Impact of febrile neutropenia on R-CHOP chemotherapy delivery and hospitalizations among patients with diffuse large B-cell lymphoma

PURPOSE: This analysis from an observational study of clinical practice describes the impact of febrile neutropenia (FN) on chemotherapy delivery and hospitalizations. METHODS: Adults with diffuse large B-cell lymphoma (DLBCL) scheduled to receive ≥3 cycles of 2- or 3-weekly CHOP with rituximab (R-CHOP-14/21) were eligible. Primary outcome was incidence of FN. RESULTS:FN data were available for 409 patients receiving R-CHOP-14 and 702 patients receiving R-CHOP-21. FN incidence was R-CHOP-14, 20% (81/409) and R-CHOP-21, 19% (133/702). Rates of primary prophylaxis with granulocyte-colony stimulating factor were R-CHOP-14, 84% (345/409) and R-CHOP-21, 36% (252/702). A large number of patients experienced their first FN episode in cycle 1 (R-CHOP-14, 24/81 [30%]; R-CHOP-21, 63/133 [47%]). Multiple risk factors (≥2) for FN were more frequent in patients experiencing FN than in patients not experiencing FN (R-CHOP-14, 60/81 [74%] versus 179/328 [55%]; R-CHOP-21, 98/133 [74%] versus 339/569 [60%]). A similar trend was observed for unplanned hospitalizations (R-CHOP-14, 63/81 [78%] versus 68/328 [21%]; R-CHOP-21, 105/133 [79%] versus 100/569 [18%]). Achievement of chemotherapy relative dose intensity ≥90% was lower among patients experiencing FN than in patients not experiencing FN (R-CHOP-14, 30/81 [37%] versus 234/328 [71%]; R-CHOP-21, 83/133 [62%] versus 434/569 [76%]). CONCLUSIONS:In patients with DLBCL treated with R-CHOP-14 or R-CHOP-21, patients with an event of FN were more likely to experience suboptimal chemotherapy delivery and increased incidence of unplanned hospitalizations than those without FN. FN-related hospitalizations are likely to impact chemotherapy delivery and to incur substantial costs

C Programming Mastery- Job Interview Oriented Preparation

<p>C Programming Mastery- Job Interview Oriented Preparation</p&gt

Levelized cost of electricity generation by small hydropower projects under clean development mechanism in India

Abstract Contrary to conventional fossil fuel-based electricity generation technologies, renewable energy centered technologies, specifically small hydropower, release a lesser amount of anthropogenic greenhouse gases but are normally more expensive. A major segment of the capital investment in the current small hydropower scenario accounts for equipment and construction process costs. The construction and cost administration process are generally limited to analysis of the capital cost of civil constructions, electro-mechanical equipment works, neglecting the costs related to operating and maintaining the plant, replacement or refurbishment, certified emission reductions, among others. Contemporary studies indicate that these costs form a substantial fraction of the total capital investment. Consequently, for cost management and investment decision making, small hydropower plant developers are drawing increased attention in recent years towards conducting life cycle costing studies that take into account the ignored costs. In addition, small hydropower plants in developing nations can become more competitive by trading the emission reductions achieved under the provision of the Clean Development Mechanism, an outcome of the Kyoto Protocol proposed at the United Nations Framework Convention on Climate Change. In this paper, a modest attempt has been made to determine the Levelized cost of electricity generation using life cycle costing methodology, which accounts for all the costs over operating lifetime on a range of small hydropower plants and the results are analyzed

A comprehensive study on the recent progress and trends in development of small hydropower projects

Abstract In terms of fuel resource, hydropower possesses a prominent advantage over any other large power plants which burn fossil fuels to generate electricity. Moreover, due to the abundance in resource availability (as a domestic source in small streams and rivers), small hydropower (SHP) plants are showing prominence all over the world. SHP plants have led to improved access to electricity usage in under-developed and developing nations, thereby contributing to sustainable development goals and social empowerment. SHP, as a technology, is regarded as the largest density renewable resource with high adaptability, and low investment costs. The primary objective of the paper is to study and analyze recent developments in SHP technologies with reporting statistical figures in terms of installed capacity and MW potential in several parts of the world. Methodologies adopted by researchers to conduct techno-economic analysis of SHP projects are reviewed. Various costs involved in conducting pre-feasibility studies—such as constructing, maintaining, and sustainably operating SHP projects—are studied. The results of the study indicate cost and regulatory issues are the major factors affecting the growth of the small hydropower sector in many nations. Major impediments to construction, development and deployment of SHP projects, mutually existing among the nations worldwide, are also reported. Technical hindrances include non-availability of the grid and very limited accessibility to SHP sites, emissions due to storage of water, disruptive technologies with limited manpower and non-technical hindrances include discouragement from local bodies and groups, lack of suitable and precise pathways to accomplish SHP goals of a nation, lack of incentives for encouraging private players to invest in SHP projects, complex approval processes, and many more

Natural energy materials and storage systems for solar dryers:state of the art

Abstract Inappropriate food conservation practices along with insufficient and inefficient storage systems are often responsible for the deterioration in food quality of agricultural products leading to food insecurity and economic loss. Open sun drying is a well-known traditional food preservation technique but is limited in use due to its low efficiency and long drying times. Solar drying is considered the most effective, economical, green and sustainable technology available to preserve farm produce. In this regard, an attempt has been made in this study, to review the solar dryer technologies, natural energy materials and storage systems available for persevering food products and reported in detail. An extensive classification and comparative analysis of solar dryers have been presented. Evolutionary classification and performance assessment using various indicators has been carried out for solar dryers employing natural energy materials for energy storage. Polices, challenges, risks and recommendations for the improvement of existing solar dryers as well as the development of new technologies impacting the quality, economic, social and environmental aspects of solar dried products have been discussed in detail. The study concluded that solar drying processes with thermal energy storage devices based on natural materials are most preferred for delivering extended shelf life for farm produce in an energy-efficient and sustainable manner

Management of Craniovertebral Junction Tuberculosis Presenting with Atlantoaxial Dislocation

Tuberculosis (TB) rarely involves the craniovertebral junction (CVJ). Atlantoaxial dislocation (AAD) is one of the most commonly encountered lesions in craniocervical TB. The incidence of TB and its craniovertebral manifestation is increasing even in developed countries because of intercontinental migration and increased prevalence rates of immunosuppression conditions. While the treatment of craniovertebral TB is well standardized and relies on conservative measures, the treatment of TB with AAD is disputable. In this paper we present a review of the literature and elucidate our approach to craniovertebral TB with AAD through a case illustration