Apparent Stability Research Articles

Pressure-sensitivity stability of poly[1-(trimethylsilyl)-1-propyne]-based pressure-sensitive paint for low-pressure conditions

Pressure-sensitive paintsusing poly[1-(trimethylsilyl)-1-propyne] (PTMSP) as a binder polymerare capable of capturing subtle pressure fluctuationsunder low-pressure conditions, butthe pressure sensitivity isunstable. The dependence of the pressure sensitivitystability onenvironmental factors and coating parameterswas evaluated under low-pressure conditions. The pressure sensitivity decreased from 56.3to 42.5%/kPa at an extremely low pressureafter60 min, and the stability decreased significantly as thebackground pressure was reduced.An apparent change inthe pressure sensitivities and stability was observed from 278 to 318 K, withoptimal performancebeingobtained at 298 K. A comparison of the pressure sensitivities and emission intensities ofshaded and irradiated samples stored at low pressuresindicated that the excitation light hardly agedthe binders. The pressure sensitivity stability decreased as the luminophore concentration increased, while an increased in the paint thickness improved both the pressure sensitivity and stability.

“The preferred classroom interaction patterns among students of the Department of Physics and its relationship to their cognitive preferences”

The aim of the research is to identify the relationship between the preferred classroom interaction patterns of the students of the Department of Physics with their cognitive preferences, and the sample consisted of (120) students of the fourth grade in the Department of Physics, College of Education for Pure Sciences for the academic year (2021-2022). The researcher on the scale prepared by Abdullah and Shukr (2021) consists of (14) positions, and each position has four patterns of cognitive preference. A question was attached to the scale through which the preferred class interaction pattern was determined, and its apparent validity and stability were checked by repetition. After that, the researcher applied the tool through practical education lessons, starting from (28/11/2021) for a period of one week , After collecting the data and analyzing it statistically using the concordance correlation coefficient and its t-test, the results indicated that: 1. The participatory style between the teaching and his students ranked first, then the teaching style and finally the student-centered style among the members of the research sample of male and female students. 2. The members of the research sample as a whole preferred the retrieval pattern of cognitive preferences, then the application, then the principles, and finally the critical pattern. 3. There is a statistically significant correlation at the level (0.05) between the preferred classroom interaction patterns for boys and girls and their cognitive preferences. In light of the results, the researcher came out with a number of conclusions and recommendations, as well as providing titles for future research.

Neural oscillations promoting perceptual stability and perceptual memory during bistable perception

Ambiguous images elicit bistable perception, wherein periods of momentary perceptual stability are interrupted by sudden perceptual switches. When intermittently presented, ambiguous images trigger a perceptual memory trace in the intervening blank periods. Understanding the neural bases of perceptual stability and perceptual memory during bistable perception may hold clues for explaining the apparent stability of visual experience in the natural world, where ambiguous and fleeting images are prevalent. Motivated by recent work showing the involvement of the right inferior frontal gyrus (rIFG) in bistable perception, we conducted a transcranial direct-current stimulation (tDCS) study with a double-blind, within-subject cross-over design to test a potential causal role of rIFG in these processes. Subjects viewed ambiguous images presented continuously or intermittently while under EEG recording. We did not find any significant tDCS effect on perceptual behavior. However, the fluctuations of oscillatory power in the alpha and beta bands predicted perceptual stability, with higher power corresponding to longer percept durations. In addition, higher alpha and beta power predicted enhanced perceptual memory during intermittent viewing. These results reveal a unified neurophysiological mechanism sustaining perceptual stability and perceptual memory when the visual system is faced with ambiguous input.

