Effect of fresh red blood cell transfusions on clinical outcomes in premature, very low-birth-weight infants: The ARIPI randomized trial

Context: Even though red blood cells (RBCs) are lifesaving in neonatal intensive care, transfusing older RBCs may result in higher rates of organ dysfunction, nosocomial infection, and length of hospital stay. Objective: To determine if RBCs stored for 7 days or less compared with usual standards decreased rates of major nosocomial infection and organ dysfunction in neonatal intensive care unit patients requiring at least 1 RBC transfusion. Design, Setting, and Participants: Double-blind, randomized controlled trial in 377 premature infants with birth weights less than 1250 g admitted to 6 Canadian tertiary neonatal intensive care units between May 2006 and June 2011. Intervention: Patients were randomly assigned to receive transfusion of RBCs stored 7 days or less (n=188) vs standard-issue RBCs in accordance with standard blood bank practice (n=189). Main Outcome Measures: The primary outcome was a composite measure of major neonatal morbidities, including necrotizing enterocolitis, retinopathy of prematurity, bronchopulmonary dysplasia, and intraventricular hemorrhage, as well as death. The primary outcome was measured within the entire period of neonatal intensive care unit stay up to 90 days after randomization. The rate of nosocomial infection was a secondary outcome. Results: The mean age of transfused blood was 5.1 (SD, 2.0) days in the fresh RBC group and 14.6 (SD, 8.3) days in the standard group. Among neonates in the fresh RBC group, 99 (52.7%) had the primary outcome compared with 100 (52.9%) in the standard RBC group (relative risk, 1.00; 95% CI, 0.82-1.21). The rate of clinically suspected infection in the fresh RBC group was 77.7% (n=146) compared with 77.2% (n=146) in the standard RBC group (relative risk, 1.01; 95% CI, 0.90-1.12), and the rate of positive cultures was 67.5% (n=127) in the fresh RBC group compared with 64.0% (n=121) in the standard RBC group (relative risk, 1.06; 95% CI, 0.91-1.22). Conclusion: In this trial, the use of fresh RBCs compared with standard blood bank practice did not improve outcomes in premature, very low-birth-weight infants requiring a transfusion. Trial Registration: clinicaltrials.gov Identifier: NCT00326924; Current Controlled Trials Identifier: ISRCTN65939658. ©2012 American Medical Association. All rights reserved

EFFECT OF HYDRATE FORMATION/DISSOCIATION ON EMULSION STABILITY USING DSC AND VISUAL TECHNIQUES

The flow assurance industry is progressively moving away from avoidance of hydrate formation towards risk management. Risk management allows hydrates to form but prevents hydrates from agglomerating and forming a plug, or delays hydrate formation within the timescale of the residence time of the water in the hydrate-prone section of the flow line. A key factor in risk management for an oil-dominated system is the stability of the emulsified water with gas hydrate formation. It is shown using Differential Scanning Calorimetry (DSC) that gas hydrate formation and dissociation has a destabilizing effect on W/O emulsions, and can even lead to a free water phase through agglomeration and coalescence of dissociated hydrate particles. Gas hydrate formation/dissociation has been shown to cause rapid hydrate agglomeration and emulsion destabilization. High asphaltene content crude oils are shown to resist hydrate destabilization of the emulsion.Non UBCUnreviewe

A NOVEL APPROACH TO MEASURING METHANE DIFFUSIVITY THROUGH A HYDRATE FILM USING DIFFERENTIAL SCANNING CALORIMETRY

The avoidance of hydrate blockages in deepwater subsea tiebacks presents a major technical challenge with severe implications for production, safety and cost. The successful prediction of when and where hydrate plugs form could lead to substantial reductions in the use of chemical inhibitors, and to corresponding savings in operational expenditure. The diffusivity of the gas hydrate former (methane) or the host molecule (water), through a hydrate film is a key property for such predictions of hydrate plug formation. In this paper, a novel application of Differential Scanning Calorimetry is described in which a hydrate film was allowed to grow at a hydrocarbon-water interface for different hold-times. By determining the change in mass of the hydrate film as a function of hold-time, an effective diffusivity could be inferred. The effect of the subcooling, and of the addition of a liquid hydrocarbon layer were also investigated. Finally, the transferability of these results to hydrate growth from water-in-oil emulsions is discussed.Non UBCUnreviewe

Biomarkers p16, Human Papillomavirus and p53 Predict Recurrence and Survival in Early Stage Squamous Cell Carcinoma of the Vulva.

