Clinical care pathway for the evaluation of patients with suspected VITT after ChAdOx1 nCoV-19 vaccination.

Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare complication after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) adenoviral vector vaccination. In British Columbia (BC), Canada, a provincial clinical care pathway was developed to guide clinicians in evaluating for VITT among patients who present with thrombocytopenia or thrombosis symptoms within 4 to 28 days after adenoviral vector vaccine exposure. All patients had enzyme-linked immunosorbent assay (ELISA) testing for platelet factor 4 (PF4) antibodies, and all cases with positive PF4-ELISA or d-dimer levels ≥2.0 mg/L fibrinogen equivalent units (FEU) had further testing for platelet-activating PF4 antibodies using a modified serotonin release assay (SRA). Between 1 May and 30 June 2021, 37% of 68 patients investigated for VITT had thrombosis, but only 3 had VITT confirmed by PF4-ELISA and SRA. Platelet counts, d-dimer levels, and ELISA optical density values were significantly different between those with and without VITT. Three patients had thrombocytopenia and thrombosis with d-dimer levels >4.0 mg/L FEU but had negative PF4-ELISA and SRA results. Patients with VITT were treated successfully with IV immunoglobulin, nonheparin anticoagulants, and corticosteroids. Our pathway demonstrated that thrombosis is common among patients investigated for VITT and that PF4-ELISA testing is necessary to confirm VITT in those presenting with thrombosis and thrombocytopenia.

Sweet and sour: A quantitative analysis of methane emissions in contrasting Alberta, Canada, heavy oil developments.

Cold heavy oil production with or without sand (CHOPS, or CHOP) are prevalent methods of oil extraction in western Canada. CHOP(S) sites account for over 40% of all reported vented methane (CH4) from oil production in Alberta, and high rates of CH4 emissions have been confirmed in independent measurement studies. In this study, we used truck-based surveys coupled with qualitative optical gas imaging (OGI) to quantify and characterize methane emission rates and sources at nearly 1350 and 940 well sites in two major CHOP(S) developments respectively in 2016 and 2018. The studies were conducted in Lloydminster, Alberta, where produced gases are sweet (i.e., <0.5% sulfur) and non-olfactory, and Peace River, Alberta, where regulations were implemented in 2017 to manage sour (i.e., >0.5% sulfur) odorous emissions (hydrogen sulfide, BTEX, etc.). Based on results from all surveys, in Peace River, 43% of measured sites were emitting CH4, compared to 37% in Lloydminster. The measured CH4 emission rates in Peace River were, however, significantly lower than in Lloydminster for both years, and had fallen from 2016 to 2018. In 2018, emissions in Lloydminster were fairly unchanged relative to previous measurements taken in 2016. OGI showed that tanks in Peace River continue to emit CH4 despite regulatory interventions and a reported venting rate of zero. The continued emissions were thus classified as "unintended venting", which can be a consequence of the non-routine malfunction (e.g., inappropriate operator action or poor equipment design/sizing) of vapor recovery equipment. Mitigation strategies implemented in Peace River targeting olfactory compounds were beneficial in reducing and keeping CH4 emissions lower, since these gases are co-emitted, and could even be co-regulated provincially. Reciprocal to that, we might expect future air quality improvements as a consequence of the new provincial requirements to reduce CH4 emissions under amended Directives 060 and 017.

Methane emissions from upstream oil and gas production in Canada are underestimated.

Methane emissions were measured at 6650 sites across six major oil and gas producing regions in Canada to examine regional emission trends, and to derive an inventory estimate for Canada's upstream oil and gas sector. Emissions varied by fluid type and geographic region, with the heavy oil region of Lloydminster ranking highest on both absolute and intensity-based scales. Emission intensities varied widely for natural gas production, where older, low-producing developments such as Medicine Hat, Alberta showed high emission intensities, and newer developments in Montney, British Columbia showed emission intensities that are amongst the lowest in North America. Overall, we estimate that the Canadian upstream oil and gas methane inventory is underestimated by a factor of 1.5, which is consistent with previous studies of individual regions.

Zoster prophylaxis after allogeneic hematopoietic cell transplantation using acyclovir/valacyclovir followed by vaccination.

Varicella zoster virus (VZV) disease (usually cutaneous zoster) occurs frequently after hematopoietic cell transplantation (HCT), and postherpetic neuralgia (PHN) results in poor quality of life. The optimal prophylaxis of VZV disease/PHN has not been established. At our center, before 2008, VZV prophylaxis consisted of ∼1 year of post-HCT acyclovir/valacyclovir ("old strategy"), whereas post-2008 prophylaxis consisted of 2 years of acyclovir/valacyclovir followed by immunization using varicella vaccine ("new strategy"). We performed a retrospective study comparing the cumulative incidence of VZV disease and PHN among patients who completed the old strategy (n = 153) vs the new strategy (n = 125). Patients who completed the old strategy had a significantly higher cumulative incidence of VZV disease (33% vs 17% at 5 years, P ≤ .01) and PHN (8% vs 0% at 5 years, P = .02). In conclusion, VZV prophylaxis with 2 years of acyclovir/valacyclovir followed by vaccination appears to result in a low incidence of VZV disease and may eliminate PHN.