Assessment of Australian Sea Lion Bycatch Mortality in a Gillnet Fishery, and Implementation and Evaluation of an Effective Mitigation Strategy

Globally, the bycatch of marine mammals in fisheries represents the greatest source of human-caused mortality that threatens the sustainability of many populations and species. The Australian sea lion (Neophoca cinerea) is an endangered species, whose populations off South Australia (SA) have been subject to bycatch in a demersal gillnet fishery targeting sharks since the 1960s. A comprehensive assessment was undertaken of sea lion bycatch mortality that combined independent fishery observer data with species distribution models (underpinned by satellite tracking, abundance data and population modeling) to model the relationship between at-sea foraging effort and bycatch rate. Combined with the distribution of fishing effort, these models enabled the overall level of bycatch mortality to be estimated by age, sex and subpopulation, facilitating population viability analyses that indicated most subpopulations were declining, and subject to unsustainable levels of bycatch mortality. To reduce this mortality, the Australian Fisheries Management Authority implemented an Australian Sea Lion Management Strategy that included an independent observer program (ultimately 100% electronic monitoring of gillnet fishing off SA), permanent spatial gillnet closures around all sea lion breeding sites, bycatch mortality limits that triggered temporal (18 months) spatial closures when zone-specific bycatch trigger limits were reached, and incentives for gillnet fishers to switch to an alternate fishing method (longlines). The Strategy had immediate impacts on the fishery: it resulted in significant reductions in gillnet fishing effort and on the reported bycatch of sea lions. In the next decade, there was an estimated 98% reduction in sea lion bycatch mortality from gillnet interactions and an apparent stabilization of the decline in sea lion pup abundances at some impacted breeding sites. There was an almost complete transition in the fishery from gillnets to longlines, and fishing catches returned to pre-management levels. The successful implementation of management measures to mitigate sea lion bycatch mortality in the gillnet fishery off SA was rapid, science informed, adaptive, comprehensive, and backed by strong compliance and monitoring of the fishery. It provides an important case study which demonstrates how management measures can be effectively applied to mitigate bycatch mortality of marine mammals and other marine protected species.

A Thermodynamic Model of an Amorphous Grain Boundary Phase in Liquid-Phase Sintered β-SiAlON Ceramic

Abstract Thermodynamic modeling has been developed to explain the apparent stability of an intergranular amorphous phase in the liquid-phase sintered ceramic. The basic postulate has been to consider such a grain boundary phase as a separate phase of the system. An analytic form of the Gibbs energy functions recently derived for amorphous silicates has been taken to describe this boundary phase. A derived equilibrium condition conforming with the construction of parallel tangents to Gibbs energy functions has been used to estimate the compositions of the bulk and of the boundary phase. The microstructure of liquid-phase sintered β-SiAlON ceramic has been ascertained in this way. This model supports the existence of amorphous boundary phases as thermodynamically stable and provides a relation between their amount and the composition of the sinter additives in agreement with the experimental evidence.

Analysis of the Timing of Puberty in a Recent Cohort of Italian Girls: Evidence for Earlier Onset Compared to Previous Studies.

Throughout the 20 century, in developed countries there has been a secular trend toward earlier menarche. Over the past 2 decades, however, there has been an apparent stabilization in the average age of menarche age in most Western countries. The objective of this study was to analyze the mean age of menarche in a cohort of Italian girls, to analyze the mean age of breast button appearance (B2), and to correlate the B2 developmental stage and age at menarche with the most important clinical and auxological parameters. We retrospectively evaluated the data of 1458 Italian girls born between 1995 and 2003. We collected the main auxological and clinical parameters, including age at B2, age at menarche, height, weight, and body mass index (BMI) at B2 and menarche and, when possible, adult/near adult height. The mean age of B2 was 10.16 ± 1.00 years, significantly earlier than previously reported for Italian girls (P < .05); the mean age of menarche was 12.07 ± 0.99 years, also significantly earlier than previously reported (P < .0001). Age at B2 and menarche inversely correlated with BMI standard deviation score (SDS) (P < .0001). The mean adult/near adult height of the girls in the study cohort was not statistically different from previously reported data for Italian women. Our results suggest a new trend for an earlier appearance of thelarche and menarche in Italian girls. Our data confirm a significant relationship between BMI and age of B2 and menarche. The girls' final height seems to be in line with average height for the Italian female population.

