Separate Intervals Research Articles

Improved Survival by Adding Lomustine to Conventional Chemotherapy for Elderly Patients With AML Without Unfavorable Cytogenetics: Results of the LAM-SA 2007 FILO Trial.

Acute myeloid leukemia (AML) in elderly patients has a poor prognosis. In an attempt to improve outcome for these patients, the prospective open-label phase III LAM-SA 2007 (Adding Lomustine to Chemotherapy in Older Patients With Acute Myelogenous Leukemia (AML), and Allogeneic Transplantation for Patients From 60 to 65 Years Old) trial randomly assigned patients to a standard induction regimen with lomustine added or to a consolidation regimen with cytarabine and idarubicin. Adults age 60 years or older with previously untreated AML who were fit to receive intensive chemotherapy and who were without unfavorable cytogenetics received standard chemotherapy with lomustine (idarubicin, cytarabine, and lomustine [ICL]) or without (idarubicin and cytarabine [IC]). The primary objective of the study was overall survival (OS); secondary objectives were response rate, cumulative incidence of relapse (CIR), event-free survival (EFS), and safety. From February 2008 to December 2011, 459 patients were enrolled. Comparing patients in the IC and ICL arms, complete response or complete response with incomplete recovery was achieved in 74.9% versus 84.7% (P = .01). The proportional hazards assumption was rejected for OS (P = .02), which led us to consider two separate time intervals: during and after induction. There was no significant difference between the two arms during induction, although induction deaths were 3.7% versus 7.7%, respectively (P = .11). However, significantly better results were observed after induction with an improved 2-year OS of 56% in the ICL arm versus 48% in the IC arm (P = .02). At 2 years, EFS was improved at 41% in the ICL arm versus 26% in the IC arm (P = .01). The CIR at 2 years was 41.2% in the ICL arm versus 60.9% in the IC arm (P = .003). Grade 3 and 4 toxicities, mostly hematologic, were significantly higher in the ICL arm (P = .04), and fewer patients required a second treatment after ICL. Adding lomustine to standard chemotherapy significantly improved the outcome of elderly patients with AML.

A comparison of complete blood count reference intervals in healthy elderly vs. younger Korean adults: a large population study.

Background The use of laboratory reference intervals based on younger populations is of questionable validity in older populations. We established reference intervals for 16 complete blood count (CBC) parameters in healthy elderly Koreans aged ≥60 years and compared them to those of individuals aged 20-59 years. Methods Among 64,532 individuals (39,609 men and 24,923 women) aged ≥20 years who underwent medical checkups, 8151 healthy subjects (12.6%, 5270 men and 2881 women, including 675 and 511, respectively, who were ≥60 years of age) were enrolled based on stringent criteria including laboratory, imaging and endoscopy results; previous medical history; and medication history. CBC parameters were measured using an Advia2120i instrument. Results Overall, healthy individuals aged ≥60 years did not require separate reference intervals from those aged <60 years except for red cell distribution width (RDW) and mean corpuscular hemoglobin (MCH) in women. However, subjects aged ≥60 years still required sex-specific reference intervals for red blood cell count, hemoglobin, hematocrit, MCH, monocytes and eosinophils. Separate reference intervals were required for MCH, eosinophils and basophils for certain age subgroups of men aged ≥60 years, and for MCH and RDW in certain age subgroups of women aged ≥60 years, compared to counterparts <60 years of age. Conclusions Healthy elderly Koreans can use the same reference intervals as younger populations. Thus, abnormal CBC results may not necessarily be attributable to physiologic changes but possible underlying diseases that should be investigated.

