pinecone/core-2020-05-10-deduplication huggingface dataset:
Quality of anticoagulation with vitamin K antagonists

[Abstract] Background. Vitamin K antagonists (VKA) have a narrow therapeutic range, and literature analysis reveals poor quality of anticoagulation control. We sought to assess the prevalence of poor anticoagulant control in patients under VKA treatment in the prevention of stroke for atrial fibrillation (AF).
Hypothesis.Control of anticoagulation with VKA is inadequate in a high percentage of patients with AF.
Methods.Patients with AF under VKA treatment were prospectively recruited in this observational registry. The sample comprised 948 patients. The estimated time spent in the therapeutic range (TTR) was calculated, and variables related with a TTR >65% were analyzed.
Results.Mean age was 73.8 ± 9.4 years, and 42.5% of the patients were women. Mean TTR was 63.77% ± 23.80% for the direct method and 60.27% ± 24.48% for the Rosendaal method. Prevalence of poor anticoagulation control was 54%. Variables associated with good anticoagulation control were university studies (odds ratio [OR]: 1.99, 95% confidence interval [CI]: 1.08-3.64), chronic hepatic disease (OR: 8.15, 95% CI: 1.57-42.24), low comorbidity expressed as Charlson index (OR: 0.87, 95% CI: 0.76-0.99), no previous cardiac disease (OR: 0.64, 95% CI: 0.41-0.98), lower risk of bleeding assessed as hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly age, and use of drugs or alcohol (HAS-BLED; OR: 0.81, 95% CI: 0.69-0.95), and lower heart rate (OR: 0.99, 95% CI: 0.98-0.99).
Conclusions.Patients who receive VKA to prevent stroke for AF spend less than half the time within therapeutic range.Pfizer/Bristol-Myers Squibb and by grants from Institute of Health Carlos III FEDER (RD12/0042/0068, RD12/0042/0010, RD12/0042/0069, RD12/0042/0049, and RD12/0042/0063
Design and rationale of the RE-DUAL PCI Trial: a prospective, randomized, phase 3b study comparing the safety and efficacy of dual antithrombotic therapy with dabigatran etexilate versus warfarin triple therapy in patients with nonvalvular atrial fibrillation who wave undergone percutaneous coronary intervention with stenting

Antithrombotic management of patients with atrial fibrillation (AF) undergoing coronary stenting is complicated by the need for anticoagulant therapy for stroke prevention and dual antiplatelet therapy for prevention of stent thrombosis and coronary events. Triple antithrombotic therapy, typically comprising warfarin, aspirin, and clopidogrel, is associated with a high risk of bleeding. A modest-sized trial of oral anticoagulation with warfarin and clopidogrel without aspirin showed improvements in both bleeding and thrombotic events compared with triple therapy, but large trials are lacking. The RE-DUAL PCI trial (NCT 02164864) is a phase 3b, a strategy of prospective, randomized, open-label, blinded-endpoint trial. The main objective is to evaluate dual antithrombotic therapy with dabigatran etexilate (110 or 150 mg twice daily) and a P2Y12 inhibtor (either clopidogrel or ticagrelor) compared with triple antithrombotic therapy with warfarin, a P2Y12 inhibtor (either clopidogrel or ticagrelor, and low-dose aspirin (for 1 or 3 months, depending on stent type) in nonvalvular AF patients who have undergone percutaneous coronary intervention with stenting. The primary endpoint is time to first International Society of Thrombosis and Hemostasis major bleeding event or clinically relevant nonmajor bleeding event. Secondary endpoints are the composite of all cause death or thrombotic events (myocardial infarction, or stroke/systemic embolism) and unplanned revascularization; death or thrombotic events; individual outcome events; death, myocardial infarction, or stroke; and unplanned revascularization. A hierarchical procedure for multiple testing will be used. The plan is to randomize ∼ 2500 patients at approximately 550 centers worldwide to try to identify new treatment strategies for this patient population
Transthoracic echocardiography for precardioversion screening during atrial flutter/fibrillation in young patients