Latitude, Elevation, and Mean Annual Temperature Predict Peat Organic Matter Chemistry at a Global Scale

AbstractPeatlands contain a significant fraction of global soil carbon, but how these reservoirs will respond to the changing climate is still relatively unknown. A global picture of the variations in peat organic matter chemistry will aid our ability to gauge peatland soil response to climate. The goal of this research is to test the hypotheses that (a) peat carbohydrate content, an indicator of soil organic matter reactivity, will increase with latitude and decrease with mean annual temperatures, (b) while peat aromatic content, an indicator of recalcitrance, will vary inversely, and (c) elevation will have a similar effect to latitude. We used Fourier Transform Infrared Spectroscopy to examine variations in the organic matter functional groups of 1034 peat samples collected from 10 to 20, 30–40, and 60–70 cm depths at 165 individual sites across a latitudinal gradient of 79°N–65°S and from elevations of 0–4,773 m. Carbohydrate contents of high latitude peat were significantly greater than peat originating near the equator, while aromatic content showed the opposite trend. For peat from similar latitudes but different elevations, the carbohydrate content was greater and aromatic content was lower at higher elevations. Higher carbohydrate content at higher latitudes indicates a greater potential for mineralization, whereas the chemical composition of low latitude peat is consistent with their apparent relative stability in the face of warmer temperatures. The combination of low carbohydrates and high aromatics at warmer locations near the equator suggests the mineralization of high latitude peat until reaching recalcitrance under a new temperature regime.

Formulation of Apigenin-Cyclodextrin-Chitosan Ternary Complex: Physicochemical Characterization, In Vitro and In Vivo Studies.

The current investigation was performed with an aim to improve the aqueous solubility, dissolution rate, and thus the biological activity of apigenin (APG) using the solubilizers hydroxypropyl beta-cyclodextrin (HPβCD) and chitosan (CTSN). A binary and ternary inclusion complexes of APG with HPβCD and CTSN were prepared by physical mixing, fusion, and solvent evaporation methods. The liquid state characterization of the APG, the solubilizers, and the physical and chemical interactions between them was done through phase solubility approach. The solid-state characterization was performed by proton nuclear magnetic resonance (1H-NMR), differential scanning calorimetry (DSC), and X-ray diffractometry (XRD). The in vitro dissolution test and antioxidant activity and in vivo anti-inflammatory activity of the ternary inclusion complex in albino rats were performed to assess the performance of the APG. Phase solubility study results revealed a remarkable increase in apparent stability constant (Kc) and complexation efficiency (CE) of HPβCD in presence of CTSN in ternary complex with above 8 folds more increment in solubility of APG than its binary complex. The in vitro dissolution rate, antioxidant activity, and the anti-inflammatory effect of the APG ternary inclusion complex were found to be significantly higher than that of pure APG. Solid state characterization confirmed the formation of a ternary inclusion complex. 1H-NMR study gave more insight at molecular level into how different groups of APG were responsible for complex formation with the HPβCD and how CTSN was significantly influencing on the APG-HPβCD complex formed. Nevertheless, pharmacokinetic and histopathological studies of our APG-HPβCD-CTSN ternary complex would yield much rewarding results.

Photo-enhanced thermal catalytic CO2 methanation activity and stability over oxygen-deficient Ru/TiO2 with exposed TiO2 {001} facets: Adjusting photogenerated electron behaviors by metal-support interactions

