 0.4 years to 13.8 years) at VTE diagnosis and a slight male predominance (57.4%). 62.6% of patients had significant past medical history (Figure 1) and 8% were immobile at baseline. Evaluation of hospital course revealed a multitude of acquired putative risk factors for HA-VTE (Figure 2). 75.7% of VTE were associated with a central venous catheter (CVC). Of CVC-related VTE, 72% were in the same vein as CVC, 20% were in a vein which previously held a CVC, 3.6% surrounded the CVC tip, 2.9% occurred in a vein where CVC placement was attempted but unsuccessful. 59% of patients had at least one documented infection during hospitalization, 48% of patients had surgery, 5.5% of patients underwent trauma prior to admission, and 59.7% (n=221) of patients were intubated at some point during their admission with 86.9% (n=192) of those patients developing VTE after a minimum of 24 hours of mechanical ventilation. Laboratory testing of hospitalized patients revealed 51.2% of patients had a d-dimer level obtained at time of VTE and 97.8% of those patients had an elevated level. 44% of patients had at least one thrombophilia lab test ordered. Conclusions: The initial CHAT database results demonstrate a slight male predisposition and multiple associated chronic medical illnesses and acquired hospital course co-morbidities, particularly CVCs which were involved in three-fourths of VTE events. Ongoing work includes incorporating additional institutions and utilizing control subjects to identify independent risk factors for the development of a risk score model. Long-term goals include prospective validation of the scoring system in a cohort of patients from pediatric centers not involved in development of the risk score with the ultimate plan of using the scoring system to stratify patients for future randomized clinical trials of risk-based prevention strategies to evaluate the safety and efficacy of this approach for reduction of pediatric HA-VTE incidence without unnecessary thromboprophylaxis exposure. Figure 1. Distribution of past medical history Figure 1. Distribution of past medical history Figure 2. Prevalence of acquired risk factors. *Some patients with more than 1 documented infection. ^Procedures included: dialysis, plasmapheresis, cardiac catheterization, stent placement, coiling procedure. Figure 2. Prevalence of acquired risk factors. *Some patients with more than 1 documented infection. ^Procedures included: dialysis, plasmapheresis, cardiac catheterization, stent placement, coiling procedure. Disclosures Young: Kedrion: Consultancy; Biogen Idec: Consultancy, Honoraria; Novo Nordisk: Consultancy, Honoraria; Bayer: Consultancy; Baxter: Consultancy.