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

MSU Xtreme: Minnesota State University, Mankato\u27s Entry into the Clean Snowmobile Challenge 2001

Minnesota State University, Mankato’s Automotive Engineering Technology program formed a team to enter the Clean Snowmobile Challenge 2001. Selections for the organization’s machine included a 2001 Polaris Edge Chassis specially outfitted with a 2000 500 cc two-stroke Polaris engine. Modifications to the snowmobile were made specifically for Clean Snowmobile Challenge 2001 events. Acceleration, emissions, cold start, noise, fuel economy/range, handling/drivability, hill climb, and static display made up the list of events featured in the competition. MSU Xtreme has modified the snowmobile in every area with special emphasis on emissions and handling. Testing and analysis of the sled’s systems brought the team to its resulting design. The technical paper describes the results of those tests, explains the team design procedures, and presents all modifications made to the snowmobile

Short-Term Performance of Modified Stone Matrix Asphalt (SMA) Produced with Warm Mix Additives

The short-term performance of the stone matrix asphalt (SMA) prepared with various warm-mix techniques (EvothermTM 3G, Sasobit®, and foamed asphalt) was conducted using extensive laboratory tests and on-site stiffness measurement. The laboratory tests included the complex modulus, flow number, loaded wheel track, indirect tension (IDT) creep and strength, and semi-circular beam (SCB) fracture. In the laboratory tests, plant-produced mixes were compacted in the laboratory with and without reheating, and performance tests were conducted at various curing time periods after compaction. In addition, light weight deflectometer (LWD) tests were conducted to monitor the in-situ pavement stiffness development of the warm SMA field sections. This study concludes that SMA containing different warm mix asphalt (WMA) additives show comparable performance with the control SMA. Both laboratory and field test results do not indicate any evidence that a longer curing time is needed before allowing traffic on warm SMA pavements. The mixtures containing WMA additives show similar variations in mixture properties due to curing time compared to the control SMA. The reheating process causes asphalt mixtures to have greater modulus, tensile strength, and rutting resistance, but smaller creep compliance and fracture resistance. The aging effect due to reheating is more significant on the control mixture than the three warm SMA mixtures due to a higher reheating temperature. An approach to determine the time for opening paved road to traffic is proposed for the tested materials.Illinois Tollwaypublished or submitted for publicationnot peer reviewe

Retention of Alzheimer Disease Research Participants.

IntroductionParticipant retention is important to maintaining statistical power, minimizing bias, and preventing scientific error in Alzheimer disease and related dementias research.MethodsWe surveyed representative investigators from NIH-funded Alzheimer's Disease Research Centers (ADRC), querying their use of retention tactics across 12 strategies. We compared survey results to data from the National Alzheimer's Coordinating Center for each center. We used a generalized estimating equation with independent working covariance model and empirical standard errors to assess relationships between survey results and rates of retention, controlling for participant characteristics.ResultsTwenty-five (83%) responding ADRCs employed an average 42 (SD=7) retention tactics. In a multivariable model that accounted for participant characteristics, the number of retention tactics used by a center was associated with participant retention (odds ratio=1.68, 95% confidence interval: 1.42, 1.98; P<0.001 for the middle compared with the lowest tertile survey scores; odds ratio=1.59, 95% confidence interval: 1.30, 1.94; P<0.001 for the highest compared with the lowest tertile survey scores) at the first follow-up visit. Participant characteristics such as normal cognition diagnosis, older age, higher education, and Caucasian race were also associated with higher retention.ConclusionsRetention in clinical research is more likely to be achieved by employing a variety of tactics

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p < 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p < 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p < 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease