Abstract Objective The study objective was to examine the safety and cost savings of selective cardiac surveillance (CS) during treatment with pegylated liposomal doxorubicin (PLD). Methods A ...retrospective, dual institution study of women receiving PLD for the treatment of a gynecologic malignancy was performed. The study period was 2002–2014. At both institutions, a selective strategy for CS was implemented in which only high-risk women with a cardiac history or with symptoms suggestive of cardiac toxicity during PLD treatment underwent a cardiac evaluation. Patient demographics, clinical and treatment history were evaluated. Cost analyses were performed utilizing professional/technical fee rates for echocardiogram and multi-gated acquisition scan for each state. Results PLD was administered in 184 women. The mean patient age was 62.7 years, and 79% were treated for recurrent ovarian or peritoneal carcinoma. The median cumulative administered dose of PLD was 300 mg/m2 ; 24 received > 550 mg/m2 . The median follow-up time was 20 months. Of the 184 patients, the majority ( n = 157, 85.3%) did not undergo either an initial cardiac evaluation or surveillance during or post-PLD treatment. Fifty-three patients considered high risk for anthracycline-induced cardiotoxicity underwent CS. Only three patients (1.6%) in the entire cohort developed CHF that was possibly related to PLD treatment; all had significant pre-existing cardiac risk factors. Selective instead of routine use of CS in the study population resulted in a cost savings of $182,552.28. Conclusion Utilizing cardiac surveillance in select women undergoing PLD treatment for gynecologic malignancies resulted in significant health care cost savings without adversely impacting clinical outcomes.
An integrated tunable CMOS laser for silicon photonics, operating at the C-band, and fabricated in a commercial CMOS foundry is presented. The III-V gain medium section is embedded in the silicon ...chip, and is hermetically sealed. The gain section is metal bonded to the silicon substrate creating low thermal resistance into the substrate and avoiding lattice mismatch problems. Optical characterization shows high performance in terms of side mode suppression ratio, relative intensity noise, and linewidth that is narrow enough for coherent communications.
The Large Binocular Telescope Interferometer (LBTI) enables nulling interferometric observations across the N band (8 to 13 m) to suppress a star's bright light and probe for faint circumstellar ...emission. We present and statistically analyze the results from the LBTI/Hunt for Observable Signatures of Terrestrial Systems survey for exozodiacal dust. By comparing our measurements to model predictions based on the solar zodiacal dust in the N band, we estimate a 1 median sensitivity of 23 zodis times the solar system dust surface density in its habitable zone (HZ; 23 zodis) for early-type stars and 48 zodis for Sun-like stars, where 1 zodi is the surface density of HZ dust in the solar system. Of the 38 stars observed, 10 show significant excess. A clear correlation of our detections with the presence of cold dust in the systems was found, but none with the stellar spectral type or age. The majority of Sun-like stars have relatively low HZ dust levels (best-fit median: 3 zodis, 1 upper limit: 9 zodis, 95% confidence: 27 zodis based on our N band measurements), while ∼20% are significantly more dusty. The solar system's HZ dust content is consistent with being typical. Our median HZ dust level would not be a major limitation to the direct imaging search for Earth-like exoplanets, but more precise constraints are still required, in particular to evaluate the impact of exozodiacal dust for the spectroscopic characterization of imaged exo-Earth candidates.
Abstract Objective The objective of this study is to investigate the impact of fluid status on perioperative outcomes of patients undergoing cytoreductive surgery (CRS) for advanced epithelial ...ovarian cancer (EOC). Methods Patients undergoing CRS for stage III or IV EOC at a comprehensive cancer center from 12/2010 to 05/2015 were identified. Those who underwent upper abdominal procedures or colon resections were included. Demographic, perioperative, and 30-day complication data were collected. Perioperative weight change was utilized as a surrogate for fluid status. The time to diuresis (tD) was defined as the postoperative day the patient's weight began to downtrend. Results One hundred ten patients were included. Median age was 62 years and median BMI 25.8 kg/m2 . The majority (74.5%) were stage IIIC. At least 1 bowel resection was performed in 60 cases (54.5%). A median of 5381 mL of crystalloid (range 1000–17,550 mL) and 500 mL of colloids (range 0–2783 mL) was given intraoperatively. The median perioperative weight change was + 7.3 kg (range − 0.9 kg to + 35.7 kg). The median tD was 3 days (range 1–17 days). On univariate analysis, net positive fluid status was associated with unscheduled reoperation, anastomotic leak, surgical site infections (SSI), and length of stay > 5 days. On multivariate analysis, fluid status was independently associated with SSI (p = 0.01). Conclusions Perioperative fluid excess is common in patients undergoing CRS for EOC and is independently associated with SSI.
