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The risk of adverse events from ascending thoracic aorta aneurysm (TAA) is poorly understood but drives clinical decision-making.To evaluate the association of TAA size with outcomes in nonsyndromic patients in a large non-referral-based health care delivery system.The Kaiser Permanente Thoracic Aortic Aneurysm (KP-TAA) cohort study was a retrospective cohort study at Kaiser Permanente Northern California, a fully integrated health care delivery system insuring and providing care for more than 4.5 million persons. Nonsyndromic patients from a regional TAA safety net tracking system were included. Imaging data including maximum TAA size were merged with electronic health record (EHR) and comprehensive death data to obtain demographic characteristics, comorbidities, medications, laboratory values, vital signs, and subsequent outcomes. Unadjusted rates were calculated and the association of TAA size with outcomes was evaluated in multivariable competing risk models that categorized TAA size as a baseline and time-updated variable and accounted for potential confounders. Data were analyzed from January 2018 to August 2021.TAA size.Aortic dissection (AD), all-cause death, and elective aortic surgery.Of 6372 patients with TAA identified between 2000 and 2016 (mean [SD] age, 68.6 [13.0] years; 2050 female individuals [32.2%] and 4322 male individuals [67.8%]), mean (SD) initial TAA size was 4.4 (0.5) cm (828 individuals [13.0% of cohort] had initial TAA size 5.0 cm or larger and 280 [4.4%] 5.5 cm or larger). Rates of AD were low across a mean (SD) 3.7 (2.5) years of follow-up (44 individuals [0.7% of cohort]; incidence 0.22 events per 100 person-years). Larger initial aortic size was associated with higher risk of AD and all-cause death in multivariable models, with an inflection point in risk at 6.0 cm. Estimated adjusted risks of AD within 5 years were 0.3% (95% CI, 0.3-0.7), 0.6% (95% CI, 0.4-1.3), 1.5% (95% CI, 1.2-3.9), 3.6% (95% CI, 1.8-12.8), and 10.5% (95% CI, 2.7-44.3) in patients with TAA size of 4.0 to 4.4 cm, 4.5 to 4.9 cm, 5.0 to 5.4 cm, 5.5 to 5.9 cm, and 6.0 cm or larger, respectively, in time-updated models. Rates of the composite outcome of AD and all-cause death were higher than for AD alone, but a similar inflection point for increased risk was observed at 6.0 cm.In a large sociodemographically diverse cohort of patients with TAA, absolute risk of aortic dissection was low but increased with larger aortic sizes after adjustment for potential confounders and competing risks. Our data support current consensus guidelines recommending prophylactic surgery in nonsyndromic individuals with TAA at a 5.5-cm threshold.

Refereed/Peer-reviewed Aims: To investigate and characterise the pharmacokinetics of febuxostat and the effect of the covariates of renal function and body size descriptors on the pharmacokinetics of the drug. Methods: Blood samples (n = 239) were collected using sparse and rich sampling strategies from healthy (n = 9) and gouty (n = 29) subjects. Febuxostat plasma concentrations were measured by a validated high-performance liquid chromatography method. Population pharmacokinetic analysis was performed using NONMEM. A common variability on bioavailability (FVAR) approach was used to test the effect of fed status on absorption parameters. Covariates were modelled using a power model. Results: The time course of the plasma concentrations of febuxostat is best described by a two-compartment model. In the final model, the population mean for apparent clearance (CL/F), apparent central volume of distribution (Vc/F), apparent peripheral volume of distribution (Vp/F), absorption rate constant (ka) and apparent intercompartmental clearance (Q/F) were 6.91 l h−1, 32.8 l, 19.4 l, 3.6 h−1 and 1.25 l h−1, respectively. The population parmater variability (coefficient of variation) for CL/F, Vc/F and Vp/F were 13.6, 22 and 19.5%, respectively. Food reduced the relative biovailability and ka by 67% and 87%, respectively. Renal function, as assessed by creatinine clearance, was a significant covariate for CL/F while body mass index was a significant covariate for Vc/F. Conclusions: Renal function and body mass index were significant covariates. Further work is warranted to investigate the clinical relevance of these results, notably as renal impairment and obesity are common occurrences in people with gout.

Drawing on Edward Said’s “Beginnings theory,” which is the central thesis in his book Beginnings: Intention and Method (1975), several post- 9/11 narratives reflect means for perceiving how these various accounts foreshadow a new era in both literature and political discourse. These accounts constitute a “beginning,” to use a Saidian term, heralding a new vision of the Islamic (Arab)/Western representation; a shift from a “historical pattern.” In this study, the tension created by turning a “historical aboriginality” into personal representations is reevaluated from a Saidian perspective. Such post- 9/11 narratives lend themselves to manifesting how the interrelation between an “obligation” for narration and a “sympathetic imagination” create beginnings. To achieve this end, the study will examine two narratives: Jonathan Foer’s Extremely Loud & Incredibly Close (2005) and Alia Yunis’ The Counter Night (2009). By advancing and investigating these narratives, the study aims at reaching new ideas about the representation of a major event in political history, namely: 9/11.

This research paper will examine the science-fiction novel Dune as a postcolonial work. Colonial history and literature that have been the central focus of postcolonial studies influenced the structure of many science-fiction novels. One of these was Herbert’s Dune (1965), which carries a colonial formula into a new fictionalized setting. However, very few postcolonial studies cross into the science-fiction novel, and fewer still consider the science-fictional element that sets it apart as a genre. Thus, this article attempts to provide a new perspective on Dune as a postcolonial novel that sets a new premise for our understanding of postcolonialism. In employing the early anticolonial thoughts of Amilcar Cabral and his notion of resistance, this study will trace these anticolonial notions throughout the novel. In addition, it will consider the novel’s science-fictional element of spice and how it proves detrimental in perceiving the novel as a new form of postcolonial narrative.

Solid-state analysis of a new quaternary solid-form of ritonavir: an oxalate salt oxalic acid co-crystal acetone solvate.