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  • Open Access English
    Authors: 
    Logan, Clare V.; Murray, Jennie E.; Parry, David A.; Robertson, Andrea; Bellelli, Roberto; Tarnauskaitė, Žygimantė; Challis, Rachel; Cleal, Louise; Borel, Valerie; Fluteau, Adeline; +36 more
    Publisher: Elsevier
    Project: NIH | UT Southwestern Center fo... (4UL1TR001105-04), EC | GrowCELL (788093), EC | HUMGENSIZE (281847), WT | Causes and Consequences o... (210752)

    During genome replication, polymerase epsilon (Pol ε) acts as the major leading-strand DNA polymerase. Here we report the identification of biallelic mutations in POLE, encoding the Pol ε catalytic subunit POLE1, in 15 individuals from 12 families. Phenotypically, these individuals had clinical features closely resembling IMAGe syndrome (intrauterine growth restriction [IUGR], metaphyseal dysplasia, adrenal hypoplasia congenita, and genitourinary anomalies in males), a disorder previously associated with gain-of-function mutations in CDKN1C. POLE1-deficient individuals also exhibited distinctive facial features and variable immune dysfunction with evidence of lymphocyte deficiency. All subjects shared the same intronic variant (c.1686+32C>G) as part of a common haplotype, in combination with different loss-of-function variants in trans. The intronic variant alters splicing, and together the biallelic mutations lead to cellular deficiency of Pol ε and delayed S-phase progression. In summary, we establish POLE as a second gene in which mutations cause IMAGe syndrome. These findings add to a growing list of disorders due to mutations in DNA replication genes that manifest growth restriction alongside adrenal dysfunction and/or immunodeficiency, consolidating these as replisome phenotypes and highlighting a need for future studies to understand the tissue-specific development roles of the encoded proteins.

  • Open Access English
    Authors: 
    Ghasan Fahim Huseien; Mohammad Ismail; Nur Hafizah A. Khalid; Mohd Warid Hussin; Jahangir Mirza;
    Publisher: Elsevier

    This paper presents the solution molarity dependent microstructures and mechanical properties of multi-blend geopolymer mortars (GPMs). Geopolymer mortars were cured at ambient temperature under varying concentration (from 2 to 16 M) of sodium hydroxide (NH) solution. GPMs are by conducting mechanical tests such as compressive, split tensile and flexural strengths and characterised by microstructural studies, such as X-ray diffraction (XRD), scanning electron microscopy (SEM) and X-ray spectroscopy (EDS). The effect of Na2O, H2O content, solution modulus (SiO2:Na2O) and Na2O:Al2O3 on GPMs strength were determined. The flow ability and setting time of such GPMs found to decrease linearly with increasing alkali concentration. Conversely, the GPMs comprehensive, split tensile and flexural strengths and the density are enhanced with increasing alkali concentration. Samples activated with 12 M NH solution are most strongly affected by silica dissolution. Furthermore, the ratio of (Na2O:Al2O3) was demonstrated to influence the compressive strength significantly and the (Na2O:Al2O3 = 0.84) presented the optimum strength. Keywords: Geopolymer, Alkali solution molarity, Compressive strength, Microstructure

  • Open Access
    Authors: 
    Schellenberg, D; Armstrong Schellenberg, J R M; Mushi, A; Savigny de, D; Mgalula, L; Mbuya, C; Victoria, C.G.;
    Country: Tanzania (United Republic of)

