Life history and convervation of Elliptio crassidens from the Blue River, Indiana.

This study assessed life history components for the elephantear freshwater mussel, Elliptio crassidens (Lamarck, 1819). The main focus of this study was to determine the suitability of various fish species as a host for E. crassidens and to determine the population status in terms of age structure, recruitment and reproduction of E. crassidens from the Blue River drainage of south-central Indiana. General observations on the life history of E. crassidens were made: brooding conditions for release of larvae, larval behavior, and larval shell dimensions. Ages of E. crassidens shells from the Blue River were also determined. A Geographic Information System (GIS) analysis compared overlap in distribution between E. crassidens and potential fish hosts. This analysis demonstrated that percentage overlap between the ranges of E. crassidens and potential fish hosts was not a sound indicator of host fish suitability. However, several potential host species were identified and others were eliminated from consideration

Business in Nebraska #267- December 1966

Manufacturing in Nebraska (E. L. Hauswald) This article is based on data from the last complete census of manufacturing taken in 1963. Developments subsequent to 1963 have been sufficient to modify the situation described herein. The efforts of the Nebraska Division of Resources have produced results not recorded in the 1963 census. Recent reactivation\u27s of operations related to the national security and expansions of industries in several of the state\u27s communities could not be incorporated in this analysis. The aggregate impact of these developments will not be ascertainable until the next census of manufacturing. Business Summary (E. L. Burgess) In September, Nebraska\u27s dollar volume of business was 8.2% above September, 1965. Physical volume of business was 5.4% above last year. The U.S. indexes were up 7.3% and 4.5% respectively. In both the U.S. and Nebraska, dollar volume decreased 0.1% from August, 1966. The physical volume in Nebraska decreased 1.5% while that of the U.S. increased 0.1% from August. Cash farm marketing\u27s was the only Nebraska indicator lower than the previous year. In the U.S., cash farm marketing\u27s, construction activity, and life insurance sales were down from the previous year\u27s level

An inexpensive device to treat postpartum hemorrhage: a preliminary proof of concept study of health provider opinion and training in Nepal

BACKGROUND: Obstetric hemorrhage remains the leading cause of maternal mortality in resource limited areas. An inexpensive pneumatic anti-shock garment was devised of bicycle tubes and tailored cloth which can be prepared from local materials in resource-limited settings. The main purposes of this study were: 1) to determine acceptability of the device by nurses and midwives and obtain suggestions for making the device more suitable for use in their particular work environments, 2) to determine whether a three hour training course provided adequate instruction in the use of this device for the application of circumferential abdominal pelvic pressure, and 3) determine production capability and cost in a resource-limited country. METHODS: Fifty-eight nurse and midwife participants took part in three sessions over eight months in Nepal. Correct device placement was assessed on non-pregnant participants using ultrasound measurement of distal aortic flow before and after device inflation, and analyzed using confidence intervals. Participants were surveyed to determine acceptability of the device, obtain suggestions for improvement, and to collect data on clinical use. RESULTS: Device placement achieved flow decreases with a mean of 39% (95% CI 25%-53%, p < 0.001) in the first session, 28% (95% CI 21%-33%, P < 0.001) after four months and 29% (95% CI 24%-34%, p < 0.001) at 8 months. All nurses and midwives thought the device would be acceptable for use in obstetric hemorrhage and that they could make, clean, and apply it. They quickly learned to apply the device, remembered how to apply it, and were willing and able to use the device clinically. Ten providers used the device, each on one patient, to treat obstetric hemorrhage after routine measures had failed; bleeding stopped promptly in all ten, two of whom were transported to the hospital. Production of devices in Kathmandu using local tailors and supplies cost approximately $40 per device, in a limited production setting. CONCLUSIONS: Preliminary data suggest that an inexpensive, easily-made device is potentially an appropriate addition to current obstetric hemorrhage treatment in resource-limited areas and that further study is warranted