Background:  Transthoracic echocardiography (TTE) is reliable for detection of thrombi in the left ventricle and right atrium, but not in the left atrial appendage. Therefore, transesophageal echocardiography (TEE) is routinely performed in adults prior to electric cardioversion for atrial flutter/fibrillation (AFF). Whetheryoung survivors of congenital heart disease repair with AFF need routine TEE prior to electric cardioversion is unknown.   Hypothesis:  Electric cardioversion for AFF is safe in survivors of congenital heart disease repair/palliation if an intracardiac thrombus is not suspected on TTE imaging.   Methods:  This study reports the outcome of patients in a pediatric tertiary care cardiac unit where electric cardioversion was performed if no intracardiac thrombus was suspected on TTE. We performed a retrospective chart review of all patients treated with electric cardioversion for AFF at Children's Hospital of Michigan during 1997‐2002.   Results:  Of 35 patients who presented with 110 episodes of AFF requiring electric cardioversion during the study duration, 32 (age 3 months‐49 years, median age 20.5 years, 104 AFF episodes) had previously undergone palliative surgery or repair of their congenital heart disease. Of these 32 patients, 18 were survivors of a Fontan palliation (for a single‐ventricle variant) and the remaining 14 were survivors of other defects and repairs (septal defects, valve replacements, and tetralogy of Fallot). During 81% of the episodes, patients were receiving aspirin, warfarin, or heparin for anticoagulation at presentation. Transthoracic echocardiography was performed in 74 AFF episodes; of these, 10 TTE studies were suspicious for atrial thrombi. Transesophageal echocardiography confirmed the presence of athrombus in 3 of these 10 patients. These patients received warfarin for 2 weeks and then underwent electric cardioversion. No thromboembolic events occurred immediately after or on follow‐up in any patient.   Conclusions:  These findings suggest that TTE may be an effective imaging tool for precardioversion screening in young patients with AFF
Rapid clinical assessment of hemodynamic profiles and targeted treatment of patient with acutely decompensated heart failure

Acutely decompensated heart failure (ADHF) is characterized by hemodynamic abnormalities and neurohormonal activation that contribute to heart failure (HF) symptoms, end‐organ dysfunction, arrhythmias, and progressive cardiac failure. The management of ADHF in the emergency department (ED) can be simplified and improved by a 2‐min bedside assessment that identifies any of four possible hemodynamic profiles on the basis of clinical signs and symptoms. The profiles are based on whether congestion is present or absent (wet or dry) and perfusion is adequate or limited (warm or cold). A wet‐warm profile is seen more frequently in the ED than any of the other three profiles (wet‐cold, dry‐warm, and dry‐cold). The four clinically determined profiles have been shown to predict clinical outcomes and may be used to guide initial HF therapy. The goals of treating ADHF are to stabilize the patient, reverse acute hemodynamic abnormalities, rapidly reverse dyspnea and/or hypoxemia caused by pulmonary congestion, and initiate treatments that will decrease disease progression and improve survival. An ideal agent for the wet‐warm profile would rapidly reduce pulmonary congestion, produce balanced arterial and venous dilation, promote natriuresis, lack direct positive inotropic effects, and not cause reflex neuroendocrine activation. Intravenous nesiritide in conjunction with loop diuretics has been found safe and effective as initial treatment for patients with the wet‐warm profile. For the wet‐cold profile, more intensive therapy and invasive hemodynamic monitoring may prove useful. This review will discuss the rapid clinical determination of hemodynamic profiles in patients presenting to the ED with ADHF and the options for their initial medical management. Case studies representing the wet‐warm, wet‐cold, dry‐warm, and dry‐cold profiles will be presented and discussed
Aldosterone blockade in post‐acute myocardial infarction heart failure

Development of heart failure (HF) or left ventricular systolic dysfunction (LVSD) significantly increases mortality post acute myocardial infarction (AMI). Aldosterone contributes to the development and progression of HF post AMI, and major guidelines now recommend aldosterone blockade in this setting. However, lack of practical experience with aldosterone blockade may make clinicians hesitant to use these therapies. This review is based on a consensus cardiology conference that occurred in May 2005 (New York City) concerning these topics. Potential barriers to the use of aldosterone blockade are discussed and an algorithm for appropriate in‐hospital pharmacologic management of AMI with LVSD and/or HF is presented
Recycling of Cathode Ray Tubes (CRTs) in electronic waste

