Assessment of CNT-doping and hot-wet storage aging effects on Mode I, II and I/II interlaminar fracture toughness of a UD Graphite/Epoxy material system

The interlaminar fracture toughness of two unidirectional Graphite/Epoxy composite material systems has been experimentally assessed. The systems studied were prepreg composite and prepreg composite treated with carbon nanotubes (CNT). The fracture toughness has been quantified in Mode I, Mode II and Mode I/II by performing DCB, ENF and MMB tests according to relevant ISO and ASTM standards. The effect of aging by storage under hot-wet conditions has been quantified by studying these systems at room temperature without aging and at 70 °C after aging treatment. Experimental data are reported in a 3- or 5-specimen batch mode, indicating non-linear behavior and sensitivity to imperfections in coupons alignment and load application. Moreover, intermediate variables required for the estimation of fracture toughness are presented in order to be used as a reference guide for principal fracture test data evaluation. In the case of the RT systems, measured data have been compared with analytical solutions and finite element model predictions yielding good correlation for DCB and ENF tests and considerable deviation in the case of MMB tests. Main findings include that CNT-doping leads to an increase of fracture toughness in all modes, especially in Mode II, and that aging leads to less variation in measurements for both systems, indicating a more uniform matrix response.The current work has received funding from EU Horizon 2020 Clean Sky II project SHERLOC (Structural Health Monitoring, Manufacturing and Repair Technologies for Life Management of Composite Fuselage) under Grant Agreement No CS2-AIR-GAM-2014-2015-01. The authors from HAI would like to thank our ex-colleagues Dimitrios Habas and Stavros Kalogeropoulos for their major assistance with coupons fabrication and experimental work, respectively.Peer ReviewedPostprint (author's final draft

A review of the evidence for occupational exposure risks to novel anticancer agents - A focus on monoclonal antibodies

INTRODUCTION: Evidence of occupational exposure risks to novel anticancer agents is limited and yet to be formally evaluated from the Australian healthcare perspective. METHODS: From March to September 2013 medical databases, organizational policies, drug monographs, and the World Wide Web were searched for evidence relating to occupational exposure to monoclonal antibodies, fusion proteins, gene therapies, and other unclassified novel anticancer agents. RESULTS: Australian legislation, national and international guidelines, and drug company information excluded novel agents or provided inconsistent risk assessments and safe handling recommendations. Monoclonal antibody guidelines reported conflicting information and were often divergent with available evidence and pharmacologic rationale demonstrating minimal internalisation ability and occupational exposure risk. Despite similar physiochemical, pharmacologic, and internalisation properties to monoclonal antibodies, fusion proteins were included in only a minority of guidelines. Clinical directives for the safe handling of gene therapies and live vaccines were limited, where available focusing on prevention against exposure and cross-contamination. Although mechanistically different, novel small molecule agents (proteasome inhibitors), possess similar physiochemical and internalisation properties to traditional cytotoxic agents warranting cytotoxic classification and handling. CONCLUSION: Novel agents are rapidly emerging into clinical practice, and healthcare personnel have few resources to evaluate risk and provide safety recommendations. Novel agents possess differing physical, molecular and pharmacological profiles compared to traditional cytotoxic anticancer agents. Evaluation of occupational exposure risk should consider both toxicity and internalisation. Evidence-based guidance able to direct safe handling practices for novel anticancer agents across a variety of clinical settings is urgently required

Diagnostic and therapeutic approach to persistent or recurrent fevers of unknown origin in adult stem cell transplantation and haematological malignancy

