To see the other types of publications on this topic, follow the link: Prospecting – Fiji.
Journal articles on the topic 'Prospecting – Fiji'
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 47 journal articles for your research on the topic 'Prospecting – Fiji.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse journal articles on a wide variety of disciplines and organise your bibliography correctly.
1
Steer, Andrew C., Adam Jenney, Joseph Kado, Michael F. Good, Michael Batzloff, Lepani Waqatakirewa, E. Kim Mullholland, and Jonathan R. Carapetis. "Prospective Surveillance of Invasive Group A Streptococcal Disease, Fiji, 2005–2007." Emerging Infectious Diseases 15, no. 2 (February 2009): 216–22. http://dx.doi.org/10.3201/eid15/2.080558.
Full text
2
Chandra, Vineet Vishal, Sarah L. Hemstock, Antoine De Ramon N', N. A. Yeurt, and Dinesh Surroop. "Environmental and economic study for a prospective ethanol industry in Fiji." Progress in Industrial Ecology, An International Journal 11, no. 2 (2017): 146. http://dx.doi.org/10.1504/pie.2017.088866.
Full text
3
Chandra, Vineet Vishal, Dinesh Surroop, Antoine De Ramon N'Yeurt, and Sarah L. Hemstock. "Environmental and economic study for a prospective ethanol industry in Fiji." Progress in Industrial Ecology, An International Journal 11, no. 2 (2017): 146. http://dx.doi.org/10.1504/pie.2017.10009839.
Full text
4
Thean, Li Jun, Adam Jenney, Daniel Engelman, Lucia Romani, Handan Wand, Jyotishna Mudaliar, Jessica Paka, et al. "Hospital admissions for skin and soft tissue infections in a population with endemic scabies: A prospective study in Fiji, 2018–2019." PLOS Neglected Tropical Diseases 14, no. 12 (December 9, 2020): e0008887. http://dx.doi.org/10.1371/journal.pntd.0008887.
Full textAbstract:
Scabies is an important predisposing factor for impetigo but its role in more serious skin and soft tissue infections (SSTIs) is not well understood. Information is limited on incidence of SSTIs in the presence of endemic scabies. We conducted a prospective study of hospital admissions for SSTIs in the Northern Division of Fiji (population: 131,914). Prospective surveillance for admissions with impetigo, abscess, cellulitis, wound infection, pyomyositis, necrotizing fasciitis, infected scabies, and crusted scabies was conducted at the Division’s referral hospital between 2018 to 2019. Information was collected on demographic characteristics, clinical features, microbiology, treatment and outcomes. Over the study period, 788 SSTI admissions were recorded corresponding to a population incidence 647 per 100,000 person-years (95%CI 571–660). Incidence was highest at the extremes of age with peak incidence in children aged <5 years (908 per 100,000) and those aged ≥65 years (1127 per 100,000). Incidence was 1.7 times higher among the Indigenous Fijian population (753 per 100,000) compared to other ethnicities (442 per 100,000). Overall case fatality rate was 3.3%, and 10.8% for those aged ≥65 years. Scabies was diagnosed concurrently in 7.6% of all patients and in 24.6% of admitted children <5 years. There is a very high burden of hospital admissions for SSTIs in Fiji compared to high-income settings especially among the youngest, oldest and indigenous population which is concordant with scabies and impetigo distribution in this population. Our findings highlight the need for strategies to reduce the burden of SSTIs in Fiji and similar settings.
5
Prabhu, Ranjana. "Acute rheumatic fever and rheumatic heart disease in Fiji: prospective surveillance, 2005–2008." TEXILA INTERNATIONAL JOURNAL OF NURSING 2, no. 1 (June 22, 2016): 1–5. http://dx.doi.org/10.21522/tijnr.2015.02.01.art015.
Full text
6
Steer, Andrew C., Joseph Kado, Adam W. J. Jenney, Michael Batzloff, Lepani Waqatakirewa, E. Kim Mulholland, and Jonathan R. Carapetis. "Acute rheumatic fever and rheumatic heart disease in Fiji: prospective surveillance, 2005–2007." Medical Journal of Australia 190, no. 3 (February 2009): 133–35. http://dx.doi.org/10.5694/j.1326-5377.2009.tb02312.x.
Full text
7
Lesher, C. M., A. M. Goodwin, I. H. Campbell, and M. P. Gorton. "Trace-element geochemistry of ore-associated and barren, felsic metavolcanic rocks in the Superior Province, Canada." Canadian Journal of Earth Sciences 23, no. 2 (February 1, 1986): 222–37. http://dx.doi.org/10.1139/e86-025.
Full textAbstract:
Archaean felsic metavolcanic rocks in the Superior Province of the Canadian Shield may be divided into three major groups on the basis of trace-element abundances and ratios. (1) FI felsic metavolcanic rocks are dacites and rhyodacites characterized by steep REE patterns with weakly negative to moderately positive Eu anomalies, high Zr/Y, low abundances of high-field-strength elements (e.g., HREE, Y, Zr, Hf), and high abundances of Sr. Examples occur in the Bowman Subgroup and Skead Group in the Abitibi Belt, in the Kakagi Lake, Lake of the Woods, Shoal Lake, and Sturgeon Lake areas of the Wabigoon Belt, and in the Confederation Lake area of the Uchi Belt. None of these horizons, as known, hosts base-metal sulphide deposits. (2) FII felsic metavolcanic rocks are rhyodacites and rhyolites characterized by gently sloping REE patterns with variable Eu anomalies, moderate Zr/Y, and intermediate abundances of HFS elements and Sr. Examples occur in the Misema Subgroup of the Abitibi Belt, in the Wabigoon Lake and Sturgeon Lake areas of the Wabigoon Belt, and in the Confederation Lake area of the Uchi Belt. Of these horizons, only those in the Sturgeon Lake area host base-metal sulphide deposits, and they exhibit the most pronounced negative Eu anomalies of this group. (3) FIII felsic metavolcanic rocks are rhyolites and high-silica rhyolites characterized by relatively flat REE patterns, which may be subdivided into two types. FIIIa felsic metavolcanic rocks exhibit variable negative Eu anomalies, low Zr/Y, and intermediate abundances of HFS elements and Sr. Examples occur in the Noranda mining district of the Abitibi Belt. FIIIb felsic metavolcanic rocks exhibit pronounced negative Eu anomalies, low Zr/Y, high abundances of HFS elements, and low abundances of Sr. Examples occur in the Kamiskotia, Kidd Creek, Matagami, and Noranda mining districts, the Garrison Subgroup in the Abitibi Belt, and at the South Bay mine in the Confederation Lake area of the Uchi Belt. All of these FIII horizons, with the exception of Garrison, host important base-metal sulphide deposits.These geochemical variations are interpreted to reflect differences in the petrogenesis of the felsic magmas, specifically, their formation or degree of modification in high-level magma chambers, which also influenced the formation of massive base-metal sulphide deposits. Most massive base-metal sulphide deposits in the Superior Province are underlain by subvolcanic magma chambers, which have been interpreted to have supplied heat to drive the ore-forming hydrothermal systems. FIII and some FII felsic volcanic rocks are interpreted to have been derived from these high-level magma chambers, accounting for their distinctive geochemical signatures and their association with massive base-metal sulphide mineralization. In contrast, FI felsic volcanic rocks are interpreted to have been derived from a deeper source and are considered to have escaped significant high-level modification, accounting for their distinctive geochemical signatures and the lack of associated base-metal sulphide mineralization. With certain limitations, the geochemistry of felsic metavolcanic rocks therefore may be used as a guide to identify prospective horizons for massive base-metal sulphide exploration in the Superior Province.
8
Garrido-Barbero, Maria, Juan Arnaez, Begoña Loureiro, Gemma Arca, Thais Agut, and Alfredo Garcia-Alix. "The Role of Factor V Leiden, Prothrombin G20210A, and MTHFR C677T Mutations in Neonatal Cerebral Sinovenous Thrombosis." Clinical and Applied Thrombosis/Hemostasis 25 (January 1, 2019): 107602961983435. http://dx.doi.org/10.1177/1076029619834352.
Full textAbstract:
Little is known about the pathogenesis of cerebral sinovenous thrombosis (CSVT) in the neonate. Although thrombophilia has been described as increasing the risk of CSVT in adults, it remains controversial in pediatric patients, and prospective case–control studies regarding neonatal CSVT are lacking. From 2008 to 2017, all 26 consecutive newborn infants ≥35 weeks of gestation diagnosed with neonatal CSVT, and their mothers, were tested for factor V Leiden (FV) G1691A, FII G20210A, and methylenetetrahydrofolate reductase C677T (MTHFR C677T) mutations. Eighty-five mother–infant pairs were recruited as controls. All infants except 1 with CSVT were suspected due to clinical symptoms, mainly seizures (22/25). Magnetic resonance imaging was performed in 24/26 infants. Heterozygous FV G1691A, FII G20210A, and homozygous MTHFR C677T mutations were present in 1/26, 3/26, and 3/20 infants with CSVT, respectively. FII (odds ratio: 10.96; 95% confidence interval [CI]: 1.09-110.35) and male sex (3.93; 95% CI: 1.43-10.76) were associated with CSVT. When FII G20210A analysis was adjusted for sex, the OR for FII G20210A was 6.70 (95% CI: 0.65-69.22). No differences were found for FV G1691A or homozygous MTHFR mutations between neonates with CSVT and their mothers, compared to controls.
9
Legnani, Cristina, Vittorio Pengo, Angelo Ghirarduzzi, Sophie Testa, Daniela Poli, Domenico Prisco, Armando Tripodi, Gualtiero Palareti, and Benilde Cosmi. "The influence of factor V Leiden and G20210A prothrombin mutation on the presence of residual vein obstruction after idiopathic deep-vein thrombosis of the lower limbs." Thrombosis and Haemostasis 109, no. 03 (2013): 510–16. http://dx.doi.org/10.1160/th12-01-0041.
Full textAbstract:
SummaryIt was our aim to assess whether factor V Leiden (FVL) and G20210A prothrombin (FII) mutation are associated with the presence of residual vein obstruction (RVO) after a standard course of anticoagulation for a first episode of idiopathic proximal deep-vein thrombosis (DVT) of the lower limbs, with or without symptomatic pulmonary embolism (PE). Patients were enrolled in two prospective multicentre studies: PROLONG and PROLONG II. RVO was detected by compression ultra-sonography according to the method of Prandoni on the day of anticoagulation withdrawal. Patients were also screened for FVL and FII mutation. The presence of FVL and/or FII mutation was determined in 872/963 (90.5%) patients, in 753 of whom RVO was assessed. FVL was significantly less frequent among subjects with isolated PE (7/176:4%) than among patients with either DVT and PE (15/133:11.3%; p=0.0018) or isolated DVT (89/563:15.8%; p<0.0001), confirming the FVL paradox. The rate of FII mutation was similar among patients with isolated PE (11/176:6.2%) and patients with either DVT and PE (12/133:9%) or isolated DVT (52/563:9.2%). FVL and FII mutation were not significantly associated with RVO at the multivariate analysis in all patients, although data suggest that FVL and FII mutation may have a differential effect on RVO in the subgroups of patients with DVT and DVT plus PE patients. Male sex and isolated DVT were significantly associated with RVO in all patients. In conclusion, male sex and isolated DVT are associated with RVO, while FVL and FII mutations are not significantly associated with RVO in this study.
10
Mudaliar, Jyotishna, Judith Mccool, Megan Gerbasi, and Anne Becker. "Impact of health messaging in a televised soap opera on diabetes risk knowledge: a longitudinal study conducted in Fiji." Pacific Health Dialog 21, no. 5 (February 6, 2020): 253–64. http://dx.doi.org/10.26635/phd.2020.625.
Full textAbstract:
Abstract
Purpose: We hypothesized that exposure to locally relevant health content in Shortland Street (a New Zealand based hospital television drama) would be associated with increased knowledge and awareness of diabetes and associated risk factors.
Methods: Prospective study design to compare knowledge of health and diabetes-related risk, and healthy behaviours, self-efficacy, behavioural intentions, and perceived social norms among a convenience sample of Fijian television viewers exposed to health messaging in three episodes of Shortland Street.
Results: Exposure to health messages in the Shortland Street episodes was associated with change in perceived health and diabetes norms. Perception that family members were engaged with healthy behaviors increased significantly following exposure (p = .033). Perceived prevalence of diabetes among acquaintances significantly increased following exposure to the episodes (p = .008).
Conclusions: Entertainment Education may be helpful in shifting health norms in the context of Fiji, alongside other health promotion measures.
11
Oliveira, Luciana C. O., Edgar G. Rizzatti, Rosemeire A. S. Inacio, Marcia S. Baggio, Marli H. Tavella, and Rendrik F. Franco. "Risk of Venous Thromboembolism in Relatives of Factor V Leiden and Factor II G20210A Carriers: A Combined Analysis of Retrospective and Prospective Studies." Blood 106, no. 11 (November 16, 2005): 1630. http://dx.doi.org/10.1182/blood.v106.11.1630.1630.
Full textAbstract:
Abstract There are scarce data on thrombotic risk in FVL and FII G20210A asymptomatic carriers, probably due to the requirement of a great number of observed people for a long period of time. This study evaluated retrospectively and prospectively the incidence of VTE in first-degree relatives of FVL and FII G20210A carriers and it performed combined analysis with previous similar observational studies. Retrospective combined analysis for FVL evaluated four previous studies and ours (Table 1). Of the 2016 included family members, 1065 subjects were FVL carries. 37464 and 33433 years of observation were recorded in the group of FVL carriers (car) and non-carriers (N-car), respectively. Annual incidence of VTE was 0.27% in FVL car and 0.08% in N-car (RR=3.4, CI95 2.22–5.19). For FII G20210A analysis, we added another study to the previously mentioned studies (Table 1). Of the 695 analysed family members, 210 subjects carried the mutation. 8312 and 18354 years of observation were recorded in the group of car and N-car, respectively. Annual incidence of VTE was 0.14% in car and 0.06% in N-car (RR=2.4, CI95 1.06–5.45). Prospective combined analysis for FVL evaluated two studies, including ours (Table 2). 653 family members were evaluated, being 357 FVL car. 1387 and 1145 years of observation were recorded in the group of car and N-car, respectively. Annual incidence of VTE was 0.79% in FVL car and 0.617% in N-car (RR=4.51, CI95 1–20.32). For FIIG20210A, the prospective analysis was performed only in our study. Included were 113 family members, being 64 FII G20210 carries. 194 and 151 years of observation were recorded in the group of car and N-car, respectively. Annual incidence of VTE was 1.55% in car and 0% in N-car (RR=∞). In conclusion, the incidence of VTE in asymptomatic carriers of the two most common prothrombotic mutations was found to be low in the retrospective and prospective analysis, not justifying a routine thrombophilia mutation screening in this population. Table 1 - Results of retrospective studies with relatives of FVL and FIIG20210A carriers. Studies Mutation N Observed years VTE Annual Incidence rate VTE (%) CI 95 FV Leiden Middeldorp 1998 present 236 6524 29 0.45 (0.28–0.61) absent 201 5716 6 0.10 (0.02–0.19) FV Leiden Simioni 1999 present 224 6114 17 0.28 (0.15–0.41) absent 154 4401 4 0.09 (<0.01–0.18) FV Leiden Lensen 2000 present 122 5294 18 0.34 (0.2–0.5) absent 111 5090 5 0.10 (0.01–0.2) FV Leiden Martinelli 2000 present 447 18320 35 0.19 (0.13–0.25) absent 436 16720 11 0.07 (0.03–0.11) FV Leiden Our study 2005 present 36 1212 4 0.33 (0.10–0.88) absent 49 1506 1 0.07 (<0.01–0.42) FII G20210A Martinelli 2000 present 158 6738 9 0.13 (0.06–0.24) absent 436 16720 11 0.07 (0.03–0.11) FII G20210A Our study 2005 present 36 1574 3 0.19 (0.04–0.59) absent 49 1634 0 0 (0–0.023) Table 2 - Results of prospective studies with relatives of FVL carriers Studies Mutation N Observed years VTE Annual incidence rate VTE (%) CI 95 FV Leiden Simioni 2002 present 313 1255 8 0.67 (0.29–1.33) absent 248 984 1 0.1 (0.003–0.56) FV Leiden Our study 2005 present 44 132 3 2.27 (0.49–6.81) absent 48 161 1 0.62 (<0.01–3.83)
12
Hundsdoerfer, Patrick, Barbara Vetter, Brigitte Stöver, Christian Bassir, Tristess Scholz, Ingrid Grimmer, Eberhard Mönch, Sabine Ziemer, Rainer Rossi, and Andreas Kulozik. "Homozygous and double heterozygous Factor V Leiden and Factor II G20210A genotypes predispose infants to thromboembolism but are not associated with an increase of foetal loss." Thrombosis and Haemostasis 90, no. 10 (2003): 628–35. http://dx.doi.org/10.1160/th03-02-0096.