The management of used electrical and electronic equipment (EEE) or e-waste is a significant problem worldwide due to rapid uptake of the technology and early obsolescence of EEE. Cathode ray tubes (CRTs) from used televisions and computer monitors represent a major e-waste problem as they consist of glass with different compositions. The front panel is a lead-free barium-strontium glass whereas parts such as the funnel hidden inside are composed of glass with lead oxides. Regulations require the glass from waste CRTs to be recycled or re-utilized. Closed-loop recycling and open-loop recycling are two principal ways of recycling CRT glass. The aim of this paper is to examine the technical characteristics and composition of the CRTs, its generation, environmental impacts and related regulatory requirements and to review the current technologies and their limitations for recycling CRT glass and its end use.Griffith Sciences, Griffith School of EngineeringFull Tex
Green electronics through legislation and lead free soldering

Management of used electrical and electronic equipment (EEE) is becoming a major issue as each year around 20 to 50 million tonnes of electronic waste (e-waste) is generated worldwide. EEE contains over 1000 materials of which lead (Pb) has been one of the targets of the regulators forcing manufacturers to adopt lead free products. Industry has come up with several lead free solders with preference given to alloys containing tin, silver, and copper but there is no ,drop-in' substitute to leaded solder. Issues with lead free solders such as temperature, intermetallics, tin whisker, tin pest, and reliability are yet to be resolved. The paper investigated the contribution of lead free soldering to green electronics in a holistic way. Global lead free movement has reached a point of no return. However, it is necessary to make sure that life span of EEE is not shortened thereby resulting in an unforeseen increase in e-waste or problem shifting does not occur by shifting a problem from one life cycle to another or from one category/media to another.Griffith Sciences, Griffith School of EngineeringFull Tex
A comparative study of the use of organoclay-based formulations and organic amendment to reduce the leaching of the herbicide MCPA in soil

MCPA (4-chloro-2-methylphenoxyacetic acid) is an acidic herbicide widely used on olive crops in Spain. Due to its anionic form at natural soil pH, there is high risk of leaching and groundwater contamination by the use of this herbicide. The aim of this work was to study the effects of organoclay-based formulations of MCPA and olive oil waste amendment on MCPA leaching in a sandy loam soil. For this purpose, batch adsorption and column leaching studies were performed. The organoclays used to prepare the clay-based formulations of MCPA were obtained by treating Wyoming montmorillonite (SWy-2) and Arizona montmorillonite (SAz-1) with an amount of hexadecyltrimethylammonium (HDTMA) cation equal to 100% of the CEC of the montmorillonites. The organic residue used in this study was a solid waste from olive oil production (olive oil waste, OOW). The soil was amended with the organic residue at the rate of 10% (w/w). Batch release and column leaching studies indicated that organoclay-based formulations of MCPA reduced the release rate and the leaching of the herbicide as compared to the use of a conventional formulation containing the herbicide in an immediately available form. The increase in soil organic matter of the soil upon amendment with the organic residue also resulted in greater adsorption and reduced leaching of MCPA in the soil. Accordingly, both the use of organoclay-based formulations and the amendment of soil with OOW are proposed as efficient strategies to reduce extensive leaching losses associated with the application of MCPA in high-risk scenarios, such as Mediterranean olive groves.This work has been financed by the Spanish Ministry of Education\ud
and Science (MEC/FEDER) through the projects AGL2007-65771-C02-\ud
01 and AGL2008-04031-C02-01, and by Junta de Andalucí a through\ud
the projects P06-AGR-1565 and P07-AGR-03077. Carmen Trigo and Alegrí a Cabrera\ud
also thank the Spanish Ministry of Education and Science for their\ud
FPI fellowship.Peer Reviewe
Artificial neural network prediction of tropospheric ozone concentrations in Istanbul, Turkey