Hydrologic connectivity and land cover affect floodplain lake water quality, fish abundance, and fish diversity in floodplain lakes of the Wabash-White River basin

Floodplain lakes are important aquatic resources for supporting ecosystem services, such as organismal habitat, biodiversity, and the retention of nutrients and sediment. Due to geomorphic alteration of river channels and land-cover change, degradation to floodplain lakes in the Ohio River basin is occurring at a rate that will escalate as climate change causes increased flood intensity and the seasonal redistribution of rainfall. A better understanding of the local drivers that affect oxbow lakes is needed for targeted floodplain restoration efforts designed to slow degradation. We examined the effects of land cover, topography, and hydrologic connectivity on water quality and fish diversity and abundance in nine floodplain lakes with potentially high remnant ecological function in the Wabash-White watershed (Indiana, Ohio, and Illinois). Data collection included water-quality parameters; stable water isotopes; total phosphorus, total nitrogen, and chlorophyll-a; and fish community diversity and abundance. Results indicate that hay/pasture land cover and decreased topographic relief in the local oxbow watersheds, along with reduced river hydrologic connectivity, were related to an increase in total phosphorus, total nitrogen, and chlorophyll-a. Greater biodiversity and abundance in fish assemblages were evident in oxbow lakes that were more disconnected from the main channel. The results of this study suggest that hydrologic connectivity of oxbow lakes with the contributing drainage area and the main channel influence nutrients and fish communities. Knowing the influencing factors can help ecosystem managers better protect these valuable floodplain lake ecosystems and prioritize restoration efforts amidst increasing stressors due to climate and land-use changes.Toyota Motor Manufacturing, Indiana, Inc.; Walton Family Foundatio

SWITCH : A randomised, sequential, open-label study to evaluate the efficacy and safety of Sorafenib-sunitinib versus Sunitinib-sorafenib in the treatment of metastatic renal cell cancer

Background Understanding how to sequence targeted therapies for metastatic renal cell carcinoma (mRCC) is important for maximisation of clinical benefit. Objectives To prospectively evaluate sequential use of the multikinase inhibitors sorafenib followed by sunitinib (So-Su) versus sunitinib followed by sorafenib (Su-So) in patients with mRCC. Design, setting, and participants The multicentre, randomised, open-label, phase 3 SWITCH study assessed So-Su versus Su-So in patients with mRCC without prior systemic therapy, and stratified by Memorial Sloan Kettering Cancer Center risk score (favourable or intermediate). Intervention Patients were randomised to sorafenib 400 mg twice daily followed, on progression or intolerable toxicity, by sunitinib 50 mg once daily (4 wk on, 2 wk off) (So-Su), or vice versa (Su-So). Outcome measurements and statistical analysis The primary endpoint was improvement in progression-free survival (PFS) with So-Su versus Su-So, assessed from randomisation to progression or death during second-line therapy. Secondary endpoints included overall survival (OS) and safety. Results and limitations In total, 365 patients were randomised (So-Su, n = 182; Su-So, n = 183). There was no significant difference in total PFS between So-Su and Su-So (median 12.5 vs 14.9 mo; hazard ratio [HR] 1.01; 90% confidence interval [CI] 0.81–1.27; p = 0.5 for superiority). OS was similar for So-Su and Su-So (median 31.5 and 30.2 mo; HR 1.00, 90% CI 0.77–1.30; p = 0.5 for superiority). More So-Su patients than Su-So patients reached protocol-defined second-line therapy (57% vs 42%). Overall, adverse event rates were generally similar between the treatment arms. The most frequent any-grade treatment-emergent first-line adverse events were diarrhoea (54%) and hand-foot skin reaction (39%) for sorafenib; and diarrhoea (40%) and fatigue (40%) for sunitinib. Conclusions Total PFS was not superior with So-Su versus Su-So. These results demonstrate that sorafenib followed by sunitinib and vice versa provide similar clinical benefit in mRCC