Performance of formulae based estimates of glomerular filtration rate for carboplatin dosing in stage 1 seminoma

<b>Background:</b> Single cycle carboplatin, dosed by glomerular filtration rate (GFR), is standard adjuvant therapy for stage 1 seminoma. Accurate measurement of GFR is essential for correct dosing. Isotopic methods remain the gold standard for the determination of GFR. Formulae to estimate GFR have improved the assessment of renal function in non-oncological settings. We assessed the utility of these formulae for carboplatin dosing.<p></p> <b>Methods:</b> We studied consecutive subjects receiving adjuvant carboplatin for stage 1 seminoma at our institution between 2007 and 2012. Subjects underwent 51Cr-ethylene diamine tetra-acetic acid (EDTA) measurement of GFR with carboplatin dose calculated using the Calvert formula. Theoretical carboplatin doses were calculated from estimated GFR using Chronic Kidney Disease-Epidemiology (CKD-EPI), Management of Diet in Renal Disease (MDRD) and Cockcroft–Gault (CG) formulae with additional correction for actual body surface area (BSA). Carboplatin doses calculated by formulae were compared with dose calculated by isotopic GFR; a difference <10% was considered acceptable.<p></p> <b>Results:</b> 115 patients were identified. Mean isotopic GFR was 96.9 ml/min/1.73 m2. CG and CKD-EPI tended to overestimate GFR whereas MDRD tended to underestimate GFR. The CKD-EPI formula had greatest accuracy. The CKD-EPI formula, corrected for actual BSA, performed best; 45.9% of patients received within 10% of correct carboplatin dose. Patients predicted as underdosed (13.5%) by CKD-EPI were more likely to be obese (p = 0.013); there were no predictors of the 40.5% receiving an excess dose.<p></p> <b>Conclusions:</b> Our data support further evaluation of the CKD-EPI formula in this patient population but clinically significant variances in carboplatin dosing occur using non-isotopic methods of GFR estimation. Isotopic determination of GFR should remain the recommended standard for carboplatin dosing when accuracy is essential.<p></p&gt

Two New Gravitationally Lensed Double Quasars from the Sloan Digital Sky Survey

We report the discoveries of the two-image gravitationally lensed quasars, SDSS J0746+4403 and SDSS J1406+6126, selected from the Sloan Digital Sky Survey (SDSS). SDSS J0746+4403, which will be included in our lens sample for statistics and cosmology, has a source redshift of z_s=2.00, an estimated lens redshift of z_l~0.3, and an image separation of 1.08". SDSS J1406+6126 has a source redshift of z_s=2.13, a spectroscopically measured lens redshift of z_l=0.27, and an image separation of 1.98". We find that the two quasar images of SDSS J1406+6126 have different intervening MgII absorption strengths, which are suggestive of large variations of absorbers on kpc scales. The positions and fluxes of both the lensed quasar systems are easily reproduced by simple mass models with reasonable parameter values. These objects bring to 18 the number of lensed quasars that have been discovered from the SDSS data.Comment: 25 pages, 6 figures, The Astronomical Journal accepte

Patiromer to Enable Spironolactone Use in the Treatment of Patients with Resistant Hypertension and Chronic Kidney Disease: Rationale and Design of the AMBER Study

BACKGROUND: While chronic kidney disease (CKD) is common in resistant hypertension (RHTN), prior studies -evaluating mineralocorticoid receptor antagonists excluded patients with reduced kidney function due to risk of hyperkalemia. AMBER (ClinicalTrials.gov identifier NCT03071263) will evaluate if the potassium-binding polymer patiromer used concomitantly with spironolactone in patients with RHTN and CKD prevents hyperkalemia and allows more persistent spironolactone use for hypertension management. METHODS: Randomized, double-blind, placebo-controlled parallel group 12-week study of patiromer and spironolactone versus placebo and spironolactone in patients with uncontrolled RHTN and CKD. RHTN is defined as unattended systolic automated office blood pressure (AOBP) of -135-160 mm Hg during screening despite taking ≥3 antihypertensives, including a diuretic, and an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker -(unless not tolerated or contraindicated). The CKD inclusion criterion is an estimated glomerular filtration rate (eGFR) of 25 to ≤45 mL/min/1.73 m2. Screening serum potassium must be 4.3-5.1 mEq/L. The primary efficacy endpoint is the between-group difference (spironolactone plus patiromer versus spironolactone plus placebo) in the proportion of patients remaining on spironolactone at Week 12. RESULTS: Baseline characteristics have been analyzed as of March 2018 for 146 (of a targeted 290) patients. Mean (SD) baseline age is 69.3 (10.9) years; 52.1% are male, 99.3% White, and 47.3% have diabetes. Mean (SD) baseline serum potassium is 4.68 (0.25) mEq/L, systolic AOBP is 144.3 (6.8) mm Hg, eGFR is 35.7 (7.7) mL/min/1.73 m2. CONCLUSION: AMBER will define the ability of patiromer to facilitate the use of spironolactone, an effective antihypertensive therapy for patients with RHTN and CKD

