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Thrombotic antiphospholipid syndrome (APS) is characterised by venous, arterial or microvascular thrombosis in the context of persistently positive antiphospholipid antibodies (aPL). The diagnosis and management of thrombotic APS continues to prove challenging for clinicians. We provide a practical guide to the diagnosis of APS including who to test for aPL and which tests to do. We also consider clinical practice points on the management of venous, arterial and small vessel thrombosis, in the context of first and recurrent thrombotic events. Non-criteria manifestations of APS are reviewed. An approach to recurrent thrombosis and anticoagulant-refractory APS is discussed, with options including increasing the anticoagulation intensity of vitamin K antagonists, switching to low-molecular-weight-heparin, the use of fondaparinux and/or the addition of antiplatelet treatment. The use of adjunctive options such as vitamin D, hydroxychloroquine and statins are also addressed.

A new approach to modelling student retention through an application of complexity thinking. This paper has been published by Studies in Higher Education as: Forsman, J., Linder, C., Moll, R., Fraser, D. and Andersson, S. (2014). A new approach to modelling student retention through an application of complexity thinking. Vol. Abstract: Complexity thinking is relatively new to education research and has rarely been used to examine complex issues in physics and engineering education. Issues in higher education such as student retention have been approached from a multiplicity of perspectives and are recognized as complex. The complex system of student retention modelling in higher education was examined to provide an illustrative account of the application of complexity thinking in educational research. Exemplar data was collected from undergraduate physics and related engineering students studying at a traditional Swedish university. The analysis shows how complexity thinking may open up new ways of viewing and analysing complex educational issues in higher education in terms of nested, interdependent and interconnected systems. Whilst not intended to present new findings, the paper does illustrate a possible representation of the system of items related to student retention and how to identify such influential items. Studies in Higher EducationKeywords: student retention; modelling systems; complexity thinking Introduction and Research AimComplexity thinking, which is derived from complexity theory, is a powerful conceptual framework in education that draws on the qualities of complex systems to characterize learning systems (e.g. Davis and Sumara 2006). As such, with its organic, non-linear, relational and holistic features, complexity thinking presents a stark point of departure for contemporary educational research thinking (Morrison 2006). Thus, its application in education research is still relatively rare, particularly in higher education contexts, and a variety of good exemplars are hard to find for newcomers contemplating the use of complexity thinking as a conceptual framework. This article uses the field of student retention to provide such an exemplar.When using complexity thinking, qualities such as decentralized network structure and short-range communication between agents can be seen to facilitate emergence of order in seemingly chaotic complex systems. Student retention is a complex system

Objectives Risk factors for thromboembolism in SLE are poorly understood. We hypothesized a possible role for protein C, based on its dual activity in inflammation and haemostasis and on the evidence of an association between acquired activated protein C (APC) resistance (APCR) and high-avidity anti-protein C antibodies (anti-PC) with a severe thrombotic phenotype in venous thrombosis APS patients. Methods In a cross-sectional study of 156 SLE patients, the presence and avidity of IgG anti-PC was established by in house-ELISA, and APCR to exogenous recombinant human APC (rhAPC) and Protac (which activates endogenous protein C) was assessed by thrombin generation-based assays. Associations with aPL profile, thrombotic history and disease activity (BILAG and SLEDAI-2K) were also established. Results Anti-PC were detected in 54.5% of patients and APCR in 59%. Anti-PC positivity was associated with APCR to both rhAPC (P <0.0001) and Protac (P =0.0001). High-avidity anti-PC, detected in 26.3% of SLE patients, were associated with APCR in patients with thrombosis only (P <0.05), and with the development of thrombosis over time (range: 0–52 years; P =0.014). High-avidity anti-PC levels correlated with SLEDAI-2K (P =0.033) and total BILAG (P =0.019); SLEDAI-2K correlated inversely with APCR to Protac (P =0.004). Conclusion Anti-PC occur in patients with SLE, independently of aPL profile, and are associated with APCR. High-avidity anti-PC are associated with thrombosis and with active disease and might prove a novel marker to monitor the risk of thrombosis and disease progression in SLE.