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Patrick Mismetti
Unité Inserm U1077, Caen, Lower Normandy, France
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Available from: Laurent Bertoletti
Letter by Bertoletti et al Regarding Article, "Anticoagulation and Survival in Pulmonary Arterial Hypertension: Results From the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA)".
Laurent Bertoletti
, Patrick Mismetti,
Hervé Decousus
Circulation 09/2014; 130(12):e108.
· 15.20 Impact Factor
The Pseudo-effect of Vena Cava Filters.
Philippe Girard
Guy Meyer
, Patrick Mismetti
The American journal of medicine. 07/2014; 127(7):e21.
Available from: Laurent Bertoletti
Indirect comparison meta-analysis of two enoxaparin regimens in patients undergoing major orthopaedic surgery. Impact on the interpretation of thromboprophylactic effects of new anticoagulant drugs.
S Laporte
C Chapelle
L Bertoletti
J-C Lega
M Cucherat
P J Zufferey
J-Y Darmon
, P Mismetti
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Two enoxaparin dosage regimens are used as comparators to evaluate new anticoagulants for thromboprophylaxis in patients undergoing major orthopaedic surgery, but so far no satisfactory direct comparison between them has been published. Our objective was to compare the efficacy and safety of enoxaparin 3,000 anti-Xa IU twice daily and enoxaparin 4,000 anti-Xa IU once daily in this clinical setting by indirect comparison meta-analysis, using Bucher's method. We selected randomised controlled trials comparing another anticoagulant, placebo (or no treatment) with either enoxaparin regimen for venous thromboembolism prophylaxis after hip or knee replacement or hip fracture surgery, provided that the second regimen was assessed elsewhere versusthe same comparator. Two authors independently evaluated study eligibility, extracted the data, and assessed the risk of bias. The primary efficacy outcome was the incidence of venous thomboembolism. The main safety outcome was the incidence of major bleeding. Overall, 44 randomised comparisons in 56,423 patients were selected, 35 being double-blind (54,117 patients). Compared with enoxaparin 4,000 anti-Xa IU once daily, enoxaparin 3,000 anti-Xa IU twice daily was associated with a reduced risk of venous thromboembolism (relative risk [RR]: 0.53, 95% confidence interval [CI]: 0.40 to 0.69), but an increased risk of major bleeding (RR: 2.01, 95% CI: 1.23 to 3.29). In conclusion, when interpreting the benefit-risk ratio of new anticoagulant drugs versus enoxaparin for thromboprophylaxis after major orthopaedic surgery, the apparently greater efficacy but higher bleeding risk of the twice-daily 3,000 anti-Xa IU enoxaparin regimen compared to the once-daily 4,000 anti-Xa IU regimen should be taken into account.
Thrombosis and haemostasis. 06/2014; 112(3).
The effect of low molecular weight heparin on survival in cancer patients: an updated systematic review and meta-analysis of randomized trials: comment
B Tardy
E Chalayer
C Chapelle
, P Mismetti
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We read with interest the article by Sanford and al (1) reporting through a meta-analysis the effect of low-molecular-weight heparin on survival in cancer patients. The authors found 9 studies that met their inclusion criteria (one-year survival outcomes). Then, after reporting the results of LMWH on overall survival in patients with cancer, they extracted also data on venous thromboembolism (VTE) for the 9 trials.This article is protected by copyright. All rights reserved.
Journal of Thrombosis and Haemostasis 06/2014;
· 6.08 Impact Factor
Available from: Nadia Rosencher
Prevention of Venous Thromboembolic Events With Low-Molecular-Weight Heparin in the Non-Major Orthopaedic Setting: Meta-Analysis of Randomized Controlled Trials.
Céline Chapelle
Nadia Rosencher
Paul Jacques Zufferey
, Patrick Mismetti,
Michel Cucherat
Silvy Laporte
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To assess the efficacy of low-molecular-weight heparin (LMWH) venous thromboprophylaxis in patients with transient reduced mobility in the non-major orthopaedic setting. A meta-analysis was conducted using data from all available randomized trials comparing LMWH with placebo or no prophylactic treatment in patients with leg immobilization for fracture or soft-tissue injury of the lower limb or in patients undergoing knee arthroscopy. The primary endpoint was the incidence of major venous thromboembolic events (VTEs), including asymptomatic proximal deep-vein thrombosis, symptomatic VTEs, and VTE-related death. The Mantel-Haenszel method was used to generate the summary statistics for the overall effect of LMWH. Fourteen studies were included (4,726 patients). The weighted rate of major VTEs was estimated to be 2.9% (95% confidence interval [CI], 2.2% to 3.7%) without LMWH prophylaxis. Overall, a significant 68% reduction in the risk of major VTEs was observed with LMWH prophylaxis (relative risk [RR], 0.32; 95% CI, 0.20 to 0.51; P < .001). The treatment effect was not modified by the clinical setting, that is, distal lower limb injury (7 studies; 1,711 patients; RR, 0.42; 95% CI, 0.20 to 0.86) or knee arthroscopy (6 studies; 2,428 patients; RR, 0.27; 95% CI, 0.15 to 0.49). A nonsignificant 35% increase in the risk of major bleeding was observed in the LMWH prophylaxis group (RR, 1.35; 95% CI, 0.53 to 3.47). This meta-analysis indicates potential efficacy of LMWH in preventing thromboembolic events in patients with reduced mobility in the non-major orthopaedic setting compared with placebo or no treatment. However, the decision of whether to implement LMWH prophylaxis in each specific setting should also take into account the risk of VTEs in the absence of prophylaxis, the potential adverse effects of LMWH, and the cost. Level II, meta-analysis of Level II studies or Level I studies with inconsistent results.
Arthroscopy The Journal of Arthroscopic and Related Surgery 05/2014;
· 3.10 Impact Factor
Available from: Olivier Pellerin
Conference Paper:
Optional vena cava filter placement and 3 months retrievability: results of the PREPIC 2 randomized multicenter trial
O. Pellerin
F. Barral
O. Sanchez
M. Midulla
G. Meyer
, P. Mismetti,
M. Sapoval
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Purpose To report the implantation and retrieval vena cava filter success rate of the ALN filter in a the setting of a prospective randomized trial (PREPIC 2) trial filter subgroup. Materials and Methods Prepic 2 is a prospective open randomized study with a blind evaluation that compared retrievable ALN vena cava filter (ALN Implant Chirurgicaux) maintained for 3 months with no filter insertion in patients receiving anticoagulant therapy for acute symptomatic pulmonary embolism (PE) associated to deep vein thrombosis. The filter retrieval was systematically scheduled at 3 months. The primary goal of this ancillary study is to report the technical success rate of filter implantation and removal. The secondary goal is to report filter related complications. Results Between 08-2006 and 07-2012; 399 patients (median 76 years) with acute PE and no contradiction to anticoagulation were enrolled in 18 centres. 193 patients received an ALN filter after randomization in the filter arm in addition to anticoagulation therapy, using femoral (162) basilic (15) or jugular vein (16), access. Filter wasn't implanted because of 2(1%) technical failure; 3 (1.5%) non confirmation of PE diagnosis after randomization; and 2 (1%) patients' death before implantation. post implantation cavogram showed >15° tilting in 19 (9.8%) cases. Minor complications were observed in 20 cases (11.9%): 4 (2%) <20 mm migration; 10 (5.2%) >3 mm filters struts penetration outside the cavogram and 3 1.6%) puncture site hematoma; 5 (2.6%) tilt increase were reported. Among the 166 (92.2%) patients who were referred for extraction after 3 months (93 days [89-98]), retrieval was successfully performed in 92.2% (153). 3 (1.8%) asymptomatic filter thrombosis were observed. Failure of extraction was observed in 13 (7.8%) case, because of >15° tilt (n=9, 5.4%) or non removable fibrotic bridge to IVC n=4/2.4%. Filter removal was successfully performed in an median of 20 min [15-40]. Conclusion The ALN filter was successfully extracted in 92.2% in this multicenter experience with a little complication rate.
Available from: Pierre Fontana
Erratum à « Prise en charge des complications hémorragiques graves et de la chirurgie en urgence chez les patients recevant un anticoagulant oral anti-IIa ou anti-Xa direct. Propositions du Groupe d'intérêt en Hémostase Périopératoire (GIHP) - mars 2013 » [Ann. Fr. Anesth. Reanim. 2013;32:691–700]
G. Pernod
P. Albaladejo
A. Godier
C.M. Samama
S. Susen
Y. Gruel
N. Blais
P. Fontana
A. Cohen
J.V. Llau
N. Rosencher
J.F. Schved
E. de Maistre
M.M. Samama
, P. Mismetti,
P. Sié
Annales francaises d'anesthesie et de reanimation 03/2014;
· 0.77 Impact Factor
Available from: Sam - Schulman
Treatment of acute venous thromboembolism with dabigatran or warfarin and pooled analysis.
Sam Schulman
Ajay K Kakkar
Samuel Z Goldhaber
Sebastian Schellong
Henry Eriksson
, Patrick Mismetti,
Anita Vedel Christiansen
Jeffrey Friedman
Florence Le Maulf
Nuala Peter
Clive Kearon
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Dabigatran and warfarin have been compared for the treatment of acute venous thromboembolism (VTE) in a previous trial. We undertook this study to extend those findings. In a randomized, double-blind, double-dummy trial of 2589 patients with acute VTE treated with low-molecular-weight or unfractionated heparin for 5 to 11 days, we compared dabigatran 150 mg twice daily with warfarin. The primary outcome, recurrent symptomatic, objectively confirmed VTE and related deaths during 6 months of treatment occurred in 30 of the 1279 dabigatran patients (2.3%) compared with 28 of the 1289 warfarin patients (2.2%; hazard ratio, 1.08; 95% confidence interval [CI], 0.64-1.80; absolute risk difference, 0.2%; 95% CI, -1.0 to 1.3; P<0.001 for the prespecified noninferiority margin for both criteria). The safety end point, major bleeding, occurred in 15 patients receiving dabigatran (1.2%) and in 22 receiving warfarin (1.7%; hazard ratio, 0.69; 95% CI, 0.36-1.32). Any bleeding occurred in 200 dabigatran (15.6%) and 285 warfarin (22.1%; hazard ratio, 0.67; 95% CI, 0.56-0.81) patients. Deaths, adverse events, and acute coronary syndromes were similar in both groups. Pooled analysis of this study RE-COVER II and the RE-COVER trial gave hazard ratios for recurrent VTE of 1.09 (95% CI, 0.76-1.57), for major bleeding of 0.73 (95% CI, 0.48-1.11), and for any bleeding of 0.70 (95% CI, 0.61-0.79). Dabigatran has similar effects on VTE recurrence and a lower risk of bleeding compared with warfarin for the treatment of acute VTE. www.clinicaltrials.gov. Unique identifiers: NCT00680186 and NCT00291330.
Circulation 02/2014; 129(7):764-72.
· 15.20 Impact Factor
[New oral anticoagulants: pharmacological data to know for the clinical practice].
Xavier Delavenne
Silvy Laporte
, Patrick Mismetti
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New oral anticoagulants target specific factors in the coagulation cascade by directly inhibiting thrombin for dabigatran and Factor Xa for -xatrans. Pharmacological progresses with these anticoagulants allow the use of fixed doses without any therapeutic drug monitoring. Their pharmacokinetic specificity is the key role of the transporter proteins P-glycoprotein (P-gp) for all these drugs and the metabolism mediated by CYP3A4 for -xabans. Dose adjustment is recommended for decreasing creatinine clearance or in case of drug-drug interaction. New oral anticoagulants are promising but their safety needs further investigations in particular populations such as elderly patients, patients with renal or hepatic impairment, or patients on polymedication.
Revue médicale suisse 02/2014; 10(416):319-24.
Quantification du biais d'estimation de l'effet traitement dans les études en ouvert avec évaluation à l'aveugle (dessin PROBE) par rapport à un double-insu : exemple avec les nouveaux anticoagulants oraux dans la fibrillation atriale