Interannual Variations in Aerosol Sources and Their Impact on Orographic Precipitation Over California's Central Sierra Nevada

Aerosols that serve as cloud condensation nuclei (CCN) and ice nuclei (IN) have the potential to profoundly influence precipitation processes. Furthermore, changes in orographic precipitation have broad implications for reservoir storage and flood risks. As part of the CalWater I field campaign (2009-2011), the impacts of aerosol sources on precipitation were investigated in the California Sierra Nevada. In 2009, the precipitation collected on the ground was influenced by both local biomass burning (up to 79% of the insoluble residues found in precipitation) and long-range transported dust and biological particles (up to 80% combined), while in 2010, by mostly local sources of biomass burning and pollution (30-79% combined), and in 2011 by mostly long-range transport from distant sources (up to 100% dust and biological). Although vast differences in the source of residues was observed from year-to-year, dust and biological residues were omnipresent (on average, 55% of the total residues combined) and were associated with storms consisting of deep convective cloud systems and larger quantities of precipitation initiated in the ice phase. Further, biological residues were dominant during storms with relatively warm cloud temperatures (up to -15 C), suggesting these particles were more efficient IN compared to mineral dust. On the other hand, lower percentages of residues from local biomass burning and pollution were observed (on average 31% and 9%, respectively), yet these residues potentially served as CCN at the base of shallow cloud systems when precipitation quantities were low. The direct connection of the source of aerosols within clouds and precipitation type and quantity can be used in models to better assess how local emissions versus long-range transported dust and biological aerosols play a role in impacting regional weather and climate, ultimately with the goal of more accurate predictive weather forecast models and water resource management

Low-Tech Riparian and Wet Meadow Restoration Increases Vegetation Productivity and Resilience Across Semiarid Rangelands

Restoration of riparian and wet meadow ecosystems in semiarid rangelands of the western United States is a high priority given their ecological and hydrological importance in the region. However, traditional restoration approaches are often intensive and costly, limiting the extent over which they can be applied. Practitioners are increasingly trying new restoration techniques that are more cost‐effective, less intensive, and can more practically scale up to the scope of degradation. Unfortunately, practitioners typically lack resources to undertake outcome‐based evaluations necessary to judge the efficacy of these techniques. In this study, we use freely available, satellite remote sensing to explore changes in vegetation productivity (normalized difference vegetation index) of three distinct, low‐tech, riparian and wet meadow restoration projects. Case studies are presented that range in geographic location (Colorado, Oregon, and Nevada), restoration practice (Zeedyk structures, beaver dam analogs, and grazing management), and time since implementation. Restoration practices resulted in increased vegetation productivity of up to 25% and increased annual persistence of productive vegetation. Improvements in productivity with time since restoration suggest that elevated resilience may further enhance wildlife habitat and increase forage production. Long‐term, documented outcomes of conservation are rare; we hope our findings empower practitioners to further monitor and explore the use of low‐tech methods for restoration of ecohydrologic processes at meaningful spatial scales

