Pretransplantation Assessments and Symptom Profiles: Predicting Transplantation-Related Toxicity and Improving Patient-Centered Outcomes

With the advent of reduced-intensity conditioning regimens and improvements in supportive care, hematopoietic cell transplantation (HCT) has become increasingly available to older adults and medically vulnerable populations with hematologic diseases. However, adverse outcomes including long-term treatment-related distress, disability (frailty), and death remain important concerns in this population. In other areas of oncology, comprehensive geriatric assessments have been used to stratify patients for treatment-related risk, and patient-reported outcomes (PROs) have helped in understanding treatment-related toxicity from a patient perspective. However, these powerful tools have not yet become widely used in HCT. Here, we review the theories and available data that support the development of pretreatment functional assessments and longitudinal PRO sampling in HCT. We discuss the potential for these techniques to improve transplantation outcomes through risk stratification, interventional studies, and predictive models that incorporate genetic and biomarker data. Predicting and understanding long-term transplantation-related toxicity through functional assessments and PROs will be critical to calculating the risk/benefit ratio of aggressive therapies in older patient populations, and we contend that functional assessments and PRO sampling should become standard parts of the routine evaluation of HCT patients

Simultaneous creep and oxidation of nickel

A comprehensive literature review, covering the effect of environment on creep and the creep and oxidation of nickel is given. The creep behaviour of high purity nickel is compared in atmospheres of oxygen (400 torr) and vacuum (10

What nonpharmacological treatments are effective against common nongenital warts?

Cryotherapy has similar cure rates to topical salicylate (a pharmacologic therapy) for non-genital common warts (strength of recommendation [SOR]: B, based on systemic review of variable quality randomized trials). Duct tape may be equivalent to cryotherapy (SOR: B, based on a single randomized trial). CO2 laser, photodynamic therapy, pulsed dye laser (PDL), and Er:Yag laser therapies may also be effective for recalcitrant warts (SOR: C, based on observational cohort studies)

Movement and Injury Rates for Three Life Stages of Spring Chinook Salmon Oncorhynchus Tshawytscha : A Comparison of Submerged Orifices and an Overflow Weir for Fish Bypass in a Modular Rotary Drum Fish Screen : Annual Report 1995.

The Pacific Northwest National Laboratory (PNNL) evaluated the effectiveness of 6-in. and 2-in. submerged orifices, and an overflow weir for fish bypass at a rotary drum fish screening facility. A modular drum screen built by the Washington Department of Fish and Wildlife (WDFW) was installed at PNNL`s Aquatic Ecology research laboratory in Richland, Washington. Fry, subyearlings, and smolts of spring chinook salmon (Oncorhynchus tshawyacha) were introduced into the test system, and their movement and injury rates were monitored. A total of 33 tests (100 fish per test) that lasted from 24 to 48 hr were completed from 1994 through 1995. Passage rate depended on both fish size and bypass configuration. For fry/fingerling spring chinook salmon, there was no difference in passage rate through the three bypass configurations (2-in. orifice, 6-in. orifice, or overflow weir). Subyearlings moved sooner when the 6-in. orifice was used, with more than 50% exiting through the fish bypass in the first 8 hr. Smolts exited quickly and preferred the 6-in. orifice, with over 90% of the smolts exiting through the bypass in less than 2 hr. Passage was slightly slower when a weir was used, with 90% of the smolts exiting in about 4 hr. When the 2-in. orifice was used in the bypass, 90% of the smolts did not exit until after 8 hr. In addition, about 7% of the smolts failed to migrate from the forebay within 24 hr, indicating that smolts were significantly delayed when the 2-in. orifice was used. Few significant injuries were detected for any of the life stages. However, light descaling occurred on about 15% of chinook salmon smolts passing through the 2-in. orifice. Although a single passage through the orifice did not appear to cause significant scale loss or other damage, passing through several screening facilities with 2-in. orifices could cause cumulative injuries

A Fisheries Evaluation of the Westside Ditch and Wapato Canal Fish Screening Facilities, Spring 1989 : Annual Report.

We evaluated the effectiveness of new fish screening facilities in the Westside Ditch and Wapato Canal in south-central Washington State. The screen integrity tests indicated that test fish released in front of the screens could enter the canal behind the screens. At Westside Ditch, between 6% and 25% of the zero-age fry passed through the rotary drum screens. The 6% estimate is based on tests with rainbow trout Oncorhynchus mykiss fry. The 25% estimate is based on monitoring chinook salmon 0. tshawytscha fry that were diverted from the river into the irrigation ditch. At Westside Ditch, we estimated that 1.8% of steelhead 0. mykiss smolts and 0.3% of chinook salmon smolts released during tests were descaled. The time required for 50% of the test fish to exit from the Westside Ditch Screen forebay was 3 to 8 h for chinook salmon smolts and up to 28 h for steelhead smolts. Methods used in 1988 were first used at Sunnyside in 1985 and were used in subsequent years at Richland. Toppenish/Satus. Wapato. and Toppenish Creek. The methods and 1985 through 1987 results have been reviewed by the Washington State Department of Fisheries, U.S. Fish and Wildlife Service, National Marine Fisheries Service, Northwest Power Planning Council, and the Yakima Indian Nation

Feasibility of Frequent Patient-Reported Outcome Surveillance in Patients Undergoing Hematopoietic Cell Transplantation