Tropospheric (ground-level) ozone has adverse effects on human health and environment. In this study, next day's maximum 1-h average ozone concentrations in Istanbul were predicted using multi-layer perceptron (MLP) type artificial neural networks (ANNs). Nine meteorological parameters and nine air pollutant concentrations were utilized as inputs. The total 578 datasets were divided into three groups: training, cross-validation, and testing. When all the 18 inputs were used, the best performance was obtained with a network containing one hidden layer with 24 neurons. The transfer function was hyperbolic tangent. The correlation coefficient (R), mean absolute error (MAE), root mean squared error (RMSE), and index of agreement or Willmott's Index (d2) for the testing data were 0.90, 8.78 μg/m3, 11.15μg/m3, and 0.95, respectively. Sensitivity analysis has indicated that the persistence information (current day's maximum and average ozone concentrations), NO concentration, average temperature, PM10, maximum temperature, sunshine time, wind direction, and solar radiation were the most important input parameters. The values of R, MAE, RMSE, and d2 did not change considerably for the MLP model using only these nine inputs. The performances of the MLP models were compared with those of regression models (i.e., multiple linear regression and multiple non-linear regression). It has been found that there was no significant difference between the ANN and regression modeling techniques for the forecasting of ozone concentrations in Istanbul. Tropospheric ozone has adverse effects on human health and environment. Here, the next-day's maximum 1-h average ozone concentrations in Istanbul were predicted using multi-layer perceptron type artificial neural networks (MLP-ANNs). The MLP-ANNs were compared to multiple linear and multiple non-linear regression models. Copyright © 2010 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.Izmir Institute of Technolog
Atmospheric concentrations and phase partitioning of polycyclic aromatic hydrocarbons in Izmir, Turkey

Ambient air polycyclic aromatic hydrocarbon (PAH) samples were collected at a suburban (n=63) and at an urban site (n=14) in Izmir, Turkey. Average gas-phase total PAH (∑ 14PAH) concentrations were 23.5ngm -3 for suburban and 109.7ngm -3 for urban sites while average particle-phase total PAH concentrations were 12.3 and 34.5ngm -3 for suburban and urban sites, respectively. Higher ambient PAH concentrations were measured in the gas-phase and ∑ 14PAH concentrations were dominated by lower molecular weight PAHs. Multiple linear regression analysis indicated that the meteorological parameters were effective on ambient PAH concentrations. Emission sources of particle-phase PAHs were investigated using a diagnostic plot of fluorene (FLN)/(fluorine+pyrene; PY) versus indeno[1,2,3-cd]PY/(indeno[1,2,3-cd]PY+benzo[g,h,i]perylene) and several diagnostic ratios. These approaches have indicated that traffic emissions (petroleum combustion) were the dominant PAH sources at both sites for summer and winter seasons. Experimental gas-particle partition coefficients (K P) were compared to the predictions of octanol-air (K OA) and soot-air (K SA) partition coefficient models. The correlations between experimental and modeled K P values were significant (r 2=0.79 and 0.94 for suburban and urban sites, respectively, p<0.01). Octanol-based absorptive partitioning model predicted lower partition coefficients especially for relatively volatile PAHs. However, overall there was a relatively good agreement between the measured K P and soot-based model predictions. Ambient air polycyclic aromatic hydrocarbon (PAH) samples were collected at a suburban and at an urban site in Izmir, Turkey. The multiple linear regression analysis indicated that the meteorological parameters were effective on the measured ambient PAH concentrations. The results indicated that traffic emissions were the dominant PAH sources at both sites for summer and winter seasons
Influences of environmental and operational factors on dark fermentative hydrogen production: a review

Hydrogen (H2) is one of renewable energy sources known for its non-polluting and environmentally friendly nature, as its end combustion product is water (H2O). The biological production of H2 is a less energy intensive alternative where processes can be operated at ambient temperature and pressure. Dark fermentation by bacterial biomass is one of multitude of approaches to produce hydrogen which is known as the cleanest renewable energy and is thus receiving increasing attention worldwide. The present study briefly reviews the biohydrogen production process with special attention on the effects of several environmental and operational factors towards the process. Factors such as organic loading rate, hydraulic retention time, temperature, and pH studied in published reports were compared and their influences are discussed in this work. This review highlights the variations in examined operating ranges for the factors as well as their reported optimum values. Divergent values observed for the environmental/operational factors merit further exploration in this field. Â© 2012 WILEY-VCH Verlag GmbH &amp; Co. KGaA, Weinheim
Evaluation of Amendments to Control Phosphorus Losses in Runoff from Pig Slurry Applications to Land