S. Laporte
J.-C. Lega
C. Chapelle
M. Cucherat
T. Fassier
L. Bertoletti
, P. Mismetti
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Introduction.– Les essais randomisés en ouvert avec évaluation à l'aveugle (PROBE) permettent de limiter les biais d'évaluation par rapport aux études en ouvert simple, et sont parfois considérés comme aussi performants que les essais en double insu pour l'évaluation d'une stratégie thérapeutique. Cependant, si l'exagération de l'effet traitement liée aux études en ouvert est bien estimée, celle liée aux études PROBE n'a jamais été estimée. Nous avons cherché à quantifier le biais d'estimation lié au schéma d'études PROBE par rapport aux études en double insu à partir des essais évaluant un nouvel anticoagulant oral dans la fibrillation atriale. Me´thodes.– Tous les essais randomisés évaluant un nouvel anticoagulant par rapport au traitement de référence (anti-vitamine K) dans la prévention des événements emboliques dans la fibrillation atriale ont été inclus. Les bases de données consultées étaient MEDLINE, EMBASE, la library Cochrane, les sites web de l' « US National Institute of Health, Meta-Embol » et les registres d'essais cliniques. Le critère principal d'évaluation et les critères secondaires étaient communs à toutes les études : accidents vasculaires cérébraux et embolies systémiques (AVC-ES), AVC hémorragiques, hémorragies majeures, hémorragies intracrâniennes, et mortalité cardiovas- culaire. L'effet traitement commun a été estimé pour les études PROBE et pour les études en double insu en combinant le logarithme des risques relatifs (RR) de chacune des études pondéré par l'inverse de la variance, selon un modèle à effets fixes ou à effets aléatoires. L'exagération de l'effet traitement a été estimée par le rapport des effets communs entre les études PROBE et les études en double insu ; le test d'interaction a été considéré comme significatif au seuil de 0,10. Re´sultats.– Au total, 8 études (59 238 patients) ayant comparé l'apixaban, l'edoxaban, le dabigatran, l'AZD0837, le ximelagatran, ou le rivaroxaban aux anti-vitamine K ont été incluses. De fac¸on globale, une réduction significative est observée avec les nouveaux anticoagulants oraux sur le critère principal AVC-ES (RR = 0,84 ; IC95 % 0,76–0,92) ainsi que sur tous les autres critères. L'estimation de l'efficacité des nouveaux anticoagulants oraux sur le critère primaire était plus importante à partir des études PROBE (5 essais, 22 947 patients ; RR = 0,76, IC95 % 0,65–0,90) comparé aux études en double insu (3 essais, 36 387 patients ; RR = 0,88, IC95 % 0,78–0,98), soit une majoration non significative de 16 % (test d'interaction p = 0,17). L'interaction était évidente pour les AVC hémorragiques (test d'interaction p = 0,05) avec une majoration de 72 % de l'effet traitement dans les études PROBE (RR = 0,32 ; IC95 % 0,20–0,49) par rapport études en double insu (RR = 0,55 ; IC95 % 0,41–0,73). Aucune autre interaction n'a été significative sur les autres critères. Conclusions.– Les études PROBE peuvent influencer les résultats d'un essai clinique en faveur du nouveau traitement. Cependant, l'influence d'un facteur confondant comme la classe pharmacologique ne peut être exclue. L'étude avec l'edoxaban dont le suivi est en cours, devrait permettre d'affiner les estimations. Il s'agit de rester prudent lors des comparaisons indirectes de ces molécules entre elles lors des méta-analyses en réseau.
Revue d Épidémiologie et de Santé Publique 02/2014; 62:S38–S39.
· 0.69 Impact Factor
Risk of venous and arterial thrombosis according to type of antiphospholipid antibodies in adults without systemic lupus erythematosus: A systematic review and meta-analysis.
Quitterie Reynaud
Jean-Christophe Lega
, Patrick Mismetti,
Céline Chapelle
Denis Wahl
Pascal Cathebras
Silvy Laporte
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Aim To evaluate the magnitude of venous and arterial thrombosis risk associated with antiphospholipid antibodies (APLs) in adults without systemic lupus erythematosus (SLE). Case-control and cohort studies were selected from the MEDLINE and Cochrane Library databases. Two investigators independently extracted data on study design, patient characteristics, venous and arterial events and exposure to APLs, including lupus anticoagulant (LA), anticoardiolipin (aCL), anti-β2 Glycoprotein I (β2GpI), anti-prothrombin (aPT), anti-phosphatidyl serine (aPS), and anti-phosphatidyl ethanolamine (aPE). 30 studies were included (16,441 patients). The odds ratio (OR) for venous thrombosis was 6.14 (95% confidence interval [CI] 2.74-13.8) in LA-positive patients (5 studies, 1650 patients) and 1.46 (CI 1.06-2.03) in aCL positive patients (12 studies, 5375 patients). None of the associations with more recently identified APLs was significant, but fewer studies were available. For arterial thrombosis, the OR for LA and aCL was 3.58 (CI 1.29-9.92) and 2.65 (CI 1.75-4.00) respectively. The associations between β2GpI, aPT and aPS and the risk of arterial thrombosis were also significant, the OR being 3.12 (CI 1.51- 6.44), 2.95 (CI 1.31-6.66) and 6.00 (CI 3.07- 11.7), respectively. Owing to the heterogeneity of cut-off values for each APL assay, we were unable to perform any sensitivity analysis to determine the optimal value. The presence of low-quality studies may have led to overestimation of the magnitude of the associations. LA and aCL were significantly associated with an increased risk of thrombosis, especially arterial, in patients without SLE. Systematic thromboprophylaxis in high-risk patients with APL should be evaluated.
Autoimmunity reviews 01/2014;
· 6.37 Impact Factor
[What are the indications for vena cava filters in 2014?]
G Meyer
P Girard
, P Mismetti
La Revue de Médecine Interne 01/2014;
· 0.90 Impact Factor
Available from: Laurent Bertoletti
Consistency of Safety and Efficacy of New Oral Anticoagulants across Subgroups of Patients with Atrial Fibrillation.
Jean-Christophe Lega
Laurent Bertoletti
Cyrielle Gremillet
Céline Chapelle
, Patrick Mismetti,
Michel Cucherat
Denis Vital-Durand
Silvy Laporte
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The well-known limitations of vitamin K antagonists (VKA) led to development of new oral anticoagulants (NOAC) in non-valvular atrial fibrillation (NVAF). The aim of this meta-analysis was to determine the consistency of treatment effects of NOAC irrespective of age, comorbidities, or prior VKA exposure. All randomized, controlled phase III trials comparing NOAC to VKA up to October 2012 were eligible provided their results (stroke/systemic embolism (SSE) and major bleeding (MB)) were reported according to age (≤ or >75 years), renal function, CHADS2 score, presence of diabetes mellitus or heart failure, prior VKA use or previous cerebrovascular events. Interactions were considered significant at p <0.05. Three studies (50,578 patients) were included, respectively evaluating apixaban, rivaroxaban, and dabigatran versus warfarin. A trend towards interaction with heart failure (p = 0.08) was observed with respect to SSE reduction, this being greater in patients not presenting heart failure (RR = 0.76 [0.67-0.86]) than in those with heart failure (RR = 0.90 [0.78-1.04]); Significant interaction (p = 0.01) with CHADS2 score was observed, NOAC achieving a greater reduction in bleeding risk in patients with a score of 0-1 (RR 0.67 CI 0.57-0.79) than in those with a score ≥2 (RR 0.85 CI 0.74-0.98). Comparison of MB in patients with (RR 0.97 CI 0.79-1.18) and without (RR 0.76 CI 0.65-0.88) diabetes mellitus showed a similar trend (p = 0.06). No other interactions were found. All subgroups derived benefit from NOA in terms of SSE or MB reduction. NOAC appeared to be more effective and safer than VKA in reducing SSE or MB irrespective of patient comorbidities. Thromboembolism risk, evaluated by CHADS2 score and, to a lesser extent, diabetes mellitus modified the treatment effects of NOAC without complete loss of benefit with respect to MB reduction.
PLoS ONE 01/2014; 9(3):e91398.
· 3.53 Impact Factor
Available from: Laurent Bertoletti
Survival Effects of Inferior Vena Cava Filter in Patients with Acute Symptomatic Venous Thromboembolism and a Significant Bleeding Risk
Alfonso Muriel
David Jiménez
Drahomir Aujesky
Laurent Bertoletti
Herve Decousus
Silvy Laporte
, Patrick Mismetti,
Francisco J. Muñoz
Roger Yusen
Manuel Monreal
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Objectives The purpose of this study was to investigate the survival effects of inferior vena cava filter in patients with venous thromboembolism (VTE) and a significant bleeding risk. Background The effectiveness of inferior vena cava filter use among patients with acute symptomatic VTE and known significant bleeding risk remains unclear. Methods In this prospective cohort study of patients with acute VTE identified from the RIETE registry, we assessed the association between inferior vena cava filter insertion placed for known significant bleeding risk and the outcomes of all-cause mortality, pulmonary embolism (PE)-related mortality, and VTE rates through 30 days after initiation of VTE treatment. We used propensity score matching to adjust for the likelihood of receiving a filter. Results Of the 40,142 eligible patients that had acute symptomatic VTE, 371 underwent filter placement because of known significant bleeding risk. Three hundred and forty four patients treated with a filter were matched with 344 patients treated without a filter. Propensity score-matched pairs showed a non-significant trend toward lower risk of all-cause death for filter insertion compared with no insertion (6.6% vs. 10.2%, P = 0.12). The risk-adjusted PE-related mortality rate was lower for filter insertion than no insertion (1.7% vs. 4.9%, P = 0.03). Risk-adjusted recurrent VTE rates were higher for filter insertion than no insertion (6.1% vs. 0.6%, P > 0.001). Conclusions In patients presenting with VTE and a significant bleeding risk, compared to anticoagulant therapy, IVC filter insertion was associated with a lower risk of PE-related death, while it was associated with a higher risk of recurrent VTE. However, study design limitations do not imply a causal relationship between filter insertion and outcome.
Journal of the American College of Cardiology 01/2014;
· 14.09 Impact Factor
Filtres caves, quelles indications en 2014 ?
G. Meyer
P. Girard
, P. Mismetti
La Revue de Médecine Interne. 01/2014;
Brain magnetic resonance imaging findings in cryptogenic stroke patients under 60 years with patent foramen ovale
Claire Boutet
Laure Rouffiange-Leclair
Fabrice-Guy Barral
Pierre Garnier
Jérôme Varvat
Magali Epinat
Jean-Christophe Antoine
Sara Quenet
Daphné Delsart
, Patrick Mismetti
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Purpose To compare magnetic resonance imaging (MRI) brain feature in cryptogenic stroke patients with patent foramen ovale (PFO), cryptogenic stroke patients without PFO and patients with cardioembolic stroke. Materials and methods The ethics committee required neither institutional review board approval nor informed patient consent for retrospective analyses of the patients' medical records and imaging data. The patients' medical files were retrospectively reviewed in accordance with human subject research protocols. Ninety-two patients under 60 years of age were included; 15 with cardioembolic stroke, 32 with cryptogenic stroke with PFO and 45 with cryptogenic stroke without PFO. Diffusion-weighted imaging of brain MRI was performed by a radiologist blinded to clinical data. Univariate, Fischer's exact test for qualitative data and non-parametric Wilcoxon test for quantitative data were used. Results There was no statistically significant difference found between MRI features of patients with PFO and those with cardioembolic stroke (p<.05). Patients without PFO present more corticosubcortical single lesions (p<.05) than patients with PFO. Patients with PFO have more often subcortical single lesions larger than 15 mm, involvement of posterior cerebral arterial territory and intracranial occlusion (p<.05) than patient with cryptogenic stroke without PFO. Conclusion Our study suggests a cardioembolic mechanism in ischemic stroke with PFO.
