The impact of 5-hydroxytryptamine-receptor antagonists on chemotherapy treatment adherence, treatment delay, and nausea and vomiting.

PurposeTo determine the incidence of chemotherapy-induced nausea/vomiting (CINV) and chemotherapy treatment delay and adherence among patients receiving palonosetron versus other 5-hydroxytryptamine receptor antagonist (5-HT3 RA) antiemetics.Materials and methodsThis retrospective claims analysis included adults with primary malignancies who initiated treatment consisting of single-day intravenous highly emetogenic chemotherapy (HEC) or moderately EC (MEC) regimens. Treatment delay was defined as a gap in treatment at least twice the National Comprehensive Cancer Network-specified cycle length, specific to each chemotherapy regimen. Treatment adherence was determined by the percentage of patients who received the regimen-specific recommended number of chemotherapy cycles within the recommended time frame.ResultsWe identified 1,832 palonosetron and 2,387 other 5-HT3 RA ("other") patients who initiated HEC therapy, and 1,350 palonosetron users and 1,379 patients on other antiemetics who initiated MEC therapy. Fewer patients receiving palonosetron experienced CINV versus other (HEC, 27.5% versus 32.2%, P=0.0011; MEC, 36.1% versus 41.7%, P=0.0026), and fewer treatment delays occurred among patients receiving palonosetron versus other (HEC, 3.2% versus 6.0%, P<0.0001; MEC, 17.0% versus 26.8%, P<0.0001). Compared with the other cohort, patients receiving palonosetron were significantly more adherent to the index chemotherapy regimen with respect to the recommended time frame (HEC, 74.7% versus 69.7%, P=0.0004; MEC, 43.1% versus 37.3%, P=0.0019) and dosage (HEC, 27.3% versus 25.8%, P=0.0004; MEC, 15.0% versus 12.6%, P=0.0019).ConclusionPalonosetron more effectively reduced occurrence of CINV in patients receiving HEC or MEC compared with other agents in this real-world setting. Additionally, patients receiving palonosetron had better adherence and fewer treatment delays than patients receiving other 5-HT3 RAs

Vibronic interactions in the visible and near-infrared spectra of C60− anions

Electron-phonon coupling is an important factor in understanding many properties of the C60 fullerides. However, there has been little success in quantifying the strength of the vibronic coupling in C60 ions, with considerable disagreement between experimental and theoretical results. We will show that neglect of quadratic coupling in previous models for C60- ions results in a significant overestimate of the linear coupling constants. Including quadratic coupling allows a coherent interpretation to be made of earlier experimental and theoretical results which at first sight are incompatible

Mechanical processing of wet stored fly ash for use as a cement component in concrete

Wet storage effects on fly ash, mean processing may be necessary to achieve physical properties required for use in concrete. This paper considers drying, de-agglomeration and milling of various wet stored fly ashes at laboratory and pilot/benchtop scales, towards meeting these. In the laboratory, different batch quantities and milling times with as received/pre-screened materials were examined using a ball mill. Greater particle size reductions were obtained with increased milling time but at gradually reducing rates. Pre-screening and batch quantity had relatively minor effects on particle size reductions, with little difference found between these materials and dry stored fly ash. Extended milling time resulted in: a darkening of colour; slight increases in loss-on-ignition, the main oxides content, and crystalline components; reductions in water requirement (to a point); and greater reactivity. Similar effects were generally noted in concrete for the superplasticizing admixture dose to achieve a target slump and compressive (cube) strength. At pilot/benchtop scale, a dryer-pulverizer and jet mill were used, which gave general agreement with the behaviour noted in the laboratory, but with the effects tending to be less. Fineness levels in Standards were achievable, with subsequent performance appearing to depend on the milling process used

Mechanical processing of wet stored fly ash for use as a cement component in concrete

Wet storage effects on fly ash, mean processing may be necessary to achieve physical properties required for use in concrete. This paper considers drying, de-agglomeration and milling of various wet stored fly ashes at laboratory and pilot/benchtop scales, towards meeting these. In the laboratory, different batch quantities and milling times with as received/pre-screened materials were examined using a ball mill. Greater particle size reductions were obtained with increased milling time but at gradually reducing rates. Pre-screening and batch quantity had relatively minor effects on particle size reductions, with little difference found between these materials and dry stored fly ash. Extended milling time resulted in: a darkening of colour; slight increases in loss-on-ignition, the main oxides content, and crystalline components; reductions in water requirement (to a point); and greater reactivity. Similar effects were generally noted in concrete for the superplasticizing admixture dose to achieve a target slump and compressive (cube) strength. At pilot/benchtop scale, a dryer-pulverizer and jet mill were used, which gave general agreement with the behaviour noted in the laboratory, but with the effects tending to be less. Fineness levels in Standards were achievable, with subsequent performance appearing to depend on the milling process used