In this study, two Ru/TiO2 samples with different TiO2 facets were prepared to investigate their photo-thermal catalytic CO2 + H2 reaction behavior. Without UV irradiation, the Ru/TiO2 with 67% {001} facet (3RT) displayed improved thermal catalytic activity for CO2 methanation than that of Ru/TiO2 with 30% {001} facet (0RT). After H2 pretreatment, both samples exhibited enhanced thermal catalytic activities, but the H2-treated 3RT (3RT-H) exhibited superior activity to that of the H2-treated 0RT (0RT-H). Under UV irradiation, 3RT-H exhibited apparent photo-promoted thermal catalytic activity and stability, but the enhanced catalytic activity was lower than that of 0RT-H. Based on the characterization results, it is proposed that both the surface oxygen vacancies (Vos) (activating CO2) and the metallic Ru nanoparticles (activating H2) were mainly responsible for CO2 methanation. For 0RT, H2 pretreatment and subsequent UV irradiation did not promote the formation of Vos, resulting in low catalytic activity. For 3RT, on the one hand, H2 pretreatment promoted the formation of Vos, which were regenerated under UV irradiation; on the other hand, the photogenerated electrons from TiO2 transferred to Ru to maintain the metallic Ru nanoparticles. Both behaviors promoted the activation of CO2 and H2 and enhanced CO2 methanation. Moreover, the photogenerated holes favored the dissociated H at Ru migrating to TiO2, also promoting CO2 methanation. These behaviors occurring on 3RT-H may be attributed to the suitable metal-support interaction between the Ru nanoparticles and TiO2 {001}, resulting in the easy activation of lattice oxygen in TiO2 to Vos. With reference to the analysis of intermediates, a photo-thermal reaction mechanism is proposed for the Ru/TiO2 {001} facet sample.

Rheological properties for determining the interaction of soluble cress seed mucilage and β-lactoglobulin nanocomplexes under sucrose and lactose treatments

Protein-polysaccharide complexes are commonly applied in different food products. Their interaction and their functional properties that arise as a consequence of interactions are remarkably influenced by the presence of co-solutes in the system. In this study, general rheological properties and the aggregation behavior of cress seed mucilage (CSM)-β-lactoglobulin (Blg) complexes were studied in the presence of sucrose (5–20% w/v) and lactose (5–20% w/v). The highest values of apparent viscosity and stability (zeta potential) in CSM-Blg complexes were measured when the medium contained 5% w/v lactose (10.00 Pa.s at 0.1 s−1, −25 ± 0.8 mV) and 20% w/v sucrose (12.89 Pa.s at 0.1 s−1, −35 ± 0.2 mV). The results of oscillatory experiments indicated that the gel-like feature of the complexes improved, parallel to a decrease in frequency, which highlighted the shear-induced gelation phenomenon. The thermal analysis test demonstrated that the thermal stability of Blg (70.5◦C), with its complexation to CSM, improved through denaturation. Also, the association of CSM-Blg (82◦C) nanocomplexes with lactose (96◦C) can enhance the thermal stability more effectively. Considering the widespread use of protein-polysaccharide complexes in diverse sugar-containing food formulations, the results of this study can contribute to the creation of new compounds with special techno-functional features.

Apparent stability masks underlying change in a mule deer herd with unmanaged chronic wasting disease

The contagious prion disease “chronic wasting disease” (CWD) infects mule deer (Odocoileus hemionus) and related species. Unchecked epidemics raise ecological, socioeconomic, and public health concerns. Prion infection shortens a deer’s lifespan, and when prevalence (proportion of adults infected) becomes sufficiently high CWD can affect herd dynamics. Understanding population responses over time is key to forecasting long-term impacts. Here we describe unexpected stability in prevalence and abundance in a mule deer herd where CWD has been left unmanaged. High apparent prevalence (~30%) since at least 2005 likely drove observed changes in the proportion and age distribution of wild-type native prion protein (PRNP) gene homozygotes among deer sampled. Predation by mountain lions (Puma concolor) may be helping keep CWD in check. Despite stable appearances, prion disease nonetheless impairs adult survival and likely resilience in this deer herd, limiting its potential for growth despite refuge from hunter harvest and favorable habitat and winter conditions.