Therapy of seizure activity following exposure to the nerve agent soman (GD) includes treatment with the anticonvulsant diazepam (DZP), an allosteric modulator of γ-aminobutyric acid A (GABAA) ...receptors. However, seizure activity itself causes the endocytosis of GABAA receptors and diminishes the inhibitory effects of GABA, thereby reducing the efficacy of DZP. Treatment with an N-methyl-d-aspartic acid (NMDA) receptor antagonist prevents this reduction in GABAergic inhibition. We examined the efficacy of the NMDA receptor antagonist caramiphen edisylate (CED; 20mg/kg, im) and DZP (10mg/kg, sc), administered both separately and in combination, at 10, 20 or 30min following seizure onset for attenuation of the deleterious effects associated with GD exposure (1.2 LD50; 132μg/kg, sc) in rats. Outcomes evaluated were seizure duration, neuropathology, acetylcholinesterase (AChE) activity, body weight, and temperature. We also examined the use of the reversible AChE inhibitor physostigmine (PHY; 0.2mg/kg, im) as a therapy for GD exposure. We found that the combination of CED and DZP yielded a synergistic effect, shortening seizure durations and reducing neuropathology compared to DZP alone, when treatment was delayed 20–30min after seizure onset. PHY reduced the number of animals that developed seizures, protected a fraction of AChE from GD inhibition, and attenuated post-exposure body weight and temperature loss independent of CED and/or DZP treatment. We conclude that: 1) CED and DZP treatment offers considerable protection against the effects of GD and 2) PHY is a potential therapeutic option following GD exposure, albeit with a limited window of opportunity.
► Soman (GD) produced seizure activity resulting in neuropathology in rats. ► Tx: caramiphen (CED) and/or diazepam (DZP) @ 10, 20 or 30 min after seizure onset. ► CED/DZP showed superior anticonvulsant and neuroprotective capacity. ► Physostigmine (PHY) was examined as an adjunct post-exposure therapy. ► PHY attenuated GD-induced seizure development, but not seizure duration.
Background. Group A Streptococcus (GAS) is an important bacterial cause of life-threatening illness among the elderly. Public health officials investigated a protracted GAS outbreak in a skilled ...nursing facility in Georgia housing patients requiring 24-hour nursing or rehabilitation, to prevent additional cases. Methods. We defined a case as illness in a skilled nursing facility resident with onset after January 2009 with GAS isolated from a usually sterile (invasive) or nonsterile site (noninvasive). Cases were "recurrent" if >1 month elapsed between episodes. We evaluated infection control practices, performed a GAS carriage study, emm-typed available GAS isolates, and conducted a case-control study of risk factors for infection. Results. Three investigations, spanning 36 months, identified 19 residents with a total of 24 GAS infections: 15 invasive (3 recurrent) and 9 noninvasive (2 recurrent) episodes. All invasive cases required hospitalization; 4 patients died. Seven residents were GAS carriers. All invasive cases and resident carrier isolates were type emm 11.0. We observed hand hygiene lapses, inadequate infection documentation, and more frequent wound care staff turnover on wing A versus wing B. Risk factors associated with infection in multivariable analysis included living on wing A (odds ratio OR, 3.4; 95% confidence interval CI, .9–16.4) and having an indwelling line (OR, 5.6; 95% CI, 1.2–36.4). Cases ceased following facility-wide chemoprophylaxis in July 2012. Conclusions. Staff turnover, compromised skin integrity in residents, a suboptimal infection control program, and lack of awareness of infections likely contributed to continued GAS transmission. In widespread, prolonged GAS outbreaks in skilled nursing facilities, facility-wide chemoprophylaxis may be necessary to prevent sustained person-to-person transmission.
