Hr Of Use Research Articles

The Effect of Corticosteroids on Prostate Cancer Outcome Following Treatment with Enzalutamide: A Multivariate Analysis of the Phase III AFFIRM Trial.

The clinical impact of concurrent corticosteroid use (CCU) on enzalutamide-treated patients with metastatic castration-resistant prostate cancer (mCRPC) is unknown. We investigated the association of CCU with overall survival (OS), radiographic progression-free survival (rPFS), and time to prostate-specific antigen progression (TTPP) in post-chemotherapy, enzalutamide-treated patients with mCRPC. Post hoc analysis of AFFIRM (NCT00974311) with patients (n = 1,199) randomized 2:1 to enzalutamide 160 mg/day or placebo. Treatment group, CCU, and known prognostic factors were evaluated for impact on OS, rPFS, and TTPP using a multivariate Cox proportional hazards model. CCU was defined as "baseline" (use started at baseline) or "on-study" (baseline plus use that was started during the trial). Enzalutamide significantly improved OS, rPFS, and TTPP independent of baseline CCU but was associated with inferior clinical outcomes when compared with no baseline CCU, including a shorter OS [10.8 months vs. not reached (NR); HR for use vs. no use, 2.13; 95% confidence interval (CI), 1.79-2.54], rPFS (5.2 months vs. 8.0 months; HR, 1.49; 95% CI, 1.29-1.72], and TTPP (4.6 months vs. 5.7 months; HR, 1.50; 95% CI, 1.25-1.81). These findings held in a multivariate analysis adjusting for baseline prognostic factors wherein baseline CCU was independently associated with decreased OS (HR, 1.71; 95% CI, 1.43-2.04; P < 0.0001) and rPFS (HR, 1.28; 95% CI, 1.11-1.48; P = 0.0007). Patients with mCRPC benefited from enzalutamide treatment independent of CCU, but CCU was associated with worse baseline prognostic factors and outcomes.

Results of Allogeneic Transplantation As First Line Rescue Therapy in Patients with Multiple Myeloma Relapsing to a Prior Autograft: Role of Conditioning Regimen

INTRODUCTIONThe availability of new and effective drugs in multiple myeloma has modified the standard management of these patients. Accordingly, allogeneic stem cell transplantation (alloSCT) is not routinely used upfront except in very specific subgroups of high risk patients. In spite of this data, the number of alloSCT has increased along the last years, most patients undergoing alloSCT beyond first relapse. AIMIn the current study we analyze the outcome of alloSCT as second line therapy among patients who have relapsed to a first line which included autologous stem cell transplantation (autoSCT) and we have compared their outcomes depending on the type of conditioning. PATIENTS AND METHODSWe selected 573 patients transplanted from 1991 to 2014 included in the EBMT data registry who received alloSCT within the first year after having relapsed to first line treatment including autoSCT. One hundred and two patients received myeloablative conditioning (MAC), 284 reduced intensity conditioning (RIC), 120 non-myeloablative (NMA) and 67 underwent tandem auto-alloSCT (Auto-allo). Patients characteristics are summarized in table 1. RESULTSWith a median follow-up of 47 months, median overall survival (OS) was 22.2 months with 39.6% and 31% patients surviving at 3 and 5 years, respectively. Variables which significantly influenced on OS in multivariable analysis were: type of conditioning [HR for MAC 1.68, (95% CI =1.16-2.44), p=0.006] , age [HR 1.02, (95% CI =1.01-1.04), p=0.001], disease status at transplant [HR for less than PR 1.56, (95% CI =1.07-2.28), p=0.01] and time from first relapse to SCT [HR 0.95, (95% CI =0.91-0.99), p=0.02 ]. Time from first autoSCT to relapse influenced on OS in univariate but not in multivariable analysis. Median Progression free survival (PFS) was 8.1 months with 17% and 12% patients being free of progression at 3 and 5 years after alloSCT. Variables which significantly influenced on PFS in multivariable analysis were: type of GVHD prophylaxis [HR for use of alemtuzumab 1.46, (95% CI =1.03-2.07), p=0.03], disease status at transplant [HR for less than PR 1.67, (95% CI =1.19-2.33), p=0.002 ], time from first autoSCT to relapse [HR 0.99, (95% CI =0.98-0.99), p=0.03 ] and time from first relapse to SCT [HR 0.95, (95% CI =0.92-0.98), p=0.009].For patients younger than 53 years old, who underwent RIC or NMA alloSCT>9 months after relapse with GVHD prophylaxis other than alemtuzumab median OS and PFS were 80 and 17 months, respectively. CONCLUSSIONAllogeneic stem cell transplantation allows to obtain remarkable median OS and PFS when used as rescue therapy after a relapse to first line treatment which includes autoSCT. Use of approached other than MAC within the conditioning and alemtuzumab as GVHD prophylaxis allows to obtain the better outcomes. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Diurnal Variations in Visual Performance for Disposable Contact Lenses