    Objective was to document the prevalence, age-distribution, and risk factors for anaemia in Tanzanian children less than 5 years old,thereby assisting in the development of effective strategies for controlling anaemia. Cluster sampling was used to identify 2417 households at random from four contiguous districts in south-eastern United Republic of Tanzania in mid-1999. Data on various social and medical parameters were collected and analysed. Blood haemoglobin concentrations (Hb) were available for 1979 of the 2131 (93%) children identified and ranged from 1.7 to 18.6 g/dl. Overall, 87% (1722) of children had an Hb <11 g/dl, 39% (775) had an Hb <8 g/dl and 3% (65) had an Hb <5 g/dl. The highest prevalence of anaemia of all three levels was in children aged 6–11 months, of whom 10% (22/226) had an Hb <5 g/dl. However, the prevalence of anaemia was already high in children aged 1–5 months (85% had an Hb <11 g/dl, 42% had an Hb <8 g/dl, and 6% had an Hb <5 g/dl). Anaemia was usually asymptomatic and when symptoms arose they were nonspecific and rarely identified as a serious illness by the care provider. A recent history of treatment with antimalarials and iron was rare. Compliance with vaccinations delivered through the Expanded Programme of Immunization (EPI) was 82% and was notassociated with risk of anaemia. Anaemia is extremely common in south-eastern United Republic of Tanzania, even in very young infants. Further implementation of the Integrated Management of Childhood Illness algorithm should improve the case management of anaemia. However, the asymptomatic nature of most episodes of anaemia highlights the need for preventive strategies. The EPI has good coverage of the target population and it may be an appropriate channel for delivering tools for controlling anaemia and malaria.

  • Publication . Other literature type . Article . 2016
    Open Access English
    Authors: 
    Trisha Greenhalgh; Ellen Annandale; Richard Ashcroft; James Barlow; Nick Black; Alan Bleakley; Ruth Boaden; Jeffrey Braithwaite; Nicky Britten; Franco A. Carnevale; +65 more
    Publisher: BMJ Publishing Group
    Countries: Netherlands, United Kingdom, United Kingdom, United Kingdom, United Kingdom, United Kingdom, Australia, United Kingdom, United Kingdom

    Seventy six senior academics from 11 countries invite The BMJ ’s editors to reconsider their policy of rejecting qualitative research on the grounds of low priority. They challenge the journal to develop a proactive, scholarly, and pluralist approach to research that aligns with its stated mission

  • Open Access
    Authors: 
    Richard M. Palin; James D P Moore; Zeming Zhang; Guangyu Huang; Jon Wade; Brendan Dyck;
    Publisher: Research Square Platform LLC

    Abstract The absence of ultrahigh pressure (UHP) orogenic eclogite in the geological record older than c. 0.6 Ga is problematic for evidence of subduction having begun on Earth during the Archean (4.0–2.5 Ga). Many eclogites in Phanerozoic and Proterozoic terranes occur as mafic boudins encased within low-density felsic crust, which provides positive buoyancy during subduction; however, recent geochemical proxy analysis shows that Archean continental crust was more mafic than previously thought, having greater proportions of basalt and komatiite than modern-day continents. Here, we show via petrological modelling that secular change in the petrology and bulk composition of upper continental crust would make Archean continental terranes negatively buoyant in the mantle before reaching UHP conditions. Subducted or delaminated Archean continental crust passes a point of no return during metamorphism in the mantle prior to the stabilization of coesite, while Proterozoic and Phanerozoic terranes remain positively buoyant at these depths. UHP orogenic eclogite may thus readily have formed on the Archean Earth, but could not have been exhumed, weakening arguments for a Neoproterozoic onset of subduction and plate tectonics. Further, isostatic balance calculations for more mafic Archean continents indicate that the early Earth was covered by a global ocean over 1 km deep, corroborating independent isotopic evidence for large-scale emergence of the continents no earlier than c. 3 Ga. Our findings thus weaken arguments that early life on Earth likely emerged in shallow subaerial ponds, and instead support hypotheses involving development at hydrothermal vents in the deep ocean.

  • Publication . Part of book or chapter of book . 2004
    Open Access
    Authors: 
    Syed Sibte Raza Abidi; Yong Han Chong;
    Publisher: Springer Berlin Heidelberg

    Constraints formalize the dependencies in a physical world in terms of a logical relation among several unknowns. Constraint satisfaction methods allow efficient navigation of large search spaces to find an optimal solution that satisfies given constraints. This paper explores the application of constraint satisfaction methods to personalize generic information content with respect to a user-model. We present a constraint satisfaction based information personalization framework that (a) generates personalized information via the dynamic selection and synthesis of multiple information-snippets; and (b) ensures that the dynamically adapted personalized information is factually consistent. We present four constraint satisfaction methods that cumulatively work to maximize collaboration and minimize conflicts between a set of information-snippets in order to dynamically generate personalized information.