Determination of the reference values of amino acids and acylcarnitines level in the newborn dry blood spots in Ukraine

Aim. Implementation of neonatal screening of the group of severe inherited disorders of amino acids, fatty and organic acids metabolism in Ukraine involves determination of the biological variation of amino acids and acylcarnitines level in the blood that depends on the gender, geographical origin of the samples and the gestation term of newborn. Methods. The main method of rapid and reliable diagnosis of this group of inherited disorders is determination of amino acids and acylcarnitines level by liquid chromatography tandem mass spectrometry. Results. Reference intervals of amino acids and acylcarnitines concentration in dry blood samples of newborns from different regions of Ukraine haven’t differed. However, it was found necessity to use separate reference intervals of some amino acids and acylcarnitines (citrulline, arginine, methionine, leucine, tyrosine, alanine, histidine, C0, C3, C3DC, C4, C5, C6, C8, C8:1, C10:2, C12, C14:1, C16, C18OH, C18:1OH) for premature and full-term newborns. Also, it was revealed that for male and female newborns it is necessary to use different reference intervals of citrulline, leucine, C8:1, arginine, methionine, C5, C8. Conclusions. In this study it was found that variation of amino acids and acylcarnitines concentration in dry blood spots depends on the newborns gestation term and sex. We have proposed a two-stage procedure of biomarkers interpretation for which the values variation in different neonatal groups was detected. Keywords: amino acids and acylcarnitines reference intervals, inherited disorders of amino acids, fatty and organic acids metabolism, newborn screening.

Effective Endoscopic Magnet Retrieval in Children

Abstract Background: Children are attracted toward magnets and magnetic toys, but ingestion may cause morbidity, particularly if consumed at separate time intervals. Ingestion of multiple magnets that pass into the intestine may present with an acute abdomen from perforation or fistulization. When multiple magnets are identified in the stomach, expedient endoscopic removal is recommended in case another unrecognized ingestion occurs at a later time. Case 1: A 3-year-old boy ingested two neodymium magnets. These powerful magnets attract with up to 6 pounds of pressure. A radiograph confirmed they were in the stomach. Procedure: Under general anesthesia, an endoscope was passed. The pacemaker magnet was applied to the anterior abdominal wall. The magnets were easily observed, stabilized, and removed with an endoscopic stone extractor. The operative time was 8 minutes. Case 2: A 5-year-old boy ingested 11, 3-mm diameter, rare earth magnets (buckyballs). He presented to the emergency department. Radiographs c...

Testosterone Levels in Third Trimester in Polycystic Ovary Syndrome: Odense Child Cohort.

Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism. In pregnancy, testosterone levels may be higher in women with PCOS compared with controls. To compare total testosterone (TT), free testosterone (FT), and sex hormone-binding globulin (SHBG) levels in third-trimester pregnant women with PCOS and controls and to establish reference ranges for TT, FT, and SHBG in PCOS and controls. The study was part of the prospective study, Odense Child Cohort. PCOS was diagnosed by questionnaires and/or patient records. Fasting blood samples were collected at gestational week 28 and plasma TT was measured by liquid chromatography-tandem mass spectrometry in women with PCOS (n = 145) and in women without PCOS (controls, n = 1341). Levels of TT (mean, 2.4 vs 2.0 nmol/L) and FT (mean, 0.005 vs 0.004 nmol/L) were higher, whereas SHBG levels (mean, 447 vs 477 nmol/L) were lower in women with PCOS vs controls (all P < 0.001). Reference intervals for TT, FT, and SHBG in women with PCOS and controls were overlapping, and partitioning of reference intervals was an ambiguous decision. In multiple regression analyses, TT and FT levels were positively associated with PCOS status and BMI and inversely associated with age and parity. Offspring sex did not predict maternal TT and FT. TT and FT levels were higher in third-trimester pregnant women with PCOS compared with controls. Separate reference interval for FT in women with PCOS should be considered.

Pediatric reference intervals for general clinical chemistry components – merging of studies from Denmark and Sweden

Background: Reference intervals are crucial tools aiding clinicians when making medical decisions. However, for children such values often are lacking or incomplete. The present study combines data from separate pediatric reference interval studies of Denmark and Sweden in order to increase sample size and to include also pre-school children who were lacking in the Danish study.Methods: Results from two separate studies including 1988 healthy children and adolescents aged 6 months to 18 years of age were merged and recalculated. Eighteen general clinical chemistry components were measured on Abbott and Roche platforms. To facilitate commutability, the NFKK Reference Serum X was used.Results: Age- and gender-specific pediatric reference intervals were defined by calculating 2.5 and 97.5 percentiles.Conclusion: The data generated are primarily applicable to a Nordic population, but could be used by any laboratory if validated for the local patient population.