Stable foam systems for improving oil recovery under high-temperature and high-salt reservoir conditions

Foams have high apparent viscosity when flowing in porous media, therefore foam flooding could significantly improve unfavorable mobility ratios, increase sweep efficiency, and enhance oil recovery. However, the applications of foam flooding in high-temperature and high-salt reservoirs are seriously restricted as foam systems often have inferior foamability and stability in these reservoirs. In this study, to improve foam flooding effectiveness in high-temperature and high-salt reservoirs, novel foam systems with excellent stability and plugging capacity are developed by combining surfactants, additives, and polymers. The performance of bulk foam, physical properties of the solutions, and properties of foam systems in core-flow experiments are investigated to determine the synergistic effects among the components of the foam systems and their foamability and plugging effect in cores. In foam systems with sodium alcohol ether sulfate (AES) and dodecylhydroxypropyl sulfobetaine (DHSB) as surfactants, and dodecanol as additive, the combination of the components makes surface tension decreased and surface dilatational modulus increased, therefore the foamability and stability of the systems are improved. The results of core-flow experiments under high-temperature and high-salt conditions show that these combined systems require low injection rate for foam generation in reservoirs, which is beneficial for foam regeneration in reservoirs. Moreover, to further improve the foam performance, a hydrophobically associating water-soluble polymer (HAWP) is employed. The interactions between HAWP and the surfactants reduce the critical association concentration of HAWP, and result in the increase of solution apparent viscosity and foam stability. The results of core-flow experiments under high-temperature and high-salt conditions show that polymer-enhanced foam systems could significantly increase the sealing pressure, widen the sealing permeability range, and deal with the gas-channeling problem of foam flooding. These foam systems could provide a potential technical pathway for improving the effectiveness of foam flooding in high-temperature and high-salt reservoirs.

Potential therapeutic response in a severe case of autosomal dominant osteopetrosis type I

The low-density lipoprotein receptor-related protein 5 gene (LRP5), which encodes a coreceptor within the canonical Wnt signaling pathway, plays a crucial role in bone mass regulation and has been associated with several bone disorders. Autosomal dominant osteopetrosis type I (ADO type I, OMIM 607634) is a rare disease caused by heterozygous, gain-of-function mutations in LRP5. Here we describe a 44-year-old female who presented with thickened calvarium, elevated bone density, torus palatinus, mandibular exostoses, enlarged mandible, and disabling headaches and bone pain. Exome sequencing revealed a previously reported heterozygous missense variant in the LRP5 gene (p.A242T). Post-diagnosis cranial vault volume measurement by computed tomography 3D reconstruction demonstrated decreasing intracranial volume over time. Off-label use of leuprolide acetate was associated with apparent stabilization of skull mineralization. This report documents a severe example of ADO type I and provides anecdotal evidence of the utility of therapy in need of formal evaluation.

The quiet transformation of the EU Commission cabinet system

ABSTRACT Although cabinets in the European Commission have attracted considerable interest, scholarly attention has mainly focused on their composition and influence. How the status of cabinets or the relations between them have changed over time, and how cabinets have been affected by changes to the wider institutional environment, has gone largely unexamined. This article takes a step towards filling that gap. It argues that, despite apparent stability in the functions that cabinets perform, the cabinet system has undergone a quiet transformation. A new differentiation has created hierarchical relations within the cabinet system, with implications for policy coordination and output. Using historical institutionalist theory, the article shows that Commission cabinets have been affected less by reforms addressed directly at them and more by internal rule change aimed at other parts of their institutional environment.

Self-schemes Among Postgraduate Students

1- Recognizing the level of self-schemes of postgraduate students. 2- Identifying the differences in the level of self-schemes among postgraduate students according to the variables (gender, specialization and stage . The research sample (construction and application) consisted of (400) male and female students in the faculties of the University of Al-Qadisiyah, they were chosen randomly according to the Department of postgraduate Studies at the University of Al-Qadisiyah, with (156) males, (174) females from the master’s degree, and (38) males, (32) PhD female. The researcher used a research tool, which is building a self-scheme scale. first: The scale of the self-schemes that the researcher built according to Marcus theory (Markus, 1977), which consisted of (45) declarative paragraphs, under which five alternatives fall, and each alternative represents a degree of the self-schemes degrees The psychometric properties of the scale were verified from the apparent validity, construct validity and stability by the method of analysis of variance (Cronbach's alpha) and halving, where the statistical means were used (percentage, t-test for two independent samples, Pearson correlation coefficient, Spearman-Brown equation, variance, standard deviation, skewness ) .