  • Open Access
    Authors: 
    John Beardall; Drew Allen; Jason G. Bragg; Zoe V. Finkel; Kevin J. Flynn; Antonietta Quigg; T. Alwyn V. Rees; Anthony J. Richardson; John A. Raven;
    Publisher: Wiley

    Phytoplankton life forms, including unicells, colonies, pseudocolonies, and multicellular organisms, span a huge size range. The smallest unicells are less than 1 microm3 (e.g. cyanobacteria), while large unicellular diatoms may attain 10(9) microm3, being visible to the naked eye. Phytoplankton includes chemo-organotrophic unicells, colonies and multicellular organisms that depend on symbionts or kleptoplastids for their capacity to photosynthesize. Analyses of physical (transport within cells, diffusion boundary layers, package effect, turgor, and vertical movements) and biotic (grazing, viruses and other parasitoids) factors indicate potential ecological constraints and opportunities that differ among the life forms. There are also variations among life forms in elemental stoichiometry and in allometric relations between biovolume and specific growth. While many of these factors probably have ecological and evolutionary significance, work is needed to establish those that are most important, warranting explicit description in models. Other factors setting limitations on growth rate (selecting slow-growing species) await elucidation.

  • Open Access
    Authors: 
    Bart Dils; M. De Mazière; J.-F. Müller; T. Blumenstock; Michael Buchwitz; R. de Beek; P. Demoulin; Pierre Duchatelet; H. Fast; Christian Frankenberg; +24 more
    Publisher: Copernicus GmbH

    Abstract. Total column amounts of CO, CH4, CO2 and N2O retrieved from SCIAMACHY nadir observations in its near-infrared channels have been compared to data from a ground-based quasi-global network of Fourier-transform infrared (FTIR) spectrometers. The SCIAMACHY data considered here have been produced by three different retrieval algorithms, WFM-DOAS (version 0.5 for CO and CH4 and version 0.4 for CO2 and N2O), IMAP-DOAS (version 1.1 and 0.9 (for CO)) and IMLM (version 6.3) and cover the January to December 2003 time period. Comparisons have been made for individual data, as well as for monthly averages. To maximize the number of reliable coincidences that satisfy the temporal and spatial collocation criteria, the SCIAMACHY data have been compared with a temporal 3rd order polynomial interpolation of the ground-based data. Particular attention has been given to the question whether SCIAMACHY observes correctly the seasonal and latitudinal variability of the target species. The present results indicate that the individual SCIAMACHY data obtained with the actual versions of the algorithms have been significantly improved, but that the quality requirements, for estimating emissions on regional scales, are not yet met. Nevertheless, possible directions for further algorithm upgrades have been identified which should result in more reliable data products in a near future.

  • Publication . Other literature type . Article . 2013
    Open Access
    Authors: 
    Angela M. Caliendo; David N. Gilbert; Christine C. Ginocchio; Kimberly E. Hanson; Larissa S May; Thomas C. Quinn; Fred C. Tenover; David Alland; Anne J. Blaschke; Robert A. Bonomo; +8 more
    Publisher: Oxford University Press (OUP)

    In this IDSA policy paper, we review the current diagnostic landscape, including unmet needs and emerging technologies, and assess the challenges to the development and clinical integration of improved tests. To fulfill the promise of emerging diagnostics, IDSA presents recommendations that address a host of identified barriers. Achieving these goals will require the engagement and coordination of a number of stakeholders, including Congress, funding and regulatory bodies, public health agencies, the diagnostics industry, healthcare systems, professional societies, and individual clinicians.