OVEMP as an objective indicator of successful repositioning maneuver

Background and objectiveBenign paroxysmal positioning vertigo (BPPV) is the most common peripheral vestibular disorder. Canalolithiasis in the posterior semi-circular canal is the most common underlying pathology that can be treated effectively by repositioning maneuvers. Our hypothesis suggested that successful maneuvers can lead to repositioning of dislodged otoconia to the utricle. Materials and methodsAir conducted oVEMP, which is thought to originate from the contra-lateral utricular organ was measured in twenty patients with unilateral BPPV and we compared n1•p1 peak to peak amplitude of the affected ears in 3 separate intervals: on pre-treatment when typical nystagmus was confirmed, immediately after, and 1 week after repositioning maneuvers to assess change, if any, in amplitude. ResultsThis study showed significant increase of oVEMP amplitude in the affected ears after successful repositioning maneuver that was more significant after 1 week. ConclusionsoVEMP can be used as a reliable objective test for ensuring a successful maneuver rather than subjective dependence on the patient's symptoms, which may be misleading due to a remission.

GEOLOGICAL-GEOPHYSICAL ANALYSIS OF FEDOROVSKOYE OIL FIELD DEVELOPMENT

Background There were 3867 field-geophysical studies carried out in extractive wells and 2364 studies in injection wells, as well as 4413 studies to establish and refine current gas saturation and gas-oil contact at the Fedorovskoye oil field. Studies were carried out in almost all wells that opened the object АС4-8. Over the period from the beginning of field development, the results of 4379 hydrodynamic studies were collected, interpreted and analyzed. Aims and Objectives Profitability analysis of Fedorovskoye oil field development and operation based on geological, hydrodynamic and field data. Results Fedorovskoye oil field development (displacement of oil) through separate productive intervals is extremely uneven. This is indicated by the electrometry data of the condensing wells drilled in the later period of reservoir development and revealed the already planted areas of the oil field. The highest values of the displacement coefficient are attained in high-permeability reservoirs, which lie mainly in the upper and middle parts of the thickness of the reservoir. As a result, the reservoir current state is represented by a layer-by-layer alternation of high-water and medium-watered interlayers. This circumstance considerably complicates the intensification of the remaining oil reserves development in the reservoir being developed.

Time trends for bacterial species and resistance patterns in semen in patients undergoing evaluation for male infertility

ABSTRACTSemen from asymptomatic men who are being evaluated as male partners in interfile couples have been reported to contain a variety of bacteria. Longitudinal studies of the variation of these bacteria over time and their resistance patterns have not been commonly reported. At our institution, residues from semen samples are routinely evaluated for bacteria, including antibiotic sensitivity profiles. We set out to profile the changes in semen bacteria and antibiotic resistance at our institution over time. A total of 72 semen isolates were examined for type of bacteria and sensitivity to a panel of antibiotics. The results were divided into two separate 5-year intervals (the first beginning in 2006, the second in 2011) and compared. The majority of bacteria were skin flora, with Streptococcus and Staphylococcus being the most prevalent. The resistance data for these two pathogens showed minimal statistically significant difference between the two time periods, although the Staphylococcus species did show a trend toward increasing resistance, suggesting that antibiotics currently used in sperm cell preparations may need to be varied.

Can an interactive e-learning training package improve the understanding of personality disorder within mental health professionals?

PurposePersonality disorder is reported to elicit strong emotional responses and negative attitudes in mental health staff (Bodner et al., 2015). The purpose of this paper is to provide an overview of the design and development of a co-produced e-learning training package for personality disorder awareness and an evaluation of its effectiveness. This study was carried out to explore if e-learning is an effective mode of training delivery for raising personality disorder awareness.Design/methodology/approachThe e-learning was uniquely developed by subject matter experts working in co-production with people with lived experience. Self-reported measures were completed at three separate intervals to evaluate the effectiveness of the training: at pre-, post- and three-month follow up. Quantitative data were collected via these questionnaires.FindingsThe results from this evaluation show that e-learning is an effective mode of delivery for raising the awareness of personality disorder among mental health professionals, achieving similar outcomes to those reported following face-to-ace training.Research limitations/implicationsAttrition at follow-up phase was high which was consistent with other similar studies. The evaluation was led by the lead contributors and in the geographical area of its development. The study was relatively small and the participants were self-selected, therefore findings should be treated with caution.Practical implicationsE-learning can provide flexible training to compliment and act as an alternative to face-to-face personality disorder training. E-learning may provide an alternative refresher course to knowledge and understanding framework or other face-to-face methods. Co-produced training can be mirrored within an e-learning programme, careful planning to ensure the service user voice is heard and that their lived experience is embraced is required.Originality/valueThis is the first evaluation of a co-produced e-learning only personality disorder awareness training. It is also the first paper to carry out a review of the published evaluations of personality awareness training in the UK with comparisons explored across the studies.

