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Abstract Lipoprotein (a) [Lp(a)] is suspected to have antifibrinolytic effects, however, its relevance for the severity of venous thromboembolic events remains unclear. We studied the association of Lp(a) levels with thrombus load in pulmonary embolism (PE). 90 patients (40% female, median age 70 [56–79] years) at our tertiary care hospital with a diagnosis of acute PE, available Lp(a) levels and CT pulmonary angiography (CT-PA) performed between April 2017 and December 2019 were included. All CT-PA scans were reanalyzed and thrombus load was determined via Qanadli CT obstruction index (CTOI) and most proximal thrombus location. Median Lp(a) levels were 11.4 [9.3–29.1] mg/dL, median D-dimer levels were 4.6 [2.1–9.8] mg/L, median CTOI was 23 [8–50], central PE was present in 27 (30%) patients. Lp(a) did not correlate with CTOI (r = 0.02, p = 0.922) and was not associated with thrombus location (p = 0.369). CTOI significantly correlated with D-dimer (r = 0.43, p

AimWe aimed to investigate a correlation between PE severity and Lp(a) levels.MethodsWe performed a retrospective data analysis from our medical records of PE patients admitted to the University Hospital Graz, Austria. Patients with an Lp(a) reading within a 1-year interval before and after PE diagnosis were included. In accordance with the 2019 ESC guidelines for the diagnosis and management of acute PE, severity assessment was carried out classifying patients into four groups: low risk (LR), intermediate low risk (IML), intermediate high risk (IMH) and high risk (HR). The study period of interest was between January 1, 2002 and August 1, 2020.ResultsWe analyzed 811 patients with PE, of whom 323 (40%) had low-risk PE, 343 (42%) had intermediate-low-risk PE, 64 (8%) had intermediate-high-risk PE, and 81 (10%) had high-risk PE, respectively. We did not observe an association between PE severity and Lp(a) concentrations. In detail, median Lp(a) concentrations were 17 mg/dL [25–75th percentile: 10-37] in low-risk PE patients, 16 mg/dL [10–37] in intermediate-low-risk PE patients, 15mg/dL [10–48] in intermediate-high-risk PE patients, and 13mg/dL [10–27] in high-risk PE patients, respectively (Kruskal-Wallis p = 0.658, p for linear trend = 0.358).ConclusionThe current findings suggest no correlation between PE severity and Lp(a) levels.

Coronavirus disease 2019 (COVID-19) vaccines were developed a few months after the emergence of the pandemic. The first cases of vaccine-induced thrombotic complications after the use of adenoviral vector vaccines ChAdOx1 nCoV-19 by AstraZeneca, and Ad26.COV2.S by Johnson & Johnson/Janssen, were announced shortly after the initiation of a global vaccination program. In these cases, the occurrence of thrombotic events at unusual sites—predominantly located in the venous vascular system—in association with concomitant thrombocytopenia were observed. Since this new entity termed vaccine-induced thrombotic thrombocytopenia (VITT) shows similar pathophysiologic mechanisms as heparin-induced thrombocytopenia (HIT), including the presence of antibodies against heparin/platelet factor 4 (PF4), standard routine treatment for thrombotic events—arterial or venous—are not appropriate and may also cause severe harm in affected patients. Thrombotic complications were also rarely documented after vaccination with mRNA vaccines, but a typical VITT phenomenon has, to date, not been established for these vaccines. The aim of this review is to give a concise and feasible overview of diagnostic and therapeutic strategies in COVID-19 vaccine-induced thrombotic complications.

Platelet-rich plasma injections have been presented as an effective treatment for androgenetic alopecia; however, reliable study data concerning this therapy are lacking. The current randomized, placebo-controlled pilot study explored this novel therapy in 30 healthy male subjects with androgenetic alopecia. Five platelet-rich plasma treatments, at intervals of 4–6 weeks, and 2 follow-up examinations were performed. Twenty subjects were injected intracutaneously with platelet-rich plasma and 10 with physiological saline. Treatment efficacy was assessed by changes in hair number and diameter, measured with the TrichoScan system. A secondary objective was to assess clinical improvement, which was evaluated by an independent reviewer using patient photographs and a 5-point Likert scale. In addition, subject satisfaction was assessed by survey. No improvements were seen over the course of the trial, using TrichoScan measurements or visual assessment. In conclusion, these results suggest that treatment with platelet-rich plasma as a monotherapy does not improve hair growth in men with androgenetic alopecia.