OBJECTIVE: Vulvar squamous cell carcinoma (VSCC) develops through 2 distinct molecular pathways, one involving high-risk human papillomavirus (HPV) infection and the other through early p53 suppressor gene mutation. We sought to evaluate the influence of p53 mutation, HPV status, and p16 expression on local recurrence and disease-specific mortality in early stage VSCC. MATERIALS AND METHODS: We performed a retrospective chart review of all patients with stage I VSCC at the Maine Medical Center from 1998 to 2007 (n = 92). Tumor size, depth of invasion, lymphatic/vascular space invasion, and growth pattern were recorded. Paraffin-embedded tissue blocks were stained by immunohistochemistry for p16 and p53; high-risk HPV was detected by polymerase chain reaction assay. Margin distance was determined by a gynecologic pathologist. Survival analyses were conducted to examine predictors of VSCC recurrence and disease-specific mortality. RESULTS: Age, depth of invasion, lymphatic/vascular space invasion, growth pattern, and margin status were not significant predictors of recurrence or disease-specific mortality. Tumor size of greater than 4.0 cm indicated a 4-fold increase in disease-specific mortality but did not significantly increase recurrence. p16-Positive patients were less likely to recur and had no VSCC-related deaths. Human papillomavirus-positive patients were less likely to recur and had no VSCC-related deaths. p53-positive patients were 3 times more likely to recur and nearly 7 times more likely to die from vulvar cancer. CONCLUSIONS: Our findings suggest that HPV and the surrogate biomarker p16 indicate a less aggressive type of vulvar cancer. p53 positivity was associated with poor prognosis and significantly increased both recurrence and disease-specific mortality

HYDRATE NUCLEATION MEASUREMENTS USING HIGH PRESSURE DIFFERENTIAL SCANNING CALORIMETRY

Understanding when hydrates will nucleate has notable importance in the area of flow assurance. Attempts to model hydrate formation in subsea pipelines currently requires an arbitrary assignment of a nucleation subcooling. Previous studies showed that sII hydrate containing a model water-soluble former, tetrahydrofuran, would nucleate over a narrow temperature range of a few degrees with constant cooling. It is desirable to know if gas phase hydrate formers, which are typically more hydrophobic and hence have a very low solubility in water, also exhibit this nucleation behavior. In this study, differential scanning calorimetry has been applied to determine the hydrate nucleation point for gas phase hydrate formers. Constant cooling ramps and isothermal approaches were combined to explore the probability of hydrate nucleation. In the temperature ramping experiments, methane and xenon were used at various pressures and cooling rates. In both systems, hydrate nucleation occurred over a narrow temperature range (2-3°C). Using methane at lower pressures, ice nucleated before hydrate; whereas at higher pressures, hydrate formed first. A subcooling driving force of around 30°C was necessary for hydrate nucleation from both guest molecules. The cooling rates (0.5-3°C/min) did not show any statistically significant effect on the nucleation temperature for a given pressure. The isothermal method was used for a methane system with pure water and a water-in-West African crude emulsion. Two isotherms (-5 and -10°C) were used to determine nucleation time. In both systems, the time required for nucleation decreased with increased subcooling.Non UBCUnreviewe

Intraperitoneal chemotherapy among women in the Medicare population with epithelial ovarian cancer.

BACKGROUND: Intraperitoneal combined with intravenous chemotherapy (IV/IP) for primary treatment of epithelial ovarian cancer results in a substantial survival advantage for women who are optimally debulked surgically, compared with standard IV only therapy (IV). Little is known about the use of this therapy in the Medicare population. METHODS: We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify 4665 women aged 66 and older with epithelial ovarian cancer diagnosed between 2005-2009, with their Medicare claims. We defined receipt of any IV/IP chemotherapy when there was claims evidence of any receipt of such treatment within 12 months of the date of diagnosis. We used descriptive statistics to examine factors associated with treatment and health services use. RESULTS: Among 3561 women with Stage III or IV epithelial ovarian cancer who received any chemotherapy, only 124 (3.5%) received IV/IP chemotherapy. The use of IV/IP chemotherapy did not increase over the period of the study. In this cohort, younger women, those with fewer comorbidities, whites, and those living in Census tracts with higher income were more likely to receive IV/IP chemotherapy. Among women who received any IV/IP chemotherapy, we did not find an increase in acute care services (hospitalizations, emergency department visits, or ICU stays). CONCLUSION: During the period between 2005 and 2009, few women in the Medicare population living within observed SEER areas received IV/IP chemotherapy, and the use of this therapy did not increase. We observed marked racial and sociodemographic differences in access to this therapy

Society of Gynecologic Oncology Clinical Outcomes Registry: From small beginnings come great things.