The purpose of this study is to compare the visual performance provided by different daily disposable contact lenses and to analyze its variation over time. Visual performance was evaluated in terms of visual acuity (VA) and contrast sensitivity (CS) in 15 myopic subjects (-0.50 to -4.00 diopters) who had been previously fitted with each one of the following seven types of soft contact lenses: DAILIES TOTAL1 (Alcon, Forth Worth, TX), DAILIES AquaComfort Plus (Alcon), 1-DAY ACUVUE TruEye (Johnson & Johnson Vision Care, Jacksonville, FL), 1-DAY ACUVUE MOIST (Johnson & Johnson Vision Care), SofLens daily disposable (Bausch & Lomb, Rochester, NY), Proclear 1 Day (CooperVision, Fairport, NY), and Clariti 1-Day (Sauflon, Twickenham, United Kingdom). We measured VA at three contrast levels (10%, 50%, and 100%) and CS for three spatial frequencies (10, 20, and 25 cycles/degree). These measurements were performed at 2-hr intervals during a 12-hr period of continuous wearing. Measurements were also performed with ophthalmic lenses before contact lens fitting. Two-way analysis of variance (ANOVA) results revealed significant differences across the lens types and over time for low-contrast VA only. For high- and medium-contrast VA, ophthalmic lens performed better than the contact lenses after 12 hr of use (without statistical differences among the contact lenses). Contrast sensitivity values also showed differences across lenses for the three spatial frequencies under analysis. For each particular lens type, no CS variations were observed with wearing time. Although some of the differences were not statistically significant, we found that, for many of the VA and CS measures, ophthalmic lens and DAILIES TOTAL1 yielded better values than the 1-DAY ACUVUE TruEye and Clariti 1-Day. Assessing VA at different contrasts and CS measurements allowed us to perform a visual function evaluation. Contact lens characteristics such as material and water content, among others, may be the cause of the differences in visual performance that emerged from this study. Our findings provide useful information for contact lens practitioners.

N95 Filtering Facepiece Respirator Deadspace Temperature and Humidity

The objective of this study was to determine the levels of heat and humidity that develop within the deadspace of N95 filtering facepiece respirators (N95 FFR). Seventeen subjects wore two models each of N95 FFR and N95 FFR with an exhalation valve (N95 FFR/EV) while exercising on a treadmill at a low-moderate work rate for 1 and 2 hr in a temperate ambient environment. FFR deadspace temperature and relative humidity were monitored by a wireless sensor housed within the FFR. Each FFR was weighed pre- and post-testing to determine moisture retention. After 1 hr, FFR deadspace temperature and humidity were markedly elevated above ambient levels, and the FFR deadspace mean apparent heat index was 54°C. N95 FFR/EV use resulted in significantly lower deadspace temperatures than N95 FFR (p = 0.01), but FFR deadspace humidity levels were not significantly different (p = 0.32). Compared with the first hour of use, no significant increase in FFR deadspace heat and humidity occurred over the second hour. FFR mean moisture retention was < 0.3 grams over 2 hr. N95 FFR/EV offer a significant advantage in deadspace heat dissipation over N95 FFR at a low-moderate work rate over 1 hr of continuous use but offered no additional benefit in humidity amelioration. Moisture retention in N95 FFR and N95 FFR/EV is minimal after 2 hr of use. [Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Occupational and Environmental Hygiene for the following free supplemental resource: a file containing N95 filtering facepiece respirator deadspace mean RH and temperature recordings for 17 subjects treadmill exercising at 5.6 Km/H over 1 hour.]