  • Open Access English
    Authors: 
    Rachel P. Rosovsky; Kristen M. Sanfilippo; Tzu-Fei Wang; Sandeep K. Rajan; Surbhi Shah; Karlyn Martin; Fionnuala Ní Áinle; Menno V. Huisman; Beverley J. Hunt; Susan R. Kahn; +4 more
    Country: Netherlands

    Abstract Background Best practice for prevention, diagnosis, and management of venous thromboembolism (VTE) in patients with coronavirus disease 2019 (COVID‐19) is unknown due to limited published data in this population. Objectives We aimed to assess current global practice and experience in management of COVID‐19–associated coagulopathy to identify information to guide prospective and randomized studies. Methods Physicians were queried about their current approach to prophylaxis, diagnosis, and treatment of VTE in patients with COVID‐19 using an online survey tool distributed through multiple international organizations between April 10 and 14, 2020. Results Five hundred fifteen physicians from 41 countries responded. The majority of respondents (78%) recommended prophylactic anticoagulation for all hospitalized patients with COVID‐19, with most recommending use of low‐molecular‐weight heparin or unfractionated heparin. Significant practice variation was found regarding the need for dose escalation of anticoagulation outside the setting of confirmed or suspected VTE. Respondents reported the use of bedside testing when unable to perform standard diagnostic imaging for diagnosis of VTE. Two hundred ninety‐one respondents reported observing thrombotic complications in their patients, with 64% noting that the complication was pulmonary embolism. Of the 44% of respondents who estimated incidence of thrombosis in patients with COVID‐19 in their hospital, estimates ranged widely from 1% to 50%. One hundred seventy‐four respondents noted bleeding complications (34% minor bleeding, 14% clinically relevant nonmajor bleeding, and 12% major bleeding). Conclusion Well‐designed epidemiologic studies are urgently needed to understand the incidence and risk factors of VTE and bleeding complications in patients with COVID‐19. Randomized clinical trials addressing use of anticoagulation are also needed.

search
Include:
The following results are related to Canada. Are you interested to view more results? Visit OpenAIRE - Explore.
15,132 Research products, page 1 of 1,514
  • Open Access English
    Authors: 
    Logan, Clare V.; Murray, Jennie E.; Parry, David A.; Robertson, Andrea; Bellelli, Roberto; Tarnauskaitė, Žygimantė; Challis, Rachel; Cleal, Louise; Borel, Valerie; Fluteau, Adeline; +36 more
    Publisher: Elsevier
    Project: NIH | UT Southwestern Center fo... (4UL1TR001105-04), EC | GrowCELL (788093), EC | HUMGENSIZE (281847), WT | Causes and Consequences o... (210752)

    During genome replication, polymerase epsilon (Pol ε) acts as the major leading-strand DNA polymerase. Here we report the identification of biallelic mutations in POLE, encoding the Pol ε catalytic subunit POLE1, in 15 individuals from 12 families. Phenotypically, these individuals had clinical features closely resembling IMAGe syndrome (intrauterine growth restriction [IUGR], metaphyseal dysplasia, adrenal hypoplasia congenita, and genitourinary anomalies in males), a disorder previously associated with gain-of-function mutations in CDKN1C. POLE1-deficient individuals also exhibited distinctive facial features and variable immune dysfunction with evidence of lymphocyte deficiency. All subjects shared the same intronic variant (c.1686+32C>G) as part of a common haplotype, in combination with different loss-of-function variants in trans. The intronic variant alters splicing, and together the biallelic mutations lead to cellular deficiency of Pol ε and delayed S-phase progression. In summary, we establish POLE as a second gene in which mutations cause IMAGe syndrome. These findings add to a growing list of disorders due to mutations in DNA replication genes that manifest growth restriction alongside adrenal dysfunction and/or immunodeficiency, consolidating these as replisome phenotypes and highlighting a need for future studies to understand the tissue-specific development roles of the encoded proteins.