Persistent or recurrent fevers of unknown origin (PFUO) in neutropenic patients on broad-spectrum antibiotics have traditionally been treated with empirical antifungal therapy (EAFT). The lack of survival benefit seen with the use of amphotericin B deoxycholate (AmB-D) as EAFT has been attributed to its toxicities. More recently, newer, less toxic and more expensive antifungal agents such as the lipid formulations of AmB, the newer azoles (fluconazole, itraconazole and voriconazole) and caspofungin have been analysed in a number of EAFT trials. Compared with AmB-D the newer agents have superior safety but are of equivalent efficacy. This lack of survival advantage is related to the fact that the trigger for commencement of EAFT is late and non-specific. Thus, alternative approaches are required. New sensitive serological and molecular tests for the detection of Aspergillus antigens and genomic DNA have been developed and evaluated in accuracy studies. These tests have been incorporated into management strategies (i.e. pre-emptive strategies) to direct antifungal therapy. The pre-emptive approach has been shown to be safe and feasible but its impact on clinically important patient outcomes such as survival is less clear. Other advances include the introduction of effective, non-toxic mould-active antifungal prophylaxis and patient risk-group stratification. In this paper we provide new evidence-based algorithms for the diagnosis and treatment of PFUO in adult patients undergoing stem cell transplantation and chemotherapy for haematological malignancy which incorporate these newer diagnostic tests and are directed by the risk category of the patient and type of antifungal prophylaxis the patient is receiving.C. O. Morrissey, P. G. Bardy, M. A. Slavin, M. R. Ananda-Rajah, S. C. Chen, S. W. Kirsa, D. S. Ritchie, A. Upto

Understanding advanced and extended professional practice

The Advanced Pharmacy Practice Framework Steering Committee (now replaced by the Pharmacy Practitioner Development Committee) undertook work to develop an advanced pharmacy practice recognition model. As part of that work, and to assure clarity and consistency in the terminology it uses, the Committee collated the definitions used in literature sources consulted. Most recently, this involved a review of the meaning attributed to the terms 'advanced' and 'extended' when used in the context of describing aspects of professional practice. Both terms encompass the acquisition of additional expertise. While 'advanced' practice involves the acquisition of additional expertise to achieve a higher performance level, 'extended' practice relates specifically to scope of practice and involves the acquisition of additional expertise sufficient to provide services or perform tasks that are outside the usual scope of practice of the profession. Performance level operates independently of scope of practice but both must be elucidated to fully describe the professional practice of an individual practitioner

Advanced practice: a survey of current perspectives of Australian pharmacists

Background: An Advanced Pharmacy Practice Framework for Australia (the 'APPF') was published in October 2012. Further to the release of theAPPF, the Advanced Pharmacy Practice Framework Steering Committee planned to develop an advanced practice recognition model forAustralian pharmacists.Aim: To gauge the perspectives of the pharmacy profession relating to advanced practice, via an online survey, in order to inform the design of the model.Method: A survey was developed and administered to Australian pharmacists through SurveyMonkey. The survey content was based on findings from a review of national and international initiatives for recognition of advanced practice in pharmacy and other health disciplines, including medicine and nursing.Results: The results of the survey showed that a high proportion of respondents considered they were already working at, or working towards achieving, an advanced level of practice. The responses relating to the assessment methods showed a clear preference for 'sub-mission of a professional portfolio'.A'written examination' had a low level of support and in relation to an 'oral examination by a panel'there was a marked preference for a panel of multidisciplinary health professionals over a panel of pharmacists.Conclusion: The survey outcomes will inform the development of an advanced pharmacy practice recognition model for Australian pharmacists, particularly in relation to the assessment methods. Survey outcomes also demonstrated that there is scope to further enhance theapplication of the APPF in the development and recognition of advanced practitioners, and to build greater awareness of the breadth ofcompetencies encompassed by 'advanced practice'

LEAP2 reduces postprandial glucose excursions and ad libitum food intake in healthy men

The gastric hormone ghrelin stimulates food intake and increases plasma glucose through activation of the growth hormone secretagogue receptor (GHSR). Liver-expressed antimicrobial peptide 2 (LEAP2) has been proposed to inhibit actions of ghrelin through inverse effects on GHSR activity. Here, we investigate the effects of exogenous LEAP2 on postprandial glucose metabolism and ad libitum food intake in a randomized, double-blind, placebo-controlled, crossover trial of 20 healthy men. We report that LEAP2 infusion lowers postprandial plasma glucose and growth hormone concentrations and decreases food intake during an ad libitum meal test. In wild-type mice, plasma glucose and food intake are reduced by LEAP2 dosing, but not in GHSR-null mice, pointing to GHSR as a potential mediator of LEAP2’s glucoregulatory and appetite-suppressing effects in mice