Full textAbstract:
SummaryProspective and controlled data about the individual risk profile in asymptomatic children with homozygous or double heterozygous risk genotypes for Factor V Leiden (FVL) and factor II (FII) G20210A are currently unavailable. The systematic and prospective observational study presented here was designed to determine the impact of the homozygous and double heterozygous FVL and FII G20210A genotypes on the prenatal and postnatal risk profiles of affected children. Risk infants and heterozygous controls were identified by screening of 85,304 neonates. Follow-up included the comparison of prenatal and postnatal development, ultrasonography of brain and kidneys, and a panel of independent determinants of thrombophilia. The numbers of identified or expected FVL homozygotes and double heterozygotes did not differ significantly (FVL: 116 ver-sus 91, p=0.08; FVL/FII: 94 versus 76, p=0.17), indicating the absence of a prenatal disadvantage. A prenatal advantage was suggested in FII homozygotes, whose identified number far exceeded the expected (19 versus 4, p=0.002). Clinical and/or imaging abnormalities indicated spontaneous thromboembolic events in 4 of 129 risk infants (3%) but in none of the 178 controls (p=0.02). Physical and neurological development was normal in both groups during the first 2 years of life. The risk genotypes appear to confer a significant predisposition for spontaneous thromboembolic events in infancy without impeding development within the first two years of life. Foetal risk genotypes do not cause an increased foetal loss rate. Moreover, homozygous FII G20210A appears to be associated with a prenatal advantage.
13
Macías Mora, David, and Luis Facundo Maldonado Granados. "Evolucion del la precisión de los juicios de metamemoria en juegos para instruccion apoyada por compiutador." Revista de Investigaciones UNAD 8, no. 1 (April 10, 2009): 67. http://dx.doi.org/10.22490/25391887.622.
Full textAbstract:
<p align="left">Los juicios de metamemoria están ligados a la adquisición, almacenamiento y recuperación de conocimiento. Desde este punto de vista, son estimaciones de: 1. Facilidad del aprendizaje; 2. Logro de aprendizaje durante un periodo de tiempo; 3. Sensación de aprendizaje; 4. Confianza en las respuestas dadas. Evalúan el contenido de la memoria mirando hacia adelante o hacia atrás. En este artículo se describe la evolución de la precisión de los juicios de metamemoria y se sugiere un modelo explicativo. En el centro de esta investigación hay dos preguntas: 1. ¿Cuál es el comportamiento de los juicios de metamemoria cuando la evaluación de la evaluación de la facilidad o dificultad toma como criterio el tiempo o el número de ensayos invertidos en la solución de un juego?; 2. ¿Cuál es el comportamiento de los juicios de metamemoria cuando el computador sugiere estrategias de solución al comienzo del juego ―estrategia fija― y cuando la sugerencia es hecha en la medida en que se desarrolla el juego ―estrategia adaptativa? Para responder a estas preguntas se llevó a cabo un trabajo experimental basado en siete juegos de computador sobre razonamiento espacial. Una muestra de 130 estudiantes de décimo grado fue distribuida aleatoriamente en cuatro condiciones: a. juicios de metamemoria basados en tiempo y sugerencia fija de estrategias; b. juicios de metamemoria basados en eventos y sugerencia fija de estrategias; c. juicios de metamemoria basados en tiempo y sugerencia adaptativa de estrategias, d. juicios de metamemoria basados en eventos y sugerencia adaptativa de estrategias. A partir de los datos experimentales construimos un modelo teórico para entender el conjunto de relaciones entre los juicios de metamemoria retrospectivos y prospectivos, y entre la evolución de la curva de aprendizaje y la evolución de la precisión de los juicios de metamemoria. En este modelo, para hacer un juicio prospectivo, se tiene que hacer primero un juicio retrospectivo, de tal manera que el conocimiento previo se relacione con la representación actual del problema. Cuando el ambiente de aprendizaje le muestra al aprendiz un error anterior, él, o ella, inicia una revisión del juicio prospectivo en la etapa anterior. Puede evaluar los pasos hacia atrás hasta la representación inicial del problema. Pero, de acuerdo con la ley del menor esfuerzo, esto no es probable y regresa sólo uno o dos pasos. La importancia de este proceso, sin embargo, está en que constituye un mecanismo poderoso para integrar los elementos del aprendizaje en un proceso secuencial y es registrado en memoria de largo plazo.</p>
14
Nowak-Gottl, Ulrike, Carmen Escuriola, Rosemarie Schobess, Christine Duering, Christoph Bidlingmaier, Hartmut Pollmann, Sylvia Horneff, and Karin Kurnik. "Factor V G1691A and Factor II G20210A Mutations and Clinical Expression of Severe Hemophilia A (< 2%) in Children: Impact on Bleeding Episodes and Joint Damage." Blood 104, no. 11 (November 16, 2004): 3095. http://dx.doi.org/10.1182/blood.v104.11.3095.3095.
Full textAbstract:
Abstract It has been recently shown that the first bleeding onset in children with severe hemophilia A (HA) carrying prothrombotic risk factors is significantly later in life than in non-carriers.1 The present multicenter study was performed to determine whether the factor (F) V G1691A or the F II G20210A are associated with decreased annual bleeding episodes (ABE) in 106 pediatric PUP patients with severe HA (Intron 22 58.6%) consecutively admitted to German pediatric hemophilia treatment centers. Treatment was initiated according to the frequency of bleedings, and most patients received on demand therapy with a switch over to prophylactic therapy 3x/week (40–60 IU/kgKG factor VIIII concentrate) when more than three bleedings (range 2–6) had occurred into the same joint (n=49). Prospective median(range) patient follow-up was 14(4–35) years. Heterozygosity of the FV mutation was found in 8 subjects, homozygosity in one, and 5 children carried the FII mutation once combined with protein C-deficiency. Carriers of the FV and FII mutations had significantly fewer ABE than non-carriers (p=0.004). 66 of 106 PUP patients developed at least one target joint with a median(range) Pettersson score of 1(0–12) available in 57 patients clearly dependent on age (p=0.039) as well as ABE (p=0.037). The “Nuss” joint score available in 33 subjects highly correlated with the Pettersson score (p=0.007). Data presented here give evidence that the clinical expression of severe HA in children is influenced by the co-expression of the FV and FII mutation.
15
Rahate, Prashant, Avinash Rode, and Prasad Y. Bansod. "Initial results of using VAAFT in the management of fistula-in-ano: a prospective observational study." International Surgery Journal 5, no. 8 (July 24, 2018): 2851. http://dx.doi.org/10.18203/2349-2902.isj20183203.
Full textAbstract:
Background: The aim of this study is to present their initial 5-year experience in the treatment of fistula-in-ano by means of VAAFT (Video-Assisted Anal Fistula Treatment).Methods: 76 patients were competent for the VAAFT procedure. Patients were subjected to routine diagnostic tests. 20 patients had classical fistula surgery. In the remaining 56 patient full procedure i.e. diagnostic fistuloscopy, closing the internal ostium, and coagulation of the fistula canal was done. The mean observation period was 23 months.Results: Majority of the cases, inter-sphincter fistula and multiple branching was observed during the diagnostic fistuloscopy. Nine patients had additional fluid compartments. In 56 patients subjected to the full VAAFT procedure the internal ostium was closed using a linear stapler. A recurrence of fistula was observed in one, while non-healing was seen in two patients. Major complications like stool and gas control deterioration (based on the FISI scoring) were not observed in VAAFT operated patients.Conclusions: The VAAFT method preserves sphincter competency, no major intraoperative and postoperative complications were observed. The recovery rate is observed to be comparable with other techniques without the risk of incontinence. It is one of the best method enabling intraoperative visualisation and identification of the internal ostium and fistula canal. Initial optimistic results require further investigations on a larger group of patients.
16
Patel, Chaitali N., Anjaly K. Antony, Hasna Kommula, Sahil Shah, Vivek Singh, and Sayan Basu. "Optical coherence tomography angiography of perilimbal vasculature: validation of a standardised imaging algorithm." British Journal of Ophthalmology 104, no. 3 (May 29, 2019): 404–9. http://dx.doi.org/10.1136/bjophthalmol-2019-314030.
Full textAbstract:
PurposeTo test the reliability and accuracy of a standardised non-invasive imaging algorithm using optical coherence tomography angiography (OCTA) in detecting and quantifying pharmacologically induced changes in the perilimbal vasculature.MethodsIn this prospective observational imaging study, 370 angiograms of 15 normal eyes and 10 eyes with nasal pterygiums were obtained using a commercially available OCTA system with split-spectrum amplitude-decorrelation angiography technology. Postprocessing of the images to quantify the area occupied by the blood vessels was performed using the Fiji software. The main outcome measures were reliability (intraobserver and interobserver agreement) and accuracy of the standardised algorithm in detecting and quantifying relative change (vasoconstriction and vasodilatation) in the area occupied by the blood vessels after instillation of topical vasoconstrictors.ResultsThe intraclass correlation coefficients for intraobserver and interobserver agreement were 0.91 and 0.88 (good to excellent), respectively. In normal eyes, significant vasoconstriction was noted at 5 min (35%–47%) after application of eye-drops, which peaked at 10 min (43%–63%) and was sustained until 20 min (35%–51%), followed by gradual recovery. Greatest effect was noted with a combination of 5% phenylephrine and 0.15% brimonidine tartrate (BT) eye-drops as compared with either one or two drops of BT alone, both at the 10 min (p=0.0058) and 20 min (p=0.0375) time points. This dose-dependent temporal trend was replicated in eyes with primary nasal pterygium (p=0.31).ConclusionsThe findings suggest that OCTA can reliably and accurately detect and quantify relative changes in the perilimbal vasculature in both normal eyes and in eyes with pterygium.
17
Reddé, Michel. "Fermes etvillaeromaines en Gaule chevelue: La difficile confrontation des sources classiques et des données archéologiques." Annales. Histoire, Sciences Sociales 72, no. 1 (March 2017): 47–74. http://dx.doi.org/10.1017/s0395264917000038.
Full textAbstract:
RésuméLes termes de «ferme indigène» et de«villa»romaines, souvent opposés par les historiens, ressortissent à un débat historiographique ancien, mais toujours actuel car jamais véritablement tranché. En Gaule du Nord, ils renvoient notamment aux travaux déjà anciens de Roger Agache, dont les prospections aériennes avaient donné à voir un paysage peuplé de grandesvillae, volontiers considérées comme de vastes domaines aristocratiques par opposition à de petits établissements de tradition indigène. Cette image a fini peu ou prou par s'imposer, donnant l'impression d'une mutation rapide et radicale des systèmes agraires du Nord de la Gaule après la conquête. Malgré de nombreuses tentatives de correction, la notion d'une économie agricole fondée sur la productivité des grands domaines reste dominante dans la pensée des historiens. Cet article se propose de rappeler la difficulté d'appréhender, à travers les sources classiques, la complexité des campagnes de l'Antiquité, afin de mieux examiner l'apport récent des grands décapages de l'archéologie préventive et les problèmes d'interprétation posés par l'intrication de nombreux établissements ruraux, dont la taille et le luxe ne constituent pas nécessairement des indicateurs pertinents de productivité.
18
Acharya, Suchitra S., and Donna DiMichele. "Defining Severity for Rare Factor Deficiencies. Insights from the North American Rare Bleeding Disorder Registry(NARBDR)." Blood 112, no. 11 (November 16, 2008): 2276. http://dx.doi.org/10.1182/blood.v112.11.2276.2276.
Full textAbstract:
Abstract Defining Severity for Rare Factor deficiencies: Insights from the North American Rare Bleeding Disorder Registry (NARBDR) The NARBDR was published in 2004 compiling data from Hemophilia Treatment Centers across North America using a questionnaire format. The goals of this registry were to establish prevalence, bleeding phenotype, treatment strategies along with disease and treatment related complications of inherited deficiencies of factors(F) FII,VII,X, V, XIII, and fibrinogen disorders. Given the paucity of genotyping data (5.4%), these deficiencies were characterized as homo/heterozygous based on factor activity levels using a previously published hemostatic level cut –off of 0.2u/ml. However, a UK group has published disorder-specific cut off levels of < 0.01–0.16u/ml, while an Italian group utilized a cut off of 0.1u/ml to define severe disease. Thus, it would seem that severity for rare factor deficiencies is not well defined and needs to be established. Defining severity would aid in predicting an individual’s bleeding phenotype for counseling and surgical prophylaxis as well as in future genotype-phenotype analysis. To this end, we re-analyzed our NARBDR data to ascertain the relative utility of two biochemical severity classifications for FII (n=16), VII (n=135), X(n=37) and V(n=35) deficiencies using hemostatic (HC) factor activity levels <0.2u/ml; and the traditional classifications (TC)used for hemophilias ≤ 0.05u/ml) to predict the following clinical parameters of severity: age at first bleed, bleeding triggers (trauma vs spontaneous) and sites/types of bleeding. A p-value<0.05 was considered statistically significant and was calculated using t-tests and ANOVA tests. There was only a weak correlation between age at first bleed and biochemical severity irrespective of classification (R2 = 0.355) for FII, V, X and no corrleation for FVII deficiencies. Table 1 summarizes the analyses. The HC correlated more significantly than TC with overall clinical bleeding severity (defined by non mucocutaneous (MC) hemorrhage) and trauma as a bleed trigger for FII and VII but not for FX. However, when mean life-time MC and musculoskeletal (MS) bleeds, most common bleeding sites, were specifically examined, significant correlation was observed using the TC but not the HC for FII, FVII and FX. For FV, both TC and HC were significantly informative in predicting mean life-time bleeds per patient. This analysis represents the initial attempt to correlate factor levels with parameters of clinical severity for the rare disorders. In this dataset, limited by low survey response rates (26%), incomplete responses to clinical phenotype questions, lack of data source verification, the hemostatic was overall more informative than the traditional severity classification for most of the clinical severity variables examined, however, traditional system tended to better characterize clinical severity based on musculoskeletal bleeding (F II, VII, X). However, differences were noted between the vitamin K and FV deficiencies. These results suggest that rare factor deficiencies may not be amenable to a single classification and underscores the need for establishing national and international prospective databases to further define disease severity. Table 1 FII FVII FX FV TC
 HC TC
 HC TC
 HC TC
 HC NS-not statistically significant Clinical Severity >5%
 1–19%
 NS
 p<0.0001 >5%
 >20%
 P<0.0001
 p<0.0001 NS
 NS NS
 NS Bleeding sites (MC vs MS) p=0.02
 NS P=0.02
 NS p=0.01
 NS p=0.003
 p=0.002 Triggers-traumatic bleeds NS
 p<0.0001 NS
 p<0.0001 NS
 NS NS
 NS
19
Fressinaud, Edith, Jocelyne Dieval, Valerie Gay, Viviane Guerin, Thierry Lambert, Jean Donadieu, and Reseau FranceCoag. "FranceCoag Network: A National Multicenter Prospective Cohort for Congenital Bleeding Disorders." Blood 106, no. 11 (November 16, 2005): 4094. http://dx.doi.org/10.1182/blood.v106.11.4094.4094.