Abstract Mean platelet volume (MPV) was recently published as a possible marker of coronary artery disease in patients at high risk for major adverse cardiac events. Because platelets play an important role in atherosclerosis, we examined the relationship between critical limb ischemia (CLI) and MPV in patients with peripheral arterial occlusive disease (PAOD). Our study comprised 2124 PAOD patients. Univariate logistic regression was performed to analyze potential predictors for CLI. Nagelkerke’s R² is reported. Cross validation was performed using the leave-one-out principle. ROC analyses were performed to identify the best cut off value for MPV predicting CLI; to this end, Youden’s index was calculated. For CLI diabetes (p

Glioblastoma is among the tumor entities with an extreme thrombogenic potential and patients are at very high risk of developing a venous thromboembolism (VTE) over the course of the disease, with an incidence of up to 30% per year. Major efforts are currently being made to understand and gain novel insights into the underlying pathomechanisms of the development of VTE in patients with glioblastoma and to find appropriate biomarkers. Yet, patients with glioblastoma not only face a high thromboembolic risk but are also at risk of bleeding events. In the case of VTE, a therapeutic anticoagulation with low molecular weight heparin or, in the case of low bleeding risk, treatment with a direct oral anticoagulant, is recommended, according to recently published guidelines. With respect to an elevated bleeding risk in glioblastoma patients, therapeutic anticoagulation remains challenging in this patient group and prospective data for this vulnerable patient group are scarce, particularly with regard to direct oral anticoagulants.

A 71 year old female Caucasian farmer without any known immunosuppression presented with a painful ulcer of her right lower leg after a trauma caused by a wood billet. There was no response to empirical antibacterial treatment. An ulcer biopsy showed an invasive Candida infection of the soft tissue and leucocytoclastic vasculitis. Voriconazole treatment was followed by wound healing. Invasive Candida infection and localized Candida vasculitis represent a rare cause of persisting leg ulcers. The similar clinical picture of chronic venous leg ulcers might blur the true cause and refractory cases should therefore promptly be processed by histopathological diagnostics.

BACKGROUND:Patients with testicular germ cell tumors (TGCT) have an increased risk for venous thromboembolism (VTE). We identified risk factors for VTE in this patient cohort and developed a clinical risk model. METHODS:In this retrospective cohort study at the Medical University of Graz we included 657 consecutive TGCT patients across all clinical stages. A predictive model for VTE was developed and externally validated in 349 TGCT patients treated at the University Hospital Zurich. RESULTS:Venous thromboembolic events occurred in 34 (5.2%) patients in the Graz cohort. In univariable competing risk analysis, higher clinical stage (cS) and a retroperitoneal lymphadenopathy (RPLN) were the strongest predictors of VTE (p

PURPOSEExoseal is a vascular clo­sure device consisting of a plug applier and a bio-absorbent polyglycolic acid plug available in sizes 5 F, 6 F, and 7 F. In this study, we aimed to evaluate the effectiveness and safety of the Exoseal vascular closure device (Cordis Corporation, Bridgewater, New Jersey, USA) for puncture site closure after antegrade endovascular procedures in peripheral arterial occlusive disease (PAOD) patients. MATERIALS AND METHODSIn this retrospective study, a total of 168 consecutive patients who underwent an interventional procedure due to PAOD, were included. In each case, an antegrade peripheral endovascular procedure was performed via the common femoral artery using the Seldinger technique, and Exoseal 5 F, 6 F, or 7 F was used for access site closure. The primary endpoint was a technically successful application of Exoseal. All complications at the access site within 24 hours were registered as a secondary endpoint.RESULTSIn a group of 168 patients (64.9% men, average age 71.9±11.9 years), the technical application of Exoseal was successful in 166 patients (98.8%). Within the first 24 hours after the procedure, 12 complications (7.2%) were recorded including, three pseudoaneurysms (1.8%) and nine hematomas (5.4%). None of the complications required surgical intervention.CONCLUSIONExoseal is a safe and effective device with high technical success and acceptable complication rates for access site closure after antegrade peripheral endovascular procedures.