Microwave-assisted enzymatic hydrolysis of wheat germ albumin to prepare polypeptides and influence on physical and chemical properties

Wheat germ albumin (WGA) is rich in nutrients and contains a number of antioxidant polypeptides. The effects of microwave-assisted alkaline protease, neutral protease, papain and compound protease on the degree of hydrolysis of WGA and the clearance rate of DPPH• were comparatively studied. The results showed that papain had the best proteolytic activity. The functional properties of WGA and its hydrolysis polypeptides were determined. The results showed that the solubility of WGA increased after papain hydrolysis, and the apparent viscosity and foam stability reduced. Compared with the amino acids of WGA, the proportions of proline, histidine, glycine, lysine, and glutamic acid in the enzymatic hydrolysis products increased, while the proportions of leucine, phenylalanine, arginine and isoleucine decreased. After papain hydrolysis, the surface structure was loose, and the surrounding blocks became more rounded.

The Reform Communist Interpretation of the Stalinist Period in Czech Historiography and Its Legacy

This article is concerned with the continuities in the interpretation of the 1950s in Czechoslovakia from 1956 to the present. It first concentrates on the way the year 1956 (one that remained quiet in the country, as opposed to Poland and Hungary) has been treated in Czechoslovak historiography. It aims to show that an almost exclusive focus on political history has produced until today a misleading image of this apparent communist stability as based on repression rather than on a genuine basis of support for the communist rule. The German historiography of communism shows the usefulness of a socio-political approach that could serve as model. The article then further retraces the permanence of this misleading interpretation to the influence of a highly politicized narrative of the terror period inspired by the work of historian Karel Kaplan and other intellectuals of the Prague Spring era. For this it makes use of Kaplan’s autobiography, which has only ever appeared in French. One particular point of interest is the historiographical treatment reserved to the Stalinist leader Klement Gottwald. The article suggests that this reform communist narrative, which blames the terror on the Soviets without questioning the responsibility of Czech society, has kept the history of the 1950s in Czechoslovakia from evolving at the same pace as the historiography of the post-1968 period. It therefore needs to be acknowledged and challenged.

Biooxazolidines‐Enabled Improvement of Monocomponent Polyurethane Coatings

AbstractSingle‐component moisture‐cured polyurethane (SPU) possesses the merit of easy preparation and high curing efficiency but suffers from poor apparent properties, mechanical performance, and thermal stability. Herein, the authors employ isophorone diisocyanate (IPDI) and 2‐isopropyl‐3‐hydroxyethyl‐1, 3‐oxazolidines (IHO) to synthesize oxazolidine (termed as IPDI‐IHO) for the subsequent modification of SPU. The structure and composition of the synthesized SPU/IPDI‐IHO composites are unraveled by 1H and 13C NMR and FTIR spectroscopies. Apart from the curing properties of SPU/IPDI‐IHO, the apparent properties, mechanical performance, thermal stability, and self‐healing ability are evaluated. SEM and AFM characterizations reveal that IPDI‐IHO incorporation significantly decreased the number of bubbles and thus reduce the SPU‐based sample surface roughness. The thermal stability of SPU is notably improved after IPDI‐IHO modification. The tensile strength and elongation at break also increases from 830 to 3710 kPa and from 210% to 600%, respectively, due to IPDI‐IHO inclusion, with the optimal mechanical properties achieved at the IPDI‐IHO mass ratio of 8 wt%. Furthermore, the cracks intentionally cut for the SPU/IPDI‐IHO sample can be self‐healed at 60 °C. The ensemble of the performance enhancements suggests that the IPDI‐IHO developed in this work opens up a new route to fabricate high‐performance SPU and related polymeric materials.

