A PERMEABLE ACTIVE AMENDMENT CONCRETE (PAAC) FOR CONTAMINANT REMEDIATION AND EROSION CONTROL

The final project report for SEED SERDP ER - 2134 describes the development of permeable active amendment concrete (PAAC), which was evaluated through four tasks: 1) development of PAAC; 2) assessment of PAAC for contaminant removal; 3) evaluation of promising PAAC formulations for potential environmental impacts; and 4) assessment of the hydraulic, physical, and structural properties of PAAC. Conventional permeable concrete (often referred to as pervious concrete) is concrete with high porosity as a result of an extensive and interconnected void content. It is made from carefully controlled amounts of water and cementitious materials used to create a paste that forms a coating around aggregate particles. The mixture has a substantial void content (e.g., 15% - 25%) that results in a highly permeable structure that drains quickly. In PAAC, the aggregate material is partly replaced by chemically-active amendments that precipitate or adsorb contaminants in water that flows through the concrete interstices. PAAC combines the relatively high structural strength, ample void space, and water permeability of pervious concrete with the contaminant sequestration ability of chemically-active amendments to produce a new material with superior durability and ability to control contaminant mobility. The high surface area provided by the concrete interstices in PAAC provides significant opportunity for contaminants to react with the amendments incorporated into the concrete matrix. PAAC has the potential to immobilize a large variety of organic and inorganic contaminants by incorporating different active sequestering agents including phosphate materials (rock phosphate), organoclays, zeolite, and lime individually or in combinations

A PERMEABLE ACTIVE AMENDMENT CONCRETE (PAAC) FOR CONTAMINANT REMEDIATION AND EROSION CONTROL

The final project report for SEED SERDP ER - 2134 describes the development of permeable active amendment concrete (PAAC), which was evaluated through four tasks: 1) development of PAAC; 2) assessment of PAAC for contaminant removal; 3) evaluation of promising PAAC formulations for potential environmental impacts; and 4) assessment of the hydraulic, physical, and structural properties of PAAC. Conventional permeable concrete (often referred to as pervious concrete) is concrete with high porosity as a result of an extensive and interconnected void content. It is made from carefully controlled amounts of water and cementitious materials used to create a paste that forms a coating around aggregate particles. The mixture has a substantial void content (e.g., 15% - 25%) that results in a highly permeable structure that drains quickly. In PAAC, the aggregate material is partly replaced by chemically-active amendments that precipitate or adsorb contaminants in water that flows through the concrete interstices. PAAC combines the relatively high structural strength, ample void space, and water permeability of pervious concrete with the contaminant sequestration ability of chemically-active amendments to produce a new material with superior durability and ability to control contaminant mobility. The high surface area provided by the concrete interstices in PAAC provides significant opportunity for contaminants to react with the amendments incorporated into the concrete matrix. PAAC has the potential to immobilize a large variety of organic and inorganic contaminants by incorporating different active sequestering agents including phosphate materials (rock phosphate), organoclays, zeolite, and lime individually or in combinations

Ustekinumab for the treatment of moderate‐to‐severe plaque psoriasis in paediatric patients (≥ 6 to < 12 years of age): efficacy, safety, pharmacokinetic and biomarker results from the open‐label CADMUS Jr study

Background Limited options are available for treatment of paediatric psoriasis. Objectives To evaluate the efficacy and safety of ustekinumab in paediatric patients with psoriasis (>= 6 to = 60 to 100 kg: 90 mg) administered by subcutaneous injection at weeks 0 and 4, then every 12 weeks through week 40. Study endpoints (all at week 12) included the proportions of patients achieving a Physician's Global Assessment score of cleared/minimal (PGA 0/1) and >= 75%/90% improvement in Psoriasis Area and Severity Index (PASI 75/90), and change in Children's Dermatology Life Quality Index (CDLQI). Serum ustekinumab concentrations, antidrug antibodies and cytokine levels were measured through week 52. Safety was evaluated through week 56. Results In total, 44 patients (median age 9 center dot 5 years) received at least one dose of ustekinumab. Three patients discontinued the study agent through week 40. At week 12, 77% of patients achieved PGA 0/1, 84% achieved PASI 75 and 64% achieved PASI 90 response. The mean change in CDLQI was -6 center dot 3. Trough serum ustekinumab concentrations reached steady state at weeks 28-52. The incidence of antidrug antibodies was 10% (n = 4). Mean serum concentrations of interleukin-17A/F and interleukin-22 were significantly reduced at weeks 12 and 52. Overall, 34 patients (77%) had at least one adverse event and three (7%) had a serious adverse event. Conclusions Ustekinumab effectively treated moderate-to-severe psoriasis in paediatric patients, and no new safety concerns were identified. What is already known about this topic? Ustekinumab is approved for use in adolescents (>= 12 to = 18 years) with moderate-to-severe psoriasis. What does this study add? Ustekinumab effectively treats moderate-to-severe psoriasis in paediatric patients (>= 6 to < 12 years of age), with no new safety concerns

Defining and measuring “eczema control”: An international qualitative study to explore the views of those living with and treating atopic eczema