E&amp;P Notes (March 2018)

E&amp;P Notes (March 2018)

Effect of pH on the Behavior of a Random Copolymer of Acrylamide

A temperature- and pH-sensitive random copolymer of N-[3-(diethylamino)propyl]-N-methylacrylamide] and N,N-diethylacrylamide was obtained. The copolymer contained 20 mol % of amine units and had a molecular weight of 3.3 × 104. Buffer solutions containing 0.0102 g/cm3 of the synthesized copolymer were studied in the pH range of 7–13.5 by light scattering and turbidimetry. At low temperatures, macromolecules and large aggregates coexist in the solutions. The copolymer is temperature- and pH-sensitive in the studied pH range. The temperature and the width of the phase separation interval increase with increasing acidity of the medium.

Radiological and clinical outcomes of medial approach open reduction by using two intervals in developmental dysplasia of the hip

ObjectiveTo evaluate the midterm clinical and radiological outcomes of the medial approach using two intervals for developmental hip dysplasia (DDH). MethodsThe study involved 62 hips of 47 patients (41 girls, 6 boys) treated with medial approach for DDH from 1999 to 2010. The age of the patients at surgery was 18.7 ± 2.25 months. Follow up of the patients was 11.3 ± 3.07 years. The age of the patients at the last follow up was 12.6 ± 1.74 years. According to the Tönnis classification, 13 hips were grade II, 27 hips were grade III and 22 hips were grade IV. Patients were evaluated according to Omeroglu radiological criteria and modified McKay functional criteria. The presence of avascular necrosis (AVN) of the hip was questioned using the KalamchiMacEwen classification. ResultsRadiologically, forty eight (77%) hips were evaluated as “excellent”, 8 (13%) hips as “good” and 5 (8%) hips as “fair plus” and 1 (%2) hip as “fair minus”. Two (3%) patients had type 1 temporary AVN and one (1%) patient had type 4 AVN with coxa magna and overgrowth of the greater trochanter. According to McKay functional criteria, 56 (90%) hips had “excellent” and 6 (10%) had “good” results. Two (3.2%) hips of one patient had to be reoperated with Salter osteotomy and femoral shortening + derotation osteotomy. ConclusionMedial approach using two separate intervals for tenotomy and capsulotomy does not jeopardize the medial circumflex or the femoral vessels and yields satisfactory midterm results for children 18 months old with dysplasia of the hip. Level of evidenceLevel IV, therapeutic study.

Measurement of longitudinal flow decorrelations in Pb+Pb collisions at sqrt{s_{text {NN}}}=2.76 and 5.02 TeV with the ATLAS detector

Measurements of longitudinal flow correlations are presented for charged particles in the pseudorapidity range |eta |<2.4 using 7 and 470 upmu hbox {b}^{-1} of Pb+Pb collisions at sqrt{s_{text {NN}}}=2.76 and 5.02 TeV, respectively, recorded by the ATLAS detector at the LHC. It is found that the correlation between the harmonic flow coefficients v_n measured in two separated eta intervals does not factorise into the product of single-particle coefficients, and this breaking of factorisation, or flow decorrelation, increases linearly with the eta separation between the intervals. The flow decorrelation is stronger at 2.76 TeV than at 5.02 TeV. Higher-order moments of the correlations are also measured, and the corresponding linear coefficients for the k{text {th}}-moment of the v_n are found to be proportional to k for v_3, but not for v_2. The decorrelation effect is separated into contributions from the magnitude of v_n and the event-plane orientation, each as a function of eta . These two contributions are found to be comparable. The longitudinal flow correlations are also measured between v_n of different order in n. The decorrelations of v_2 and v_3 are found to be independent of each other, while the decorrelations of v_4 and v_5 are found to be driven by the nonlinear contribution from v_2^2 and v_2v_3, respectively.