Spatial variation of subduction zone fluids during progressive subduction: Insights from Serpentinite Mud Volcanoes

Geological processes at subduction zones control seismicity, plutonism and volcanism, and geochemical cycling between the oceans, crust, and mantle. The down-going plate experiences metamorphism, and the associated dehydration and fluid flow alters the physical properties of the plate interface and mantle wedge, as well as controlling the composition of material descending into the mantle. Any direct study of slab evolution during subduction is inhibited by the prohibitive depths at which these processes occur. To examine these processes we use serpentinite mud volcanoes in the Mariana forearc, that permit sampling of serpentinite materials and their pore waters that ascend from the subduction channel. We present new pore water chemical data from the summit and flanks of three serpentinite mud volcanoes that were drilled during International Ocean Discovery Program Expedition 366 which are reflective of reactions within the crust and mantle during the early, shallow (<20 km) stages of subduction. We show, via thermodynamic modelling, that our new data on the evolution of pore water chemical compositions reflect mineralogical characteristics of a predominately basaltic source from the downgoing Pacific Plate. However, a component from sedimentary sources is likely, especially for those mud volcanoes near the trench. Other potential slab-derived constituents, such as lithospheric serpentinite, carbonate-rich sediments, or seamount basalts with an intraplate geochemical character, are not required to explain our results. Our results indicate that with progressive subduction the lawsonite-epidote mineral transformation boundary at ∼250 °C may help drive slab carbonate destabilisation, despite its apparent thermodynamic stability at such temperatures and projected pressures (∼300 °C and ∼0.6 GPa). New dissolved gas data also point to primary thermodynamic controls over methane/ethane production within the subduction channel as depths-to-slab increase. Our findings provide direct evidence for the progressive mineralogical and chemical evolution of a subducting oceanic plate, which liberates a progressively evolving fluid phase into the subduction channel.

Reduced-Dose Intravenous Thrombolysis for Acute Intermediate-High-risk Pulmonary Embolism: Rationale and Design of the Pulmonary Embolism International THrOmbolysis (PEITHO)-3 trial.

Intermediate–high-risk pulmonary embolism (PE) is characterized by right ventricular (RV) dysfunction and elevated circulating cardiac troponin levels despite apparent hemodynamic stability at presentation. In these patients, full-dose systemic thrombolysis reduced the risk of hemodynamic decompensation or death but increased the risk of life-threatening bleeding. Reduced-dose thrombolysis may be capable of improving safety while maintaining reperfusion efficacy. The Pulmonary Embolism International THrOmbolysis (PEITHO)-3 study (ClinicalTrials.gov Identifier: NCT04430569) is a randomized, placebo-controlled, double-blind, multicenter, multinational trial with long-term follow-up. We will compare the efficacy and safety of a reduced-dose alteplase regimen with standard heparin anticoagulation. Patients with intermediate–high-risk PE will also fulfill at least one clinical criterion of severity: systolic blood pressure ≤110 mm Hg, respiratory rate >20 breaths/min, or history of heart failure. The primary efficacy outcome is the composite of all-cause death, hemodynamic decompensation, or PE recurrence within 30 days of randomization. Key secondary outcomes, to be included in hierarchical analysis, are fatal or GUSTO severe or life-threatening bleeding; net clinical benefit (primary efficacy outcome plus severe or life-threatening bleeding); and all-cause death, all within 30 days. All outcomes will be adjudicated by an independent committee. Further outcomes include PE-related death, hemodynamic decompensation, or stroke within 30 days; dyspnea, functional limitation, or RV dysfunction at 6 months and 2 years; and utilization of health care resources within 30 days and 2 years. The study is planned to enroll 650 patients. The results are expected to have a major impact on risk-adjusted treatment of acute PE and inform guideline recommendations.