e17040 Background: Our aim was to evaluate two distinct clinical settings catering to US patients with metastatic castration-resistant prostate cancer (mCRPC): academic (A) and community (C) ...practice. We used data from a real-world non-interventional study (REASSURE; NCT02141438) examining the use of 223 Ra. Methods: Patients with mCRPC who received at least one dose of 223 Ra in the US were included. Enrolment occurred between 2014 and 2017; median follow-up was nearly 12 months. Our analysis included patient disease characteristics, treatment history, short- and long-term safety of 223 Ra, patient overall survival (OS), and patient-reported pain (Brief Pain Inventory – Short Form BPI–SF scores). A clinically meaningful pain response was a ≥2-point decrease from a baseline score of ≥2 in the BPI-SF worst pain item during treatment until last dose. Results: Analysis included 498 patients (A: 147; C: 351). Comparing A with C, the median ages were 70 and 76 years, respectively, and the majority of patients (74% and 84%) had bone-only metastases. A higher percentage of patients in A (69%) than in C (49%) had completed at least one life-prolonging therapy (LPT) prior to 223 Ra; these included abiraterone (A: 38%; C: 19%), enzalutamide (A: 32%; C:17%), docetaxel (A: 38%; C: 19%), and sipuleucel-T (A: 18%; C: 25%). Most patients received 5–6 223 Ra injections in both settings (A: 65%; C: 71%). 223 Ra was used concomitantly with LPTs in 48% of patients in A and 57% in C, predominantly with abiraterone (A: 25%; C: 25%) or enzalutamide (A: 25%; C: 36%); fewer patients in A (35%) received concomitant bone health agents than in C (52%). For safety outcomes, refer to the table. During treatment, 47% and 62% of patients with a baseline BPI-SF ≥2 had a clinically meaningful pain response in A and C, respectively. The median OS was 17.2 months (95% CI 14.0–19.4) in A and 18.4 months (14.8–21.0) in C. More patients in A (42%) than in C (26%) received a LPT after 223 Ra, most commonly docetaxel (A: 25%; C: 12%). Conclusions: Patients treated in A tended to be younger and more heavily treated, as evidenced by a higher number of patients receiving LPTs prior to and following 223Ra treatment. Bone health agents were more frequently used in C. Additionally, more patients in C had a clinically meaningful pain response and more drug-related AEs were reported in A. Despite the observed differences, overall survival was comparable for both practice settings. Clinical trial information: NCT02141438 . Table: see text
In Argentinean Patagonia, there exists a growing interest in understanding local problems associated with the increasing of wind energy penetration in the grid. Recent papers show that some of these ...power quality problems can be reduced by the proper control of the wind farms. In this way, this work deals with the impact and potential contribution of wind generation on the damping of the electromechanical oscillations called inter- and intra-area oscillations. For gaining qualitative insights and understandings on this complex subject, a test system that allows to isolate the oscillations modes is considered. The analysis shows that new control concepts for wind farm can efficiently contribute to the power system damping.
Calls to increase undergraduate involvement in research have led to a significant increase in student participation via course-based undergraduate research experiences (CUREs). These CUREs provide ...students an authentic research experience, which often involves dissemination of research by public speaking. For instance, the First-year Research Immersion (FRI) program at Binghamton University is a three-semester CURE sequence that prepares students for scientific research and effective communication of their findings. After one semester of research, students from the FRI program are tasked with presenting their research to hundreds of faculty members, staff, friends, and family at the annual FRI poster session. However, our students, and undergraduates in general, report high anxiety and fear around public speaking such as this. To better prepare our students for public speaking at a research poster session, we developed a workshop that includes a novel role-play activity to mimic a fast-paced poster session or conference in order to address students' fears and increase confidence levels. The role-play activity gives students iterative practice such that they are prepared for the realities of a poster session including variation of poster attendees. During the activity, students switch roles between presenter and audience member. In the role of an audience member, students are given Pokèmon-like role-playing cards that explain the traits and abilities of various types of poster-goers that students might come across (faculty in and out of discipline, staff, family, friends, etc.). Students improvise and enact their card-assigned role as they engage with their classmates who are practicing their poster presentations. To assess student outcomes, students were given three surveys: pre-activity, post-activity, and post-poster presentation. Immediately following the activity, 64% of students reported the highest level of confidence, and following the poster session, 93% of students reported extreme confidence in their poster presentation abilities. These data show that this role-play activity can help address student confidence and better prepare students to communicate their research.
