| 1. |
- van de Munckhof, A., et al.
(författare)
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Outcomes of Cerebral Venous Thrombosis due to Vaccine-Induced Immune Thrombotic Thrombocytopenia After the Acute Phase
- 2022
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Ingår i: Stroke. - : Ovid Technologies (Wolters Kluwer Health). - 0039-2499 .- 1524-4628. ; 53:10, s. 3206-3210
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Tidskriftsartikel (refereegranskat)abstract
- Background: Cerebral venous thrombosis (CVT) due to vaccine-induced immune thrombotic thrombocytopenia (VITT) is a severe condition, with high in-hospital mortality rates. Here, we report clinical outcomes of patients with CVT-VITT after SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) vaccination who survived initial hospitalization. Methods: We used data from an international registry of patients who developed CVT within 28 days of SARS-CoV-2 vaccination, collected until February 10, 2022. VITT diagnosis was classified based on the Pavord criteria. Outcomes were mortality, functional independence (modified Rankin Scale score 0-2), VITT relapse, new thrombosis, and bleeding events (all after discharge from initial hospitalization). Results: Of 107 CVT-VITT cases, 43 (40%) died during initial hospitalization. Of the remaining 64 patients, follow-up data were available for 60 (94%) patients (37 definite VITT, 9 probable VITT, and 14 possible VITT). Median age was 40 years and 45/60 (75%) patients were women. Median follow-up time was 150 days (interquartile range, 94-194). Two patients died during follow-up (3% [95% CI, 1%-11%). Functional independence was achieved by 53/60 (88% [95% CI, 78%-94%]) patients. No new venous or arterial thrombotic events were reported. One patient developed a major bleeding during follow-up (fatal intracerebral bleed). Conclusions: In contrast to the high mortality of CVT-VITT in the acute phase, mortality among patients who survived the initial hospitalization was low, new thrombotic events did not occur, and bleeding events were rare. Approximately 9 out of 10 CVT-VITT patients who survived the acute phase were functionally independent at follow-up.
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| 2. |
- Hale, S. E., et al.
(författare)
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Evaluating Nature-Based Solutions for Water Management in Peri-Urban Areas
- 2023
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Ingår i: Water. - : MDPI. - 2073-4441. ; 15:5
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Tidskriftsartikel (refereegranskat)abstract
- The term nature-based solutions (NBS) has gained traction in recent years and has been applied in many settings. There are few comprehensive assessment frameworks available that can guide NBS planning and implementation while at the same time capturing the short- and long-term impacts and benefits of the NBS. Here a recently presented framework, which builds on the theory of change and was developed to assess NBS at different phases of the project cycle, was applied to seven diverse case studies. The case studies addressed water quality and quantity issues in peri-urban areas across the global north and south. Framework indicators covering the sustainability dimensions (environmental, social and economic) were assessed at three stages of the framework: context, process and results. The work sought to investigate the following research objectives: (1) Can this framework be robust and yet flexible enough to be applied across a diverse selection of NBS projects that are at different phases of the project cycle and address different kinds of water challenges within varied ecological, social and economic contexts? (2) Is it possible to draw generalisations from a comparative analysis of the application of the framework to the case studies? Results showed that the framework was able to be applied to the case studies; however, their diversity showed that NBS projects designed in one context, for a specific purpose in a specific location, can not necessarily be transferred easily to another location. There were several process-based indicators that were universally significant for the case studies, including expertise, skills and knowledge of the involved actors, roles and responsibilities of involved actors and political support. The result-based indicators were case study-specific when environmental indicators were case study-specific, and important social indicators were environmental identity and recreational values. Overall, the use of the framework benefits the recognition of the implementation’s advances, such as the change in context, the processes in place and the results obtained.
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| 3. |
- Morais de Lima, Ana Paula, et al.
(författare)
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Framework for Planning and Evaluation of Nature-Based Solutions for Water in Peri-Urban Areas
- 2022
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Ingår i: Sustainability. - : MDPI. - 2071-1050. ; 14:13
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Tidskriftsartikel (refereegranskat)abstract
- Recent efforts to achieve social, economic, and environmental goals related to sustainability emphasize the importance of nature-based solutions (NBS), as grey infrastructure alone is insufficient to address current challenges. The majority of frameworks proposed in the literature fail to address the full potential of NBS, neglecting long-term results, unintended consequences, co-benefits, and their contribution to achieving global environmental agreements, such as the Agenda 2030, especially for water management in a peri-urban context. Here we present an innovative framework that can be applied to both NBS project planning and evaluation for several water-based challenges, giving practitioners and researchers a tool not only to evaluate ongoing projects but also to guide new ones. The framework considers three main stages of a NBS project: (1) context assessment, (2) NBS implementation and adaptation process, and (3) NBS results. This tool has the potential to be used to evaluate whether NBS projects are aligned with sustainability dimensions through a set of adaptable sustainability indicators. The framework can also highlight how the NBS targets are related to the sustainable development goals (SGD) and contribute to catalyzing the 2030 Agenda. The framework is an important tool for water management and other NBS types.