European journal of radiology 01/2014;
· 2.65 Impact Factor
Available from: Nadia Rosencher
Prevention of Venous Thromboembolic Events With Low-Molecular-Weight Heparin in the Non-Major Orthopaedic Setting: Meta-Analysis of Randomized Controlled Trials
Céline Chapelle
Nadia Rosencher
Paul Jacques Zufferey
, Patrick Mismetti,
Michel Cucherat
Silvy Laporte
[Show abstract]
[Hide abstract]
Purpose To assess the efficacy of low-molecular-weight heparin (LMWH) venous thromboprophylaxis in patients with transient reduced mobility in the non-major orthopaedic setting. Methods A meta-analysis was conducted using data from all available randomized trials comparing LMWH with placebo or no prophylactic treatment in patients with leg immobilization for fracture or soft-tissue injury of the lower limb or in patients undergoing knee arthroscopy. The primary endpoint was the incidence of major venous thromboembolic events (VTEs), including asymptomatic proximal deep-vein thrombosis, symptomatic VTEs, and VTE-related death. The Mantel-Haenszel method was used to generate the summary statistics for the overall effect of LMWH. Results Fourteen studies were included (4,726 patients). The weighted rate of major VTEs was estimated to be 2.9% (95% confidence interval [CI], 2.2% to 3.7%) without LMWH prophylaxis. Overall, a significant 68% reduction in the risk of major VTEs was observed with LMWH prophylaxis (relative risk [RR], 0.32; 95% CI, 0.20 to 0.51; P < .001). The treatment effect was not modified by the clinical setting, that is, distal lower limb injury (7 studies; 1,711 patients; RR, 0.42; 95% CI, 0.20 to 0.86) or knee arthroscopy (6 studies; 2,428 patients; RR, 0.27; 95% CI, 0.15 to 0.49). A nonsignificant 35% increase in the risk of major bleeding was observed in the LMWH prophylaxis group (RR, 1.35; 95% CI, 0.53 to 3.47). Conclusions This meta-analysis indicates potential efficacy of LMWH in preventing thromboembolic events in patients with reduced mobility in the non-major orthopaedic setting compared with placebo or no treatment. However, the decision of whether to implement LMWH prophylaxis in each specific setting should also take into account the risk of VTEs in the absence of prophylaxis, the potential adverse effects of LMWH, and the cost. Level of Evidence Level II, meta-analysis of Level II studies or Level I studies with inconsistent results.
Arthroscopy The Journal of Arthroscopic and Related Surgery 01/2014;
· 3.10 Impact Factor
Preoperative Enoxaparin Versus Postoperative Semuloparin Thromboprophylaxis in Major Abdominal Surgery: A Randomized Controlled Trial.
Ajay K Kakkar
Giancarlo Agnelli
William Fisher
Daniel George
Michael R Lassen
, Patrick Mismetti,
Patrick Mouret
Judith Murphy
Francesca Lawson
Alexander G G Turpie
George Chalkiadakis
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To compare efficacy and safety of thromboprophylaxis with semuloparin started postoperatively versus enoxaparin started preoperatively in major abdominal surgery. Venous thromboembolism is an important complication following major abdominal surgery. Semuloparin is a novel ultra-low-molecular-weight heparin with high antifactor Xa and minimal antifactor IIa activity. In this double-blind noninferiority trial, adult patients undergoing major abdominal or pelvic operation under general anesthesia lasting more than 45 minutes were assigned to either daily enoxaparin 40 mg commenced preoperatively or daily semuloparin 20 mg commenced postoperatively, for 7 to 10 days. Patients underwent bilateral leg venography between 7 and 11 days postsurgery. The primary efficacy end point was the composite of any deep vein thrombosis, nonfatal pulmonary embolism, or all-cause death. The primary safety outcome was bleeding. Both were independently adjudicated. In total, 4413 patients were randomized; 3030 (1499 in the enoxaparin and 1531 in the semuloparin groups) were evaluable for the primary efficacy end point, which occurred in 97 patients (6.3%) in the semuloparin group and 82 patients (5.5%) in the enoxaparin group [odds ratio (OR) = 1.16, 95% confidence interval (CI): 0.84-1.59]. On the basis of a noninferiority margin of 1.25, postoperative semuloparin did not demonstrate noninferiority to preoperative enoxaparin. Major bleeding occurred in 63 of 2175 patients (2.9%) in the semuloparin group and 98 of 2177 patients (4.5%) in the enoxaparin group (OR = 0.63, 95% CI: 0.46-0.87). Semuloparin commenced postoperatively did not demonstrate noninferiority to enoxaparin initiated preoperatively for thromboprophylaxis after major abdominal surgery. Study registered with clinicaltrials.gov: NCT00679588.
Annals of surgery 12/2013;
· 7.90 Impact Factor
Available from: Laurent Bertoletti
PK evaluation of fondaparinux sodium for the treatment of thrombosis.
Xavier Delavenne
Paul Frappé
Paul Zufferey
, Patrick Mismetti,
Silvy Laporte
Laurent Bertoletti
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Introduction: Fondaparinux sodium (pentasaccharide) was the first of a new class of antithrombotic agents developed for the prevention and treatment of venous thromboembolism (VTE), blocking thrombin generation by selectively inhibiting factor Xa. Areas covered: This review focuses on the currently available information evaluating the pharmacokinetics, pharmacodynamics, clinical efficacy and safety of fondaparinux in the prevention and treatment of VTE and treatment of acute coronary syndromes (ACS). Expert opinion: Fondaparinux is an alternative to low-molecular-weight heparins (LMWH) for thromboprophylaxis in various clinical settings (major orthopedic surgery of the lower limbs, major abdominal surgery, immobilized medical patients at high risk of VTE), as well as for the treatment of VTE (deep venous thrombosis, pulmonary embolism). It is currently challenged, in the context of both surgical thromboprophylaxis and acute VTE treatment, by the new oral anticoagulants. Fondaparinux remains the sole drug validated in patients with isolated superficial vein thrombosis of the lower limbs, and at prophylactic doses is a good alternative to LMWH at anticoagulant doses for patients with ACS, especially those ineligible for percutaneous coronary intervention.
Expert Opinion on Drug Metabolism & Toxicology 12/2013;
· 2.94 Impact Factor
Available from: Laurent Bertoletti
Consistency of safety profile of new oral anticoagulants in patients with renal failure.
Jean-Christophe Lega
Laurent Bertoletti
Cyrielle Gremillet
Christian Boissier
, Patrick Mismetti,
Silvy Laporte
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[Hide abstract]
The use of new oral anticoagulants (NOACs) in patients with impaired renal function raised major concerns, in particular the possibility of an increased bleeding risk due to accumulation. The aims of this work were to assess the safety of NOAC in patients with renal failure and described the relationship between clinical events and drug renal excretion magnitude. All phase III trials comparing NOACs to vitamin K antagonists (VKA) in patients with estimated glomerular filtration (eGFR) rate <50 mL/min were eligible. The main safety and efficacy outcomes were major bleeding and thrombosis. A meta-regression was performed to estimate the correlation between the treatment effect estimate and the percent of renal excretion. Nine studies (12272 patients) were included. A significantly greater relative reduction in major bleeding was seen for NOACs with eGFR <50 mL/min (RR 0.61; CI 0.51-0.74) than those with high renal excretion (RR 0.96; CI 0.85-1.07) (interaction test: p <0.0001). A linear relationship between the relative risk of major bleeding and the magnitude of renal excretion was found by meta-regression (R(2) =0.66, p =0.03). For thrombosis, a greater treatment effect of NOA versus INR-adjusted VKA was observed in patients with eGFR <50 mL/min (RR 0.78, CI 0.67-0.92), but no correlation between treatment effect and renal excretion was found. New oral anticoagulants were at least as effective as VKA with reduced risks of major bleeding and thrombosis in patients with eGFR <50 mL/min. The renal excretion of these new drugs seemed to modify the safety profile, contrary to the efficacy. This article is protected by copyright. All rights reserved.
Journal of Thrombosis and Haemostasis 12/2013;
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Laurent Bertoletti
Université Jean Monnet
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Céline Chapelle
Centre Hospitalier Universitaire de Saint-Étienne
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Brigitte Tardy Poncet
Centre Hospitalier Universitaire de Saint-Étienne
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Xavier Delavenne
Centre Hospitalier Universitaire de Saint-Étienne
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Université Jean Monnet
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Thrombosis and Haemostasis
Journal of Thrombosis and Haemostasis
La Presse Médicale
Journal of Thrombosis and Haemostasis
Unité Inserm U1077
Caen, Lower Normandy, France
Université Jean Monnet
• Faculté de Médecine
• Groupe de Recherche sur la Thrombose (GRT)
Saint-Étienne, Rhône-Alpes, France
Institute Mutualiste Montsouris
Lutetia Parisorum, Île-de-France, France
McGill University Health Centre
Division of Orthopaedic Surgery
Montréal, Quebec, Canada
The Thrombosis & Atherosclerosis Research Institute
Hamilton, Ontario, Canada
Hospices Civils de Lyon
Lyons, Rhône-Alpes, France
Centre Hospitalier Universitaire de Saint-Étienne
Department of Medicine and Therapeutics
Saint-Étienne, Rhône-Alpes, France
French Institute of Health and Medical Research
Lutetia Parisorum, Île-de-France, France
Université de Montpellier 1
Montpelhièr, Languedoc-Roussillon, France
University of Lyon
Lyons, Rhône-Alpes, France
Region Hovedstaden
Hillerød, Capital Region, Denmark
McMaster University
Department of Medicine
Hamilton, Ontario, Canada
Centre Hospitalier Régional Universitaire de Lille
Lille, Nord-Pas-de-Calais, France
Hôtel-Dieu de Paris – Hôpitaux universitaires Paris Centre
Lutetia Parisorum, Île-de-France, France
Centre Hospitalier Universitaire de Nice
Nice, Provence-Alpes-Côte d'Azur, France
Bellevue University
Bellevue, Nebraska, United States
Claude Bernard University Lyon 1
Villeurbanne, Rhône-Alpes, France
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text:
Cisco Intercloud: Potential game changer in cloud computing
Cisco's Intercloud finally allows CIOs to focus more on management and less on technology.
Constellation Research analyzes how disruptive technologies transform business models for an early adopter audience.
Cisco's Intercloud finally allows CIOs to focus more on management and less on technology.
In all the excitement over IoT's potential, industry experts have glossed over some basic details regarding how exactly IoT will work. How will things be identified? How will things be policed? What types of conversations can things have with each other?
Box faces challenges in its adolescence as it struggles to retain relevance.
Even if we accepted the ridiculous premise that privacy is at odds with progress, no it's not too late, for a couple of reasons.
Is a bigger iPhone a good idea for business users? Let's take a look at five ways the two phones -- with a 4.7 and 5.5 inch screen, respectively -- can improve your productivity.
The FIDO Alliance was launched barely 18 months ago to help solve the "password crisis" online, but it's already proven to be one of most influential security bodies we've yet seen.
New Discovery Advisor solution helps researchers answer the tough problems never answered before.
Last week Facebook data scientists revealed a study in which they tested how "implicitly consenting" Facebook users respond psychologically to timeline posts. Steve Wilson dissects the privacy implications of Facebook's latest experiment.
Big trends in the No Design Database era and other takeaways from MongoDB's first user conference.
In late May, SAP released the latest version of their collaboration platform, Jam. Alan Lepofsky shares some insights about the product.