Full textAbstract:
Abstract The FranceCoag Network is a prospective national cohort of patients affected with hemophilia and severe hereditary hemorrhagic diseases except platelet disorders. It has been set up in France since January 2003 as replacement of a previous project only dedicated to hemophilia. The objectives are to know the exhaustive number, type and characteristics of these patients registered in hemophilia centers. Inclusion criteria are: FVIII or IX defect (<30%), severe defect (<10%) in FII, V, VII, X, XI, XIII or FI (< 0.1 g/l) or severe VWD. Once per year centers send datas on severe bleeding episodes, surgery, replacement therapy i.e. type of concentrate, units, place of treatment and main complications (including new inhibitors). These data are collected and monitored by a coordinating center attached to a public health institution (InVS). Direct transmission of datas via a highly protected web site is foreseen for the end of 2005. The follow-up of the study is ensured by a steering committee (regional coordinators, clinicians, committed health institutions, representatives of patients association) periodically extended to scientific experts and other public health agencies. Beside its epidemiologic interest, this cohort will also promote research projects on this population such as Pups cohort (defined as severe hemophilia A or B patients with none or few cumulative exposure days at the enrolment). On July 2005, 3469 patients were included by 37 centers. The diagnosis are hemophilia A n=2594 (75%); hemophilia B n=539 (15%), VWD n=239 (7%), severe defect in other coagulation factor: n= 97 (3%). At their inclusion, 373 patients (11%) were infected by HIV1, 1383 (40%) had a positive HCV serology, while 365 patients (10%) were co infected by HIV1 and HCV. Among this cohort, 45 deaths were observed since 1994, which represent 4.5 deaths per 1 000 years-patients (95% CI: [3.3–6.0]). Deaths were related to AIDS or HCV in 19 cases. Inhibitors was observed in 388 patients (11%) (hemophilia A: n=369, hemophilia B n=15, VWD n=2, FXIII defect n= 1, FV defect n=1). The incidence of inhibitor during the follow-up was 9.4 cases per 1000 person-years.
20
Hess, Nicholas, Nisreen Mesiwala, Catherine Marando, Richard A. Bilonick, Leonard K. Seibold, Joel S. Schuman, Gadi Wollstein, et al. "Effect of iStent Trabecular Micro-Bypass device on outflow system morphology." Modeling and Artificial Intelligence in Ophthalmology 2, no. 4 (June 16, 2020): 44–54. http://dx.doi.org/10.35119/maio.v2i4.108.
Full textAbstract:
Purpose: Rigorous clinical testing has established that Schlemm’s canal cross-sectional area (SC-CSA) is reduced in glaucomatous eyes. However, to date, it is unclear whether trabecular bypass procedures impact the morphology of the proximal aqueous outflow tract, or if the introduction of a local region of low outflow resistance adversely affects SC-CSA elsewhere, specifically presenting as SC diminution. This study quantifies changes in the morphology of the distal outflow pathway after iStent Trabecular Micro-Bypass stent (Glaukos Corp, Laguna Hills, CA, USA) implantation in living eyes by anterior segment optical coherence tomography (OCT).
Design: This was a prospective observational study.
Subjects: This study included six patients (eight eyes) with primary-open angle glaucoma.
Methods: Patients underwent iStent placement in the nasal anterior chamber angle quadrant. OCT imaging was obtained of both nasal and temporal eye quadrants before and after surgery. For each SC parameter, an average of ten consecutive, evenly spaced measurements were manually obtained over a 1 mm segment of SC on FIJI ImageJ. Linear mixed effects modeling quantified the effect of the iStent on these parameters.
Main outcome measures: Main outcome measures were changes in SC-CSA, inner-to-outer wall distance (IOD), and trabecular meshwork (TM) thickness following iStent placement.
Results: Following iStent placement, total SC-CSA increased an average of 1,039.12 μm2 (P = 0.05). Individually, there were no significant changes in SC-CSA in the nasal or temporal quadrants. Total SC-IOD and nasal SC-IOD increased an average of 2.35 μm (P = 0.01) and 2.96 μm (P = 0.04), respectively. There were no significant changes in temporal quadrant SC-IOD. There were no significant changes in TM thickness in either quadrant.
Conclusions: Implantation of the iStent Trabecular Micro-Bypass stent significantly increases SC-IOD in the nasal quadrant at the location of implant, with no evidence of SC diminution in the temporal quadrant. It remains unclear how these observations relate to the surgical efficacy of trabecular bypass procedures.
21
Arsène, Sophie, Bénédicte Delahousse, Sandra Regina, Marie-Laure Le Lez, Pierre-Jean Pisella, and Yves Gruel. "Increased prevalence of factor V Leiden in patients with retinal vein occlusion and under 60 years of age." Thrombosis and Haemostasis 94, no. 07 (2005): 101–6. http://dx.doi.org/10.1160/th04-10-0659.
Full textAbstract:
SummaryRetinal vein occlusion (RVO) is a multifactorial disease involving vessel damage, stasis, viscosity and thrombosis. Conflicting findings on hereditary thrombophilic risk factors have been reported and their impact on RVO features remains to be defined. The aim of the present study was to evaluate the prevalence of hereditary thrombophilic risk factors (HTRF) and characteristics of RVO in patients with or without HTRF. The design of the study was a prospective, observational case series. Two hundred and thirty-four patients with RVO were included consecutively. A French healthy population of the same region was studied as control group. The HTRF studied were protein C (PC), protein S (PS) and antithrombin (AT) deficiencies, factor V Leiden (FVL) and factor II 20210A polymorphisms. Chi-Square was used for comparison with the healthy subjects and between RVO patient with and without HTRF according to localisation (branch vs. central), type of RVO (ischemic or non-ischemic), recurrence, age at first event and classical vascular risk factors. Twenty-two patients had HTRF (12 FV Leiden heterozygotes, 9 FII 20210A heterozygotes and 1 PS deficiency). No AT or PC deficiency was detected. Frequencies of PS deficiency, FVL and FII 20210A allele were similar to the reference population as well as to published data in the general caucasian population. Eighty-six patients experienced their first episode before the age of 60 years. Systemic hypertension, glaucoma and angina were significantly less frequent in patients with RVO before 60 years. Fourteen of the 22 patients with one HTRF (64%) experienced their first episode of RVO before the age of 60 years compared to 72 of 212 without HTRF (34%) (p = 0.006). Heterozygote status for FV Leiden was significantly more frequent in patients who had experienced their first episode of RVO before 60 years (p = 0.027). In conclusion, this study suggests a role of FV Leiden in the occurrence of RVO in patients younger than 60 years who exhibit fewer acquired vascular risk factors than in older patients.
22
Salamea, Cinthya Coralia. "Filtración marginal con ionómero de vidrio y compómero en molares temporarios en pacientes de 5-10 años." Odontología Activa Revista Científica 6, no. 1 (December 29, 2020): 13–18. http://dx.doi.org/10.31984/oactiva.v6i1.528.
Full textAbstract:
Resumen
Objetivo: El objetivo de esta investigación fue comparar las características clínicas entre el ionómero de vidrio (Ionolux, Vocco) y el compómero (TwinkyStar, Vocco) en molares temporales para evitar el filtrado marginal en niños de 5-10 años. Materiales y métodos: Estudio de cohorte, prospectivo, con población fija y de enfoque cuantitativo. La muestra estuvo constituida por 22 pacientes de 5 a 10 años de la Clínica de Odontopediatría de la Facultad de Odontología de la Universidad de Cuenca. Se realizaron 44 obturaciones dos en cada participante, una a base de ionómero vítreo fotopolimerizable y otra a base de compómero, con múltiples controles durante 5 meses. Las evaluaciones clínicas siguieron los criterios modificados de la United State Public Health Service (USPHS). Los datos fueron procesados en EXCEL y SPSS con la prueba Tau C de Kendall. Resultados: Las características clínicas entre el ionómero vítreo y el compómero fueron similares, no se observaron diferencias estadísticamente significativas en relación a integridad marginal, decoloración, forma anatómica, presencia de caries marginal, textura superficial y sensibilidad postoperatoria entre ellos. El ionómero vítreo mostró diferencias estadísticamente significativas en cuanto a integridad marginal (p 0,029) entre los tres a los cinco meses. Conclusiones: Ninguno de estos materiales produce sensibilidad posoperatoria. Los dos materiales presentan características aceptables de integridad marginal y textura superficial por lo cual su uso en dientes deciduos es recomendado.
23
Gusinsky de Gelman, Susana Paulina, Antonio Humberto Closas, Rosa Teresa Cruz de Innocente, Margarita Carlota Carbajal, Susana Rosa Jerez, and Idalia Gabriela De Castro. "Nivel de sustentabilidad en pequeñas explotaciones sojeras del Chaco - Argentina. Rentabilidad y aceptación social." Revista de la Facultad de Ciencias Económicas, no. 14 (February 3, 2015): 102. http://dx.doi.org/10.30972/rfce.014368.
Full textAbstract:
En el Chaco se conjugan, la importancia económica del cultivo de soja con la significación social de las pequeñas empresas agrícolas, predominantemente familiares. Es objetivo del presente trabajo, describir las condiciones de producción de soja evaluando el grado de sustentabilidad de las pequeñas empresas chaqueñas, particularmente: rentabilidad y aceptación social. Las decisiones metodológicas definieron un diseño no experimental, observacional, descriptivo, transversal y prospectivo, cuya recolección de datos se implementó con un cuestionario ad hoc. La muestra está integrada por 27 participantes escogidos en forma aleatoria de una población seleccionada de manera intencional. Los resultados se agrupan conforme las variables del estudio. Vinculado a rentabilidad, indican que el 59.26% de los productores está disconforme con el beneficio obtenido; un 29,63% contrata seguros agrícolas para gestionar el riesgo climático; y la comercialización se canaliza principalmente a través de acopiadores locales. El precio se fija teniendo como referencia la operatoria del mercado de cereales de Rosario, neto de costos de transporte e intermediación. El volumen de producción, representativo del rendimiento normal, es 2000 kg/ha (valor inferior a la media provincial). Respecto a aceptación social, la mayoría de los agricultores sojeros disponen de 120 hectáreas no propias, su familia no vive ni trabaja en el campo, hecho que impide desarrollar sentido de pertenencia y transferir el saber hacer. La ocupación es de una persona cada cien hectáreas cultivadas. Finalmente, se anhela que éste estudio, contribuya a una explotación sustentable y con la comunidad científico-profesional involucrada.
24
Ayala, Rosa M., Angeles M. Martin, Joaquin Martinez, Juan Carlos Meneu, Almudena Moreno, Teresa Toledo, Javier De la Serna, and Carmen Ribera. "The Role of a Thrombofilia Screening in Prospective Liver Donors (LDLT, Live Donor Liver Transplant)." Blood 106, no. 11 (November 16, 2005): 4125. http://dx.doi.org/10.1182/blood.v106.11.4125.4125.
Full textAbstract:
Abstract Liver transplantation (tx) from live donors brings an opportunity to many patients with terminal stages liver disease, who are at high risk of a fatal event while waiting for a cadaveric liver transplantation. A main issue in this setting is to extreme the safety of the live donor. Tests that could predict the risk of thrombotic complications in the donor of LDLT are under investigation. In addition such tests could be useful in the prevention of vascular hepatic thrombotic complications in the recipient. OBJECTIVES.- In this study we evaluate the value of a thrombophilia screening in the live donor prior to LDLT in order to determine the thrombotic and hemorrhagic risk in both the donor at surgery and in the recipient of LDLT. METHODS.- Genetic study and functional coagulative tests were performed on samples of peripheral blood of 136 candidates liver donors. For genetical tests, genomic DNA was extracted and detection of factor V Leiden, factor II and MTHFR mutations were performed by real-time PCR technology (LightCycler®). Phenotypic tests included prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin clotting time (TT), functional fibrinogen, antithrombin (AT), protein C (PC) and protein S (PS) (coagulative and chromogenic techniques), resistance to activated protein C (RAPC), and factor VIII. In addition the following tests were carried out: anticardiolipin immunoglobulin G and M antibody (ACA IgG and ACA IgM), test for lupus anticoagulant (tissular thromboplastin inhibition, TTI, and diluted TTPA), and quantification of plasmatic homocystein. RESULTS.- Because abnormal thrombophilic studies 32 candidates were excluded for LDLT due to factor V Leiden (2), mutation FII G20210A (4), chromogenic PC deficiency (1), anticoagulant PC deficiency(2), free PS deficiency (Ag) (5), functional PS deficiency (2), factor VIII < 65% (1) or > 150% (4), positive lupic anticoagulant test (5) and high homocystein levels (9). CLINICAL DATA.- Finally there were 34 donors (17M, 17F) selected for LDLT. The 34 recipients of LDLT were 10 children and 24 adults. During the donor operation for an adult recipient, the right lobe of the liver were removed. For infant and pediatric LDLT recipients, smaller pieces of the liver were used. None of donors suffered from thrombotic complications. The average transfusional needs of donors were 1.1 units of packed red cells, (range 0–2), and one donor required fresh plasma transfusion in the early postsurgery. Overalll post-LTLD thrombosis was observed in 4 patients (11,8%). 4 patients were submitted to a second liver tx from a cadaveric donor (2 of them due to hepatic arterial thrombosis). CONCLUSIONS.- Thrombophilia studies in the donor prior to LTDL should be included in the laboratory work, to exclude conditions associates with increased risk of thrombotic and hemorrhagic complications. In addition these studies could minimize the risk of vascular hepatic thrombotic complications in the recipient.
25
Jensdottir, Hulda M., Brynjar Vidarsson, Brynja R. Gudmundsdottir, Alma R. Oskarsdottir, Olafur S. Indridason, David O. Arnar, Einar S. Bjornsson, et al. "Gender Differences during Long-Term Warfarin Anticoagulation in Patients with Atrial Fibrillation Monitored with Fiix-Prothrombin Time or Prothrombin Time. the Fiix Trial." Blood 126, no. 23 (December 3, 2015): 1134. http://dx.doi.org/10.1182/blood.v126.23.1134.1134.
Full textAbstract:
Abstract Background: During warfarin treatment rapid fluctuations occur in the traditional prothrombin time (PT) as a result of the short half-life of factor (F) VII which has little effect on the antithrombotic activity of warfarin, contrary to FII and FX. Such confounding INR fluctuations influence dosing and, hence also the variability of FII and FX. The new Fiix-PT measures only the activity of the longer half-life FII and FX leading to less variability of anticoagulation as shown in the Fiix-trial. Objectives: To assess if stability of warfarin anticoagulation monitored by PT and Fiix-PT was affected differently by gender. Methods: This study is a subgroup analysis of the prospective, randomized, double-blind Fiix-trial. A subgroup of 815 atrial fibrillation patients on long-term warfarin monitored with Fiix-PT (Fiix-warfarin patients) or PT (PT-warfarin patients) were assessed in an intention-to-monitor manner by comparing surrogate anticoagulation indicators such as dose and dose frequency, time in therapeutic range (TTR, Rosendaal method) and variance growth rate of the INR (VGR; an indicator of INR fluctuation size). Results: Baseline parameters between the 396 Fiix-warfarin and 419 PT-warfarin patients did not differ. The median observation time was 1.4 years. Fiix-warfarin patients had more tests within therapeutic range (66% vs 63%, p=0.0019) and fewer tests below range (19% vs 21%, p=0.0061) than PT-warfarin patients. The test-in-range improvement observed with Fiix-warfarin over that with PT-warfarin was mainly explained by an improvement observed in women, i.e. the fraction of monitoring tests within range was higher (64% vs 59%, p=0.0001) and the fraction below range was lower (20% vs 24%, p=0.0002) in women on Fiix-warfarin. Likewise, with Fiix-warfarin TTR was higher (81% compared with 79%) and this was mainly explained by higher TTR in women on Fiix-warfarin (80%) than in women on PT-warfarin (75%; p=0.0401). Little difference was observed in TTR in men. The INR varied less with Fiix-warfarin than with PT-warfarin (VGRB1 0.20 vs 0.24, p=0.0810). There was significantly more variation in VGR in women than in men. Thus, Fiix-warfarin men vs women had a VGRB1 of 0.18 vs 0.25, p=0.0372, and PT-warfarin men vs women had VGRB1 0.21 vs 0.30, p=0.0056. A trend for fewer annual dose changes with Fiix-warfarin than with PT-warfarin was observed (5.6 vs 6.2 annually, p=0.0822) and this was mainly explained by 20% fewer annual dose changes with Fiix-warfarin than with PT-warfarin in women (6.0 vs 7.4, p=0.0342). Also, there were fewer dose changes per monitoring test in Fiix warfarin women (0.27 vs 0.32, p=0.0292). Finally, women treated with Fiix-warfarin used a lower median daily warfarin dose than women treated with PT-warfarin (3.4 vs 4.2 mg, p=0.0029). Conclusions: Monitoring warfarin with the Fiix-PT improved the stability of warfarin anticoagulation and reduced the daily dose significantly in women. A non-significant but consistent smaller effect in the same direction was seen in men. Disclosures Gudmundsdottir: Fiix Diagnostics Ltd.: Equity Ownership, Patents & Royalties: Patent pending for Fiix prothrombin time. Onundarson:Fiix Diagnostics Ltd: Equity Ownership, Patents & Royalties: Patent pending status for Fiix prothrombin time.