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| 4. |
- Van De Munckhof, Anita, et al.
(författare)
-
Outcomes of cerebral venous thrombosis due to vaccine-induced immune thrombotic thrombocytopenia after the acute phase
- 2022
-
Ingår i: Stroke. - : American Heart Association. - 0039-2499 .- 1524-4628. ; 53:10, s. 3206-3210
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Cerebral venous thrombosis (CVT) due to vaccine-induced immune thrombotic thrombocytopenia (VITT) is a severe condition, with high in-hospital mortality rates. Here, we report clinical outcomes of patients with CVT-VITT after SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) vaccination who survived initial hospitalization.Methods: We used data from an international registry of patients who developed CVT within 28 days of SARS-CoV-2 vaccination, collected until February 10, 2022. VITT diagnosis was classified based on the Pavord criteria. Outcomes were mortality, functional independence (modified Rankin Scale score 0-2), VITT relapse, new thrombosis, and bleeding events (all after discharge from initial hospitalization).Results: Of 107 CVT-VITT cases, 43 (40%) died during initial hospitalization. Of the remaining 64 patients, follow-up data were available for 60 (94%) patients (37 definite VITT, 9 probable VITT, and 14 possible VITT). Median age was 40 years and 45/60 (75%) patients were women. Median follow-up time was 150 days (interquartile range, 94-194). Two patients died during follow-up (3% [95% CI, 1%-11%). Functional independence was achieved by 53/60 (88% [95% CI, 78%-94%]) patients. No new venous or arterial thrombotic events were reported. One patient developed a major bleeding during follow-up (fatal intracerebral bleed).Conclusions: In contrast to the high mortality of CVT-VITT in the acute phase, mortality among patients who survived the initial hospitalization was low, new thrombotic events did not occur, and bleeding events were rare. Approximately 9 out of 10 CVT-VITT patients who survived the acute phase were functionally independent at follow-up.
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| 5. |
- Parker, Mike, et al.
(författare)
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A historical perspective on the introduction of laparoscopic basic surgical training in the Caribbean and factors that contribute to sustainability of such training
- 2019
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Ingår i: International Journal of Surgery. - : ELSEVIER. - 1743-9191 .- 1743-9159. ; 72, s. 6-12
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Forskningsöversikt (refereegranskat)abstract
- Objective: To report the development of minimally invasive training courses and workshops in the Caribbean and specifically the establishment of the Basic Surgical Skills Course of the Royal College of Surgeons of England (RCSEng) in Trinidad with respect to their value toward Surgical laparoscopic or minimally invasive training in the Caribbean. Design: & Methods: The literature written on laparoscopy in the region was reviewed and in particular that related to the minimally invasive training courses provided over the period 2004 to 2019 and the development of laparoscopic surgical training described from a historic perspective. The factors that contribute to sustainability of courses were identified. Results: Laparoscopic surgical training courses were sporadically introduced into the Caribbean over the period 2004 to 2019 in countries including Barbados, Curacao, Guyana, St. Lucia, Jamaica and Trinidad & Tobago. These were timed and closely related to the establishment of the Caribbean College of Surgeons (CCOS) with the help of the Royal College of Surgeons of England. However, the only certified course introduced was the Basic Surgical Skills (BSS) course of the RCSEng into Trinidad in 2012. This has now been established as a recognised overseas centre by the RCSEng and provides the Intercollegiate BSS course annually forming a solid basis for trainees to learn safe surgical and laparoscopic skills prior to commencing formal surgical training. This has resulted in the sustainable development of minimally invasive training in Trinidad in particular. Conclusion: Laparoscopic skills courses and workshops have been established in the Caribbean for 15 years beginning circa. 2004 to 2019 and have grown in number and locations throughout the Caribbean. The RCSEng and the CCOS have been instrumental in the development process. Of note, the only recognised overseas training centre for Basic Surgical Skills Course was established in Trinidad & Tobago with the support of the RCSEng and seems to be the main contributor to the successful, regular maintenance of these and other minimally invasive courses in General Surgery, ENT, Gynaecology and other fields on an annual, sustainable basis.
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