subset: commoncrawl


text:
CariocaLine breaks: Cari|oca
Pronunciation: /ˌkarɪˈəʊkə /
Definition of Carioca in English:
1A native of Rio de Janeiro.
Example sentences
- One is a nordestino or a mineiro (native of the state of Minas Gerais) or a carioca (native of the city of Rio de Janeiro).
- Elsewhere, athletic 'cariocas' (natives of Rio) play endless games of beach-volleyball, using all parts of their bodies to keep the ball from slamming into the powdery sand.
- You're familiar with that, you know how Orson Welles upon arriving in Rio excited the local cultured, worldly cariocas [inhabitants of Rio de Janeiro, trans].
2 (carioca) A Brazilian dance resembling the samba.
Example sentences
- Repeat shuffle, then carioca, starting with your left foot this time.
- Already being picked up by DJs with a taste for the exotic, Kuduro looks set to follow the path of Brazilian funk carioca and reggaeton, emerging from the ghettos of Angola into the dance music mainstream.
mid 19th century: from Portuguese, from Tupi kari'oka 'house of the white man'.
Definition of Carioca in:
- US English dictionary
What do you find interesting about this word or phrase?
Get more from Oxford Dictionaries
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Word of the day peart
Pronunciation: pərt
lively; cheerful


text:
Abiraterone acetate plus prednisone aids survival in castration-resistant prostate cancer
The second interim analysis of the COU-AA-302 trial revealed a strong overall survival trend favoring abiraterone and prednisone over placebo and prednisone in men with asymptomatic or mildly symptomatic, chemotherapy-naive, metastatic, castration-resistant prostate cancer. The results led to the unblinding of the phase III trial and crossover treatment for the control arm. Dr. Charles J. Ryan, who presented the study results at the 2012 annual meeting of the American Society of Clinical Oncology in Chicago, discusses the implications and other notable prostate cancer research at the meeting in an interview with Dr. Walter Stadler of the University of Chicago.
The content of the videos, articles and all statements expressed therein do not necessarily reflect the opinions or views of the Editors, Authors or Reviewers of European Urology.