26
Bauersachs, Rupert M., Joachim Dudenhausen, Andree Faridi, Thorsten Fischer, Samson Fung, Ulrich Geisen, Job Harenberg, et al. "Safety and Efficacy of Low-Molecular-Weight Heparin in Pregnant Women at Increased Risk of Venous Thromboembolism: A Prospective Stratified Multicentre Trial." Blood 108, no. 11 (November 16, 2006): 715. http://dx.doi.org/10.1182/blood.v108.11.715.715.
Full textAbstract:
Abstract Women with a history of VTE, thrombophilia or both are at increased risk for VTE during pregnancy, but the optimal management strategy, and the need for thromboprophylaxis is not well defined in clinical guidelines because of limited trial data. The EThIG (Efficacy of Thromboprophylaxis as an Intervention during Gravidity) is a multicenter trial that prospectively enrolled 810 pregnant women at risk of VTE. Women were assigned to one of 3 management strategies: Low risk group I (including women with prior secondary VTE, or asymptomatic thrombophilia) with “watchful waiting” management, and dalteparin prophylaxis postpartum (50–100 IU/kg), or earlier if additional risk factors occurred; high risk group II (e.g. idiopathic VTE or symptomatic thrombophilia) receiving 50–100 IU/kg dalteparin; and very high-risk group III (e.g. acute VTE, prior long-term OAC, symptomatic AT-deficiency or antiphospholipid syndrome), receiving 100–200 IU/kg dalteparin. Primary efficacy outcome measure was symptomatic VTE, main safety outcome measures were haemorrhages, osteoporosis, thromboctopenia and pregnancy outcome. Results (mean ± SD / 95% CI): 810 women (age 30.8±5.4 years, weight 73.6±16.1kg) were enrolled, 28 % in group I, 58 % in II and 14% in III, including 66 women with acute VTE. 60.1% had prior VTE, 75.4% had thrombophilia (42.1 % FV-Leiden, 2.1 % homozygous, 9.5 % FII G20210A, 4.1% PC-, 1 % AT-deficiency; 17.4 % APS). 35.8 % had previous miscarriage, still birth or physical malformation. Comorbid conditions included lupus erythematosus, liver transplantation, ventricular septum defect, paraplegia, hepatitis C, nephrotic syndrome, asthma, chronic haemolytic anaemia, thalassaemia, osteoporosis and thrombocytopaenia. Median treatment initiation was at 17.0 weeks, at 24.0 weeks in group I, 14.5 weeks in group II and 16.0 weeks for group III. Mean daily dose was 66.2 ± 22.5 IU per kg (group I), 76.8 ± 24.1 IU per kg (group II) and 120.0 ± 49.1 IU per kg (group III). Objectively confirmed, symptomatic VTE occurred in 5 of 810 women (0.6%;0.2–1.5%). The rate of serious bleeding was 3.0% (1.9–4.4%), 0.9% (0.3–1.8%) occurred in the antepartum period, 2.1% (1.3–3.4%) peri-partum;1.1% (0.5–2.2%) was possibly heparin-related. There was no evidence of heparin-induced thrombocytopenia, and one case of osteoporosis (fracture of the saccygous bone during delivery). There were 94.4% successful pregnancies, 40 foetuses (4.9%; 3.6–6.7%) were lost due to miscarriage, 7 due to elective termination. Risk-stratified heparin prophylaxis was associated with a low incidence of symptomatic venous thromboembolism and few clinically important adverse events. Antepartum heparin prophylaxis is warranted in pregnant women with prior idiopathic thrombosis or symptomatic thrombophilia.
27
Ozoliņa, Agnese, Indulis Vanags, Karina Drizlionoka, Liene Ņikitina-Zaķe, and Biruta Mamaja. "Inherited Thrombophilias in Thrombosis Advancement in Microvascular Flap Surgery." Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences. 75, no. 2 (April 1, 2021): 113–20. http://dx.doi.org/10.2478/prolas-2021-0018.
Full textAbstract:
Abstract Microvascular flap surgery is a reliable method for reconstructive surgery. To avoid and foresee free flap thrombosis advancement after microvascular flap surgery, patient assessment, flawless surgical technique, and eligible perioperative care are pivotal. In this prospective observational study, we aimed to elucidate the most common inherited single nucleotide polymorphisms (SNPs) attributable to free flap thrombosis. A total of 152 patients undergoing microvascular flap surgery during the study period of 2016–2019 were analysed for five SNPs: rs6025 in Factor V Leiden (FVL) gene, rs1799963 in Factor II (FII) gene, rs2066865 in Fibrinogen Gamma Chain gene (FGG), rs2227589 in SERPINC 1 gene and rs1801133 in Methylene Tetrahydrofolate Reductase (MTHFR) gene. Activated protein C resistance (aPCR), prothrombin, antithrombin (AT), fibrinogen and homocysteine plasma levels were measured to determine association with the analysed SNPs and with free flap thrombosis advancement. Our preliminary results show that carriers of FVL mutation were associated with aPCR, as we observed significantly lower aPCR plasma levels in carriers of genotype C/T, as compared to C/C; p = 0.006 (CI 95%, 0.44 to 1.19). Additionally, mean fibrinogen plasma levels were higher in carriers of FGC gene rs2066865 genotype A/A (5.6 ± 1.81 g/l), as compared to G/A and G/G; p = 0.04 (CI 95%, 0.007 to 1.09); p = 0.004 (CI 95%, 0.48 to 2.49), respectively. The study group included 12 patients (7.9%) with free flap thrombosis. For one patient free flap thrombosis advancement might have been related to the rs6025T – FVL mutation with a PCR plasma level 1.21. Lower aPCR levels was associated with carriers of FVL rs6025 C/T and higher fibrinogen plasma levels with carriers of FGG rs2066865 A/A, suggesting that these genotypes might predict higher free flap thrombosis risk, but we found no significant association between analysed SNPs and free flap thrombosis advancement.
28
Nowak-Gottl, Ulrike, Monika Stoll, Rolf Mesters, Sabine Thedieck, Susan Halimeh, Christine Heller, Karin Kurnik, Neil A. Goldenberg, and Susanne Holzhauer. "Impact of Thrombophilia and Incidence of Symptomatic Thromboembolism in First Degree Family Members (FM) of Pediatric Index Cases: a Prospective Cohort Study in FM > 14 Years of Age." Blood 114, no. 22 (November 20, 2009): 2977. http://dx.doi.org/10.1182/blood.v114.22.2977.2977.
Full textAbstract:
Abstract Abstract 2977 Poster Board II-957 Background: Venous thrombosis is a multifactorial disease and inherited genetic traits (IT) constitute a major risk factor. The aim of the present prospective cohort study was to determine i) the relative and absolute risks of first symptomatic thromboembolism [TE] in previously healthy family members of children with venous thromboembolism, and ii) whether to screen family members in a high risk population. Methods: In 205 patients (neonate to 18 years) and 526 FM followed over a total person-time of 14157 years /1000 units [person-time] a comprehensive IT screening was performed along with recording of family histories of preexisting cardiovascular diseases. FM were followed until July 2009: study endpoint was cumulative time to first TE within FM. Survival analysis (Cox regression: hazard ratio (HR/95% Confidence intervals (CIs)] adjusted for age and gender and number of new cases divided by the total population at risk (incidence rate) were calculated (events (%) per 1000 person-years [CIs]). Results: The final study population included 526 FM with 462 subjects > 14 years. The cumulative TE –free survival in FM with IT was significantly lower compared to those without: HR/CI: 6.6/ 3.3-13.5. The overall rate of symptomatic TEs was 2.9%[2.07-3.9]. The hazard adjusted for age and gender in the group of antithrombin(AT)-/protein C[PC)-/protein S(PS)-deficient FM was 29.4%[13.3-62.5], and for carriers of factor (F) V G1691A, F II G202010A mutations or elevated lipoprotein (a) it was found to be 3.3%[1.3-8.3], 1.96% [0.4- 9.0] and 2.1%[1.04-3.8]. Corresponding annual incidence rates in FM > 14 years were 4.8% for AT-/PC- or PS-deficiency states, 0.72% in subjects carrying the FV mutation, 0.36 % in FII carriers, and 0.20% for subjects with elevated lipoprotein (a) compared with 0.19% in FM with no IT. Thus, compared to adult data from the view of adult index cases [Lijfering W et al. Blood 2009] i) the risk of TE in family members of pediatric index cases with TE depends on IT, ii) the age at TE in the index patient as well as in the family members has a strong effect on TE incidence, and iii) the first symptomatic TE in primary healthy family members > 14 years of age with respect to the IT investigated is comparable to or exceeds adult data. Conclusions: i) Adult family members of pediatric index patients with an early onset of symptomatic thrombosis should be considered for IT testing, ii) primary thromboprophylaxis in family members derived from pediatric index patients should be considered in risk situations in adult carriers of AT/PC/PS-deficiencies & FV mutation. In addition, iii) larger prospective studies are needed to investigate the effects of multiple ITs and its interactions to take into account whether events are provoked or not to investigate the effect of screening. Disclosures: Off Label Use: Enoxaparin (LMWH) is used off-label in children to prevent symptomatic thromboembolism.
29
Young, Guy, Frauke Friedrichs, Anthony Chan, Gili Kenet, Paolo Simioni, Helen van Ommen, Anne Krumpel, et al. "Impact of Inherited Thrombophilia on Symptomatic Venous Thrombo-Embolism (VTE) in Children: A Systematic Review & Meta-Analysis of 37 Studies Including 2470 Pediatric Patients." Blood 110, no. 11 (November 16, 2007): 3189. http://dx.doi.org/10.1182/blood.v110.11.3189.3189.
Full textAbstract:
Abstract Background: Inherited thrombophilia (IT) has been described as a risk factor for venous thromboembolism (VTE) in children. So far the majority of studies performed in the field were either retrospective or prospective on small numbers of patients. Thus, the results are contradictory or inconclusive mainly due to lack of statistical power. The aim of this study was to better estimate the impact of IT on early VTE onset and recurrence in children as a prerequisite to develop primary and secondary treatment options. Methods: A systematic search of publications listed in the electronic databases (Pubmed, Medline, EMBASE, Web of Science, The Cochrane Library) up to August 2007 using key words in combination both as MeSH terms and text words, was conducted. Citations were screened by two independent group members and those meeting the inclusion criteria were retained. Articles were included if published after 1990, when pediatric VTE was started to be systematically investigated. Findings: Twenty case-control and 17 cohort studies from 13 countries met the inclusion criteria. In these studies > 70% of patients had at least one clinical risk factor. The summary odds ratios (OR) and 95% confidence intervals (CI) of included studies under a fixed-effects and random-effects model showed statistically significant associations between the IT traits investigated and VTE onset (table). For the rare event of VTE recurrence, 1227 patients (eight studies) were evaluated: at the present state due to high heterogeneity, a trend towards association with recurrent VTE was found for ≥2 IT traits in the fixed-effects model (0R/CI: 2.8/1.6–4.8). Interpretation: The present meta-analysis gives evidence that the detection of inherited thrombophilia is clincially meaningful in children with VTE and underlines the importance of a pediatric thrombophilia screening program. Summary of Data Risk Factors OR/CI:fixed model OR/CI:random model patients/controls 2470/4119 N/A FV G1691A 3.5/2.9–4.2 3.2/2.3–4.4 FII G20210A 2.2/1.5–3.3 2.2/1.5–3.4 Protein C defiiciency 9.8/5.9–16 9.9/6.1–16.1 Protein S deficiency 7.1/3.9–13.2 6.8/3.7–12.7 Antithrombin deficiency 7.9/3.8–16.6 7.3/3.4–15.3 Lipoprotein(a) 4.4/3,2–5.9 4/2.4–6.6 ≥ 2 risk factors 12.6/7.3–21.8 11.6/6.2–20.2
30
Oskarsdottir, Alma R., Brynja R. Gudmundsdottir, Olafur S. Indridason, Hulda M. Jensdottir, David O. Arnar, Einar S. Bjornsson, Magnus K. Magnusson, et al. "Thromboembolism and Clinically Relevant Bleeding in Relation to Warfarin Anticoagulation Variability in Patients Monitored with Either Fiix-Prothrombin Time or Quick-Prothrombin Time. the Fiix-Trial." Blood 126, no. 23 (December 3, 2015): 1129. http://dx.doi.org/10.1182/blood.v126.23.1129.1129.
Full textAbstract:
Abstract Introduction: Anticoagulation with vitamin K antagonists (VKA) requires monitoring of their effect, traditionally with the prothrombin time (PT) that is affected by VKA influence on coagulation factors (F) II, VII and X. Rapid fluctuations in factor VII, which has a short half-life, contribute to the PT (INR) variation but not to the antithrombotic effect that depends mainly on reductions of FII and FX. This was lately confirmed by the Fiix-trial that showed that monitoring warfarin with Fiix-PT (affected only by FII and FX) improved anticoagulation stability. Here, we assessed anticoagulation variability in relation to the occurrence of thromboembolism and bleeding in patients monitored with Fiix-PT or PT. Methods and materials: This is a subgroup analysis of the Fiix-trial, a single-center, double blind, prospective, randomized controlled clinical trial, comparing outcomes in patients in whom warfarin was monitored with either Fiix-PT/Fiix-INR (Fiix-warfarin patients) or PT/INR (PT-warfarin patients). Patients on warfarin, 18 years and older, with target INR range of 2.0 - 3.0, were randomized and assessed for occurrence of clinically relevant vascular events (CRVE), i.e. thromboembolism (TE), major bleedings (MB) and other non-major clinically relevant bleedings. Using an intention-to-monitor method, we assessed test parameters, dosing, time in range (TTR) and the variance growth rate (VGR) of the INR (an INR fluctuation index) in relation to occurrence of CRVE. Results: The median observation time was 1.4 years in 572 patients managed with Fiix-warfarin and 571 with PT-warfarin. CRVE occurred in 115 Fiix-warfarin patients and 132 PT-warfarin patients (PNI=0.0066). MB and TE occurred in 19 vs. 21 (PNI=0.0142) and 10 vs. 19 (PNI=0.0002) patients, respectively. There were 11,026 monitoring tests in the Fiix-arm and 11,499 in the PT-arm. Patients suffering CRVE had significantly more frequent monitoring tests and shorter intervals between tests than those without. Patients with CRVE also had significantly greater dose changes (p<0.0001 in both arms). The median TTR was lower with PT-warfarin than with Fiix-warfarin and patients with CRVE had lower TTR than those without in both study arms (Fiix-warfarin 79% vs. 82%, p=0.0441 vs. PT-warfarin 75% vs. 80%, p=0.0004). The lowest median TTR was observed in PT-warfarin patients suffering from MB (73%) or TE (62%). There was consistently more INR-fluctuation (higher VGR, here shown by B1 method measuring INR jumps from one test to the next) with PT-warfarin than with Fiix-warfarin. Also, patients with CRVE had VGR of 0.35 vs. 0.21 (p=0.0643) and without CRVE 0.21 vs. 0.17 (p=0.0146), respectively. The fluctuation was particularly high in both PT-warfarin and Fiix-warfarin patients suffering from MB (0.59 and 0.31, n.s.). PT-warfarin patients with TE had VGR 0.50 vs. 0.20 with Fiix-warfarin (p=0.0051). Finally, the median INR observed at the time of major events corresponded to the risk of bleeding and TE in the Fiix arm, and with risk of TE in the PT arm. Conclusions: Fiix-warfarin is a more stable anticoagulant than PT-warfarin. The significantly lower INR variation in Fiix-warfarin patients with TE is in agreement with the reduced long-term thromboembolism observed in the Fiix-trial. Monitoring warfarin with the Fiix-PT (Fiix-INR) instead of the PT (INR) and paying particular attention to patients demonstrating anticoagulation instability could improve the clinical outcome of patients on warfarin further. Disclosures Gudmundsdottir: Fiix Diagnostics Ltd.: Equity Ownership, Patents & Royalties: Patent pending for Fiix prothrombin time. Onundarson:Fiix Diagnostics Ltd: Equity Ownership, Patents & Royalties: Patent pending status for Fiix prothrombin time.
