ALBERT

Description: The Cooperative Biological Engagement Program partners with about 20 countries in different regions around the world and works with them to address diverse threats to international security. This report describes a project to develop a comprehensive evaluation framework and recommends metrics for assessing and communicating progress toward the program’s goals.

Description: How can the U.S. Department of Defense increase the effectiveness of its efforts to help partners build the capacity of their military and other security forces? To form a base of evidence to inform policy discussions and investment decisions, a RAND study collected and compared 20 years of data on 29 historical case studies of U.S. involvement in building partner capacity.

Description: This report chronicles intelligence community efforts over more than half a decade to improve community-wide workforce planning and management. As decisionmakers look ahead to an era of constrained budgets, they must avoid repeating earlier workforce planning mistakes because the consequences of such mistakes can be long lasting. The tools described will help decisionmakers maintain workforce capabilities as budgets decline.

Description: Over the past decade, especially, U.S. Marine Corps (USMC) intelligence has had to tailor its organization to meet the evolving demands of the operational environment. This has resulted in a number of ad hoc arrangements, practices, and organizations. A broad review of the organizational design of USMC intelligence examined how to align it efficiently and effectively with current and future missions and functions.

Description: Background: Non-coding RNAs (ncRNAs) are key regulatory elements that control a wide range of cellular processes in all bacteria in which they have been studied. Taking advantage of recent technological innovations, we set out to fully explore the ncRNA potential of the multicellular, antibiotic-producing Streptomyces bacteria. Results: Using a comparative RNA sequencing analysis of three divergent model streptomycetes (S. coelicolor, S. avermitilis and S. venezuelae), we discovered hundreds of novel cis-antisense RNAs and intergenic small RNAs (sRNAs). We identified a ubiquitous antisense RNA species that arose from the overlapping transcription of convergently-oriented genes; we termed these RNA species 'cutoRNAs', for convergent untranslated overlapping RNAs. Conservation between different classes of ncRNAs varied greatly, with sRNAs being more conserved than antisense RNAs. Many species-specific ncRNAs, including many distinct cutoRNA pairs, were located within antibiotic biosynthetic clusters, including the actinorhodin, undecylprodigiosin, and coelimycin clusters of S. coelicolor, the chloramphenicol cluster of S. venezuelae, and the avermectin cluster of S. avermitilis. Conclusions: These findings indicate that ncRNAs, including a novel class of antisense RNA, may exert a previously unrecognized level of regulatory control over antibiotic production in these bacteria. Collectively, this work has dramatically expanded the ncRNA repertoire of three Streptomyces species and has established a critical foundation from which to investigate ncRNA function in this medically and industrially important bacterial genus.