  • Open Access English
    Authors: 
    Ghasan Fahim Huseien; Mohammad Ismail; Nur Hafizah A. Khalid; Mohd Warid Hussin; Jahangir Mirza;
    Publisher: Elsevier

    This paper presents the solution molarity dependent microstructures and mechanical properties of multi-blend geopolymer mortars (GPMs). Geopolymer mortars were cured at ambient temperature under varying concentration (from 2 to 16 M) of sodium hydroxide (NH) solution. GPMs are by conducting mechanical tests such as compressive, split tensile and flexural strengths and characterised by microstructural studies, such as X-ray diffraction (XRD), scanning electron microscopy (SEM) and X-ray spectroscopy (EDS). The effect of Na2O, H2O content, solution modulus (SiO2:Na2O) and Na2O:Al2O3 on GPMs strength were determined. The flow ability and setting time of such GPMs found to decrease linearly with increasing alkali concentration. Conversely, the GPMs comprehensive, split tensile and flexural strengths and the density are enhanced with increasing alkali concentration. Samples activated with 12 M NH solution are most strongly affected by silica dissolution. Furthermore, the ratio of (Na2O:Al2O3) was demonstrated to influence the compressive strength significantly and the (Na2O:Al2O3 = 0.84) presented the optimum strength. Keywords: Geopolymer, Alkali solution molarity, Compressive strength, Microstructure

  • Open Access
    Authors: 
    Schellenberg, D; Armstrong Schellenberg, J R M; Mushi, A; Savigny de, D; Mgalula, L; Mbuya, C; Victoria, C.G.;
    Country: Tanzania (United Republic of)

    Objective was to document the prevalence, age-distribution, and risk factors for anaemia in Tanzanian children less than 5 years old,thereby assisting in the development of effective strategies for controlling anaemia. Cluster sampling was used to identify 2417 households at random from four contiguous districts in south-eastern United Republic of Tanzania in mid-1999. Data on various social and medical parameters were collected and analysed. Blood haemoglobin concentrations (Hb) were available for 1979 of the 2131 (93%) children identified and ranged from 1.7 to 18.6 g/dl. Overall, 87% (1722) of children had an Hb <11 g/dl, 39% (775) had an Hb <8 g/dl and 3% (65) had an Hb <5 g/dl. The highest prevalence of anaemia of all three levels was in children aged 6–11 months, of whom 10% (22/226) had an Hb <5 g/dl. However, the prevalence of anaemia was already high in children aged 1–5 months (85% had an Hb <11 g/dl, 42% had an Hb <8 g/dl, and 6% had an Hb <5 g/dl). Anaemia was usually asymptomatic and when symptoms arose they were nonspecific and rarely identified as a serious illness by the care provider. A recent history of treatment with antimalarials and iron was rare. Compliance with vaccinations delivered through the Expanded Programme of Immunization (EPI) was 82% and was notassociated with risk of anaemia. Anaemia is extremely common in south-eastern United Republic of Tanzania, even in very young infants. Further implementation of the Integrated Management of Childhood Illness algorithm should improve the case management of anaemia. However, the asymptomatic nature of most episodes of anaemia highlights the need for preventive strategies. The EPI has good coverage of the target population and it may be an appropriate channel for delivering tools for controlling anaemia and malaria.

  • Publication . Other literature type . Article . 2016
    Open Access English
    Authors: 
    Trisha Greenhalgh; Ellen Annandale; Richard Ashcroft; James Barlow; Nick Black; Alan Bleakley; Ruth Boaden; Jeffrey Braithwaite; Nicky Britten; Franco A. Carnevale; +65 more
    Publisher: BMJ Publishing Group
    Countries: Netherlands, United Kingdom, United Kingdom, United Kingdom, United Kingdom, United Kingdom, Australia, United Kingdom, United Kingdom

    Seventy six senior academics from 11 countries invite The BMJ ’s editors to reconsider their policy of rejecting qualitative research on the grounds of low priority. They challenge the journal to develop a proactive, scholarly, and pluralist approach to research that aligns with its stated mission