BackgroundRecently, chemical blood parameters gain more attraction as potential prognostic parameters in pancreatic cancer (PC). In the present study we investigated the prognostic relevance of the uric acid (UA) level in blood plasma at the time of diagnosis for overall survival (OS) in a large cohort of patients with PC.Patients and methodsData from 466 consecutive patients with ductal adenocarcinoma of the pancreas were evaluated retrospectively. Overall survival (OS) was analysed using the Kaplan-Meier method. To further evaluate the prognostic significance of the UA level, univariate and multivariate Cox regression models were calculated.ResultsNone of the clinicopathological parameters (tumour grade, clinical stage, age, CA19-9 level, Karnofski Index (KI) or surgical resection) except gender was associated with UA level. In univariate analysis we observed the elevated UA level (ConclusionIn conclusion, we identified the UA level at time of diagnosis as an independent prognostic factor in PC patients. Our results indicate that the UA level might represent a novel and useful marker for patient stratification in PC management.

OBJECTIVE: Endothelial dysfunction plays a key role in the development, progression, and clinical manifestation of atherosclerosis, and in symptomatic peripheral arterial disease, endothelial dysfunction and enlarged intima-media thickness might be associated with increased cardiovascular risk. Flow-mediated dilatation and serologic parameters are used to evaluate individual endothelial function. Brachial intima-media thickness, a less recognized parameter of cardiovascular risk, is independently associated with coronary artery disease. The aim of this study was to evaluate the prognostic value of ultrasound and serologic parameters of endothelial function in relation to cardiovascular mortality in peripheral arterial disease. DESIGN: monocentric, prospective cohort study. METHODS: Flow mediated dilatation and brachial intima-media thickness were assessed in 184 (124 male) patients with peripheral arterial disease (Rutherford stages 2-3). Serologic parameters of endothelial function included asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), and L-homoarginine. Cardiovascular events were recorded during a follow-up of 99.1±11.1 months. Subjects who died of noncardiovascular causes were excluded from further analysis. RESULTS: Eighty-two patients (44.6%) died during follow-up after a mean duration of 49.7±28.3 months. There were 49 cardiovascular deaths (59.8%) and 33 other deaths (40.2%). Flow mediated dilatation was associated with cardiovascular death [1.17% (0.0, 4.3) vs. 4.1% (1.2, 6.4), p

BACKGROUND: Platelet-to-Lymphocyte Ratio (PLR) is an easily applicable blood test. An elevated PLR has been associated with poor prognosis in patients with different oncologic disorder. As platelets play a key role in atherosclerosis and atherothrombosis, we investigated PLR and its association with critical limb ischemia (CLI) and other vascular endpoints in peripheral arterial occlusive disease (PAOD) patients. METHODS AND FINDINGS: We evaluated 2121 PAOD patients treated at our institution from 2005 to 2010. PLR was calculated and the cohort was categorized into tertiles according to the PLR. An optimal cut-off value for the continuous PLR was calculated by applying a receiver operating curve analysis to discriminate between CLI and non-CLI. In our cohort occurrence of CLI significantly increased with an increase in PLR. As an optimal cut-off value, a PLR of 150 was identified. Two groups were categorized, one containing 1228 patients (PLR≤150) and a second group with 893 patients (PLR>150). CLI was more frequent in PLR>150 patients (410(45.9%)) compared to PLR≤150 patients (270(22.0%)) (p150 was associated with an OR of 1.9 (95%CI 1.7-2.1) for CLI even after adjustment for other well-established vascular risk factors. CONCLUSIONS: An increased PLR is significantly associated with patients at high risk for CLI and other cardiovascular endpoints. The PLR is a broadly available and cheap marker, which could be used to highlight patients at high risk for vascular endpoints.