Evidence for the Hierarchical Formation of the Galactic Spheroid

The possibility that the Galactic spheroid was assembled from numerous chemically-distinct, proto-Galactic fragments is investigated using a Monte-Carlo technique designed to simulate the chemical evolution of the Galaxy in hierarchical formation scenarios which involve no gas dissipation. By comparing the observed and simulated metallicity distributions of Galactic globular clusters and halo field stars, we estimate the level of fragmentation in the collapsing proto-Galaxy. Although the formation process is highly stochastic, the simulations often show good agreement with the observed metallicity distributions, provided the luminosity function of proto-Galactic fragments had a power-law form with exponent ~ -2. While this steep slope is strongly at odds with the presently observed luminosity function of the Local Group, it is in close agreement with the predictions of semi-analytic and numerical models of hierarchical galaxy formation. We discuss a number of possible explanations for this discrepancy. These simulations suggest that the Galactic halo and its globular cluster system were assembled via the accretion and disruption of approximately 1000 metal-poor, proto-Galactic fragments by the dominant Galactic building block: a proto-bulge whose own metal-rich globular clusters system has been preferentially eroded by dynamical processes. We argue that the same process (ie, hierarchical growth involving little gas dissipation) is responsible for the formation of both giant elliptical galaxies and the bulge-halo components of spiral galaxies. (ABRIDGED).Comment: 20 pages, 9 postscript figures. Accepted for publication in the ApJ, April 10 2000 issu

A Lay Health Worker Intervention to Increase Uptake and Completion of Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease: Assessing Fidelity of Intervention Delivery

“This is an Accepted Manuscript of an article published by Taylor & Francis Group in COPD: Journal of Chronic Obstructive Pulmonary Disease on 17 Aug 2020, available online: https://doi.org/10.1080/15412555.2020.1797658

Image resonance in the many-body density of states at a metal surface

The electronic properties of a semi-infinite metal surface without a bulk gap are studied by a formalism that is able to account for the continuous spectrum of the system. The density of states at the surface is calculated within the GW approximation of many-body perturbation theory. We demonstrate the presence of an unoccupied surface resonance peaked at the position of the first image state. The resonance encompasses the whole Rydberg series of image states and cannot be resolved into individual peaks. Its origin is the shift in spectral weight when many-body correlation effects are taken into account

Dynamics of the Globular Cluster System Associated with M87 (NGC 4486). II. Analysis

We present a dynamical analysis of the globular cluster system associated with M87 (= NGC 4486), the cD galaxy near the dynamical center of the Virgo cluster. The analysis utilizes a new spectroscopic and photometric database which is described in a companion paper (Hanes et al. 2001). Using a sample of 278 globular clusters with measured radial velocities and metallicities, and new surface density profiles based on wide-field Washington photometry, we study the dynamics of the M87 globular cluster system both globally --- for the entire cluster sample --- and separately --- for the metal-rich and metal-poor globular cluster samples. This constitutes the largest sample of radial velocities for pure Population II tracers yet assembled for any galaxy. We discuss the implications of our findings for models for the formation of giant elliptical galaxies, globular cluster systems, and the Virgo cluster. (ABRIDGED)Comment: 28 pages, 19 postscript figures, 1 jpeg image. See http://www.physics.rutgers.edu/ast/ast-rap.html to download the manuscript with higher quality figures. Accepted for publication in the Astrophysical Journa

Planning for Project ECHO in New Hampshire

Assuring a healthy New Hampshire requires making sure that all of the state’s residents can get the right care in the right place at the right time. Yet, access to timely, effective health care is not always a given in our state, especially for vulnerable populations. Health and community care workforce shortages, long distances to care, and social, economic, and cultural barriers make accessing care challenging for many. The Project ECHO Model™ is an evidence-based method using web-based teleconferencing to link specialist teams with community-based sites to help community providers improve their ability to manage complex conditions. It has been proven to improve health care outcomes for vulnerable populations with limited access to care because of socioeconomic factors or geography. The New Hampshire Project ECHO® (Extension for Community Healthcare Outcomes) Planning for Implementation and Business Sustainability Project (Planning for Project ECHO in NH) undertook a planning process to inform how to best to develop Project ECHO at UNH to serve New Hampshire health and community care providers and ultimately improve access to effective, timely care. Planning for Project ECHO in NH also developed a business and sustainability plan for long-term success of the UNH Project ECHO Hub and an evaluation plan for measuring efficacy. Planning for Project ECHO in NH included: A Project ECHO Needs Assessment and Prioritization Process, including review of existing needs assessments in the field; a stakeholder survey of health and community care providers conducted by the New Hampshire Citizens Health Initiative (Initiative); and analysis of data from the NH Comprehensive Health Information System (NH CHIS), NH’s all-payer claims database (APCD). A business and sustainability plan including Key Informant Interviews, an environmental scan, and a template for business sustainability planning to identify funding sources and structures to sustain Project ECHO in NH. A framework for Project ECHO evaluation