31
Ribera, Josep-Maria, Albert Oriol, Mireia Morgades, Josep Sarra, Pau Montesinos, Salut Brunet, Ramon Guardia, et al. "Treatment of High-Risk (HR) Philadelphia Chromosome-Negative (Ph-) Adult Acute Lymphoblastic Leukemia (ALL) According to Baseline Risk Factors and Minimal Residual Disease (MRD). Results of the PETHEMA ALL-AR-03 Trial." Blood 112, no. 11 (November 16, 2008): 3291. http://dx.doi.org/10.1182/blood.v112.11.3291.3291.
Full textAbstract:
Abstract Background and aim: Current therapeutic protocols for adult ALL consider MRD together with the baseline risk factors (age, WBC count, immunophenotype, cytogenetics) and speed in response to therapy for treatment decisions. On the other hand, the systematic use of allogeneic SCT for all adult patients (pts) with Ph- HR-ALL is still a matter of debate. The aim of the prospective study ALL-AR-03 from the Spanish PETHEMA Group was to evaluate the response to a differentiated therapy (chemotherapy or allogeneic SCT) according to early bone marrow blast clearance and MRD levels (assessed by cytofluorometry at the end of induction and consolidation therapy) in HR Ph- adult ALL patients. Patients and methods: HR ALL included one or more of the following baseline parameters: age 30–60 yr, WBC count >25x109/L and 11q23 or MLL rearrangements. Induction therapy included vincristine, prednisone and daunorubicin for 4 weeks. In pts with slow cytologic response to therapy (≥10% blasts in bone marrow assessed on d14) intensified induction with high dose ARA-C and mitoxantrone was administered. Early consolidation therapy included 3 cycles with rotating cytotoxic drugs including high-dose methotrexate, high-dose ARA-C and high-dose asparaginase. Pts. with slow cytologic response on d14 or MRD level >0.05% after consolidation were assigned to allogeneic SCT (related or unrelated) and those with standard cytologic response on d14 and MRD level <0.05% after consolidation received 3 additional cycles of delayed consolidation (identical to those of early consolidation) followed by maintenance therapy up to 2yr in CR. Results: On June 2008,192 patients were evaluable (mean (SD) age 37(10) yr, 105 males, 119 precursor B-ALL, 73 T-ALL, WBC count 65(99) x109/L). Induction death: 17(9%), resistance: 12 (6%), CR: 163 (85%). MRD<0.1% was observed in 64% of CR patients. Early consolidation was completed in 126 patients. MRD<0.05% was observed in 65% at the end of consolidation. On June 2008, allogeneic SCT was performed to 30 pts (15 from HLA-identical siblings and 15 MUD), TRM 11 pts, relapse 4, CCR 15. Delayed consolidation and maintenance was administered to 79 pts (toxic death 4 pts, relapse 21, CCR 54). Four-yr DFS for the whole series was 36±7% (37±19% for pts assigned to SCT and 56±12% for those assigned to chemotherapy). Slow cytologic response was associated with a lower CR probability and higher induction death. No baseline variable was associated with a higher probability of MRD negativity after induction or consolidation. Conclusions: These results suggest that in HR Ph- adult ALL pts with adequate response to induction and adequate clearance of MDR the results of therapy are not hampered by avoiding allogeneic SCT. Supported by grants P-EF/07 from FIJC and RD 06/0020/1014 from Instituto Carlos III
32
Baba, Khadija, Lahcen Bahi, and Latifa Ouadif. "Geostatistical Analysis for delineating sterile inclusions in Sidi Chennane' phosphatic series, Morrocco." Earth Sciences Research Journal 18, no. 2 (March 16, 2015): 143–48. http://dx.doi.org/10.15446/esrj.v18n2.41173.
Full textAbstract:
<p>The anomalies detected in phosphatic series of Sidi Chennane, one of phosphatic basins in Morocco, hinder the proper exploitation of phosphate levels and the assessing phosphate reserves seems incorrect. The purpose of this study was the evaluation of geostatistical methods for delimitation of these disturbances. To cover all the zones being able to be disturbed, we carried out, during the geophysical prospection in a parcel of 50 ha, 5151 resistivity measurements as horizontal profiling using the well-known Schlumberger array, in order to map the spatial distribution of the sterile hardpan inclusions.</p><p>Geostatistical tools were used to quantify the spatial correlation between apparent resistivity data. Semivariograms were obtained using a classical Matheron semivariogram estimator and fit to the experimental semivariograms obtained. We have selected those with the best fit in terms of sum of squared residuals (SSR).</p><p>Geostatistical analysis was performed using the software VESPER 1.63. Spatial distribution maps were made by ordinary kriging, the qualitative interpretation of these maps reflects that the exponential model is found to be the best model representing the spatial variability of our geoelectric data. The qualitative interpretation of the kriged resistivity maps allows defining resistivity contrast, consequently we have delimited the crossing dominate area from a “normal” into a “disturbed” area. Models of the geology were successfully obtained from geostatical method, which help mapping the phosphate deposit inclusions and the estimations of phosphate reserves were improved and better constrained.</p><p> </p><p><strong>Resumen</strong></p><p>Las anomalías detectadas en las series fosfóricas de Sidi Chennane, una de las cuencas fosfóricas de Marruecos, dificultan la explotación apropiada de los niveles de fosfato y hacen parecer incorrectos los cálculos de las reservas. El propósito de este estudio es la evaluación de los métodos geoestadísticos para la delimitación de estas anomalías. Para cubrir todas las zonas donde se pueden presentar estas alteraciones se llevaron a cabo,durante la exploración geofísica en una parcela de 50 hectáreas, 5151 medidas de resistividad con perfileshorizontales a través del conocido sondeo Schlumberger, con el fin de mapear la distribución espacial de las inclusiones estériles de la capa sólida.</p><p>Se utilizaron herramientas geoestadísticas para cuantificar la correlación espacial entre los datos de resistividad. Se obtuvieron semivariogramas a través del tradicional estimador de semivariogramas Matheron y se adecuaron a los semivariogramas experimentales obtenidos. La selección se basó en aquellos que mejor se acoplaban en términos de la suma de cuadrados residuales (SCE). Los análisis geoestadísticos se realizaron con el programa VESPER 1.63. Los mapas de distribución espacial se hicieron por Kriging regular, y la interpretación cualitativa de estos mapas refleja que el modelo exponencial es el que mejor representa la variablilidad espacial de estos datos geoeléctricos. La interpretación cualitativa de los mapas de resistividad obtenidos por la técnica del Kriging permite definir el contraste de resistencia, lo que fija el área entre los estándares de “normal” y “Con Alteraciones”. Los modelos geológicos fueron obtenidos del método geoestadístico, lo que ayudó a mapear los depósitos de inclusiones de fosfato y mejoró las estimaciones de las reservas a través de una mejor definición de estas.</p><p> </p>
33
Colunga Orozco, Zurisadai, Mariana Reymundo Flores, Maria Viviana Valdes Salinas, and Javier Alonso Trujillo. "Terapia ocupacional en el adulto mayor como estrategia para prevenir el deterioro cognitivo." Revista CuidArte 3, no. 6 (February 17, 2015): 26. http://dx.doi.org/10.22201/fesi.23958979e.2014.3.6.69085.
Full textAbstract:
<div>Resumen</div><div>Hoy en día existe la posibilidad de contar con terapias ocupacionales (TO) en los centros de atención al Adulto Mayor que teóricamente pueden ayudar a prevenir el Deterioro Cognitivo y a permitir que ellos realicen de manera independiente sus actividades básicas de la vida cotidiana (ABVC). Objetivo: Demostrar el efecto que tienen las terapias ocupacionales en el adulto mayor como estrategia para prevenir el deterioro cognitivo y permitir que las ABVC se sigan desarrollando de manera independiente. Metodología: Tipo de investigación Pre-Experimental, prospectivo, longitudinal, analítico. Nivel de investigación comparativo. Muestra de 14 adultos mayores del centro gerontológico DIF Tacuba, seleccionados de manera no probabilística. Se procedió a valorar las ABVC y el estado cognitivo (EC) utilizando los instrumentos Índice de Katz y el MMSE de Folstein respectivamente. Ambas mediciones arrojan puntajes. Se realiza la prueba estadística de K-S para demostrar normalidad de los datos y se aplica la prueba de Wilcoxon para comparar el puntaje inicial contra el puntaje final del seguimiento. El nivel de significancia se fijó en 0.05. Resultados: Solo el 7% de los sujetos se encuentra en la categoría de dependiente para realizar sus ABVC. La comparación de las mediciones de las ABVC demostró que en esta muestra de sujetos, no hubo diferencia en la calificación promedio de la medición inicial y final (p > 0.05). En cuanto al EC, nuestros hallazgos señalan que tampoco hubo diferencias entre la medición inicial y final (p > 0.05). De acuerdo a nuestros resultados, las terapias ocupacionales mantienen sin cambios las ABVC y el EC de los adultos mayores, lo cual significa que en el grupo observado no ocurrió mejoría ni deterioro, no obstante a nivel individual si se observan cambios. Conclusión: De manera general, la TO mantiene sin cambios tanto el patrón de ABVC como el EC en los adultos mayores.</div><div><br /></div><div>Palabras clave: Actividades básicas de la vida cotidiana, Adulto mayor, Estado cognitivo, Terapia ocupacional.</div><div><br /></div><div><br /></div><div>Summary</div><div>Nowadays there exists the possibility of possessing occupational therapies (OT) in the centers of attention to the Major Adult that theoretically they can help to anticipate the Cognitive Deterioration and to allowing that they should realize in an independent way his basic activities of the daily life (BADL). Objetive: To demonstrate the effect that the occupational therapies have in the major adult as strategy to anticipate the cognitive deterioration and to allow that the BADL should continue developing in an independent way. Methodology: Type of Pre-experimental investigation (Expost-fact), prospective, longitudinal, analytical. Comparative level of investigation. Sample of 14 major adults of the center gerontology DIF Tacuba, selected of way not probabilístic. One proceeded to value the BADL and the cognitive condition (CC) using the instruments Katz’s Index and Folstein’s MMSE respectively. Both measurements throw puntajes. There is realized K-S’s statistical test to demonstrate normality of the information and Wilcoxon’s test is applied to compare the initial puntaje against the final puntaje of the follow-up. The level of significancy was fixed in 0.05. Results: Only 7 % of the subjects is in the salesman’s category to realize his BADL. The comparison of the measurements of the BADL demonstrated that in this sample of subjects, there was no difference in the average qualification of the initial and final measurement (p> 0.05). As for the CC, our findings indicate that neither there were differences between the initial and final measurement (p> 0.05). In agreement to our results, the occupational therapies support without changes the BADL and the CC of the major adults, which means that in the observed group neither improvement nor deterioration happened, nevertheless to individual level if changes are observed. Conclusion: In a general way, the TO supports without changes both the boss of BADL and the CC in the major adults.</div><div><br /></div><div>keywords: Basic activity daily life, Major Adult, cognitive condition, occupational therapy. </div>
34
Ribera, Josep-Maria, Albert Oriol, Mireia Morgades, Miguel-Angel Sanz, Pau Montesinos, Josep Sarra, Salut Brunet, et al. "Treatment of High-Risk (HR) Philadelphia Chromosome-Negative (Ph-) Adult Acute Lymphoblastic Leukemia (ALL) According to Baseline Risk Factors and Minimal Residual Disease (MRD). Results of the PETHEMA ALL-AR-03 Trial Including the Use of Propensity Score (PS) Method to Reduce Assignment Bias." Blood 114, no. 22 (November 20, 2009): 322. http://dx.doi.org/10.1182/blood.v114.22.322.322.
Full textAbstract:
Abstract Abstract 322 Introduction: Current therapeutic protocols for adult ALL consider MRD together with the baseline risk factors (age, WBC count, immunophenotype, cytogenetics) and speed in response to therapy for treatment decisions. On the other hand, the systematic use of allogeneic SCT for all adult patients (pts) with Ph- HR-ALL is still a matter of debate. The aim of the prospective study ALL-AR-03 from the Spanish PETHEMA Group was to evaluate the response to a differentiated therapy (chemotherapy or allogeneic SCT) according to early bone marrow blast clearance (<10% blasts in bone marrow assessed on day 14) and MRD levels (assessed by cytofluorometry at the end of induction –week 5- and consolidation therapy –week 17-) in HR Ph- adult ALL patients. Patients and methods: HR ALL included one or more of the following baseline parameters: age 30–60 yr, WBC count >25×109/L and 11q23 or MLL rearrangements. Induction therapy included vincristine, prednisone and daunorubicin for 4 weeks. In pts with slow cytologic response to therapy intensified induction with high dose ARA-C and mitoxantrone was administered. Early consolidation therapy included 3 cycles with rotating cytotoxic drugs including high-dose methotrexate, high-dose ARA-C and high-dose asparaginase. Pts. with slow cytologic response on d14 or MRD level >0.05% after consolidation were assigned to allogeneic SCT (related or unrelated) and those with standard cytologic response on d14 and MRD level <0.05% after consolidation received 3 additional cycles of delayed consolidation (identical to those of early consolidation) followed by maintenance therapy up to 2yr in CR. Results: On June 2009, 235 HR ALL pts were evaluable [mean (SD) age 37(14) yr, 129 males, 155 precursor B-ALL, 80 T-ALL, WBC count 64(96) ×109/L]. Induction death: 20(8%), resistance: 11 (5%), CR: 202 (87%). Slow cytologic response on d14 was observed in 137/186 (74%) pts, MRD<0.1% at the end of induction was observed in 70% of CR patients and MRD<0.05% was shown in 82% of pts at the end of consolidation. By intention-to treat allogeneic SCT was assigned to 51 pts and delayed consolidation and maintenance to 107 pts. 4-yr DFS and OS probabilities were 40±15% and 49±15%, respectively, for pts assigned to SCT and 49±13% and 64±12%, respectively, for those assigned to chemotherapy. For OS the Cox model including PS showed that patients assigned to allogeneic SCT had a risk of death of 1.27 (95%CI 0.68–2.37) compared to that of the pts assigned to chemotherapy. Patients with MRD<0.1% at the end of induction and <0.05% at the end of consolidation showed a 4-yr DFS and OS of 54±16% and 77±12%, respectively vs. 31±29% and 38±32%, respectively for those with MRD≥0.1% after induction and ≥0.05% after consolidation (p=0.04 and 0.006, respectively). By multivariate analysis, including the type of treatment as covariate, age and slow cytologic response were the prognostic factors for CR, MRD level was associated with DFS, and MRD level and WBC count were the main parameters with influence on OS. Conclusions: These results suggest that in HR Ph- adult ALL pts with adequate response to induction and adequate clearance of MDR after consolidation the results of therapy are not hampered by avoiding allogeneic SCT. MRD is the main prognostic factor for CR, DFS and OS. Supported by grants P-EF/07 from FIJC and RD 06/0020/10556 from RETICS, and PI051490 from FIS, Instituto Carlos III. Disclosures: No relevant conflicts of interest to declare.