Evaluation of a community‐based effort to reduce blueberry harvesting injury

Harvesting of blueberries is associated with musculoskeletal injury. This study assessed the effects of several alternative designs of the harvesting rake. A community-based work team selected rake design for intervention and pilot tested potential design modifications to the blueberry harvesting rake. An "extended" handle design was selected for comparison with the traditional short-handle rake. Tested rakes were of two widths (70 and 80 tines) and four handle lengths (short handle; extended: 10, 14, or 16 in.). Workers rated each of five configurations after 4 hr of use. Evaluators tracked qualitative and quantitative indicators of the community-based approach throughout. Data from 29 subjects were analyzed using two-factor analysis of variance. There was increased productivity (P = 0.041); greater acceptability (P < 0.0001); less force (P < 0.001); and less pain (P < 0.0001) with the extended handle designs. The 80 tine width was favored over the 70. Process evaluation identified problems that generally could be addressed. Outcome evaluation indicated successful achievement of all stated goals. The "extended" handle rake may prove effective in reducing musculoskeletal injury associated with blueberry harvesting. A community-based approach to migrant farmworker injuries can be effective, particularly if employers participate.

Design and implementation of a web-based, database-driven histology atlas: Technology at work

At Vanderbilt University, the "Human Cell and Tissue Biology" course is a required lecture and laboratory course with 2 full-time instructors and 106 students. To address demands placed on faculty for individual attention, an interactive Web-based histology atlas was developed and implemented in January 2005. This atlas was specifically designed to complement the existing laboratory manual and to transform the manual into an interactive educational tool whereby students could view high-resolution images of histological specimens online. By utilizing a computer scripting language, interactive highlighting of histological structures was accomplished through the implementation of a simple mouse-rollover function. This computer-aided instruction software allows students to preview histological structures of interest prior to entering the laboratory, to have additional faculty-directed contact hours during laboratory, and to review material efficiently. The conversion of the originally developed static application into a database-driven tool streamlined the development and modification of the atlas while facilitating the creation of advanced features. Six weeks after launching this interactive atlas, Vanderbilt medical students logged 1,200 hr of use. Through the cooperative efforts of faculty and students, the interactive atlas evolved to meet the educational demands of medical students owing to the development and implementation of a database structure. The functionality and educational value of the interactive atlas in facilitating self-learning was ultimately measured by positive student feedback and use.

Emissions and Demonstration of an Emission Control Technology for Small Two-Stroke Utility Engines

Small utility engines represent an important contribution to the emissions inventory and have been subjected to increasingly stringent regulations in recent years. For this project, a Tanaka two-stroke engine was tested in its original condition and with a modified fuel/oil injection system. The modified fuel/oil injection system applied to the Tanaka two-stroke engine resulted in significant emissions reductions of ∼52% for carbon monoxide (CO), 70% for total hydrocarbons (THC), 70% for particulate matter (PM), and 67% for the regulated THC + nitrogen oxides metric. This technology met the California Air Resources Board's 2000 model-year regulations for all pollutants, with the exception of slightly higher PM emissions. Two additional two-stroke engines were tested under a new condition and after at least 100 hr of use to examine the effects of deterioration on in-use, two-stroke engines. For one engine, CO and PM emissions more than tripled after 162 hr of operation in the field, with smaller increases also observed for THC (20%). For the second engine, significant repairs were required throughout the 100 operating hours, which counteracted the effects of the emissions deterioration and resulted in lower CO and THC emissions.

Changing heat and moisture exchangers after 96 hours rather than after 24 hours: a clinical and microbiological evaluation.