peer-reviewedIf spread in excess of crop requirements, incidental phosphorus (P) losses from agriculture can lead to eutrophication of receiving waters. The use of amendments in targeted areas may help reduce the possibility of surface runoff of nutrients. The aim of this study was to identify amendments which may be effective in reducing incidental dissolved reactive phosphorus (DRP) losses in surface runoff from land applied pig slurry. For this purpose, the DRP losses under simulated conditions across the surface of intact grassland soil cores, loaded with unamended and amended slurry at a rate equivalent to 19 kg P ha−1, were determined over a 30 h period. The effectiveness of the amendments at reducing DRP in overlying water were (in decreasing order): alum (86%), flue gas desulfurization by-product (FGD) (74%), poly-aluminum (Al) chloride (PAC) (73%), ferric chloride (71%), fly ash (58%), and lime (54%). FGD was the most costly of all the treatments (€7.64/m3 for 74% removal). Ranked in terms of feasibility, which takes into account effectiveness, cost, and other potential impediments to use, they were: alum, ferric chloride, PAC, fly ash, lime, and FGD.Irish Research Ccouncil (EMBARK Scholarship
Spatial Pattern of Benthic Diatoms and Water Quality Assessment using Diatom Indices in a Subtropical River, China

Benthic algae including benthic diatoms are one of the most vital primary producers in riverine ecosystems, and their spatial distribution and assemblage structure respond sensitively to various environmental variables. Thus, benthic diatoms have been widely used as indicators of water quality in riverine systems. Here, we present a study on benthic diatoms and water quality assessment using diatom indices in the upper Han River, a subtropical river with a length of 925?km in China. Canonical correspondence analysis indicated that spatial patterns of diatom assemblages could be primarily explained by dissolved organic carbon, pH, major ions, and flow velocity. Two-way indicator species analysis on the diatom assemblages grouped the sampling sites into those from mainstream and tributaries. There were also significant differences in the Shannon-Wiener diversity index, evenness index, species richness, and diatom indices between the mainstream and tributary sites, and diatom indices categorized the mainstream as mesotrophic and the tributaries as oligo-mesotrophic in the upper Han River. Lower water quality in the mainstream led to the dominance of pollution tolerant species such as Eolimna subminuscula, while tributaries were characterized by Achnanthidium pyrenaicum and A. subatomus. The research demonstrates the applicability of diatom indices for water quality and ecohealth assessment in subtropical rivers.Griffith Sciences, Griffith School of EnvironmentFull Tex
Heavy metal partitioning in sediments from rivers flowing through coal fields in Mpumalanga, South Africa

The association of elements Cd, Co, Cr, Fe, Mn, Pb, Ti and V with various geochemical phases in the
sediments from the Olifants, Klein Olifants, Wilge rivers and a tributary of the Olifants River was
studied using a four step sequential extraction scheme. By employing enrichment factors these
elements were found to be contaminating the sediments. Sequential extraction enabled partitioning of
the metals into exchangeable, reducible, oxidizable and residual fractions. Most of the elements were
found to exist in the residual fraction, characterized by stable compounds. Application of risk
assessment code (RAC) to the exchangeable fraction revealed that most of the elements posed a
medium risk to aquatic life, with the exception of Co, Pb, and Mn which were classified into the high
risk category. Non-residual/more bioavailable fractions were examined using statistics. Correlation
analysis was employed to understand the interaction between the more bioavailable fractions of the
metals with the reducible phase consisting of oxides of Fe-and Mn. These oxides contribute to the
adsorption of trace metals onto sediments. Elements Co, V, Pb, Cr and Cd in the reducible fraction
were found to be associated with Fe-oxides, while some V, Cr and Ti were associated with Mnoxides,
as indicated by significantly high correlation coefficients. Through cluster and factor analysis
three anthropogenic activities associated with mining and use of coal and iron and steel
manufacturing were found to be contributing metals to the sediments.Tshwane University of Technology (TUT) and the National Research Fund (NRF).http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1863-06692016-06-30hb201