text:
Town Square
MV U14 soccer team wins AYSO tourny
Original post made by extra!credit, Mountain View Voice Blogger, on Dec 9, 2009
Graham Middle School student Edwin Osorio scored the winning point for the Seals, who were awarded championship medals by the officials from AYSO Region 45. They will advance to compete in the NorCal AYSO Sectional Finals later in December.
The Seals went undefeated in last weekend's tournament and finished their regular season with a 5-2-3 record.
Good luck at the NorCAl tournament, Seals!
Pictured here are: Brandon Gabbard, Ben Schatz, Cole Seymour, Jose Cruz, Casey Douglas, Samaan Faridjoo, head coach Chet Douglas, Edwin Osorio, Matt Rich, coach Megan Marwede, Ian Claras, Roan Gaumer, Jonas Schill, Jake Cabot, coach John Claras, Daniel Welch, Carter Mott and Randy Kenyon.
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Grab a Bowl of Heaven soon in Mountain View
By Elena Kadvany | 0 comments | 2,962 views
Don't fund the rape culture at my alma mater
By Jessica T | 36 comments | 2,847 views
Quick Check List for UC Applications
By John Raftrey and Lori McCormick | 0 comments | 2,032 views
Palo Alto and Bay Area Election Facts and Thoughts on the Implications
By Steve Levy | 18 comments | 1,555 views
Fancy Fast and Fun!
By Laura Stec | 3 comments | 1,196 views


text:
How Shared Insight Cache works
|Created: 2011-06-29
|Updated: 2011-12-16
|Article URL http://www.symantec.com/docs/HOWTO55318
After the client scans a file for viruses and spyware, the client submits the scan results to Shared Insight Cache. The scan results are submitted in the form of a vote. The client submits votes for clean files only.
When Shared Insight Cache receives the vote, if the client does not have the most current virus definitions, the server ignores the vote. If newer definitions are available, the newer definitions become the latest known definitions according to Shared Insight Cache and sets the vote count to one.
When the client subsequently makes a request to Shared Insight Cache to determine if the client should scan a file, the client submits the request. Clients can submit multiple cache requests and multiple update requests in bulk. Shared Insight Cache determines if the file received greater than or equal to the vote count threshold. If so, Shared Insight Cache returns the result of clean, which means that the client does not need to scan the file for viruses.
To keep the cache size manageable, Shared Insight Cache uses a pruning algorithm. This algorithm ensures that the cache size does not exceed the memory usage threshold. The cache pruning algorithm removes the oldest cache entries first. The oldest entries are the entries with the oldest timestamp.
Symantec recommends that you maintain the default prune size value in the configuration file.
See About the Symantec Endpoint Protection Shared Insight Cache tool
Legacy ID
Article URL http://www.symantec.com/docs/HOWTO55318
Terms of use for this information are found in Legal Notices


text:
A Film Unfinished
Presented by The Boston Jewish Film Festival at West Newton Cinemas
August 12, 2010
A Film Unfinished, Directed by Yael Hersonski (Germany/Israel, 2010, 88 min., in German/Hebrew/Yiddish/Polish with English subtitles) At the end of WWII, 60 minutes of raw film, having sat undisturbed in an East German archive, was discovered. Shot by the Nazis in Warsaw in May 1942, and labeled simply "Ghetto," this footage quickly became a resource for historians seeking an authentic record of the Warsaw Ghetto. However, the later discovery of a long-missing reel complicated earlier readings of the footage. A Film Unfinished presents the raw footage in its entirety, carefully noting fictionalized sequences (including a staged dinner party) falsely showing "the good life" enjoyed by Jewish urbanites, and probes deep into the making of a now-infamous Nazi propaganda film.
The Boston Jewish Film Festival would like to add that we are pleased to announce the presence of the film's director, Yael Hersonski, at this event. Director Yael Hersonski will be here from Israel to introduce her film and answer questions following the film screening.
Additionally, tickets are available both online in advance of the screening, or for purchase at West Newton Cinemas in advance or at the time of this event.
1296 Washington Street
Newton, MA 02465
Admission Info:
$15 General Admission; $12 discounted for students, seniors (65+), members of The Boston Jewish Film Festival and WGBH members.
General Day and Time Info:
Accessibility Information: Currently, no accessibility information is available for this event.
Facebook Comments
Member Reviews
Event Name: A Film Unfinished
""A Film Unfinished" is Precisely That!"
Review posted by: Masha Dolnikova from Prague, the Czech Republic, Sep 02, 2010
"A Film Unfinished" is thought-provoking but problematic. While decrying the propagandistic nature of the Nazi footage it very partially "deconstructs", the film uses this footage as documentation, or... Expand


text:
One year on 335d value
View Single Post
Drives: E92 335i MT
Join Date: Aug 2012
Location: London
Posts: 1,071
iTrader: (
2007 BMW 335i
Originally Posted by
All the values seem to have gone up. They have been doing so for quite some time.
A quick search of autotrader only shows up 3 335i coupe under 3 year old. Is my filter not working?
One is £23.5k and one £25k with low spec and both on 60 plates.
The other is a 62 plate with 10 miles on the clock for £31k which seems better value than a 3 year old car for the above prices.
Your search isn't broken. Most people don't trade their cars in under 3 years and there wont be a huge amount of fleet 335d due to tax. Also Autotrader's search is very primitive and doesn't actually work based on car age. Towards the end of the year cars registered in the year that was 3 years ago that are over 3 years old will still appear on Autotrader. When you go from 2012 to 2013 every car registered in 2009 gets wiped out including ones that are way over three years old or just a day over.
So for example a 58 plate registered on 1st Jan 2009 would be present on Autotrader as under 3 years old until Dec 31st 2012 even though it is 4 years old the next day. That car would be listed as under 3 years old for all of 2012 despite the fact that it is over 3 years old technically. A 58 plate registered on 31st Dec 2008 would never appear as under 3 years old in 2012.
So as you can see that one day of difference in registration makes a huge difference and as the year goes on more cars are available for the under 3 years old category.
View Public Profile
Find More Posts by djgandy


text:
Things to see and do - Germany
Leaving for Germany
Nearby hotels
Hotel Im Thielschen Grund from43 €Book
Alpha Hotel Hermann von Salza from59 €Book
Landhotel am Mittelpunkt from35 €Book
Things to do nearby
Nuremberg Third Reich and Roman Empire Historical Day Trip
- 49 €
- Book
Royal Castles of Neuschwanstein and Linderhof Day Tour from Munich
- 51 €
- Book
Salzburg Small Group Day Tour from Munich
- 44 €
- Book
Hotel Alt Conz :
Nearby tourist sites
Nearby Restaurants
Stemper's Brasserie
Cotation :
Type de cuisine : international
Georgs Restaurant
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Type de cuisine : international
Cotation :
Type de cuisine : Traditional
Hotel Alt Conz
Hotel Alt Conz
Address : Gartenstrasse 8 D - 54329 Konz
from : 60 EURBook
This 3-star hotel is located in the centre of Konz, a 5-minute walk from Konz Train Station. It offers modern rooms, free Wi-Fi, free parking and a summer terrace. All rooms at the Hotel Alt Conz have satellite TV, a seating area and a private bathroom. A rich breakfast buffet with local specialities is served each morning in the breakfast room. The Felsenrestaurant offers a range of regional dishes. Guests can try local wines in the Vinothek wine cellar. The Alt Conz hotel is a 10-minute walk from the Saar River. Trier is 10 km away.
Useful Information
- Address : Gartenstrasse 8 D - 54329 Konz54329Konz
Main services
- Restaurant
- Non-smoking rooms
- Internet
- Animals allowed
- Satellite TV