35
Onundarson, Pall T., Charles W. Francis, Einar S. Bjornsson, Magnus K. Magnusson, David O. Arnar, Olafur S. Indridason, Sigrun Helga Lund, Sigurdur J. Juliusson, Hulda M. Jensdottir, and Brynja R. Gudmundsdottir. "Monitoring Warfarin with the Fiix-Prothrombin Time Improves Anticoagulation Stability and Long-Term Clinical Outcome. the Fiix-Trial." Blood 124, no. 21 (December 6, 2014): 347. http://dx.doi.org/10.1182/blood.v124.21.347.347.
Full textAbstract:
Abstract Introduction: Experiments suggest that the anticoagulation effect of warfarin is mainly influenced by a reduction in coagulation factor (F) II and X activity and that FVII may have relatively little effect. Due to the short half-life of FVII but its strong influence on the prothrombin time (PT), monitoring warfarin using PT may therefore confound warfarin dosing. The Fiix-prothrombin time is specially designed to circumvent measuring FVII activity and is only sensitive to the activity of FII and FX in the sample. The Fiix-trial was a single center randomized prospective and blinded non-inferiority clinical trial that examined monitoring warfarin with the Fiix-PT compared to the PT. Methods: All community dwelling patients 18 years and older with an INR target of 2-3 managed by our center´s anticoagulation management service were eligible for participation. A PT ratio adapted for thromboplastin sensitivity (INR) was calculated for both tests and results were reported by the laboratory as R-INR (“research INR”) to the dosing staff that was blinded to each patient´s test method. Warfarin dosing was software assisted using the DAWN anticoagulation software. Protocols designed for monitoring with PT were used, including a recommended maximum six week interval between tests. The major efficacy endpoint was fatal and non-fatal thromboembolism (TE) rate and the major safety endpoint was major bleeding per patient year (ppy). Surrogate efficacy parameters included number of tests, tests in range, time within target range 2-3 (TTR), monitoring test interval and dose adjustment rate. Results: After exclusion of 4 patients in each group, 573 patients were evaluable in the Fiix-PT arm and 575 in the control arm. About 69% had atrial fibrillation (AF) and 21% had venous thromboembolism (TE). The median monitoring time was 1.7 (IQR 1.1-1.9) years per patient in both study arms. The TE rate was similar in the first six months but thereafter the event curves diverged (Figure 1) and therefore we specially examined events occuring after six months in a secondary analysis. In the primary analysis of events during days 1-720, the TE rate ppy was 1.2% in the Fiix-arm vs 2.3% in controls (-48%, p = 0.09) demonstrating at least non-inferiority of Fiix-PT monitoring compared to the PT in reducing TE. The major bleeding rate did not differ; 2.2% and 2.5%, respectively (p = n.s., non-inferior). In the secondary analysis, after excluding the first six observation months, the Fiix-PT lead to a superior long-term reduction in TE (1.1% vs 2.2% annual rate, -50%, p = 0.03) with major bleeding rate of 1.5% vs 2.3% respectively (p = 0.8). A subanalysis of patients with AF yielded similar results. The intracranial hemorrhage (ICH)/intracerebral hemorrhage rate was 0.26%/0.13% ppy in the Fiix-arm and 0.64%/0.38% ppy in the PT-arm. In the first six months the test volume was the same in both arms but therafter a 5.8% reduction occurred in the Fiix-arm. The dose adjustment rate was reduced 12% overall and 18% during long term monitoring (4.1 vs 5.0 ppy, p = 0.01). At six month intervals, the median percent TTR was 84.9 (79.9-86.7) in the Fiix-arm vs 80.3 (78.5-81.3%) in the PT-arm. Figure 1 Figure 1. Conclusion: Monitoring warfarin with Fiix-PT is non-inferior and possibly superior to the PT in reducing long-term recurrent TE. Bleeding is not increased despite omitting FVII activity in the monitoring test. With the Fiix-PT, the warfarin effect fluctuates less than with standard PT as manifested by a higher TTR and reduced dose-adjustment need. Overall, the results suggest that the fluctuation typically observed during warfarin treatment is partly caused by the traditional prothrombin time itself. Disclosures Onundarson: Fiix Diagnostics Ltd: Equity Ownership, I am a co-inventor of the Fiix prothrombin time and have stocks in Fiix Diagnostics, a startup company with the two inventors of the test as majority shareholders. The company is responsible for patent applications in process. Patents & Royalties. Gudmundsdottir:Fiix Diagnostics Ltd: Equity Ownership, I am a co-inventor of the Fiix prothrombin time and have stocks in Fiix Diagnostics, a startup company with the two inventors of the test as majority shareholders. The company is responsible for patent applications in process. Patents & Royalties.
36
Gangadharan, Bagirath, Birgit Reipert, Fritz Scheiflinger, Joel Bowen, Elizabeth Donnachie, Karin Fijn van Draat, Ralph A. Gruppo, et al. "Longitudinal Antibody Signatures Following FVIII Replacement Therapy in Previously Untreated Patients with Severe Hemophilia Α- New Insights from the Hemophilia Inhibitor PUP Study (HIPS)." Blood 130, Suppl_1 (December 7, 2017): 88. http://dx.doi.org/10.1182/blood.v130.suppl_1.88.88.
Full textAbstract:
Abstract Background and objectives The Hemophilia Inhibitor PUP Study (HIPS, clinicaltrials.gov NCT01652027) is a prospective multicenter observational study of PUPs with severe hemophilia A during their first 50 exposure days (EDs) to recombinant Factor VIII (FVIII, Advate TM). The objective is to elucidate immune system changes and identify potential early biomarkers of inhibitor development in PUPs. Previously we reported that the appearance of high-affinity anti-FVIII antibodies preceded clinical diagnosis of FVIII inhibitors in patients (Reipert 2016). Here we present longitudinal antibody data including titers of FVIII-specific IgM, IgG1-4, IgA, apparent affinities of antibodies and titers of FVIII inhibitors for the first 15 patients who completed the antibody analysis of the HIPS study. Moreover, we present longitudinal monitoring data for key circulating immune cells such as FoxP3+ T cells (Tregs), pro-inflammatory Th17 cells, total T cells and granulysin+ NK cells. Methods FVIII inhibitor testing (Nijmegen methodology, performed in the central laboratory Medical College of Vienna) and antibody analytics were done prior to first exposure, 7-9 days after ED 1 and 5-7 days after EDs 5, 10, 20, 30, 40, and 50. FVIII-specific antibody analytics, including specifications of isotypes, IgG subclasses and apparent affinities were done using methodology described by Whelan 2013 and Hofbauer 2015. Circulating immune cells including FoxP3+ T cells (Tregs), pro-inflammatory Th17 cells, total T cells and granulysin+ NK cells were monitored by epigenetic cell counting in whole blood using quantitative PCR-based methylation assays (www.epiontis.com) Results 25 subjects have been enrolled among 15 study sites. Data for 15 subjects who had completed 50 exposure days were available for analysis. Among these 15 subjects, 4 developed FVIII inhibitors by study criteria (> 0.6 B.U. x 2 measurements in central laboratory) at exposure days 6, 10 and 20. All inhibitors were associated with the development of high affinity FVIII-specific antibodies. High-affinity IgG1 antibodies were detected first and subsequently switched to IgG3 and IgG4, switching to IgG2 was observed only in one of the 4 patients. Two of the 4 inhibitor patients initially developed low affinity IgG1 antibodies which were subsequently accompanied by high affinity IgG1 before switching to high-affinity IgG3 and IgG4. One of the 4 inhibitor patients expressed non-neutralizing FVIII-specific IgG1 antibodies prior to first FVIII infusion already and developed a high-titer inhibitor as early as ED6 Six of the 15 patients who had completed 50 exposure days developed non-neutralizing antibodies (detected on at least 2 time points). Five of them expressed low affinity IgG1 which was never accompanied by high affinity IgG1 or by any other IgG subclass. One of the 6 patients initially expressed low affinity IgG1 which was later accompanied by non-neutralizing high affinity IgG1. Switching to other IgG subclasses was not observed. Three patients had no antibodies detected and 2 had non-neutralizing antibodies detected at a single time point only. Levels of circulating FoxP3+ Tregs in the infant patients were in the same range as in healthy adults with some variation between individuals. In contrast, circulating TH17 cells were barely detectable. The levels of granulysin+ NK cells showed substantial variations between patients as well as during longitudinal monitoring in the same patient. Conclusion Antibody data obtained from the first 15 patients who completed 50 exposure days in the HIPS study confirms that FVIII inhibitor development is preceded by the detection of high-affinity FVIII-specific antibodies. High affinity IgG1 antibodies appeared first and subsequently switched to IgG3 and IgG4 which indicates a T-cell dependent pathway in FVIII inhibitor development. Switching to IgG2 was only seen in 1 of the 4 inhibitor patients. In contrast, patients with non-neutralizing antibodies only expressed IgG1 antibodies and never switched to another IgG subclass. 5 of the 6 patients with non-neutralizing antibodies only expressed low affinity IgG1 which might reflect a T-cell independent pathway of antibody development. In summary, our data indicate that comprehensive analysis of FVIII-specific antibodies might provide early biomarkers which indicate evolving FVIII inhibitors. Disclosures Gangadharan: Shire: Employment. Reipert: Shire: Employment. Scheiflinger: Shire: Employment. Bowen: Shire: Research Funding. Fijn van Draat: ZonMW,CSL Behring: Research Funding; Baxalta: Membership on an entity's Board of Directors or advisory committees; Pfizer, Novo Nordisk: Other: Lectures. Gruppo: Shire: Other: Honorarium for participation on physician advisory board. Male: Bayer, Baxalta, Biotest, CSL Behring, Novo Nordisk, Pfizer: Other: Speaker Honoraria and/Travel support. McGuinn: Shire/Baxalta: Consultancy; Shire / Baxalta, Spark, Biogen, Roche/Genetehc: Research Funding. Recht: Baxalta, Novo Nordisk, Biogen, Pfizer: Research Funding; Biogen , Kediron: Consultancy. Ragni: A Anylam,Biomarin,Tecere, Benitec: Honoraria; Alnylam, CSL Behring, Dimensions, Genetech/Roche,Pfizer, Shire, SPARK: Research Funding. Yaish: Baxalta, Bayer and Octapharma, CSL behring: Consultancy, Membership on an entity's Board of Directors or advisory committees; Baxalta: Honoraria, Membership on an entity's Board of Directors or advisory committees. Santagostino: : Bayer, Shire, Pfizer, Novo Nordisk, Kedrion, Roche, Sobi, Bioverativ, CSL Behring, Grifols, Octapharma: Speakers Bureau; Bayer, Shire, Pfizer, Novo Nordisk, Kedrion, Roche, Sobi, Bioverativ: Other: Advisory board. Brown: Shire: Research Funding.
37
Thean, Li Jun, Lucia Romani, Daniel Engelman, Adam Jenney, Handan Wand, Jyotishna Mani, Jessica Paka, et al. "Prospective Surveillance of Primary Healthcare Presentations for Scabies and Bacterial Skin Infections in Fiji, 2018–2019." American Journal of Tropical Medicine and Hygiene, May 24, 2021. http://dx.doi.org/10.4269/ajtmh.20-1459.
Full textAbstract:
Scabies, impetigo, and other skin and soft tissue infections (SSTIs) are highly prevalent in many tropical, low-middle income settings, but information regarding their burden of disease is scarce. We conducted a surveillance of presentations of scabies and SSTIs, including impetigo, abscesses, cellulitis, and severe SSTI, to primary health facilities in Fiji. We established a monthly reporting system over the course of 50 weeks (July 2018–June 2019) for scabies and SSTIs at all 42 public primary health facilities in the Northern Division of Fiji (population, ≈131,914). For each case, information was collected regarding demographics, diagnosis, and treatment. There were 13,736 individual primary healthcare presentations with scabies, SSTI, or both (108.3 presentations per 1000 person-years; 95% confidence interval [CI], 106.6–110 presentations). The incidence was higher for males than for females (incidence rate ratio [IRR], 1.15; 95% CI, 1.11–1.19). Children younger than 5 years had the highest incidence among all age groups (339.1 per 1000 person-years). The incidence was higher among the iTaukei (indigenous) population (159.9 per 1000 person-years) compared with Fijians of Indian descent (30.1 per 1000 person-years; IRR, 5.32; 95% CI, 5.03–5.61). Abscesses had the highest incidence (63.5 per 1,000 person-years), followed by scabies (28.7 per 1,000 person-years) and impetigo (21.6 per 1,000 person-years). Scabies and SSTIs impose a substantial burden in Fiji and represent a high incidence of primary health presentations in this population. The incidence in low-middle income settings is up to 10-times higher than that in high-income settings. New public health strategies and further research are needed to address these conditions.
38
Ali, Mohammad Javed, Adit Gupta, Chittabhathina Sri Lakshmi, and Mohammad Hasnat Ali. "The FICI grading for a dacryocystorhinostomy ostium." European Journal of Ophthalmology, February 12, 2021, 112067212199474. http://dx.doi.org/10.1177/1120672121994747.
Full textAbstract:
Purpose: The objective of this study is to propose a simple grading to assess the health of a dacryocystorhinostomy (DCR) ostium. Methods: Prospective case series of 237 Ostia evaluated following dacryocystorhinostomy were included in the study. All the ostia were assessed for 10 parameters in detail using the earlier published DCR ostium scoring (DOS scoring). Each of the 10 parameters were scored individually, and final DOS scores were obtained. The anatomical and functional outcomes of each of the surgery were noted. The most significant parameters that influenced the success were determined using the binary recursive partitioning in a conditional inference framework. Data management and statistical tests were performed using the statistical “Software R” and the library “partykit” toolkits. Results: The most significant DCR ostium parameters that influenced the outcomes were anatomical and functional fluorescein dye transit ( p < 0.001), dynamicity of internal common opening (ICO) on the blink ( p < 0.001), end-on threats to ICO from granuloma, membrane or a synechia, and cicatricial closure of the Ostia. Each of these significant factors (FICI – Fluorescein endoscopy dye test, ICO dynamicity, Cicatricial ostium closure and ICO threats) were assigned simple scoring and the final scores were graded from 0 (poor DCR ostium) to +5 (excellent DCR ostium). FICI grading can guide the physician on the health status of the DCR ostium and the possible need for intervention. Conclusion: FICI DCR ostium grading is a simple, easy to perform, and physician-friendly system. More studies with larger sample size would help in further validating the FICI grading.
39
Николаева, М. Г., А. П. Момот, А. Н. Мамаев, Н. Г. Хорев, Н. М. Пасман, Ю. Н. Вагнер, М. С. Зайнулина, И. Ф. Фаткуллин, М. М. Сиразитдинова, and Н. Н. Ясафова. "Thrombotic events in rare kinds of genetic thrombophilias." Тромбоз, гемостаз и реология, no. 4 (December 9, 2020). http://dx.doi.org/10.25555/thr.2020.4.0950.
Full textAbstract:
Цель исследования: изучить лабораторный фенотип редких мутаций Лейдена [FVL А(1961)A] и гена протромбина [FII А(20210)A] при их клинической реализации в виде тромбозов. Материалы и методы. Проведено многоцентровое проспективное наблюдательное исследование, включающее 80 носителей редких генетических форм тромбофилий: FVL А(1961)A (n = 31), FII А(20210)A (n = 10) и компаунд FII G(20210)A + FVL G(1691)A (n = 39). У всех пациентов исследована резистентность фактора Va к активированному протеину С (APC-R) по нормализованному отношению (НО) и уровень активности протромбина в плазме крови в состоянии физического здоровья и в случае эпизода тромботического события. Результаты. Определена ассоциативная связь развития тромботических событий со снижением НО при оценке APC-R как у гомозиготных носителей мутации Лейден (Ме = 0,35; 95% ДИ = 0,31–0,37 по НО), так и гетерозиготных компаундов (Ме = 0,43; 95% ДИ = 0,42–0,45 по НО). Заключение. Лабораторный мониторинг пациентов с редкими формами генетических тромбофилий позволяет выделить группу высокого тромбогенного риска, нуждающуюся в пролонгированной тромбопрофилактике. Objectives: to study the laboratory phenotype of rare Leiden mutation [FVL A(1961)A] and the prothrombin gene mutation [FII А(20210)A] implementating clinically as thrombosis. Patients / Methods. A multicenter prospective observational study included 80 carriers of rare genetic kinds of thrombophilia: FVL A(1961)A (n = 31), prothrombin FII А(20210)A (n = 10) and the compound FII G(20210)A + FVL G(1691)A (n = 39). All patients were tested for the factor Va resistance to activated protein C (APC-R), normalized ratio (NR), and the plasma prothrombin activity (%) in healthy conditions and in the case of thrombotic event. Results. An associative relation between the development of thrombotic events and a decrease in NR was determined when assessing APC-R, both in homozygous carriers of the Leiden mutation (Me = 0.35; 95% CI = 0.31–0.37 in NR) and heterozygous compounds (Me = 0.43; 95% СI = 0.42–0.45 in NR). Conclusions. Laboratory follow up for patients with rare kinds of genetic thrombophilias allows to identify a group at high thrombogenic risk requiring prolonged thromboprophylaxis.