BACKGROUND: The Neutrophil-to-Lymphocyte ratio (NLR) is an easy to perform test from the white blood cell count. An increase in NLR has been associated with vascular endpoints reflecting inflammation in atherosclerotic lesions. Atherosclerosis is a global threat and vascular endpoints, like myocardial infarction or critical limb ischemia (CLI), are a leading cause of death in industrialized countries. We therefore investigated NLR and its association with CLI and other vascular endpoints in peripheral arterial occlusive disease (PAOD) patients. METHODS AND FINDINGS: We evaluated 2121 PAOD patients treated at our institution from 2005 to 2010. NLR was calculated and the cohort was divided into tertiles according to the NLR. An optimal cut-off value for the continuous NLR was calculated by applying a receiver operating curve analysis to discriminate between CLI and non-CLI. In our cohort occurrence of CLI significantly increased with an increase in NLR. As an optimal cut-off a NLR of 3.95 was identified. Two groups were categorized, one containing 1441 patients (NLR≤3.95) and a second group with 680 patients (NLR>3.95). CLI was more frequent in NLR>3.95 patients (330(48.5%)) compared to NLR≤3.95 patients (350(24.3%)) (p3.95 was associated with an OR of 2.5 (95%CI 2.3-2.7) for CLI even after adjustment for other vascular risk factors. CONCLUSIONS: An increased NLR is significantly associated with patients at high risk for CLI and other vascular endpoints. The NLR is an easy to perform test, which could be used to highlight patients at high risk for vascular endpoints.

There have been significant increases in the number of children sent to non-maintained special schools in recent years. To assess the extent of this trend and its probable consequences, Freedom of Information requests about spending on private special schools were sent to a stratified sample of 24 local authorities in England. The responses indicated substantial rises in spending recently, with very substantial spending on certain kinds of provision in the private sector--spending of up to £0.3 million per child per annum. We argue that the increasing reliance on private special school placement carries not only potential risks for the education, care and wellbeing of the students placed in often distant schools, with recent evidence of cases of serious neglect and abuse in such schools, but also threats to the development of inclusive practice. Current policy and its associated funding mechanisms incentivise separation and are inimical to the development of inclusive solutions to children's and young people's problems at school. We argue that systems need to be developed which enable the substantial sums currently spent on private special schools to be re-deployed to cultivate imaginative inclusive responses to the difficulties experienced by some children at school.

I examine the ways in which words such as "evidence" are used inappropriately to support policy that may be formulated for convenience, cost or political dogma. I interrogate the processes by which this happens, as words and terms are bestowed with symbolic power to support and promote favoured policy. I examine the ways in which such power may be acquired and deployed by exploring the use of the word "evidence" and its derivatives in education discourse. Via corpora and discourse analysis of extracts from policymakers' statements, speeches and assertions I examine how "evidence" -- a powerful word in lay use because of its association with research and reason -- is used habitually as a proxy for the specification of actual evidence, simply to add weight to an argument or to impart legitimacy on a policy position. I conclude that the idea of "evidence-based" persists only because of its value in enabling and promoting particular policy agendas.

Those who work in education strive to create more inclusive environments in school but are often stymied in their efforts by challenges coming from many and varied directions. Politicians, for example, exhort us to be more inclusive but create conditions that encourage separation and exclusion, and inclusive education's history in special education means that the default response of the system around special education is to diagnose, treat and manage separately. That legacy continues to have its effects. Looking both at the history of the management of 'special needs' and at the continuing rise in numbers of marginalised, separated and excluded youngsters, we suggest that some fundamental shifts are necessary in the way that we think about and research into difficulty at school if we are to move beyond Groundhog Day.