Rapid diagnosis of coagulopathy in the bleeding patient using point-of-care (POC) devices would be ideal. The Hemochron Signature Elite® (HC®) is a POC device that determines international normalized ...ratio (INR) and activated partial thromboplastin time (aPTT). The aim of the study was to evaluate the agreement for INR and aPTT between the HC® and standard laboratory values in acute haemorrhage.
This was a single-centre observational prospective study including patients with acute haemorrhage. Laboratory INR and aPTT were compared with simultaneous measurements performed with the HC®. The diagnostic performance of HC® was determined; bias and limits of agreement were calculated according to the method of Bland and Altman.
Seventy-two pairs of measurements from 39 patients were analysed. The bias between the INR-HC® and aPTT-HC® measurements and the central laboratory were 0.02 and −1.13, respectively. The Spearman's correlation coefficients for the INR-HC®/INR-lab and the aPTT-HC®/aPTT-lab were 0.68 and −0.29, respectively. Twenty-seven per cent of INR-HC® values and 89% of the aPTT-HC® values exceeded the predefined limits of agreement. The INR-HC® measurement identified patients with a central laboratory INR >1.5 with a sensitivity, specificity, and positive and negative predictive values of 83%, 70%, 76%, and 77%, respectively.
The results showed a lack of agreement between the INR-HC® and the aPTT-HC® measurements and the standard laboratory in the context of acute haemorrhage. The INR-HC® showed moderate performance as a decision-making tool to detect coagulopathy in the context of acute haemorrhage.
ABSTRACT We present new ultraviolet, optical, and X-ray data on the Phoenix galaxy cluster (SPT-CLJ2344-4243). Deep optical imaging reveals previously undetected filaments of star formation, ...extending to radii of ∼50-100 kpc in multiple directions. Combined UV-optical spectroscopy of the central galaxy reveals a massive (2 × 109 M ), young (∼4.5 Myr) population of stars, consistent with a time-averaged star formation rate of 610 50 M yr−1. We report a strong detection of O vi λλ1032,1038, which appears to originate primarily in shock-heated gas, but may contain a substantial contribution (>1000 M yr−1) from the cooling intracluster medium (ICM). We confirm the presence of deep X-ray cavities in the inner ∼10 kpc, which are among the most extreme examples of radio-mode feedback detected to date, implying jet powers of 2-7 × 1045 erg s−1. We provide evidence that the active galactic nucleus inflating these cavities may have only recently transitioned from "quasar-mode" to "radio-mode," and may currently be insufficient to completely offset cooling. A model-subtracted residual X-ray image reveals evidence for prior episodes of strong radio-mode feedback at radii of ∼100 kpc, with extended "ghost" cavities indicating a prior epoch of feedback roughly 100 Myr ago. This residual image also exhibits significant asymmetry in the inner ∼200 kpc (0.15R500), reminiscent of infalling cool clouds, either due to minor mergers or fragmentation of the cooling ICM. Taken together, these data reveal a rapidly evolving cool core which is rich with structure (both spatially and in temperature), is subject to a variety of highly energetic processes, and yet is cooling rapidly and forming stars along thin, narrow filaments.
Automated titration of propofol and remifentanil guided by the bispectral index (BIS) has been used for numerous surgical procedures. Orthotopic liver transplantation (OLT) uniquely combines major ...changes in circulating volume, an anhepatic phase, and ischaemia–reperfusion syndrome. We assessed the behaviour of this automated controller during OLT.