40
Grasa, Rafael. "Colombia cuatro años después de los acuerdos de paz: un análisis prospectivo." Documentos de Trabajo, November 19, 2020. http://dx.doi.org/10.33960/issn-e.1885-9119.dt39.
Full textAbstract:
El presente documento analiza prospectivamente el impacto y las perspectivas de transformación social y política de Colombia, en clave de construcción de paz (baja probabilidad de que la conflictividad social, ine- vitable, devenga violencia directa). Para ello, examina el estado de la implementación del Acuerdo final de Paz entre el Gobierno de Colombia y las Fuerzas Armadas Revolucionarias de Colombia-Ejército del Pueblo (FARC-EP) tras cuatro años de su firma (La Habana, 24 de agosto de 2016; Teatro Colón, 24 de noviembre de 2016). El objetivo es presentar un balance de hasta qué punto se ha avanzado en la solución del principal problema de Colombia, incluso por encima de la desigualdad y la inequidad: la reproducción intergenera- cional de la violencia directa política desde principios del siglo XX. El documento se estructura en una in- troducción y cinco apartados. La introducción plantea el contexto, antecedentes y objetivos. El primer apartado sintetiza, en clave comparada y académica, las negociaciones, el acuerdo y el proceso de refren- dación. El segundo ofrece una visión de conjunto, en perspectiva comparada, con otros acuerdos de paz sobre conflictos armados internos, y analiza la implementación diferenciando los dos períodos de aplicación que corresponden a la Administración Santos y a la Administración Duque. El tercero se focaliza, mediante algunas catas, en el grado de incidencia de la implementación en el proceso, más largo, de construcción de paz, prestando atención a la persistencia de otras fuentes de violencia directa y otros conflictos armados, así como al papel crucial del atractivo de las economías ilegales de la droga, la minería ilegal y delincuencial, y el contrabando. El cuarto se fija en la agenda presente y su impacto a corto y medio plazo en la implemen- tación, tomando en cuenta la movilización social, la polarización, y, sobre todo, la pandemia. Finalmente, el quinto apartado ofrece tres recomendaciones de amplio aliento e impacto a corto, medio y largo plazo para todos los actores.
41
Kashyap, Rahul, Srinivas Murthy, Grace M. Arteaga, Yue Dong, Lindsey Cooper, Tanja Kovacevic, Chetak Basavaraja, et al. "Effectiveness of a Daily Rounding Checklist on Processes of Care and Outcomes in Diverse Pediatric Intensive Care Units Across the World." Journal of Tropical Pediatrics, August 27, 2020. http://dx.doi.org/10.1093/tropej/fmaa058.
Full textAbstract:
ABSTRACT Background Implementation of checklists has been shown to be effective in improving patient safety. This study aims to evaluate the effectiveness of implementation of a checklist for daily care processes into clinical practice of pediatric intensive care units (PICUs) with limited resources. Methods Prospective before–after study in eight PICUs from China, Congo, Croatia, Fiji, and India after implementation of a daily checklist into the ICU rounds. Results Seven hundred and thirty-five patients from eight centers were enrolled between 2015 and 2017. Baseline stage had 292 patients and post-implementation 443. The ICU length of stay post-implementation decreased significantly [9.4 (4–15.5) vs. 7.3 (3.4–13.4) days, p = 0.01], with a nominal improvement in the hospital length of stay [15.4 (8.4–25) vs. 12.6 (7.5–24.4) days, p = 0.055]. The hospital mortality and ICU mortality between baseline group and post-implementation group did not show a significant difference, 14.4% vs. 11.3%; p = 0.22 for each. There was a variable impact of checklist implementation on adherence to various processes of care recommendations. A decreased exposure in days was noticed for; mechanical ventilation from 42.6% to 33.8%, p < 0.01; central line from 31.3% to 25.3%, p < 0.01; and urinary catheter from 30.6% to 24.4%, p < 0.01. Although there was an increased utilization of antimicrobials (89.9–93.2%, p < 0.01). Conclusions Checklists for the treatment of acute illness and injury in the PICU setting marginally impacted the outcome and processes of care. The intervention led to increasing adherence with guidelines in multiple ICU processes and led to decreased length of stay.
42
Castañeda Garzón, Diana Patricia, Ricardo Pachón Mantilla, and Sulied Fernanda Salazar Díaz. "Claro S.A. y el desarrollo de las telecomunicaciones en Colombia." Punto de vista 10, no. 15 (June 5, 2019). http://dx.doi.org/10.15765/pdv.v10i15.1223.
Full textAbstract:
<p>El presente artículo muestra cómo ha sido el desarrollo de Claro S.A. y como sus estrategias han influenciado el sector de las telecomunicaciones en Colombia, las regulaciones iniciales a las que fue sometido el sector y como poco a poco se ha ido consolidando como uno de los sectores económicos más importantes del país.<br />Se realiza una prospectiva en general del negocio de las telecomunicaciones a nivel mundial y en particular en Colombia y como estas tendencias afectarían las decisiones a futuro de la empresa Claro y cuáles serían los retos a los cuales se enfrentaría.<br />Para la realización del presente artículo en forma de estudio de caso se utilizó una metodología cualitativa con alcance descriptiva, basada en el rastreo bibliográfico, encontrando que Claro Colombia es reconocida por ser una de las empresas más importantes y solidas del país, no solo por la prestación de sus servicios, ayudando a que los rincones más apartados del país se encuentren comunicados con las principales ciudades, sino que también es considerada como una de las empresas generadoras de empleo predilecta por los colombianos.<br />Además, Claro Colombia desde sus inicios ha sentado las bases de la transformación tecnológica del negocio de telecomunicaciones en el país, se ha caracterizado por estar a la vanguardia en prestación de servicios, infraestructura de telefonía móvil y fija, convirtiéndola<br />en un elemento accesible a toda la población colombiana, ratificándose como la principal empresa de telecomunicaciones por su amplia cobertura.</p>
43
Joksic, Ivana, Zeljko Mikovic, Dejan Filimonovic, Jelena Munjas, Natasa Karadzov Orlic, Amira Egic, and Gordana Joksic. "Combined presence of coagulation factor XIII V34L and plasminogen activator inhibitor 1 4G/5G gene polymorphisms significantly contribute to recurrent pregnancy loss in serbian population." Journal of Medical Biochemistry, July 13, 2019. http://dx.doi.org/10.2478/jomb-2019-0028.
Full textAbstract:
SummaryBackgroundRecurrent pregnancy loss (RPL) is a heterogeneous condition affecting up to 5% of women of reproductive age. Inherited thrombophilia have been postulated as one of the causes of RPL. Here we examined the prevalence of nine thrombophilic gene polymorphisms among women with history of recurrent miscarriages and fertile controls.MethodsThe study included 70 women with history of at least three early pregnancy losses and 31 fertile controls with no miscarriages. We investigated mutations in genes responsible for clotting and fibrinolysis, including factor V (FV) Leiden, FV H1299R, factor II (FII) G20210A, methylene tetrahydrofolate reductase (MTHFR) C677T and A1298C, factor XIII (FXIII) V34L, plasminogen activator inhibitor-1 (PAI-1) 4G/5G and endothelial protein C receptor (EPCR) H1 and H3 haplotypes using reverse polymerase chain reaction ViennaLab cardiovascular disease StrippAssays.ResultsOur results showed no significant increase in prevalence of tested polymorphisms in women with RPL. However, relative risk for PRL among women heterozygous for FXIII V34L was 2.81 times increased (OR 2.81, 95% CI 1.15–6.87, P=0.023). Haplotype analysis showed that combined presence of high-risk genotypes for FXIII and PAI-1 significantly increases risk for RPL (OR 13.98, CI 95% 1.11–17.46, P=0.044).ConclusionsThis is the first study in Serbian population that investigated prevalence of FVR2, A1298C, FXIII V34L and EPCR gene variants. Compound heterozygosity for FXIII V34L and PAI-1 4G is significant risk factor for recurrent miscarriage. Our results should be viewed in context of small case-control study, so further large prospective studies are need for confirmation of our findings.
44
Sanyahumbi, A., G. Karthikeyan, T. Aliku, A. Beaton, J. Carapetis, N. Culliford-Semmens, D. Engelman, et al. "P3131Evolution of subclinical rheumatic heart disease: a multi-centre retrospective cohort study." European Heart Journal 40, Supplement_1 (October 1, 2019). http://dx.doi.org/10.1093/eurheartj/ehz745.0206.
Full textAbstract:
Abstract Background Screening echocardiography (echo) detects subclinical rheumatic heart disease (RHD) which is categorised as definite or borderline. The natural history of subclinical RHD is not known. Follow up single centre studies have included a relatively small number of participants, and have shown variable progression rates. Aim To determine incidence of and factors associated with progression and regression among a cohort of children with baseline subclinical RHD across multiple countries and regions. Methods This is a retrospective cohort study of RHD evolution in children with subclinical RHD. Study sites were Australia, Fiji, Malawi, New Zealand, and Uganda. Progression or regression was determined from echos obtained at baseline and most recent follow-up. Factors associated with echo progression or regression were identified using multivariable logistic regression. Results 482 participants (131 with definite, 351 with borderline subclinical RHD) from 5 countries were included (mean age 11.5 years, range 5–19 years). Mean follow up was 3.4 yrs (range 0.4–9.5 yrs). Of 482 participating children, 204 (42%) regressed. Among 131 children with definite lesions, 48 (37%) regressed to borderline or normal, and 83 (63%) remained definite. Among 351 children with borderline lesions, 39 (11.1%) progressed, 156 (44.4%) remained borderline, and 156 (44.4%) regressed to normal. World Heart Federation defines subcategories based on characteristics of affected valves. By subcategory, children with definite C (pathological aortic regurgitation and 2 morphologic characteristics of the aortic valve) and borderline A (at least 2 morphologic features of the mitral valve without pathologic mitral regurgitation or stenosis) were less likely to regress, and borderline A was more likely to progress. In univariable analysis, good adherence (>80%) to penicillin prophylaxis (BPG) was associated with more regression among all patients (definite + borderline) (OR 1.9, CI 1, 3.5; p=0.04) but this association did not remain significant after adjustment. With multivariable analysis, borderlines prescribed BPG was the only factor related to progression from borderline to definite (OR 4.1, CI 1.8, 9.3, p<0.01). Conclusion This is the largest reported subclinical RHD cohort followed to report outcomes. 42% of definite RHD regressed with subtype C more likely to regress. 11% of borderline RHD progressed. Borderline A was more likely to progress and less likely to regress. We have also identified that being prescribed BPG is associated with borderline progression. This is likely because children with more advanced borderline disease may be more likely to be prescribed BPG. This study highlights that RHD evolution is variable out to 3–4 years post echo detection. While borderline disease is likely, in some cases, to reflect the earliest change of RHD, how this should be monitored and whether it should be treated with BPG should be a priority for future prospective evaluation.
45
Chiba, Fernando Yamamoto, Suzely Adas Saliba Moimaz, Artênio José Ísper Garbin, and Cléa Adas Saliba Garbin. "Avaliação da procura pelos serviços de saúde e tratamento farmacológico de pacientes com anorexia e bulimia nervosa." ARCHIVES OF HEALTH INVESTIGATION 8, no. 5 (August 8, 2019). http://dx.doi.org/10.21270/archi.v8i5.3824.
Full textAbstract:
Introdução: Os transtornos alimentares são caracterizados como distúrbios do comportamento alimentar, associados ao desequilíbrio nos pensamentos, ações e atitudes dos indivíduos resultando em prejuízos à saúde do indivíduo. Estas condições são cada vez mais comuns na sociedade atual e têm ganhado crescente atenção da comunidade científica. Objetivo: Analisar a procura pelo atendimento e farmacoterapia em mulheres com anorexia e bulimia nervosa atendidas em uma faculdade de medicina em 2018. Material e método: Realizou-se análise documental dos prontuários médicos. A procura pelo atendimento foi considerada não-espontânea quando a paciente foi encaminhada pela unidade de urgência/emergência ou compareceu acompanhada por responsável legal sem admitir necessidade de tratamento. Resultados: Identificou-se 14 pacientes, com idade média de 31,21 anos. 43% apresentaram procura não-espontânea pelo atendimento, sendo 83% destas encaminhadas por unidades de urgência/emergência. Foram prescritos 21 medicamentos diferentes, sendo a maioria antidepressivos. 52% dos fármacos prescritos não são disponibilizados pelo Sistema Único de Saúde. 29% dos pacientes apresentavam polifarmácia, 43% automedicação e 57% pensamento de morte. Houve associação entre o pensamento de morte e uso de 4 ou mais medicamentos. Conclusão: Uma parcela considerável das pacientes teve procura não-espontânea pelo atendimento. Os fármacos prescritos foram principalmente antidepressivos e a maioria não é disponibilizado no Sistema Único de Saúde, evidenciando a onerosidade econômica e social do tratamento.Descritores: Transtornos da Alimentação e da Ingestão de Alimentos; Anorexia; Bulimia; Tratamento Farmacológico.ReferênciasLe LK, Barendregt JJ, Hay P, Mihalopoulos C. Prevention of eating disorders: A systematic review and meta-analysis. Clin Psychol Rev. 2017;53:46-58.Herpertz-Dahlmann B. Adolescent eating disorders: definitions, symptomatology, epidemiology and comorbidity. Child Adolesc Psychiatr Clin N Am. 2009;18(1):31-47.Zabala MJ, Macdonald P, Treasure J. Appraisal of caregiving burden, expressed emotion and psychological distress in families of people with eating disorders: a systematic review. Eur Eat Disord Rev. 2009;17(5):338-49.Sharan P, Sundar AS. Eating disorders in women. Indian J Psychiatry. 2015; 57(Suppl 2): S286–S295.Brandys MK, de Kovel CG, Kas MJ, van Elburg AA, Adan RA. Overview of genetic research in anorexia nervosa: The past, the present and the future. Int J Eat Disord. 2015;48(7):814-25.Mitchison D, Hay PJ. The epidemiology of eating disorders: genetic, environmental, and societal factors. Clin Epidemiol. 2014;6:89-97.American Psychiatric Association; 2013. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington.Smink FR, van Hoeken D, Hoek HW. Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep. 2012;14(4):406-14.Geneva: World Health Organization; 1992. World Health Organization. The ICD-10 classification of mental and behavioural disorders. Clinical descriptions and diagnostic guidelines.Stewart TM, Williamson DA. Multidisciplinary treatment of eating disorders--Part 1: Structure and costs of treatment. Behav Modif. 2004;28(6):812-30.Donaldson AA, Hall A, Neukirch J, Kasper V, Simones S, Gagnon S, et al. Multidisciplinary care considerations for gender nonconforming adolescents with eating disorders: A case series. Int J Eat Disord. 2018;51(5):475-479.Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Política Nacional de Alimentação e Nutrição/Ministério da Saúde, Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Brasília: Ministério da Saúde, 2013. 84 p.Brasil. Ministério da Saúde. Secretaria de Ciência, Tecnologia e Insumos Estratégicos. departamento de assistência farmacêutica e insumos estratégicos. Relação nacional de medicamentos essenciais: RENAME 2017. Brasília: Ministério da Saúde, 2017. 210 p.Stice E, Marti CN, Rohde P. Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women. J Abnorm Psychol. 2013;122(2):445-57.Lewinsohn PM, Striegel-Moore RH, Seeley JR. Epidemiology and natural course of eating disorders in young women from adolescence to young adulthood. J Am Acad Child Adolesc Psychiatry. 2000;39(10):1284-92.van Son GE, van Hoeken D, Bartelds AI, van Furth EF, Hoek HW. Time trends in the incidence of eating disorders: a primary care study in the Netherlands. Int J Eat Disord. 2006;39(7):565-9.Hoek HW, van Hoeken D. Review of the prevalence and incidence of eating disorders. Int J Eat Disord. 2003;34(4):383–96.Brand-Gothelf A, Leor S, Apter A, Fennig S. The impact of comorbid depressive and anxiety disorders on severity of anorexia nervosa in adolescent girls. J Nerv Ment Dis. 2014;202(10):759-62.Bühren K, Schwarte R, Fluck F, Timmesfeld N, Krei M, Egberts K, et al. Comorbid psychiatric disorders in female adolescents with first-onset anorexia nervosa. Eur Eat Disord Rev. 2014;22(1):39-44.Mizusaki K, Gih D, LaRosa C, Richmond R, Rienecke RD. Psychotropic usage by patients presenting to an academic eating disorders program. Eat Weight Disord. 2018 Jun 7. doi: 10.1007/s40519-018-0520-3. [Epub ahead of print]Fazeli PK, Calder GL, Miller KK, Misra M, Lawson EA, Meenaghan E, et al. Psychotropic medication use in anorexia nervosa between 1997 and 2009. Int J Eat Disord. 2012;45(8):970-6.Nascimento RCRM, Álvares J, Guerra Junior AA, Gomes IC, Costa EA, Leite SN et al. Availability of essential medicines in primary health care of the Brazilian Unified Health System. Rev. Saúde Pública. 2017;51(Suppl 2):10s.Fassino S, Abbate-Daga G. Resistance to treatment in eating disorders: a critical challenge. BMC Psychiatry. 2013;13:282.Becker AE, Fay KE, Agnew-Blais J, Khan AN, Striegel-Moore RH, Gilman SE. Social network media exposure and adolescent eating pathology in Fiji. Br J Psychiatry. 2011;198(1):43-50.Groesz LM, Levine MP, Murnen SK. The effect of experimental presentation of thin media images on body satisfaction: a meta-analytic review. Int J Eat Disord. 2002;31(1):1-16.