Association Between Early Hyperoxia Exposure After Resuscitation From Cardiac Arrest and Neurological Disability: Prospective Multicenter Protocol-Directed Cohort Study

BACKGROUND: Studies examining the association between hyperoxia exposure after resuscitation from cardiac arrest and clinical outcomes have reported conflicting results. Our objective was to test the hypothesis that early postresuscitation hyperoxia is associated with poor neurological outcome. METHODS: This was a multicenter prospective cohort study. We included adult patients with cardiac arrest who were mechanically ventilated and received targeted temperature management after return of spontaneous circulation. We excluded patients with cardiac arrest caused by trauma or sepsis. Per protocol, partial pressure of arterial oxygen (Pao2) was measured at 1 and 6 hours after return of spontaneous circulation. Hyperoxia was defined as a Pao2 >300 mm Hg during the initial 6 hours after return of spontaneous circulation. The primary outcome was poor neurological function at hospital discharge, defined as a modified Rankin Scale score >3. Multivariable generalized linear regression with a log link was used to test the association between Pao2 and poor neurological outcome. To assess whether there was an association between other supranormal Pao2 levels and poor neurological outcome, we used other Pao2 cut points to define hyperoxia (ie, 100, 150, 200, 250, 350, 400 mm Hg). RESULTS: Of the 280 patients included, 105 (38%) had exposure to hyperoxia. Poor neurological function at hospital discharge occurred in 70% of patients in the entire cohort and in 77% versus 65% among patients with versus without exposure to hyperoxia respectively (absolute risk difference, 12%; 95% confidence interval, 1-23). Hyperoxia was independently associated with poor neurological function (relative risk, 1.23; 95% confidence interval, 1.11-1.35). On multivariable analysis, a 1-hour-longer duration of hyperoxia exposure was associated with a 3% increase in risk of poor neurological outcome (relative risk, 1.03; 95% confidence interval, 1.02-1.05). We found that the association with poor neurological outcome began at ≥300 mm Hg. CONCLUSIONS: Early hyperoxia exposure after resuscitation from cardiac arrest was independently associated with poor neurological function at hospital discharge

Situational Domains of Social Phobia

Although social phobia is defined as severe anxiety in social situations, little is known about the range or prevalence of social situations that elicit anxiety in social phobic individuals. The present study developed the concept of situational domains, groups of similar situations that may provoke anxiety in subsets of social anxious persons. Four conceptually derived situational domains were examined: formal speaking/interaction, informal speaking/interaction, observation by others, and assertion. Ninety-one social phobic patients were classified as anxiety-positive or anxiety-negative within each situational domain, varying inclusion criteria of anxiety experienced in each situation and the number of anxiety-producing situations within a domain. Patients were highly likely to be classified to the formal speaking/interaction domain, regardless of inclusion criteria employed or presence of anxiety within other domains. Support was also found for previous findings that most social phobics experience anxiety in more than one social situation, even under conservative classification criteria. Implications for the current diagnostic nosology and directions for future research are discussed

Situational Domains of Social Phobia

Although social phobia is defined as severe anxiety in social situations, little is known about the range or prevalence of social situations that elicit anxiety in social phobic individuals. The present study developed the concept of situational domains, groups of similar situations that may provoke anxiety in subsets of social anxious persons. Four conceptually derived situational domains were examined: formal speaking/interaction, informal speaking/interaction, observation by others, and assertion. Ninety-one social phobic patients were classified as anxiety-positive or anxiety-negative within each situational domain, varying inclusion criteria of anxiety experienced in each situation and the number of anxiety-producing situations within a domain. Patients were highly likely to be classified to the formal speaking/interaction domain, regardless of inclusion criteria employed or presence of anxiety within other domains. Support was also found for previous findings that most social phobics experience anxiety in more than one social situation, even under conservative classification criteria. Implications for the current diagnostic nosology and directions for future research are discussed