Patient-reported outcomes (PROs), including symptoms and health-related quality of life (HRQOL), provide a patient-centered description of hematopoietic cell transplantation (HCT)-related toxicity. These data characterize the patient experience after HCT and may have prognostic usefulness for long-term outcomes after HCT. We conducted a study of 32 patients after HCT (10 autologous HCT recipients, 11 full-intensity conditioning allogeneic HCT recipients, and 11 reduced-intensity conditioning allogeneic HCT recipients) to determine the feasibility of weekly electronic PRO collection from HCT until day (D) +100. We used questions from the PRO version of the Common Terminology Criteria for Adverse Events to capture symptoms, and the Patient-Reported Outcomes Measurement Information System Global Health scale to measure physical and mental HRQOL. The vast majority (94%) of patients used the electronic PRO system, with only 6% opting for paper-and-pencil only. The median weekly percentage of participants who completed the surveys was 100% in all cohorts through hospital discharge, and remained 100% for the autologous HCT and reduced-intensity allogeneic HCT cohorts through D+100. Patients were satisfied with the electronic system, giving high marks for readability, comfort, and questionnaire length. Symptom severity varied by absolute level and type of symptom across the 3 cohorts, with the full-intensity allogeneic HCT cohort exhibiting the greatest median overall symptom severity, peaking at D+7. Median physical health HRQOL scores decreased with time in the 3 cohorts, and HRQOL was generally correlated with overall symptom severity. Our results demonstrate the feasibility of frequent electronic PROs in the early post-HCT period. Future studies in larger populations to explore predictive models using frequent PRO data for outcomes, including long-term HRQOL and survival, are warranted

A Fisheries Evaluation of the Wapato, Sunnyside and Toppenish Creek Canal Fish Screening Facilities, Spring 1988 : Annual Report.

We evaluated the effectiveness of new screening facilities at the Toppenish Creek, Wapato, and Sunnyside canals in southcentral Washington State. Screen integrity tests indicated that fish released in front of the screens were prevented from entering the canal behind the screens. Screen efficiency estimates are 99% ({+-}0.6%) for Toppenish Creek, 99% ({+-}0.3%) for Wapato, and 98% ({+-}0.5%) for Sunnyside. During 1987 at the Wapato Canal, we estimated screen efficiency was 97% ({+-}l%). We conducted descaling tests at the Toppenish Creek Screens. We estimated that 0.2% of steelhead Qncorhynchus mykiss smelts released during tests were descaled. None of the fish released through the fish return pipe were descaled. We measured the time required for fish to move through the screen facilities. The time required for 50% of the test fish to exit the Toppenish Creek Screen forebay was 4 to 9 h for rainbow trout fry and up to 39 h for steelhead smelts. The time for 50% of the test fish to exit the Wapato and Sunnyside screen forebays was less than 8 h. As with past studies, exit times varied with canal flow and species. After 39 h at Toppenish Creek, half the steelhead smelts were still in the forebay when canal flows were 20 cfs. At Sunnyside, half the chinook salmon fry exited the forebay in 1 h or less. Methods used in 1988 were the same as those used at Sunnyside in 1985 and in subsequent years at Richland, Toppenish/Satus, and Wapato. The methods and previous results have been reviewed by the Washington State Department of Fisheries, U.S. Fish and Wildlife Service, National Marine Fisheries Service, Northwest Power Planning Council, and Yakima Indian Nation

Comparison of Seven-Day and Repeated 24-Hour Recall of Symptoms in the First 100 Days After Hematopoietic Cell Transplantation

Patient-reported outcomes (PROs) provide a way to understand the effects of hematopoietic cell transplantation (HCT)-related stress upon patients' lives. We previously reported that weekly collection of PROs is feasible

Data for cancer comparative effectiveness research: Past, present, and future potential

Comparative effectiveness research (CER) can efficiently and rapidly generate new scientific evidence and address knowledge gaps, reduce clinical uncertainty, and guide health care choices. Much of the potential in CER is driven by the application of novel methods to analyze existing data. Despite its potential, several challenges must be identified and overcome so that CER may be improved, accelerated, and expeditiously implemented into the broad spectrum of cancer care and clinical practice

Grass Species Flammability, Not Biomass, Drives Changes in Fire Behavior at Tropical Forest-Savanna Transitions

Forest-savanna mosaics are maintained by fire-mediated positive feedbacks; whereby forest is fire suppressive and savanna is fire promoting. Forest-savanna transitions therefore represent the interface of opposing fire regimes. Within the transition there is a threshold point at which tree canopy cover becomes sufficiently dense to shade out grasses and thus suppress fire. Prior to reaching this threshold, changes in fire behavior may already be occurring within the savanna. Such changes are neither empirically described nor their drivers understood. Fire behavior is largely driven by fuel flammability. Flammability can vary significantly between grass species and grass species composition can change near forest-savanna transitions. This study measured fire behavior changes at eighteen forest-savanna transition sites in a vegetation mosaic in Lopé National Park in Gabon, central Africa. The extent to which these changes could be attributed to changes in grass flammability was determined using species-specific flammability traits. Results showed simultaneous suppression of fire and grass biomass when tree canopy leaf area index (LAI) reached a value of 3, indicating that a fire suppression threshold existed within the forest-savanna transition. Fires became less intense and less hot prior to reaching this fire suppression threshold. These changes were associated with higher LAI values, which induced a change in the grass community, from one dominated by the highly flammable Anadelphia afzeliana to one dominated by the less flammable Hyparrhenia diplandra. Changes in fire behavior were not associated with changes in total grass biomass. This study demonstrated not only the presence of a fire suppression threshold but the mechanism of its action. Grass composition mediated fire-behavior within the savanna prior to reaching the suppression threshold, and grass species composition was mediated by tree canopy cover which was in turn mediated by fire-behavior. These findings highlight how biotic and abiotic controls interact and amplify each other in this mosaicked landscape to facilitate forest and savanna co-existence