46
Kerr, Andrew. "Long Walks, Lost Documents and the Birthplace of Igneous Petrology: Exploring Glen Tilt, Perthshire, Scotland." Geoscience Canada, July 10, 2020, 83–102. http://dx.doi.org/10.12789/geocanj.2020.47.159.
Full textAbstract:
The spectacular angular unconformity at Siccar Point is the most famous site associated with James Hutton (1726–1797), but it was not his only place of insight. In 1785, three years before he discovered Siccar Point, Hutton examined outcrops in the still-remote valley of Glen Tilt, in the Scottish Highlands. He documented contact relationships between Precambrian metasedimentary rocks and Paleozoic granite bodies, although he had no knowledge of their true ages. Near to the hunting lodge where he and his colleague John Clerk of Eldin stayed, veins of granite clearly cut through relict bedding in the stratified rocks and disrupt their layering, breaking apart individual strata and leaving fragments (xenoliths) surrounded by granite. Hutton correctly deduced that the granite must originally have been in a ‘state of fusion’ and was forcefully injected into much older ‘schistus’. Such conclusions contravened prevailing ideas that granite bodies formed from aqueous solutions, and also refuted a wider philosophical view that granite and other crystalline rocks were the oldest and first-created parts of the Earth. Hutton’s key outcrops in Glen Tilt are easy to visit, although they do require a long (but easy) roundtrip hike of some 25 km. These are certainly not the most spectacular intrusion breccias that I have ever seen, but they are very instructive, and were very influential, because they sparked a long, and at times acrimonious, debate about the origins of igneous rocks and especially granite. This controversy had many strange twists and turns. These include the disappearance of Hutton’s original manuscript after his death, and its serendipitous rediscovery a century later, and the similar loss and rediscovery of exquisite drawings by John Clerk, almost two centuries after they were first penned. Among the lost drawings is an early example of detailed outcrop-scale mapping, which would become a key field-work technique. Hutton’s vision of granite as the product of hot, liquid material that moved upward in the Earth’s crust (plutonism) eventually prevailed over the idea that crystalline rocks formed from a primordial ocean that once enveloped the Earth (neptunism), but this victory did not come easily or quickly. In another strange twist of history, new evidence from the Cape of Good Hope in South Africa eventually acted to further the plutonist cause. Glen Tilt has changed very little since the time of Hutton, but the observations that were made here, and the long debate that followed, brought fundamental changes in our understanding of the Earth. Although Siccar Point should remain the first entry on the bucket list of any prospective geopilgrim to Scotland, the long and beautiful valley of the River Tilt should also be a priority. RÉSUMÉLa spectaculaire discordance angulaire de Siccar Point est le site le plus célèbre associé à James Hutton (1726–1797), mais ce n'était pas le seul lieu qui l’ait inspiré. En 1785, trois ans avant de découvrir Siccar Point, Hutton a examiné des affleurements dans la vallée encore enclavée de Glen Tilt, dans les Highlands écossais. Il a documenté les contacts entre les roches métasédimentaires précambriennes et les corps granitiques du Paléozoïque, bien qu'il ne connût pas leur véritable âge. Près du pavillon de chasse où lui et son collègue John Clerk of Eldin ont séjourné, des veines de granit ont clairement percé le litage relique dans les roches stratifiées et perturbé leur superposition, brisant les strates individuelles et laissant des fragments (xénolithes) entourés de granit. Hutton a correctement déduit que le granit devait à l'origine être dans un « état de fusion » et qu'il avait été injecté de force dans des « schistes » beaucoup plus anciens. De telles conclusions contrevenaient aux idées dominantes selon lesquelles des corps granitiques se formaient à partir de solutions aqueuses et réfutaient également une vision philosophique plus large selon laquelle le granit et d'autres roches cristallines étaient les parties de la Terre les plus anciennes et les premières créées. Les principaux affleurements de Hutton à Glen Tilt sont faciles à visiter, bien qu'ils nécessitent une longue randonnée (mais facile) d'environ 25 km aller et retour. Ce ne sont certainement pas les brèches d'intrusion les plus spectaculaires que je n’ai jamais vues, mais elles sont très instructives et ont eu un rôle très influent, car elles ont déclenché un long débat, parfois acrimonieux, sur les origines des roches ignées et en particulier du granit. Cette controverse a eu de nombreux rebondissements étranges. Ceux-ci incluent la disparition du manuscrit original de Hutton après sa mort, et sa redécouverte fortuite un siècle plus tard, et la perte et la redécouverte similaires de dessins remarquables de John Clerk, près de deux siècles après qu’ils aient été esquissés. Parmi les dessins perdus, se trouve un premier exemple de cartographie détaillée à l'échelle des affleurements, qui deviendra une technique clé de travail sur le terrain.La vision de Hutton du granit en tant que produit d'un matériau chaud et liquide qui s'est déplacé vers le haut dans la croûte terrestre (plutonisme) a finalement prévalu sur l'idée que des roches cristallines se sont formées à partir d'un océan primordial qui enveloppait autrefois la Terre (neptunisme), mais cette victoire n'est pas venue facilement ou rapidement. Dans une autre tournure étrange de l'histoire, de nouvelles preuves provenant du Cap de Bonne-Espérance en Afrique du Sud ont fini par faire avancer la cause plutoniste. Glen Tilt a très peu changé depuis l'époque de Hutton, mais les observations qui ont été faites ici, et le long débat qui a suivi, ont apporté des changements fondamentaux dans notre compréhension de la Terre. Bien que Siccar Point devrait rester en haut de la liste des lieux à visiter de tout visiteur potentiel lors d’un pèlerinage géologique en Écosse, la longue et belle vallée de la rivière Tilt devrait également être une priorité.
47
Din, A. Kadir. "Conference Report The Second Tourism And Hospitality International Conference (Thic 2014)." Malaysian Management Journal, March 1, 2020. http://dx.doi.org/10.32890/mmj.18.2014.9020.
Full textAbstract:
In the morning of 5 May 2014, over sixty people took their seats in the cosy conference hall of the Holiday Villa Beach Resort and Spa Langkawi, to witness the opening ceremony of the THIC 2014 on the theme: Dimensions of Sustainability in the Planning, Development and Management of Tourism and Hospitality Industry. The Deputy Secretary General, Ministry of Tourism and Culture Malaysia, Rashidi Hasbullah, officiated at the ceremony and joined the conference Chair Dr. Shaharuddin Tahir in welcoming participants from over a dozen countries, mostly Malaysians, Indonesians and Thais, who were also collaborators in organising the meeting. As a display of regional fraternity, the Thai and Malaysian contingents took turns to entertain attendees with a repertoire of traditional dances. This social warm up was to be continued in the evening when UUM Dean of Tourism and Hospitality, Dr. Basri Rashid, played host at a dinner given by the Langkawi Development Authority (LADA). The theme on sustainability was a timely choice given the growing interest in Langkawi and the industry at large in green tourism and the issues of sustainability. Altogether, sixty-seven papers were presented but few addressed the theme explicitly. To be sure, most papers touched on aspects of tourism and hospitality management which were linked, directly or indirectly, to the general concept of sustainable development. Most of the papers that dealt with sustainability issues were contributed by tourism researchers and this preponderance was well reflected in the keynote addresses with three of the four papers focusing on tourism. The only keynote address from a hospitality perspective was a presentation by Dr. Yusak Anshori (Universitas Ciputra) who spoke on sustainable hotel business through environment friendly practices such as a ban on smoking and commercialised recycling of waste material. He observed that although there was a general skepticism if not rejection of the radical approach to ban smoking in the Surabaya Plaza Hotel while he was in charge, the management was able to secure ample sustenance from the segment of market that favoured a smoke-free facility. The three keynote papers that discussed sustainable tourism began with Kadir Din’s address which provided an overview of the concept, current thinking on the subject, and its application on the conference site, Langkawi Island. In his view, the three pillars of sustainability as commonly presented in the literature were arguably too general to capture the influence of context-specific features which may appear to be more localised such as location in areas prone to natural hazards, inept leadership, political instability and technological change. In the case of Langkawi, he considered resource limitations (water, space, power, food supply) to be possible impediments to sustainable tourism, besides a dozen other dimensions which may constrain the capacity of the island to cater to the needs of the visitor. The second address by Kalsom Kayat traced the evolution of the concept “sustainable tourism development” which was linked to the concept of balanced development as promulgated through activities organised by the Club of Rome in 1972. The concern with economic growth was whether it could be sustained in terms of the positive and negative consequences, inluding the impacts of development on the well being of future generations. A desirable model for community-based tourism would be a situation in which the entire community consisting of heterogeneous groups of stakeholders are empowered to plan for their own future with collective community welfare in mind. To do this, there must be appropriate policies, standards and institutional arrangements. As illustrations, Kalsom described examples from four different contexts in Thailand, Nepal, China and Fiji, which together presented a range of cases with different literacies, capacities and degrees of consensus in the community, indicating non-homogeneity among host stakeholders. Institutional support from the state is thus clearly needed to harmonise the needs of hosts and guests for now and the future. The next keynote speaker, Manat Chaisawat, is a familiar figure in the ASEAN tourism circle. His long established involvement in the tourism training gave him enough exposure to recall many regional pronouncements and institutional networks which were always promising on paper, but left much to be desired on the ground. Acharn Manat recounted many initiatives articulated in documents issued by the ASEAN Economic Community (AEC), and Indonesia, Malaysia, Thailand Growth Triangle (IMT-GT) since the 1980s. These regional bodies organised meetings where roadmaps, blueprints and strategic development models were presented, but as the THIC 2014 conference participants were fully aware, there had hardly been much meat that could be appreciated on the ground other than the initiatives which arose from private enterprises. Manat and the other keynote speakers were fortunate to be able to enjoy gratis the luxury of lodging at the Frangipani Langkawi Resort & Spa where innovations towards sustainable hospitality were being experimented as he had happily complimented during his keynote speech. The beaches to the east of Frangipani were probably cleaner than Waikiki, thanks to the operator Anthony Wong who continues to pursue green hospitality as his lifelong corporate goal. My own quick stroll on the beach abutting the venue of the THIC 2014 conference however, revealed a contrasting situation. I saw site occupiers engaged in open burning at the edge of a beachfront property. Along the beach there were plastic and styrofoam litters that could be seen on the spot which was ostensibly one of the best beaches on the island. The idea of acquiring a strip for a pedestrian walk, in line with the Langkawi Blueprint initiatives was strongly opposed by the local community. In this sense, Kalsom was correct in the observation that there was rarely a consensus in the community but there must be a common understanding among locals, tourists and industry insiders, before any blueprint can be effectively translated into a harmonious management of the environment. Manat’s expressed desire to see the development of a sacred heritage trail in honour of an eminent Buddhist monk Luang Pu Tuad was understandable given his religious background. The challenge here, however, was how to persuade the host community to share his sentiment that such a trail which would circumambulate non-Buddhist areas would be for the common good. My own reaction, from the lens of a believer in the wasatiyyah (moderate) approach, was that it was a great idea. Discussing the subject after his presentation, I also raised the need to promote heroines Mok and Chan, the two Malay sisters who are valourised in a downtown statue, in honour of their contributions to the provincial government of Phuket during their war of liberation from Burma. The last time I met Manat was in Pusan (Korea) where we were guests of honour as founding members of the Asia-Pacific Tourism Research Association. I subsequently attended a tourism conference and later a meeting he organised in Phuket which allowed me the opportunity to visit Kamala Beach where Aisyah the descendent of Mahsuri lived. Such was my networking with an old scholar who is now in his seventies. As we parted with a big hug at the Padang Matsirat airport, my hope was that we will meet again, so that we can continue to “gaze across the cultural border” as I had written in a presentation entitled “Gazing across the border from Sintok” in a regional meeting of a similar kind, held both in Sintok and Haatyai several years ago. My desire is that such meetings will strengthen interest among researchers in Malaysia to look beyond the Malaysian context. In so doing, they will also be interested in looking beyond the confines of their own cultural sphere, to be in a position to know and eventually accept the other. For me, this is the only way forward for a harmonious, and through that, a prosperous Malaysia. At the risk of being stigmatized by Non-Muslim readers, I must confess that I am fully committed to Prophet Muhammad’s teaching that one should not subscribe to groupism or asabiyyah. This is the way forward for a sustainable Malaysian society. If we go by the theme of the conference, there seems to be little interest in interrogating any of the multifarious dimensions of sustainable tourism, not even in the three presumed pillars—economic, social and environmental. Looking at the key words of papers, only six of the sixty-three papers mentioned sustainable or sustainability and among them only three had mindfully used the term. When a series of announcement on the conference was made almost a year earlier the subscript was intended to draw a wide audience who would be in the position to share ideas on their respective perspectives on sustainable tourism development since the concept in the subscript can be read as a catch-all tagline intended to persuade prospective participants to attend the gathering. In this sense, the organisers had succeeded in securing that critical mass of some eighty attendees, but in terms of sharing ideas and networking on sustainable tourism and hospitality the THIC series must await many more meetings before this interest in grand ideas and frameworks can gather the momentum it deserves. To be sure, as Kalsom said of the non-homegeneity of the host community, there was a non-homegeneity of attendees, with some showing spirited interest in the sustainability theme while others were more interested in the experience visiting Langkawi, period. As the meeting came to a close with a brief parting message from the conference Chair Shaharuddin and Dean Basri, we were left with a measure of excitement–on the prospect of meeting again for the THIC 2015 in Surabaya. As I write this report, there was an announcement on TV on the discovery of debris from Air Asia carrier flight QZ 8501 which left Surabaya two days earlier. It left us ordinary mortals with a tinge of sadness, but now that more people know the city called Surabaya, we hope our prospective co-organiser at Universitas Cipura will rekindle the regional IMT-GT spirit that we have tried to build together in Phuket, Haatyai and Langkawi.