The aim of this study was to determine whether changing heat and moisture exchangers (HMEs) every 96 hrs rather than 24 hrs would affect their efficacy to preserve the heat and moisture of inspiratory gases. The impact of a prolonged use of the HME on its microbial colonization was also assessed. Prospective cohort observational study. Intensive care unit of a university hospital. Thirteen consecutive patients with no previous history of respiratory disease requiring controlled mechanical ventilation with an HME for >4 days were evaluated. The same HME was used for 96 hrs in each patient. In each patient, during the inspiration phase, the following measurements were performed: peak and mean airway pressures, mean values of temperature, and relative and absolute humidity of inspired gases. In each patient, measurements were performed after 1 hr of HME use and then daily up to the fourth day. On days 1 and 4, microbiological samples were obtained from the patients' bronchial secretions and the ventilator side of the HME. After 96 hrs of ventilation with the same HME, tracheal tube occlusion was never observed. Using the same HME for 96 hrs rather than 24 hrs did not affect its technical performances: temperature at 24 hrs: 32.2 +/- 1.5 degrees C (90.0 +/- 34.7 degrees F), at 96 hrs: 32.1 +/- 1.6 degrees C (89.8 +/- 34.9 degrees F); relative humidity at 24 hrs: 97.9 +/- 2%, at 96 hrs: 98.1 +/- 1.7%; absolute humidity at 24 hrs: 33.1 +/- 2.4 mg H2O/L, at 96 hrs: 33.0 +/- 2.5 mg H2O/L. This analysis was based on a total of 312 measurements performed on the 13 patients. Peak and mean airway pressures did not change during the 96-hr study period, with identical tidal and minute volumes in the study patients. On day 1, ten patients had a positive culture of their tracheal secretions at a colony count of > or = 10(3) colony forming units/mL. After 96 hrs of use with the same HME, only seven patients had a positive culture of their tracheal secretions. Cultures from the ventilator sides of the HMEs were all sterile (13/13) after 96 hrs of use. In patients free from previous chronic respiratory disorder and ventilated for neurologic reasons, changing the HME after 96 hrs rather than 24 hrs did not affect its technical performance in terms of heat and water preservation of ventilatory gases. There is also some indirect evidence of very little, if any, changes in the HME resistance. No bacterial colonization of the ventilator sides of the HMEs was observed after 96 hrs of use. However, other large clinical trials should be undertaken to confirm the safety of extending the time between HME changes.

Development, acceptance, and use patterns of a computer-based education and social support system for people living with AIDS/HIV infection

A computer-based support system has been developed to provide information, referrals, decision support, and social support to people living with AIDS/HIV infection. CHESS (the Comprehensive Health Enhancement Support System) uses personal computers placed in users' homes and linked together via modem through a central “host” computer. Color, graphics, and simple user prompts make the system easy to use. HIV-positive subjects (96 male, 20 female) were given CHESS computers to use in their homes for 3 to 6 months. Subjects used CHESS services a total of 15,966 times for over 4,600 hr of use, an average of about one use per subject per day throughout the study. Each subject used CHESS an average of over 39 hr. The system was heavily used by all segments of the study population. Women and minorities used the system at least as frequently as their male and Caucasian counterparts. In fact, Caucasian and minority women used some parts of the system significantly more than other subjects. Subjects rated CHESS very positively in terms of usefulness and ease of use. Thus, CHESS appears to be a heavily used and highly accepted means of providing information and support to HIV-infected individuals.

A breathing circuit alarm system based on neural networks

The objectives of our study were (1) to implement intelligent respiratory alarms with a neural network; and (2) to increase alarm specificity and decrease false-alarm rates compared with current alarms. We trained a neural network to recognize 13 faults in an anesthesia breathing circuit. The system extracted 30 breath-to-breath features from the airway CO2, flow, and pressure signals. We created training data for the network by introducing 13 faults repeatedly in 5 dogs (616 total faults). We used the data to train the neural network using the backward error propagation algorithm. In animals, the trained network reported the alarms correctly for 95.0% of the faults when tested during controlled ventilation, and for 86.9% of the faults during spontaneous breathing. When tested in the operating room, the system found and correctly reported 54 of 57 faults that occurred during 43.6 hr of use. The alarm system produced a total of 74 false alarms during 43.6 hr of monitoring. Neural networks may be useful in creating intelligent anesthesia alarm systems.