Determining the most appropriate method of scoring an assessment is based on multiple factors, including the intended use of results, the assessment's purpose, and time constraints. Both the ...dichotomous and partial credit models have their advantages, yet direct comparisons of assessment outcomes from each method are not typical with constructed response items. The present study compared the impact of both scoring methods on the internal structure and consequential validity of a middle-grades problem-solving assessment called the problem solving measure for grade six (PSM6). After being scored both ways, Rasch dichotomous and partial credit analyses indicated similarly strong psychometric findings across models. Student outcome measures on the PSM6, scored both dichotomously and with partial credit, demonstrated strong, positive, significant correlation. Similar demographic patterns were noted regardless of scoring method. Both scoring methods produced similar results, suggesting that either would be appropriate to use with the PSM6.
Objectives: To identify independent risk factors for first hip fracture over 10 years of follow‐up.
Design: Prospective cohort study.
Setting: Four U.S. clinical centers.
Participants: A total of ...6,787 women aged 66 and older in the Study of Osteoporotic Fractures.
Measurements: Total hip bone mineral density (BMD) using dual‐energy x‐ray absorptiometry and a comprehensive set of potential risk factors were collected. Incident hip fractures were identified prospectively and confirmed using radiographic report.
Results: Six hundred two women (8.9%) had a hip fracture during a mean ±standard deviation (SD) follow‐up of 10.1±3.2 years. Older age, previous self‐reported fracture after age 50, maternal history of hip fracture after age 50, greater height at age 25, impaired cognition, slower walking speed, nulliparity, type II diabetes mellitus, Parkinson's disease, and depth perception each independently predicted a 1.17‐ to 1.83‐fold increase in hip fracture risk, whereas each SD (0.13 g/cm2) decrease in hip BMD was independently associated with a 1.84‐fold increase in risk. Lower body mass index also was associated with an increased risk of hip fracture, although lower hip BMD largely explained this association.
Conclusion: Although hip BMD is strongly related to hip fracture risk in elderly white women, other clinical risk factors also are independent predictors of long‐term risk and provide additional insight into the prevention of fracture in high‐risk women. Clinicians should be alert to factors other than BMD that place older women at a high risk of hip fracture.
BACKGROUND: Antioxidant defenses are one possible mechanism for decreasing oxidative damage and its potentially negative effects on age-related bone mass. OBJECTIVE: This study cross-sectionally ...examined whether higher dietary intakes, total intakes, and serum concentrations of antioxidants may be associated with higher bone mineral density (BMD). DESIGN: Total hip (and subregions), spine, and total-body BMDs were measured in 11 068 women aged 50-79 y enrolled in the Women's Health Initiative Observational Study and Clinical Trial at 3 clinics. Antioxidant intakes from diet (vitamin A, retinol, {szligbeta}-carotene, vitamin C, vitamin E, and selenium) were estimated by using a self-reported food-frequency questionnaire. Antioxidants from supplements were estimated with an interviewer-administered questionnaire. A random subset (n = 379) had serum concentrations of retinol, carotenoids, and tocopherols measured. RESULTS: After adjustment for important BMD-related covariates, increasing intakes of antioxidants were not independently associated with BMD. A significant interaction effect was observed between intake of total vitamin C (lower three-fourths compared with highest one-fourth) and use of hormone therapy (HT) (P < 0.01). The beneficial effect of current HT use on femoral neck BMD appeared to be greater in women with higher concentrations of total vitamin C. This interaction was also significant for total-body (P < 0.045), spine (P = 0.03), and total-hip BMDs (P = 0.029). CONCLUSIONS: Our results do not support independent associations between dietary intake, total intake, or serum concentrations of antioxidants and BMD in women participating in the Women's Health Initiative. The extent to which HT use may interact with vitamin C intake and BMD warrants further exploration.
The quark-meson coupling (QMC) model describes atomic nuclei on the basis of the quark structure of nucleons and their self-consistent change as they interact with each other in the nuclear medium. ...The model has been successfully applied to even-even nuclei across the entire nuclear chart and results were comparable to other existing models despite having fewer adjustable parameters. Nuclear matter properties derived from the model are also within the widely used range of values. In this paper, we explore the latest version of the model, QMCπ-II. We put some emphasis on QMC predictions for neutron skin thickness which will be the subject for experiments in the near future. QMCπ-II predicts a value of around 0.15 and 0.16 fm for 48Ca and 208Pb, respectively, with the slope of symmetry energy at around 40 MeV.
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