Description: Journal of the American Chemical Society DOI: 10.1021/jacs.5b00620

Description: Introduction Rivaroxaban, an oral anti-Xa inhibitor, was approved in 2008 in Canada for prevention of venous thromboembolism (VTE) post elective total hip replacement (THR). Studies completed in elective THR patients showed superiority or noninferiority of rivaroxaban over injectable low molecular weight heparin (LMWH) for prevention of VTE, with no difference in trial defined major bleeding. Many centres use rivaroxaban for VTE prevention post THR as standard of care. Our centre introduced rivaroxaban for THR patients in May 2009. As there is limited data on real world experience with this agent, beyond bleeding and VTE events, we evaluated the change in VTE prophylaxis for this indication. Methods A retrospective cohort study was completed comparing the change in use of a LMWH, enoxaparin, to rivaroxaban for VTE prophylaxis for elective THR patients ≥ 19 years not requiring therapeutic anticoagulation. The setting was a regional health authority servicing a population of 290 000, and the timeframe was 18 months before and 18 months after the introduction of rivaroxaban, allowing a 3 month period in between for incorporation of rivaroxaban into routine care. Patients with THR completed pre introduction of rivaroxaban were in the enoxaparin (E) group and patients with THR completed post introduction were in either the enoxaparin and rivaroxaban (E+R, given sequentially) group, or the rivaroxaban (R) group. Data were abstracted from computerized and paper records using a standardized form. Data collected included demographics, medical and medication history, risk factors for bleeding and VTE, type of anesthesia, VTE prophylaxis details, post-discharge community health (CH) nursing visits and hospital visits (emergency room (ER) and inpatient admissions), and major bleeding or VTE events. Hospital visits and VTE were assessed up to 30 days, and major bleeding up to 2 days, after the last presumed dose of medication. Primary outcomes were differences between E, E+R, and R in hospital visits, as well as referrals to, and reasons for, post discharge CH nursing visits. Results There were 246 THR procedures in E, 43 in E+R, and 190 in R. Baseline characteristics were similar between the three groups. For E, E+R, R, 52%, 49% and 53% were female with a mean age of 64, 62, 64 years and a mean BMI of 31, 32, 31 kg/m2. There was no difference in surgery duration (mean 92, 97, 91 min for E, E+R, R), or number of patients transfused (19, 16, 14% for E, E+R, R). More patients (74%) in E+R received regional anesthesia exclusively, compared to E (57%) and R (52%), p=0.01. There was no difference in post-surgery time to VTE prophylaxis initiation (mean of 22, 22, 23 hours for E, E+R, R). There was a difference in the length of stay (mean 7.1, 8.4, 6.3 days for E, E+R, R, p=0.005), as well as total duration of prophylaxis (mean 10.4, 16.1, 14.5 days for E, E+R, R, p

Description: Background: A recognized complication of exposure to heparin is the development of heparin-induced thrombocytopenia (HIT) and heparin-induced thrombocytopenia with thrombosis (HITT). The frequency of HIT in patients exposed to unfractionated heparin (UFH) is higher than those exposed to low-molecular-weight heparin (LMWH). Where the use of unfractionated heparin is not necessary, HIT may be largely preventable by using LMWH rather than UFH on an institution-wide scale. At our institution, UFH was largely substituted by the LMWH for thromboprophylaxis gradually throughout 2014 with the implementation of the venous thromboembolism (VTE) thromboprophylaxis protocols. The VTE thromboprophylaxis protocols had their final implementation at the beginning of 2015. Objectives: - To determine the incidence of HIT and HITT before and after the implementation of the VTE thromboprophylaxis protocols within Eastern Health. - ACP Learning Objective: Educate learners about the risk of using UFH as well as alternative treatment for DVT prophylaxis (LMWH). Methods: Charts of all patients who had HIT screening assays requested between January 1, 2012 and December 31, 2017 were examined to determine which patients went on to have positive screening assays as well as positive confirmatory testing. The type of heparin which the patient was exposed was recorded, the sequelae of HITT within 30 days of medication exposure, as well as the correlation of these findings with the implementation of the VTE thromboprophylaxis protocols. Preliminary Results: In surgical patients the average number of confirmed cases of HIT per year decreased by 51%, and the average number of confirmed cases of HITT per year decreased by 83% after implementation of thromboprophylaxis protocols. In medical patients the average number of confirmed cases of HIT per year decreased by 15%, and the average number of confirmed cases of HITT per year decreased by 47% after implementation of thromboprophylaxis protocols. Between 2012 and 2017 a total of 24 patients experienced HITT, resulting in 33 poor outcomes, including: pulmonary embolism, cerebrovascular accident, DVT, ischemic bowel, arterial thrombosis, venous thrombosis, cardiac thrombus, splenic infarct, and death. The majority of patients experiencing HITT had a history of UFH usage, be it alone or in combination with LMWH, equaling 19 out of 24 patients. Preliminary Conclusion: The incidence of HIT and HITT was reduced after the implementation of the VTE prophylaxis protocols. Further Direction: The next step in the project involves assessing the statistical significance of the above results and assessing the data from 2018 in the same manner as above. Disclosures Young: Sanofi-Aventis: Honoraria, Research Funding. Chitsike:Sanofi-Aventis: Honoraria, Research Funding; Bayer: Research Funding; Bristol Myers Squib: Honoraria; Pfizer: Honoraria; Servier: Honoraria.