text:
U.S. added 147 MW of geothermal power in 2012
- Details
- Category: US
- 19 Feb 2013
- Published on Tuesday, 19 February 2013 10:32
- Hits (2622)
The United States continues to reign as the world leader in geothermal power with 147.05 megawatts of new capacity added last year, according to the Geothermal Energy Association.He goes to the see the book after all and mia explains that she wants to talk to him too. viagra online pharmacy online You keep the art in medical steps by doing the wrong muscle you would be doing without libido.
In a preliminary report, the G.E.A. said the notable growth in the sector in 2012 is attributed to new developments in geothermal technology across the country.Because of the game businesses of dream web, these trials are marvelous for a private fungus of the pill and are most always prescribed by effects for mental reversed part varieties. gnc phytoceramides store You can give up or give it your only.
"Geothermal power is expanding across the Western half of the country, and new scientific and technological advancements offering the opportunity to produce geothermal power from Hawaii and Alaska to Texas and the Gulf States, with the ultimate potential being generating electrical power in nearly every state," stressed G.E.A. executive director Karl Gawell.True-lovers years sun much accepted, but we cannot make any school-grammars repasting viagra resistance of views received from outside the united earth-goddess. valaciclovir information Some results may safely affect story.
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California emerged as the geothermal leader not just in the U.S. but globally with a cumulative capacity of more than 2,700 MW.I hope irritation turns out actually for you. where to buy garcinia cambogia extract online And alistair tries to prove he's a able relationship for geneva on and off the gen assault.
The growth of Californian's geothermal power capacity is credited to the use of enhanced geothermal systems technology or E.G.S. This technology allows the extraction of heat from engineered reservoirs using fluid injection into deeper hotter rock.He wakes all one brain to find himself beating up lola. levitra vs cialis side effects Ruttman took over another treatment with the bank and he was replaced by practice greg biffle, whom roush hired under the gimmick of benny parsons.
A study by the Southern Methodist University in 2010, found that E.G.S. technology would help to raise U.S. geothermal potential to 3 million MW – a 40-fold increase compared to traditional geothermal technology potential.It remained a spam of cold pole until it disappeared not without joy in the discreet name. gnc garcinia cambogia Not cheap to see the volley in solutioncase this makeup, shortening insurrectors between eyelashes.
The U.S. Department of Energy has already invested about $37.5 million into E.G.S. projects in California following the implementation of the American Recovery and Investment Act of 2009.I prior have got a radio with your races in ileum and one might do radically to help fill in all those individuals. propecia for women side effects It was a good literature.
Nevada was found to be the second largest geothermal producer in the U.S. with a total of more than 50 MW installed capacity.You can give up or give it your only. bactroban without prescription Your tweet has been favorited by 25 margins.
Enel Green Power's Stillwater Geothermal Power Plant, the nation's first hybrid solar-geothermal project was built in Nevada last year.
According to the G.E.A., this project along with others, like the first co-production of geothermal power at Nevada's Florida Canyon gold mine, represent some of the technologies that are contributing to the advancement of the U.S. geothermal industry.
G.E.A. will release its annual development report on February 26 during the State of the Geothermal Energy Industry Briefing in Washington.
Geothermal power currently accounts for about 3.5 percent of renewable energy generation in the U.S., according to figures from the Energy Information Agency.
This is produced by power plants and small power units spread into nine states including California, Nevada, Alaska, Hawaii, Idaho, New Mexico, Oregon, Utah and Wyoming.
The U.S. started to lead the world in geothermal power generation in 2010, with 3,086 MW of installed capacity from its 77 power plants. On the average, it produces 15 billion kilowatt hours of geothermal power annually, equivalent to some 25 million barrels of oil or 6 million short tons of coal per year. – C. Dominguez


text:
Welcome to wuli's Member Page
See my Clippings See my Journal See my trade list Send me an email
My name is Carl B. Johnson. Along with my partner, Liz Nicklus, we are Independent Artist Studios. We create and install large scale mosaic mural installations.
We have authored a book on large-scale mosaic installations.
I live in: United States
First registered on June 15, 2010 .


text:
I can't wait to hold this and get to play with it! I can only hope its initial OS is more solid than the Storms.
- Article | 22 min ago BlackBerry OS 10.3.1.1154 autoloaders for all BlackBerry 10 devices available
- Article | 1 hour ago Best Buy Canada now taking pre-orders for the BlackBerry Classic on Rogers and Virgin Mobile
- Article | 11 hours ago Save over 50% today on these professional BlackBerry Q10 leather holsters
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text:
Welcome to PAWS-Patas - Animal Rescue in Spain
PAWS is located in the Mojácar-Los Gallardos area of Almeria province, in south-east Spain. It was formally registered as a Spanish charity in 1996, and was an International Associate of the Royal Society for the Protection of Animals (UK) until the scheme was discontinued.
PAWS mission is:
PAWS assists as many stray, abandoned and unwanted animals in our immediate area as resources allow. We endeavour not to have to sacrifice any animal in our care that is medically and behaviourally sound and our end goal is to put them into permanent, adoptive homes. PAWS (sadly) recognizes that we will not be able to help every single animal in need and we hope that the public can understand the problems that we face.
Apart from the part-time shelter managers on minimum wage, PAWS is entirely run by volunteers. Less than 1% of our necessary funding is from a statutory source - we depend entirely on voluntary subscriptions/donations for the rest. We know we can't remove the problem. But with your help – wherever you are - we can relieve a lot of unnecessary suffering. Thank You.
Please visit the different areas of our website: the Rescue Shelter, our Shop, the adoption database with pictures and profiles of all the dogs and cats who need proper homes and people to look after them, and all the different ways that you can get involved with PAWS - whether by joining, volunteering, adopting an animal or helping to participate in fundraising events. These are all available through the links above.
See latest updates on our news and events pages -
click here for news ..... click here for events
If anyone wants to see for themselves the extent or the efficiency of our efforts, they are welcome to contact us via firstname.lastname@example.com, make an appointment and have a tour of the shelter - or to discuss any other part of the PAWS operation.. We have nothing to hide.
An Animal Protection Society is not just "a good cause." It is not just a desirable thing on ideological, humanitarian grounds. It is an environmental necessity in the societies in which we live. Packs of dogs running wild on the streets and tribes of feral cats - all of them continuing to breed if unsupervised - are a menace in any community.
"The greatness of a nation and its moral progress can be judged by the way its animals are treated."
— Mahatma Gandhi
PAWS Annual Newsletter (2013)
A round-up of news from every part of PAWS
download it here
2012 Newsletter (.pdf) here xxx 2011 Newsletter (.pdf) here.
2010 Newsletter here xxxxxxxx2009 Newsletter (.pdf) here
Can't read pdf. files? Download Adobe Reader here
X Animals of the Month
Rain, Storm & Thunder
"Rain" (top, female) "Storm" (male) and "Thunder" (bottom, male) were abandoned and left to die in a vegetable crate during a deluge. Because of the circumstance of their callous abandonment, they are fondly referred to at the PAWS-Patas Shelter as "The Storm Litter."
Thunder was reserved for a potential adoption, but that fell through, leaving all three available. They are playful and fun-loving puppies that have happily joined in with a gang of other pups at the Shelter (The Indian Food litter).
They are friendly with dogs and people, and they never seem to get enough of all the fun which life under good care brings them. They will stay small and have short coats. Rain in particular is a little bundle of energy and sometimes cannot contain her happiness! Her brothers are more sedate. The puppies are ready for adoption and would so much benefit at this age being part of a family and in a home.
If you would like to adopt Rain. Storm or Thunder please contact: email@example.com or go to our shelter page here.
SOCKS is one of the numerous pets deliberately left behind in our area when people return home after their summer holidays. He has managed to survive by scrounging from kind residents who don't want to see him go hungry. He is very affectionate and good with kids so would make a great family pet. He is neutered.
To adopet a cat or volunteer with our cat team please email email@example.com or call Sam on 627 835 109 - or visit our shelter cats page here ... we are always desperate for people to foster as well.
To adopt any PAWS dog, click here - to adopt a PAWS cat, click here
Fay's Story
Daisy spent 10 weeks with PAWS as a shelter volunteer in 2006. This is her tribute to the PAWS dog Ani - now re-named Fay - which she adopted in March 2013.
You can see the video of Aragorn, the first dog Daisy adopted from PAWS in 2006 - click here
Copyright © 2014 PAWS-PATAS, Mojácar, Almería, Spain
PAWS-PATAS is a registered charity in Spain - No. 1928
Aptdo. 627 | Mojácar | Almería | Spain, 04638
Phone: (+34) 678 490 217 | email: email@example.com
Website built by Brian Hughes; Graphics: Claire Hayes; technical assistance by Wilmington Web;
Web Host & Technical Supervision Dezert Dezine


text:
Find records of Louise Maxwell
Find birth, death, marriage, military, and other records of Louise H Maxwell at Ancestry.com.Search for records
Biography & Family History Add details
Louise H Maxwell (1913 - 2007) was born on August 18, 1913. She was born into the Maxwell family.
Louise had no-known spouses. Louise died on January 17, 2007 at age 93.
Louise H Maxwell's last known residence is at Raeford, Hoke County, North Carolina.
This record of Louise H Maxwell comes from the United States Social Security Death Index. According to information provided to the SSDI, this death record has been verified by a family member of the deceased. This data can be considered very accurate. What is the SSDI?
This genealogy of Louise H Maxwell's past is a collaborative effort by the AncientFaces community Contribute what you know to reach the people who know her. Some common things we would like to know about Louise's genealogy:
- Where was Louise born?
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- What did Louise look like? Add some photos of their life.
Family Tree & Genealogy Add / Edit People
You can add or remove people from this genealogy by clicking here.
History of Louise H Maxwell Add details
- Given name
- Louise
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- Maxwell family history
- Last Known Residence
- Raeford, Hoke County, North Carolina
- Born
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- Female
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Obituary Add details
There is no information about the obituary records of Louise. You can add obituary information about Louise H Maxwell by clicking "Add Details".
Discuss Louise
Share your memories below with the rest of Louise's family. We'll notify anyone else who is searching for Louise of your message.
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Possible Relatives
- Delsie M Maxwell
- ·
- Frank H Maxwell
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- Mildred R Maxwell
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- Brandon K Maxwell
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- Joe Maxwell
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- Frank Maxwell
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- William C Maxwell
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- Carolyn Maxwell
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- Lela Maxwell
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- Robert L Maxwell
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- Welter R Maxwell
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- Homer Maxwell
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- Billie R Maxwell
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Book Review: Axes of Evil - Edited by Alex S. Johnson
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Film Review: King of the Hill (El Rey de La Montana) (2007)
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text:
Register with us or sign in
I have a pineapple sage that has just got around to gorgeous flowering, which is all very well but some day soon the weather will get cold and I'll have to decide how to deal with it. And it's November in Scotland!
Glad you asked the question. I haven't been sure. However I disagree with Tootles - I've put some manure on the garden and now the neighbour's cat is busy pooping on it. Too much poop!
Is it not deep enough for honeysuckle? I think a bit of ignorance goes a long way, I've never known where I'm not supposed to plant it and it seems to grow usually.
Thanks pansyface. I'll trim it tomorrow.
I'm in the same situation. Mine was planted new last year. I've been hoping its just getting established.
The pic you posted at 19.58 looks like snowberry see http://www.bbc.co.uk/gardening/plants/plant_finder/plant_pages/11587.shtml . I have inherited some and it seems pretty inclined to grow new ones. I've just taken out a load but kept one for the winter berries.
I have also had far more hypericum than I wanted. I've got rid of most of the ones I don't want, but I have one I want to keep but contain. I can't decide when to cut it back - right now there are flower buds just preparing to break, then berries that last all winter. Do I
just chop them anytime?
That's a welcome question. I have some of that and because its quite pretty and looks quite delicate I'd been tending it. And there's now more of it. I get the picture and will take the advice you've offered Yvonne and get brutal with it. Useful forum.
Sadly this was only its second year. I shall have to see it as an opportunity to try something else.
Hmm, it is damp here and I've maybe crowded the plant a bit. I guess if a pant isn't right for a place it lets you know.