Evidence for stratigraphy in molluscan death assemblages preserved in seagrass beds: St. Croix, U.S. Virgin Islands

AbstractDeath assemblages that occupy the upper tens of centimeters of sediment in shallow-marine settings are often subject to extensive mixing, thereby limiting their usefulness in assessing environmentally mediated compositional changes through time in the local biota. Here, we provide evidence that dense,Thalassia-rich seagrass beds preserve a stratigraphic record of biotic variation because their dense root–rhizome mats inhibit mixing. We sampled benthic mollusk assemblages at seven localities inThalassia-rich beds around St. Croix, USVI, collecting three separate sediment intervals of ~13 cm each to a total depth of ~40 cm below the sediment–water interface, and found evidence that sedimentary intervals preserved compositional stratigraphy. Further, some localities displayed systematic, directional changes down-core. An examination of interval-to-interval changes in composition revealed that compositional variation was unique from locality to locality rather than reflecting coordinated, island-wide transitions. In general, however, relative abundances of epifaunal gastropods and small lucinid bivalves tended to decrease with depth below the sediment–water interface. Quantitative comparisons of life-to-death assemblages from each successive sedimentary interval demonstrated that the shallowest death assemblages were typically more similar to the life assemblages than were deeper assemblages, suggesting that deeper intervals provide records of earlier community states.

Post-endoscopic procedure satisfaction scores: Can we improve?

AIMTo organize post-procedure satisfaction data into a useful reference and analyze patient-centered parameters to find trends that influence patient satisfaction.METHODSA robust database of two cohorts of outpatients that underwent an endoscopic procedure at Georgetown University Hospital at two separate three-month intervals ranging from November 2012 to January 2013 and November 2015 to January 2016 was compiled. Time of year was identical to control for weather/seasonal issues that may have contributed to the patient experience. The variables recorded included age, sex, body mass index (BMI), type of procedure, indication for procedure, time of the procedure, length of the procedure, type of prep used, endoscopist, satisfactory score, and comments/reasons for score. For continuous variables, differences in averages were tested by two sample t-test, Wilcoxon rank sum test, and ANOVA as appropriate. For categorical variables, differences in proportions between two groups were tested by χ2 test. Correlation test and linear regression analyses were conducted to examine relationships between length of procedure and continuous predictors. A P value < 0.05 used to indicate statistically significant relationship.RESULTSThe primary outcome of this study was to assess if telephone outreach after an endoscopic intervention was a satisfactory method of obtaining post-procedure satisfaction scores from patients at a tertiary care center. With the addition of post-procedure calls, instilled in January 2014, the response rate was 40.5% (508/1256 patients) from a prior completion rate of 3.4% (31/918) with the mail out survey initially. There was a statistically significant improved response rate pre and post intervention with P < 0001. The secondary outcome of this study was to assess if we could use predictive analytics to identify independent predictors of procedure length, such as gender, age, type of procedure, time of procedure, or BMI. The combined pre and post intervention data was used in order to optimize the power to identify independent predictors of procedure length. The total number of patient’s data analyzed was 2174. There was no statistically significant difference in procedure length between males and females with P value 0.5282. However, there was a small (1 min), but statistically significant difference (P = 0.0185) in procedure length based on the time of day the procedure took place, with afternoon procedures having a longer duration than morning procedures. The type of procedure was an independent predictor of procedure length as demonstrated with P value < 0.0001. There is a statistically significant correlation between age and procedure length, although it is only a weak relationship with a correlation coefficient < 0.3. Contrary to patient age, BMI did not have a statistically significant correlation with procedure length (P = 0.9993), which was also confirmed by linear regression analysis.CONCLUSIONOur study proves calling patients after endoscopy improves post-procedure satisfaction response rates and changing procedural time allotment based on patient characteristics would not change endoscopic workflow.