Inclusion is positioned at the forefront of global educational reform. The study reported focused on a national Continuing Professional Development (CPD) programme for Inclusive Physical Education (IPE) in England. The research was designed to critically explore how CPD providers (i.e. tutors) variously conceptualised and practiced inclusion in the context of running a day-long CPD course for physical education teachers. Using qualitative methodology, data were collected via course observations (n = 27), informal interviews with tutors (n = 10), and a tutor questionnaire (n = 18). Findings suggest that although tutors' theoretical interpretations of inclusion were largely consistent with contemporary, broad understandings, there was notable variability and inherent tensions in the ways they talked about and enacted inclusion in practice. In many instances, inclusion was infused with particular perceptions about ability and ability grouping. Only a small number of tutors encouraged teachers to question and 'disturb' their current practices. Findings from this research extend insights into the contested nature of inclusion in contemporary PE and highlight the need for research to engage with multiple stakeholders in physical education teaching and CPD. This research reflects that CPD providers have a key role to play in extending teachers' understandings of inclusive pedagogy.

An analysis was conducted of contemporary notions of inclusion and their provenance in developing thought about difference in education, with a particular focus on the role of community in promoting and enabling inclusion. Being informed by: (1) an international group of advisers; and (2) a national group of informants and commentators, a review was conducted of the theoretical and practical analysis of the issue. Conclusions were drawn about consequences deriving from intersectional thought about inclusion, which suggest that more attention should be paid, especially in a world of increasing diversity and 'superdiversity', to the kinds of groupings encouraged and facilitated by schools. A framing device is advanced for explicating kinds of community in schools, which draws on a range of theorists and particularly on the distinction between bonding and bridging made by Robert Putnam. An analysis of bridging proffers a range of means for brokering and cultivating groupings in schools and between schools and the communities in their localities.

Natural scientists are relaxed about the multiple forms experiment takes in their various fields. Yet in education we have for many years constrained our notion of experiment. This methodological circumscription has been self-imposed on the grounds that experiment of a particular, well-defined form offers the clearest evidence of a link between cause and effect in assessing the impact of interventions. I challenge the legitimacy of this assertion and further argue that the model of intervene-and-experiment is ineffective and misleading. There is currently emerging a large body of findings from such experiment, and evaluations of these--like similar evaluations from a wave of experiments in the 1960s and 1970s across education and the applied social sciences--mainly concur on how disappointing the findings from this kind of work are. I argue that interventions are found to have largely nugatory consequences because the influence of independent variables is routinely overwhelmed by powerful contextual influences. I discuss the significance and nature of these contextual influences and question the legitimacy of the idea that one can test interventions with formal experiment in education. I conclude that the assertion that formal experiment can be fruitfully employed may drive policy in unhelpful directions, as models which may be successful in some circumstances are rejected on the basis of low effectiveness scores, while others in which potential effectiveness is indicated are unproductively imposed where circumstances are unpropitious. I suggest that a more unrestricted interpretation of 'experiment' needs to return to education discourse.

Whilst attendance at short, day-long courses or workshops features prominently in teachers' continuing professional development (CPD) profiles, research remains equivocal about their lasting impact. The present study addresses questions about the impact of short-course CPD in the context of a national CPD programme aimed at developing teachers' and teaching assistants' self-efficacy in relation to inclusive physical education. A repeated measures design was adopted to examine the contribution of the CPD programme to participants' self-efficacy. Data were collected from n = 1533, n = 1432, and n = 149 teachers and teaching assistants at baseline, immediately after the course, and 3-6 months later as a follow up. Results suggest that short-course CPD can positively affect teachers' and teaching assistants' self-efficacy in the short term. However, longer-term benefits were confounded by gender, age, years experience working in the profession, efficacy beliefs prior to attending the CPD course, and perceptions on the quality of the course attended. The results of this study reinforce existing research that the effectiveness of short-course CPD is dependent on a range of individual factors and perceptions on CPD quality, and that greater tailoring of delivery is required to ensure that learning is maximised for all involved.