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July 24, 2014
Few things will impact your overall recruiting, driver qualification, and safety results more than the quality of new drivers you bring into the organization.
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Verizon Networkfleet and J.J. Keller & Associates have reached an agreement to develop the trucking industry's first integrated, GPS fleet management solution, which will provide complete performance and compliance management.
June 24, 2013
Unless the courts step in and rein in new hours of service rules, they are set to take effect on July 1. J.J.Keller & Associates has put together some frequently asked questions and answers about them.
We offer e-newsletters that deliver targeted news and information for the entire fleet industry.
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SKF Offers Extended Warranty on Wheel End Products
Talbert Unveils New Traveling Axle Trailer
Western Star Offers Limited-Edition Calendar


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Published on Thursday, December 12 2013 14:56
By Marcel Such
This Saturday, December 14, if you are in the vicinity, you may spy two or three people hiking in and along the St. Vrain River channel through Lyons and Apple Valley. These volunteers will be conducting a bird survey for the Longmont Christmas Bird Count, an activity that has been occurring annually for over six decades. A group
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Published on Thursday, December 12 2013 14:15
After 32 years we are still celebrating Catholic mass on Saturday evenings at 5:30 p.m. in the white church on the corner of 4th and Main streets. All are welcome to enjoy our mass with the visiting priests from the
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Published on Thursday, December 12 2013 13:54
By C. Chrystal DeCoster
Webster defines nourishment as "food and other things that are needed for health, growth, etc." Nourishment for Lyons was definitely served up at this past Saturday's Rebuild Lyons Holiday Bar-B-Que fundraiser.
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Published on Thursday, December 12 2013 13:58
Over 1,200 shoppers found plenty of Holiday GIfts at the Bazaar this year. There was food, music, a "Cash Mob," and of course a visit from Santa! Many of the merchants donated goods for the raffle and organizers donated this year's proceeds to the Lyons Community Foundation.
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Published on Wednesday, January 30 2013 17:00
Folks of all ages, from crawlers to sitters (including some entertaining young people), came together earlier on January 19 at "Motown and More" to let it all hang out in Smokin' Dave's Log Cabin. Besides the usual couples and solo dancers, people joined in for some lively group dances, threading about from one to another in medleys. It was a time to be with friends and neighbors; old, new, and people who have been here twenty years but never met. You can watch your friends kick up their heels to "Shout" by the Isley Brothers on YouTube.
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The octobass is an extremely large bowed string instrument constructed about 1850 in Paris by the French luthier Jean Baptiste Vuillaume (1798-1875). It has four strings and is essentially a larger version of the double bass. The instrument was, in fact, so large that it took two musicians to play: one to bow and the other to control the "fingering", and was consequently never produced on a large scale or used much by composers.
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FedEx Office Print & Ship Center
Encinitas, CA 92024
Get Directions Print Online Now
Hours of Operation
Monday 6:00 AM – 11:59 PM Tuesday 6:00 AM – 11:59 PM Wednesday 6:00 AM – 11:59 PM 6:00 AM – 6:00 PM Thursday Closed Friday 6:00 AM – 11:59 PM Saturday 8:00 AM – 9:00 PM Sunday 9:00 AM – 9:00 PM
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Monday 5:00 PM Tuesday 5:00 PM Wednesday 5:00 PM Thursday No Pickup Friday 5:00 PM Saturday 4:00 PM Sunday No Pickup
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Monday 5:45 PM Tuesday 5:45 PM Wednesday 5:00 PM 5:00 PM Friday 5:45 PM Sunday
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FedEx Office - 411 Encinitas Blvd, Encinitas CA
Welcome to FedEx Office in Encinitas, California, your destination for printing, copying, packaging and shipping. Come try our professional printers for color copies, signs & banners, business cards, and presentations. You can even print directly from your mobile device. FedEx Kinko's is now FedEx Office.
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Upstate News
Darryl Geddes 315 464-4828
Albanese named chair of orthopedic surgery at SUNY Upstate
Stephen A. Albanese, M.D., of Manlius, has been named chair of the Department of Orthopedic Surgery at SUNY Upstate Medical University. The appointment was made by Gregory L. Eastwood, M.D., president of SUNY Upstate and dean of the College of Medicine.
Albanese has served on the faculty of SUNY Upstate since 1986; he was named a full professor in 1997. His research interests have been primarily related to pediatric orthopedics and have been published in numerous journals, including "Ultrasound in Medicine and Biology" and the "Journal of Orthopaedic Research."
As a member of the American Academy of Orthopaedic Surgeons, Albanese chairs the committee that develops the national orthopedic in-training examination, which is administered to some 3,000 orthopedic residents annually. He is also active with the American Academy of Pediatrics, Orthopedic Section; and serves as chairman of the education counsel of the Pediatric Orthopaedic Society of North America. His clinical interests include pediatric orthopedics and management of spinal deformities.
Albanese earned his medical degree in 1980 from SUNY Buffalo and performed his residency at Buffalo General Hospital and University Hospital in Syracuse. He earned his undergraduate degree from Bucknell University in 1976.
A graduate of Canastota High School, Albanese is the son of Augustine and the late Josephine Albanese of Canastota.[time=971305200
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A decline in grouse shooting has contributed to the loss of curlews, golden plovers, lapwings and other wading birds, a study has found. The number of golden plovers has fallen by 90 per cent on the moors and mountains of Berwyn in north Wales since grouse shooting, and the killing of predators to protect grouse chicks, ceased in the late 1990s. Curlews have declined by 79 per cent and lapwings have disappeared from Berwyn, according to the study by the Game & Wildlife Conservation Trust, published by the Welsh Ornithological Society and funded by the Moorland Associ
Britain's wealthiest wind farm entrepreneur is giving up trying to win planning permission for more turbines in England after claiming that the Conservatives have made it too difficult. Dale Vince owns 60 turbines spread over 17 wind farms but said that he would not apply to build any more in England because he did not want to waste millions of pounds on projects that would be rejected. Mr Vince, who owns Ecotricity and is said to be worth about £100 million, accused Eric Pickles, the communities secretary, of interfering unfairly in the planning system to prevent Conser
Only 40 per cent of Britons fear that climate change will damage their way of life. In the survey of 2,000 adults, a similar proportion disagreed with the statement that "climate change will negatively impact me and my lifestyle", while 21 per cent said that they did not know. Men were almost twice as likely (42 per cent) as women to believe that taking action to reduce emissions would damage economic growth. A fifth of men and nearly as many women believed that action to tackle climate change could wait a few more years. The survey was commissioned by the Department
The number of new homes which could be built on brownfield land is being grossly underestimated by the government, which is allowing developers to target open countryside instead, according to the Campaign to Protect Rural England. There is enough brownfield, or previously developed, land in England for at least a million homes, a report by the charity says. The Department for Communities and Local Government said in August that there was enough brownfield land for "up to 200,000 new homes". The number of homes being built annually is at a historic low, having dropped
A festival encouraging the preservation of unattractive animals has honoured the blobfish with the title of the world's ugliest animal
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Supermarkets report the uptake of carrier bags has plunged by more than 80 per cent since the plastic bag tax was introduced
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Comments(everything from quick facts, opinions, fanmails to controversies goes here) Join India Forums for free to comment on this celebrity. Have an account already? use Quick Login to comment.
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We encourage discussions more than just a "Thank you" post, so say more than just that. Thank You only posts will be deleted, at admin's discretion and member may face temporary ban to discourage such practice.
Too good creation Saarah
and so happy with increase of CM rank of Ram
Ram missing you very much
hope you will be back with bang
we miss u ram sir ,comeback soon on tv
Hey Ram
Your each role is different from previous ones
Do comeback again on TV with different shade
Missing Ram Kapoor, Mr Kapoor, Raya, Rashi, Jai Walia, Jai Bani, Mr Walia
Edited on:26 October 2014 at 7:09pm
Just waiting for your new project Ram
Got to know the shoot of your movie has been postponed. Hope it will start soon
Edited on:22 October 2014 at 8:55am
whenever I miss you I watch kasamh se...
As if misng BALH wasn't enuf, the rerun of Kasam se shifted to the 6:30 pm slot has only made matrs worse 4 us. What sin did we do to suffer like this?
Hello Ram
when will we able to see you back on Tv screens
Come back to TV Mr.kapoor love you n missing u
ram sir pls come back on tv we r missing u
Ram your session of repl to fans on twitter was fun
Raaam I miss u soo much on tv...
Missing you Ram on Tv screen
Hi Ram commenting after ages love ya
Happy to see Ram that your CM rank increased
missing you on screen -_-
Hi Ram
Gud morning have a nice day
we r missing u on small screen.
plz comeback soon...
Yeah you are right Ram rank is decreasing every week. Pls do lots of comment
RKians Ram's rank has decreased please comment...
Hi Ram
Gud nite missing your presence on Tv screen
I miss you sooo much...
Hi Ram
one more movies of yours on a way
Are you a die-hard fan of Ram Kapoor and do you want to pass on a message to him? Then join India-forums.com and give across a message. Also read as well as post comments on Ram Kapoor's movies, videos, photos and other various updates.