Adult patients undergoing OLT were included in this pilot study. Consumption of propofol and remifentanil was calculated for each surgery period (dissection, anhepatic, and liver reperfusion phases). Arterial blood samples were collected at several time points to allow comparison of actual with calculated propofol and remifentanil concentrations. Data are presented as median 25th and 75th percentiles or percentage (95% confidence interval).
Thirteen patients were studied. System performance, defined as the percentage of time with BIS in the range 40-60, was 88% (86-94) of the total duration of anaesthesia. Propofol requirement was decreased during the anhepatic phase compared with the dissection phase (2.9 1.9-5.0 mg kg−1 h−1 and 4.6 3.5-8.1 mg kg−1 h−1; P<0.03) while remifentanil consumption was unchanged (0.11 0.09-0.19 µg kg- 1 min−1). Bland-Altman analysis showed a weak concordance for propofol (bias of 0.7 µg ml−1 and limits of agreement of −2.2 to +3.7 µg ml−1) and remifentanil (bias of 1.3 ng ml−1 and limits of agreement −4.3 to +6.8 ng ml−1). No adverse events were reported during anaesthesia.
This pilot study indicates that automated titration of propofol and remifentanil guided by the BIS is feasible during OLT.
Posttraumatic stress disorder (PTSD) is a common consequence of traumatic injury, yet certain biological factors contributing to PTSD are poorly understood. The gut microbiome may influence mental ...health outcomes, but its role in heterogeneous PTSD presentations requires elucidation.
Bacterial composition was examined in adults 2–4 years post-trauma with probable PTSD (n = 24) versus trauma-exposed controls without probable PTSD (n = 24). 16S rRNA sequencing and bioinformatic tools assessed microbial diversity and abundance. Relationships between taxa and PTSD symptom clusters were evaluated.
No differences were found in overall microbial community structure between groups. The probable PTSD group exhibited significantly reduced Actinobacteriota and increased Verrucomicrobiota phylum abundance compared to controls. Specific taxa showed notable inverse associations with negative mood/cognition versus hyperarousal symptoms. Prevotella and Ruminococcaceae were negatively associated with negative mood but positively associated with hyperarousal.
Results demonstrate microbial signatures of probable PTSD subtypes, highlighting the microbiome as a potential mediator of heterogeneous trauma psychopathology. Definition of PTSD microbial correlates provides a foundation for personalized psychobiotic interventions targeting predominant symptom profiles.
•PTSD group had lower relative Actinobacteriota, higher Verrucomicrobiota compared to controls.•No differences in overall community structure, diversity, or other major phyla•Prevotella, Ruminococcaceae, Lachnospiraceae inversely related to symptom clusters.•Findings suggest microbial heterogeneity across PTSD subtypes.
This paper deals with linear and non-linear control of wind farms equipped with doubly-fed induction generators (DFIG). Both, active and reactive wind farm powers are employed in two independent ...control laws in order to increase the damping of the oscillation modes of a power system. In this way, it presented a general strategy where two correction terms are added, one by each independent control, to the normal operating condition of a wind farm. The proposed control laws are derived from the Lyapunov approach. Meanwhile for the reactive power a non-linear correction is presented, for the wind farm active power it is demonstrated that the classical proportional and inertial laws can be considered via the Lyapunov approach if wind farms are considered as real power plants, i.e. equivalent to conventional synchronous generation. Finally, some simulations are presented in order to support the theoretical considerations demonstrating the potential contributions of both control laws.
Claims are frequently made that practice should be based on evidence. However, the nature of what should count as 'evidence' depends on purpose and context. In the case of curriculum development, ...decisions may rest on local and provisional evidence. This article takes an area of contemporary political interest-enhancing student employability-and illustrates the point with two examples of the use of survey methods for pedagogical purposes.
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