  • Open Access
    Authors: 
    Richard M. Palin; James D P Moore; Zeming Zhang; Guangyu Huang; Jon Wade; Brendan Dyck;
    Publisher: Research Square Platform LLC

    Abstract The absence of ultrahigh pressure (UHP) orogenic eclogite in the geological record older than c. 0.6 Ga is problematic for evidence of subduction having begun on Earth during the Archean (4.0–2.5 Ga). Many eclogites in Phanerozoic and Proterozoic terranes occur as mafic boudins encased within low-density felsic crust, which provides positive buoyancy during subduction; however, recent geochemical proxy analysis shows that Archean continental crust was more mafic than previously thought, having greater proportions of basalt and komatiite than modern-day continents. Here, we show via petrological modelling that secular change in the petrology and bulk composition of upper continental crust would make Archean continental terranes negatively buoyant in the mantle before reaching UHP conditions. Subducted or delaminated Archean continental crust passes a point of no return during metamorphism in the mantle prior to the stabilization of coesite, while Proterozoic and Phanerozoic terranes remain positively buoyant at these depths. UHP orogenic eclogite may thus readily have formed on the Archean Earth, but could not have been exhumed, weakening arguments for a Neoproterozoic onset of subduction and plate tectonics. Further, isostatic balance calculations for more mafic Archean continents indicate that the early Earth was covered by a global ocean over 1 km deep, corroborating independent isotopic evidence for large-scale emergence of the continents no earlier than c. 3 Ga. Our findings thus weaken arguments that early life on Earth likely emerged in shallow subaerial ponds, and instead support hypotheses involving development at hydrothermal vents in the deep ocean.

  • Publication . Part of book or chapter of book . 2004
    Open Access
    Authors: 
    Syed Sibte Raza Abidi; Yong Han Chong;
    Publisher: Springer Berlin Heidelberg

    Constraints formalize the dependencies in a physical world in terms of a logical relation among several unknowns. Constraint satisfaction methods allow efficient navigation of large search spaces to find an optimal solution that satisfies given constraints. This paper explores the application of constraint satisfaction methods to personalize generic information content with respect to a user-model. We present a constraint satisfaction based information personalization framework that (a) generates personalized information via the dynamic selection and synthesis of multiple information-snippets; and (b) ensures that the dynamically adapted personalized information is factually consistent. We present four constraint satisfaction methods that cumulatively work to maximize collaboration and minimize conflicts between a set of information-snippets in order to dynamically generate personalized information.

  • Open Access
    Authors: 
    John Beardall; Drew Allen; Jason G. Bragg; Zoe V. Finkel; Kevin J. Flynn; Antonietta Quigg; T. Alwyn V. Rees; Anthony J. Richardson; John A. Raven;
    Publisher: Wiley

    Phytoplankton life forms, including unicells, colonies, pseudocolonies, and multicellular organisms, span a huge size range. The smallest unicells are less than 1 microm3 (e.g. cyanobacteria), while large unicellular diatoms may attain 10(9) microm3, being visible to the naked eye. Phytoplankton includes chemo-organotrophic unicells, colonies and multicellular organisms that depend on symbionts or kleptoplastids for their capacity to photosynthesize. Analyses of physical (transport within cells, diffusion boundary layers, package effect, turgor, and vertical movements) and biotic (grazing, viruses and other parasitoids) factors indicate potential ecological constraints and opportunities that differ among the life forms. There are also variations among life forms in elemental stoichiometry and in allometric relations between biovolume and specific growth. While many of these factors probably have ecological and evolutionary significance, work is needed to establish those that are most important, warranting explicit description in models. Other factors setting limitations on growth rate (selecting slow-growing species) await elucidation.