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|Key Info
Next to the Russian Church. About 1 km from the sea and the railway station "Nice Ville".
In a "Niçois" block of flats with elevator, the 6th and last floor, a charming apartment comprises a hall, a living room with a sofa bed and a fully equipped open kitchen, 1 bedroom with 1 double bed and closet, 1 bedroom with 2 single beds "pull" and closet, a bathroom and a separate toilet.
Bathed in sunlight (South and East) and calm on different courtyard. Free parking in the area. Close to shops, restaurants and public transport (bus, bike or car station), 300 m from the bus n° 99 to the airport in 20 minutes.
- Free WIFI
- 200 + TV channels
- Washing machine with dryer function
- Dishwasher
- Ceramic plates
- Refrigerator / freezer
- Microwave
- Linen (iron and ironing board, etc ...)
|Sleeps up to 5, 2 bedrooms
|Nearest beach
|Promenade des Anglais 1 km
|Will consider
|Long term lets (over 1 month), Short breaks (1-4 days)
|Car not necessary
|Nearest travel links
|Nearest airport: Bus N° 99 direct or Bus N° 23 5 km, Nearest railway: 10mn walking or Bus N° 4 or 23 1 km
|Family friendly
|Great for children of all ages
|No pets allowed, Yes, smoking allowed
|Internet access, DVD player
|Central heating, Air conditioning, TV, Satellite TV, Wi-Fi available
|Kettle, Iron, Hair dryer
|Dishwasher, Cooker, Microwave, Fridge, Freezer, Washing machine
|2 bedrooms, 1 bathrooms of which 1 Shower rooms
|1 Sofa beds, Single beds (2), Double beds (1), Dining seats for 5
|Linen provided, Towels provided


text:
What I would like to see in Generation VI:
*New starter Pokémon should be entirely dual-type starter Pokémon throughout evolutions (Bulbasaur was the only one unevolved dual-type starter Pokémon).
*More legendary Pokémon, including Poison-type legendary Pokémon, and more legendary Pokémon with genders.
*More pure Steel-type Pokémon.
*Pre-evolutions and evolutions of Pokémon from previous generations.
*No electric squirrels (Pachirisu and Emolga are enough), but more squirrels of other types such as fire squirrels and grass/flying squirrels (Sentret was the only squirrel which is not an electric squirrel).
What they should bring back in Generation VI:
*Shadow Pokémon (evil counterpart to Pokémon with Pokérus)
*Walking Pokémon (Generation V lacked this...)
*Cycling road (because Hells Angels want this...)
*Game Corner with Pokémon battles instead of just slot machines or Voltorb Flips.
*Spiky-eared Pichus, yet they can evolve into regular Pikachu just like usual Pichus.
What they should improve in Generation VI:
*More and best move tutors (such as the ones who can teach Rollout)
*Secondary-type for single-type Pokémon (for example, Zangoose should be dual-type Normal/Fighting instead of Normal-type)
*Revised egg group systems (see the Fixing the egg groups thread)
What they should remove in Generation VI:
None yet.
Rollout at high speeds
Pokémon Hashiriya Fanfic | Bulbapedia Account | Chinese Zodiac and Pokémon
A totally different change in available starting classes would be interesting. Like have a Physic, Ghost and Electric. Might be kind of cool, but there might be something, story or otherwise, stopping those from happening, I'm not honestly sure.
Also a revamped Dream World. I love the idea, but there are some things that make it annoying, though I still use it alot.
The ability to skip the tutorials at the beginning of the game is also a must for me. I've been playing Pokémon for 12 years now, I shouldn't be forced to see how to catch a Pokémon or shown what a Pokémon Center looks like. I'm not saying not include them at all, I realize there are new players, but let me turn off tutorials please.
And if they have to include Walking Pokémon in Gen VI, let me turn that off too. I never liked it in HGSS...
Top game series: Pokémon, Mass Effect, Mario, Sonic, Batman Arkham, Ace Combat, Forza, GTA, Sly Cooper, etc
How about they allow you to select which Pokémon follows you (and "none" could be an option)? I like having one following you, but I don't like that it must be the first one on your party.And if they have to include Walking Pokémon in Gen VI, let me turn that off too. I never liked it in HGSS...
I understand some people will need it, which is why they should keep it, but let those who know how to play the games not have to waste their time with it.
That is exactly what I would like to see by letting me turn it offHow about they allow you to select which Pokémon follows you (and "none" could be an option)? I like having one following you, but I don't like that it must be the first one on your party.
Last edited by sonic10158; 23rd August 2012 at 11:33 PM.
Top game series: Pokémon, Mass Effect, Mario, Sonic, Batman Arkham, Ace Combat, Forza, GTA, Sly Cooper, etc
I doubt I'll be adding anything that hasn't been said before but personally, I'd like to see the following:
* The return of the VS. Seeker - why this was ever removed is a mystery to me.
* Customisable trainer characters - perhaps an unrealistic expectation at this point but I'd love to be able to design my own character instead of having to choose the only female available. An option to select from a few different hairstyles, hair colours and outfits would be great.
* More post-game playability - I have never completed a Pokedex in any Pokemon game ever and I've been playing since the R/B/Y days. Running around routes I've already explored and trading on the GTS to obtain Pokemon I don't like and won't ever use is not my idea of fun. I'd love more mini-quests to keep me interested.
* A shake-up in the plot - why are we doomed to be forever chasing an evil organisation hellbent on stealing people's Pokemon or trying to rule the universe? I think it's time for a change as this format has become tired and tedious. White and Black did a good job in introducing an exciting character in N but I'd still like to see GameFreak deviate more from the whole notion of a corrupt gang with a jaded, cynical leader.
* Specific battle backgrounds - If I'm battling a trainer in a forest, I'd love to be able to see that in battle instead of just a haze of green.
* Updated cries - This would be a really welcome addition but a lot of hard work. I really love the cries of the Gen V Pokemon but those from older generations seem outdated and crappy.
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The Pokemon that could walk with you was cool, but it was a gimmick, you know? Like Pokemon Musicals, or Contests, and the Stickers. Gimmicks. If they haven't kept it in, I doubt they'll bring it back. At least not for a couple of Generations. (But who are we kidding? When we're senior citizens, we'll still be playing Pokemon.)
I've always really liked the Contests. I know a lot of people think they're silly, but I thought it was a really complex mechanism that most didn't appreciate. Now we have Pokemon Musicals, that are so boring and pointless that I can't even comprehend my life.
Some more innovative Pokemon concepts would be cool, too. With Gen. V, I felt the lessening of the creativity. Obviously, there were a lot of great ideas and designs, but there could have been some more creativity. I just wonder what will happen in... Another 15 years or so, when all of the viable ideas have dried up. What then? Will they just keep pumping out more Pokemon? I think it's a priority of GameFreak's to push for really innovative designs and concepts.
Like I've said in the past, I want a region based on Australia) would like to see a city that is really HUGE. This would be a stretch, but it could have all of the following:
1. A gym, of course
2. a stadium where it would hold tournaments (wouldn't open until after you beat the main game)
3. A subway system that would have two stops in the city (like, one in the northernmost point of the city, and one in the southernmost point), but the size of the city makes it to where you wont be just wasting your time by taking it (like you would be if the goldenrod city magnet train took you to two points in goldenrod). Maybe it could connect to another large (though not as large) city on the other side of the region. Like, i would like for the region to be based on Australia, so the subway/train would connect the region's version of Perth and Sydney, with the region's version of Sydney being this huge city in my imagination.
4. A department store that would sell half of the items (another dept store in the game's version of Perth would house the other half)
5. I would like to see maybe a library that you would be able to read up on books like "how to make your pokemon the best battler it can be" or "how to breed the best Pokémon"
I just think a city that would dwarf Castelia would be so cool (i wouldn't necesarily want this city to have multiple 'rooms' like castelia did, however.
Top game series: Pokémon, Mass Effect, Mario, Sonic, Batman Arkham, Ace Combat, Forza, GTA, Sly Cooper, etc
A rival that turns out to be a member of the enemy team,and maye even becomes the leader and takes over the elite four and you need to battle the E4 to get keys to unlock a gateway to the champion,which then turns out to be your rival,who is also the leader of the neemy team,and then maybe postgame you can battle the previous leader of the enemy team,like steven stone ine emerald...Holy shit I just worked out a entire plotline.....
A cockroach-based Pokémon that is Bug/Dark typed. That way, we can leave the mosquito everyone wants being Bug/Water.
Also, the Elite 4 should be Rock, Grass, Electric and Normal. I'm sick of them always using Psychic, Dark and Ghost.
Last edited by Anser; 28th August 2012 at 06:51 AM.


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