A BREATHING CIRCUIT ALARM SYSTEM BASED ON NEURAL NETWORKS

Objective. The objectives of our study were (1) to implement intelligent respiratory alarms with a neural network; and (2) to increase alarm specificity and decrease false-alarm rates compared with current alarms.Methods. We trained a neural network to recognize 13 faults in an anesthesia breathing circuit. The system extracted 30 breath-to-breath features from the airway CO2, flow, and pressure signals. We created training data for the network by introducing 13 faults repeatedly in 5 dogs (616 total faults). We used the data to train the neural network using the backward error propagation algorithm.Results. In animals, the trained network reported the alarms correctly for 95.0% of the faults when tested during controlled ventilation, and for 86.9% of the faults during spontaneous breathing. When tested in the operating room, the system found and correctly reported 54 of 57 faults that occurred during 43.6 hr of use. The alarm system produced a total of 74 false alarms during 43.6 hr of monitoring.Conclusion. Neural networks may be useful in creating intelligent anesthesia alarm systems.

Distribution of computer-assisted instructional materials in biomedicine through the Lister Hill Center Experimental Network

This paper discusses the organization and present configuration of the Lister Hill Experimental CAI network. Three institutional sources of CAI expertise—University of Illinois Medical Center, Massachusetts General Hospital and Ohio State University College of Medicine—are connected through a commercial time-sharing network to some 50 institutional users. Each of the three institutions provides five access ports, 20 hr a day, 7 days a week. During a month early in 1973 the network logged 2000 hr of use, which gave somewhat more than 4000 student encounters. The network is being operated both as a prototype of a possible service for libraries of the future to offer to their patrons and as an experiment to test the transferability of CAI programs.

Wear and Performance of Nozzles in Applying Trifluralin

In a stationary sprayer in a laboratory, wear was not detected in nozzles delivering α,α,α-trifluro-2,6-dinitro-N,N-dipropyl-p-toluidine (trifluralin) in 4.3 to 6.9 gpa (assuming 4 mph at 30 psi) after 60 hr of use. In contrast, there was 1.7 to 2.0% increase in discharge volume during the first 5 to 10 hr from nozzles delivering 12.9 to 26.6 gpa. Wear was attributed to the greater amount of liquid discharged through the larger nozzles. Average wear in stainless steel nozzles was 1.7% as compared with 2.5 and 2.6% in brass and aluminum nozzles, respectively, delivering 4.3 to 26.0 gpa over a 60-hr period, while volume decreased 4.1% in nylon nozzles. Although trifluralin concentrations in the field were lower when the herbicide was applied in 2.7 or 5.4 gal of carrier/A, as compared to nozzles discharging 8.0 to 31.0 gpa, control of smooth pigweed (Amaranthus hybridus L.) was 95% or higher with all carrier rates 6 months following application.

Hydrogenolysis of alcohols: III. Effect of supports on reduced nickel oxide for the conversion of alcohols to ethers

Catalysts prepared from nickel oxide deposited on kieselguhr, silica, silicaalumina, and alumina were reduced and studied for the conversion of primary alcohols. The alcohols studied were n-propanol, n-butanol, 2-methylbutanol, and 2,2-dimethylbutanol (neopentyl alcohol). The exepriments were made in a pulse reactor in the presence of a flow of hydrogen, at atmospheric pressure and at about 190 °. Three main reactions occur in the presence of a nickel-kieselguhr catalyst: (1) reductive dehydroxymethylation, (2) reductive dehydroxylation, and (3) ether formation. The last two reactions are related to the intrinsic acidic sites of the catalyst. Nickel-kieselguhr catalyst containing 6–10% of nickel gave in the case of n-butanol 73% conversion, with 72 mole % of di- n-butyl ether in the product. The presence of Na + in the catalyst inhibits the formation of ethers, while the dehydroxymethylation reaction increases. A continuous flow reaction at 190 ° demonstrated that nickel-kieselguhr catalyst containing 6% of nickel shows no deterioration after 16 hr of use. At 170 °, with a hydrogen to alcohol ratio of 10 and LHSV of 2, n-butanol reacted to the extent of 89%, with 91% yield of di- n-butyl ether.