  • Open Access
    Authors: 
    Bart Dils; M. De Mazière; J.-F. Müller; T. Blumenstock; Michael Buchwitz; R. de Beek; P. Demoulin; Pierre Duchatelet; H. Fast; Christian Frankenberg; +24 more
    Publisher: Copernicus GmbH

    Abstract. Total column amounts of CO, CH4, CO2 and N2O retrieved from SCIAMACHY nadir observations in its near-infrared channels have been compared to data from a ground-based quasi-global network of Fourier-transform infrared (FTIR) spectrometers. The SCIAMACHY data considered here have been produced by three different retrieval algorithms, WFM-DOAS (version 0.5 for CO and CH4 and version 0.4 for CO2 and N2O), IMAP-DOAS (version 1.1 and 0.9 (for CO)) and IMLM (version 6.3) and cover the January to December 2003 time period. Comparisons have been made for individual data, as well as for monthly averages. To maximize the number of reliable coincidences that satisfy the temporal and spatial collocation criteria, the SCIAMACHY data have been compared with a temporal 3rd order polynomial interpolation of the ground-based data. Particular attention has been given to the question whether SCIAMACHY observes correctly the seasonal and latitudinal variability of the target species. The present results indicate that the individual SCIAMACHY data obtained with the actual versions of the algorithms have been significantly improved, but that the quality requirements, for estimating emissions on regional scales, are not yet met. Nevertheless, possible directions for further algorithm upgrades have been identified which should result in more reliable data products in a near future.

  • Publication . Other literature type . Article . 2013
    Open Access
    Authors: 
    Angela M. Caliendo; David N. Gilbert; Christine C. Ginocchio; Kimberly E. Hanson; Larissa S May; Thomas C. Quinn; Fred C. Tenover; David Alland; Anne J. Blaschke; Robert A. Bonomo; +8 more
    Publisher: Oxford University Press (OUP)

    In this IDSA policy paper, we review the current diagnostic landscape, including unmet needs and emerging technologies, and assess the challenges to the development and clinical integration of improved tests. To fulfill the promise of emerging diagnostics, IDSA presents recommendations that address a host of identified barriers. Achieving these goals will require the engagement and coordination of a number of stakeholders, including Congress, funding and regulatory bodies, public health agencies, the diagnostics industry, healthcare systems, professional societies, and individual clinicians.

  • Open Access English
    Authors: 
    Rachel P. Rosovsky; Kristen M. Sanfilippo; Tzu-Fei Wang; Sandeep K. Rajan; Surbhi Shah; Karlyn Martin; Fionnuala Ní Áinle; Menno V. Huisman; Beverley J. Hunt; Susan R. Kahn; +4 more
    Country: Netherlands

    Abstract Background Best practice for prevention, diagnosis, and management of venous thromboembolism (VTE) in patients with coronavirus disease 2019 (COVID‐19) is unknown due to limited published data in this population. Objectives We aimed to assess current global practice and experience in management of COVID‐19–associated coagulopathy to identify information to guide prospective and randomized studies. Methods Physicians were queried about their current approach to prophylaxis, diagnosis, and treatment of VTE in patients with COVID‐19 using an online survey tool distributed through multiple international organizations between April 10 and 14, 2020. Results Five hundred fifteen physicians from 41 countries responded. The majority of respondents (78%) recommended prophylactic anticoagulation for all hospitalized patients with COVID‐19, with most recommending use of low‐molecular‐weight heparin or unfractionated heparin. Significant practice variation was found regarding the need for dose escalation of anticoagulation outside the setting of confirmed or suspected VTE. Respondents reported the use of bedside testing when unable to perform standard diagnostic imaging for diagnosis of VTE. Two hundred ninety‐one respondents reported observing thrombotic complications in their patients, with 64% noting that the complication was pulmonary embolism. Of the 44% of respondents who estimated incidence of thrombosis in patients with COVID‐19 in their hospital, estimates ranged widely from 1% to 50%. One hundred seventy‐four respondents noted bleeding complications (34% minor bleeding, 14% clinically relevant nonmajor bleeding, and 12% major bleeding). Conclusion Well‐designed epidemiologic studies are urgently needed to understand the incidence and risk factors of VTE and bleeding complications in patients with COVID‐19. Randomized clinical trials addressing use of anticoagulation are also needed.