Background Atopic eczema (also known as eczema) is a chronic, inflammatory skin condition that often afflicts patients’ health and wellbeing. The Harmonising Outcome Measures for Eczema (HOME) initiative recommends that “long-term control of eczema” is measured in all clinical trials 3 months or longer in duration. However, little has been published on what eczema control means to those living with or treating atopic eczema. Objectives To i) develop understanding of what eczema control means to patients, carers and clinicians and ii) explore the feasibility and acceptability of different ways of measuring eczema control in the long-term. Methods Online focus groups explored patients/carers experiences in the UK, USA, the Netherlands, France, Sweden and Japan, and an international online survey gathered views of clinicians. The Framework Method was used to analyse the focus groups and thematic analysis was used to analyse survey data. All findings were integrated into a theoretical framework to create overarching themes that cut across these diverse groups. Results Eight focus groups with patients (16 years+) and eight groups with carers of children took place (N=97). Sixty-two people took part in the survey. Eczema control was described as a multifaceted construct involving changes in disease activity, the treatment and management of the condition, and psychological, social and physical functioning. Patient /carer measurement allows personal accounts and frequent measurement, whilst clinician measurement was deemed less subjective. The burden on patients/carers and issues for analysing and interpreting data should be considered. Conclusions This study formed the basis of judging the content validity and feasibility of measurement instruments/methods to assess control of eczema in clinical trials. This online approach to an international qualitative study is an example of how core outcome set developers with limited resources can engage with multiple stakeholder groups on an international basis to inform consensus meeting discussions

Laboratory safety of dupilumab in patients aged 6–11 years with severe atopic dermatitis : results from a phase III clinical trial

Background Previous studies of dupilumab in adolescents and adults with moderate-to-severe atopic dermatitis (AD) showed no clinically meaningful adverse changes in laboratory parameters. Objective The aim of this study was to assess laboratory outcomes in children aged 6–11 years with severe AD in a randomized, placebo-controlled, phase III trial of dupilumab. Methods Children aged 6–11 years with severe AD were randomized 1:1:1 to 16 weeks of dupilumab 300 mg every 4 weeks, 100 or 200 mg every 2 weeks, or matching placebo, all with concomitant topical corticosteroids (TCS). Blood samples were collected at baseline and Weeks 4, 8, and 16; urine samples were collected at baseline and Weeks 4 and 16. Results Of 367 patients enrolled in the study, 362 were included in the safety analysis, 351 completed study treatment, and 4 withdrew due to treatment-emergent adverse events not related to laboratory abnormalities. Both dupilumab + TCS groups showed overall trends toward increases in mean blood levels of eosinophils and alkaline phosphatase, and decreases in mean blood levels of platelets, neutrophils, and lactate dehydrogenase levels, without corresponding mean changes in the placebo + TCS group. None of these changes were associated with symptoms or clinically meaningful adverse outcomes, and none led to treatment modification. No clinically significant changes or trends were observed for other measured laboratory parameters. Conclusion There were no clinically meaningful adverse changes in routine laboratory parameters attributable to treatment with dupilumab + TCS. Changes in platelet counts and lactate dehydrogenase levels likely reflect reduced inflammation. These results confirm similar findings in adults and adolescents, and suggest that there is no need for routine laboratory monitoring of children aged 6–11 years treated with dupilumab + TCS for severe AD. Trial Registration ClinicalTrials.gov Identifier: NCT03345914

Electrocortical evidence for long-term incidental spatial learning through modified navigation instructions

© Springer Nature Switzerland AG 2018. The use of Navigation Assistance Systems for spatial orienting has become increasingly popular. Such automated navigation support, however, comes with a reduced processing of the surrounding environment and often with a decline of spatial orienting ability. To prevent such deskilling and to support spatial learning, the present study investigated incidental spatial learning by comparing standard navigation instructions with two modified navigation instruction conditions. The first modified instruction condition highlighted landmarks and provided additional redundant information regarding the landmark (contrast condition), while the second highlighted landmarks and included information of personal interest to the participant (personal-reference condition). Participants’ spatial knowledge of the previously unknown virtual city was tested three weeks later. Behavioral and electroencephalographic (EEG) data demonstrated enhanced spatial memory performance for participants in the modified navigation instruction conditions without further differentiating between modified instructions. Recognition performance of landmarks was better and the late positive complex of the event-related potential (ERP) revealed amplitude differences reflecting an increased amount of recollected information for modified navigation instructions. The results indicate a significant long-term spatial learning effect when landmarks are highlighted during navigation instructions

Supportive care in the acute phase of Stevens-Johnson syndrome and toxic epidermal necrolysis : an international, multidisciplinary Delphi-based consensus

Background Supportive care is the cornerstone of management of adult and paediatric Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). However, consensus on the modalities of supportive care is lacking. Objectives Our aim in this international multicentric Delphi exercise was to establish a multidisciplinary expert consensus to standardize recommendations regarding supportive care in the acute phase of SJS/TEN. Methods Participants were sent a survey via the online tool SurveyMonkey, consisting of 103 statements organized into 11 topics: multidisciplinary team composition, suspect drug management, infection prevention, fluid resuscitation and prevention of hypothermia, nutritional support, pain and psychological distress management, management of acute respiratory failure, local skincare, ophthalmological management, management of other mucosa, and additional measures. Participants evaluated the level of appropriateness of each statement on a scale of 1 (extremely inappropriate) to 9 (extremely appropriate). The results were analysed according to the RAND/UCLA Appropriateness Method. Results Forty-five participants from 13 countries (on three continents) participated. After the first round, a consensus was obtained for 82.5% of the 103 initially proposed statements. After the second round, a final consensus was obtained for 102 statements. Conclusions We have reached an international Delphi-based consensus on best supportive care practice for SJS/TEN. Our expert consensus should help guide physicians in treating patients with SJS/TEN and thereby improve short-term prognosis and the risk of sequelae.Peer reviewe