OBJECTIVE: Clinical registries within medical societies have demonstrated the capacity to promote quality improvement. Opportunities for well-designed data repositories could yield reliable national standards for informing reimbursement, determining adherence to care guidelines, maintaining board certification, and developing bundled payment models. Looking to the future, we set out to develop a gynecologic cancer registry serving the members of the Society of Gynecologic Oncology (SGO). METHODS: The SGO Clinical Outcomes Registry (COR) initiated a web-based data entry platform as a foray into developing a functional registry, compiling data elements specific to gynecologic oncology. Endometrial and ovarian cancer patients began enrollment in early 2014. Within one year, 19 sites were participating with the addition of cervical cancer patients in January 2015. RESULTS: To date, \u3e6500 patients are currently entered from 29 sites, and the COR is being queried to address topics of quality improvement, disparities, and cancer outcomes. CONCLUSIONS: The SGO COR has proven the feasibility of developing a functional gynecologic cancer registry, with high uptake, rapid accrual, and ability to investigate topics of quality and outcome using the COR

Cover Crop Mixture Effects on Maize, Soybean, and Wheat Yield in Rotation

Despite the popularity of multispecies cover crop mixtures, there is little published evidence of their effects on subsequent crop yields, especially for multiple crops grown in rotation. We examined the effects of fall-planted cover crops—both mixtures and their component monocultures—on subsequent crop yields in an organically managed maize ( L.)–soybean [ (L.) Merr.]–winter wheat ( L.) rotation in central Pennsylvania. We hypothesized that cover crop biomass C/N ratio would be negatively correlated with crop yields. This held true for maize ( = 0.134, < 0.0001), but there was no cover crop effect on soybean or wheat yields. All multispecies mixtures produced high biomass, and none affected maize yield relative to fallow. Our findings suggest that both multispecies cover crops and diverse crop rotations may increase opportunities to gain the benefits of cover crops with high biomass and C/N ratio—such as erosion control, weed suppression, N retention, and soil C accumulation—without compromising yield

Quality of life, symptoms and care needs in patients with persistent or recurrent platinum-resistant ovarian cancer: An NRG Oncology/Gynecologic Oncology Group study.

ObjectivesThe goals of treating recurrent platinum-resistant ovarian cancer are palliative, aimed at reducing symptoms and improving progression free survival. A prospective trial was conducted to determine the prevalence and severity of symptoms, and associated care needs.MethodsEligible women included those with persistent or recurrent platinum-resistant ovarian cancer with an estimated life expectancy of at least 6 months. The Needs at the End-of-Life Screening Tool (NEST), FACIT-Fatigue (FACIT-F), NCCN-FACT Ovarian Symptom Index [NFOSI-18]; Disease Related Symptoms (DRS), Treatment Side Effects (TSE), and Function/Well Being (F/WB) were collected at study entry, 3 and 6 months.ResultsWe enrolled 102 evaluable patients. Initiation of Do Not Resuscitate (DNR) discussions increased over time from 28% at study entry to 37% at 6 months. At study entry, the most common disease-related symptoms were fatigue (92%), worry (89%), and trouble sleeping (76%); 73% reported being "bothered by treatment side effects", which included nausea (41%) and hair loss (51%) neither of which changed over time. The most common NEST unmet needs were in the symptom dimension. The social dimension was associated with F/WB (p = 0.002) and FACIT-F (p = 0.006); symptoms were associated with DRS (p = 0.04), TSE (p = 0.03), and FACIT-F (p = 0.04); existential was not associated with any of the patient-reported symptoms; therapeutic was associated with F/WB (p = 0.02).ConclusionsIn patients nearing the end of life, there are significant associations between disease and treatment related symptoms and unmet patient needs, which do not change substantially over time. Careful exploration of specific end-of-life care needs can improve patient-centered care and QOL