Constructing Joint Confidence Bands for Impulse Response Functions of VAR Models: A Review

Methods for constructing joint confidence bands for impulse response functions which are commonly used in vector autoregressive analysis are reviewed. While considering separate intervals for each horizon individually still seems to be the most common approach, a substantial number of methods have been proposed for making joint inferences about the complete impulse response paths up to a given horizon. A structured presentation of these methods is provided. Furthermore, existing evidence on the small-sample performance of the methods is gathered. The collected information can help practitioners to decide on a suitable confidence band for a structural VAR analysis.

Behavioral and cortisol responses of adult marmoset monkeys (Callithrix penicillata) to different home-cage social disruption intervals

Social separation is an increasingly used strategy to experimentally assess psychogenic stress in nonhuman primates, yet it is also inherently required for captive management. Surprisingly, little is known on the effects of an individual left alone in a highly familiar place, compared to novel-environment isolation. Therefore, using stable heterosexual pairs of adult marmosets (Callithrix penicillata), we assessed in the individual left behind in the home-cage: (1) the behavior during and after a 5 and 15 min separation; (2) the behavior and cortisol levels before, during and after a 7-day separation; and (3) the relationship between these two components of the stress response. All conditions induced social contact calls and hyperlocomotion, with prolonged separation yielding a habituation effect (p < 0.05). How each parameter returned to baseline following the reunion depended on the duration of the preceding separation interval, with post-reunion affiliative behaviors increasing significantly only after longer intervals (experiment 1: p = 0.02; experiment 2: p = 0.001). Cortisol concentrations, which also increased during the 7-day separation (p = 0.04), were temporally dissociated from and not correlated with the marmosets’ behavioral response (p > 0.05). Interestingly, cortisol levels during the social separation phase were negatively correlated with post-reunion affiliative behavior (p = 0.05). Stress-induced cortisol may thus hinder putative behavioral coping strategies. However, post-reunion affiliative behavior was not correlated with the last cortisol measure (p = 0.21). Therefore, social disruption in a familiar environment – even if brief – induces stress-related responses and behavioral coping strategies. These findings bear important implication for captive management and research protocols using marmosets.

European Seabirds Show Stable Contemporary Biogeography

Abstract The geographic distribution and populations of cliff-nesting seabirds are essential elements in the assessment of their ecological roles and status. Here, a geographic mapping approach was used to visualize the biogeography of European seabirds. This approach was conducted at two temporally separated time intervals: 2004–2010 was compared to 1982–1988. Three biogeographic regions were identified: Arctic, Boreal and Ibero-Atlantic. The data show that species richness has remained stable over the approximately 20-year interval, as have, in general, population numbers and geographic distribution. Such stability, compared to recent declining trends worldwide, may be due to earlier human-driven declines in the European Atlantic, followed by effective conservation measures for the remaining populations. The species richness of cliff-nesting seabirds may not be principally determined by island area and distance from a large land mass, but rather by the extent of vertical cliff facade and distance from f...

Chinese Pediatric Reference Intervals for Serum Cortisol on IMMULITE 2000.

Clinical interpretation of the test results for cortisol based on continuous reference intervals with appropriate partitions improves pediatric diagnosis; however, these values are available only for Caucasians. To develop the pediatric reference intervals for Chinese population, we examined the serum cortisol levels in 1,143 healthy Chinese children aged 4–18 years (566 boys and 577 girls), using an IMMULITE 2000 Immunoassay System (Siemens Healthcare GmbH). Phlebotomy was performed at 7–9 a.m. for 284 boys and 287 girls and at 1–3 p.m. for the others. They were divided into four age groups according to the Clinical and Laboratory Standards Institute guideline EP28-A3c, with the last group further stratified according to sampling time. Separate reference intervals of 49.6–323.7, 70.9–395.3, and 90.1–448.7 nmol/L were established for children aged 4–8, 9–12, and 13–15 years, respectively. Further, reference intervals of 118.2–464.7 and 71.4–446.7 nmol/L were established for morning and afternoon cortisol levels, respectively, in children aged 16–18 years. Further studies are necessary to transfer and validate these reference intervals in other analytical systems and pediatric populations, and to allow for broader applications.