The author comments on Noel Entwistle's paper "Contributions of Educational Psychology to Understanding Student Learning: What Has Been Discovered -- What More Could Be Done?" He begins the article by expressing his delight because he feels Entwistle's work has been a beacon in the understanding of student learning and his contributions have helped the author's own teaching in universities incalculably. He observes that the paper for this Open Dialogue in "The Psychology of Education Review," seems to fall into two parts. The first offers a commentary on methods of inquiry used by psychologists and researchers, and the second gives a 'view from the bridge', succinctly summarising the research in the field of student learning over the years. The author confines his remarks to the first part of the paper on Entwistle's observations about different kinds of theory and the forms of inquiry conducted by psychologists in this area and elsewhere. [For "Contributions of Educational Psychology to Understanding Student Learning: What Has Been Discovered -- What More Could Be Done?" see EJ1247419.]

Learning management systems (LMS) have been utilised for enhancing the quality of learning and teaching in higher education, yet the cultural needs of Indigenous students are rarely considered. The study reimagines culturally inclusive learning in an LMS by critically reviewing theories of culturally inclusive learning and Indigenous pedagogical values. It explores perceptual gaps between Indigenous cultural needs and the current use of an LMS through analysis of data collected from Indigenous students and academic staff via an online questionnaire (n = 100) and face-to-face interviews (n = 20) at one Australian university. As a result, it articulates and unpacks mythical perceptions of using an LMS. Consequently, there is clear evidence that Indigenous students expect to experience more human-to-human interactions and develop a sense of community through the use of available communication tools, whereas academic staff tend to rely on a binary opposition between pedagogy and culture in which culture is regarded as a subordinate concept to pedagogy.

Every engineering, computing, and engineering technology program accredited by the Accreditation Board for Engineering and Technology (ABET) has formulated many and varied self-assessment methods. Methods used to assess a program for ABET accreditation and continuous improvement are for keeping programs current with academic and industrial innovation. The methods used to assess programs are varied and mostly depend on the program and ABET objectives. Assessment instruments include course assessment report (CAR) done solely by faculty for every course that the faculty member teaches, student and faculty survey instruments, industrial advisory board input on curriculum, and the fundamentals of engineering exam (F.E.). These methods provide a continuous self-evaluation of instruction related activities which are critical to maintaining a quality undergraduate program and critical to maintaining ABET accreditation of engineering, computing, and technology programs (www.abet.org, 2015). This paper examines the usefulness of the exit examination given to senior students in their final year or final semester of the Electronics Engineering Technology program. This examination is comprehensive and covers every course taught in the program. It consist of problems on the analog and digital electronics segments of the program. It also covers ABET's objectives which assess lifelong learning, diversity, ethical, and professional behavior and responsibilities of engineers, and global issues. The examination is given to students to complete graduation requirements, but the data gained from such examination is also used for self-assessment of the program, as a tool for continuous improvement of the program, and for ABET assessment criteria. The format of the exit examination, as well as how it conforms to ABET assessment and program objectives is discussed. Further, we provide data and analysis of students' results over a five year period and show how feedback from the results is used to make improvement to the program.

Online learning has become a conventional term and practice in Australian higher education, yet cultural inclusivity for Indigenous (Indigenous for the purposes of this paper refers to Australian Aboriginal and Torres Strait Islander peoples) students is insufficiently reflected in learning management system (LMS) policies and design. This study aims to explore culturally inclusive learning entrenched in Australian university policies on and practices of LMS by applying Indigenous holistic pedagogical values in LMS design. Based on a literature review, we articulate four dimensions: communication, collaboration, community and interculturality for culturally inclusive learning in an online learning environment. By using the dimensions, we critically review policies (n = 10) and LMS sites (n = 50). In this review, we argue that there are contrasts of individually heterogeneous and collectively homogeneous approaches, self-focused and community-driven pedagogy, and task-oriented and relational learning. Significantly, the review results indicate that Indigenous holistic pedagogies have a metaphysical strength to be the ontological foundation for cultural inclusivity.