Unique approaches for testicular shielding during total-body irradiation for pediatric patients.

Total-body irradiation (TBI) has been used as a part of the conditioning regimen for patients undergoing hematopoietic stem cell transplantation for certain nonmalignant conditions such as sickle cell disease. Although effective, TBI can cause lasting side effects for pediatric patients. One of these potential side effects includes oligospermia or even permanent azoospermia. Although many investigators have studied ways to shield the testicles during the TBI for nonmalignant conditions, there is no set standard. We describe the technical aspects of effective techniques to shield the testicles of male pediatric patients undergoing TBI. We verified that our techniques reduced the testicular dose by approximately 80%-85% of the TBI prescription dose in four male pediatric patients, keeping the dose well below the documented doses that can cause permanent infertility and hypogonadism.

A study of the healthcare resource use for the management of postpartum haemorrhage in France, Italy, the Netherlands, and the UK.

OBJECTIVE: Postpartum haemorrhage (PPH) complicates approximately 5% of births worldwide and is a leading direct cause of maternal death. Rates of PPH are increasing in many developed countries, particularly PPH related to uterine atony. There is a lack of published up-to-date information about healthcare resource use associated with management of PPH following vaginal birth. The objective of this study was to describe healthcare resource use for the management of minor PPH (blood loss 500-1,000 ml) and major PPH (blood loss > 1,000 ml) compared to uncomplicated birth (no PPH) following hospital vaginal birth in France, Italy, the Netherlands, and the UK. STUDY DESIGN: In-depth interviews with two midwives from each participating country were conducted to establish differences in resource use for the management of minor PPH, major PPH, and uncomplicated birth. A web-survey was then developed and one obstetrician per participating country reviewed the survey. In total, 100 midwives (25 per country) completed the survey. Results were discussed at a multi-professional consensus meeting of midwives and obstetricians/gynaecologists (n = 6). RESULTS AND CONCLUSIONS: Midwives participating in the survey estimated that 80% of women receive Active Management of the Third Stage of Labour (AMTSL) and 93% of participants specified that uterotonics would routinely be used during AMTSL. Most participants (84%) reported that blood loss is routinely measured in their hospital, using a combination of methods. PPH is associated with increased healthcare resource use, including administration of additional uterotonics and use of additional medical interventions, such as urinary catheter, intravenous fluids, and possible requirement for surgery. The number of nurses, obstetricians/gynaecologists, and anaesthetists involved in the management of PPH increases with the occurrence and severity of PPH, as well as the proportion of healthcare personnel providing continuous care. Women may spend an additional 24 h in hospital following major PPH compared to uncomplicated birth. The results of this study highlight the burden of PPH management on healthcare resources. To reduce costs associated with PPH, prevention is the most effective strategy and can be enhanced with the use of an effective uterotonic as part of the active management of the third stage of labour.

Delay in transit: the NCEPOD review of care provided to patients with acute bowel obstruction.

Acute bowel obstruction can occur in the small or large bowel and accounts for up to 10% of emergency surgical admissions. This high-risk group of patients requires careful management. Early diagnosis via computed tomography can help to prevent delays when surgery is required, which can impact patient outcomes.

Escherichia coli isolate for studying colonization of the mouse intestine and its application to two-component signaling knockouts.

The biology of Escherichia coli in its primary niche, the animal intestinal tract, is remarkably unexplored. Studies with the streptomycin-treated mouse model have produced important insights into the metabolic requirements for Escherichia coli to colonize mice. However, we still know relatively little about the physiology of this bacterium growing in the complex environment of an intestine that is permissive for the growth of competing flora. We have developed a system for studying colonization using an E. coli strain, MP1, isolated from a mouse. MP1 is genetically tractable and does not require continuous antibiotic treatment for stable colonization. As an application of this system, we separately knocked out each two-component system response regulator in MP1 and performed competitions against the wild-type strain. We found that only three response regulators, ArcA, CpxR, and RcsB, produce strong colonization defects, suggesting that in addition to anaerobiosis, adaptation to cell envelope stress is a critical requirement for E. coli colonization of the mouse intestine. We also show that the response regulator OmpR, which had previously been hypothesized to be important for adaptation between in vivo and ex vivo environments, is not required for MP1 colonization due to the presence of a third major porin.

A repeat-dose thorough QT study of inhaled fluticasone furoate/vilanterol combination in healthy subjects.

AIMS: This study was designed as a thorough QT (TQT) study to evaluate the effects of fluticasone furoate (FF)/vilanterol (VI) in healthy subjects. Supportive data from a TQT study conducted with FF are also presented. METHODS: This was a randomized, placebo- and positive-controlled, double-dummy, double-blind, four-way crossover study, in which healthy subjects (n = 85) were randomized to 7 days of once-daily treatment of FF/VI (200/25 or 800/100 µg) or placebo or single-dose oral moxifloxacin (single-blind, 400 mg). In the supportive TQT study, subjects (n = 40) were randomized to single-dose inhaled FF (4000 µg), oral moxifloxacin (400 mg) or placebo. RESULTS: There was a lack of effect of FF/VI (200/25 µg) on QTcF (Fridericia's correction); all time-matched mean differences from baseline relative to placebo (0-24 h) were <5 ms, with upper 90% confidence intervals (CI) of <10 ms. At 800/100 µg, FF/VI had no significant clinical effect on QTcF except at 30 min postdose when the 90% CI was >10 ms [mean (90% CI), 9.6 ms (7.2, 12.0)]. No effect on QTci (individually corrected) was observed at either strength of FF/VI, with mean time-matched treatment differences <5 ms at all time points [upper 90% CIs <10 ms (0-24 h)]. Assay sensitivity was confirmed; moxifloxacin prolonged QTcF and QTci, with time-matched mean differences from baseline relative to placebo of >10 ms (1-8 h postdose). CONCLUSIONS: Repeat once-daily dosing of FF/VI (200/25 µg), which is the highest therapeutic strength used in phase III studies, is not associated with QTc prolongation in healthy subjects. Supratherapeutic strength FF/VI (800/100 µg) demonstrated a small transient effect on QTcF but not on QTci.

Linking El Niño, local rainfall, and migration timing in a tropical migratory species.

Current climate models project changes in both temperature and precipitation patterns across the globe in the coming years. Migratory species, which move to take advantage of seasonal climate patterns, are likely to be affected by these changes, and indeed, a number of studies have shown a relationship between changing climate and the migration timing of various species. However, these studies have almost exclusively focused on the effects of temperature change on species that inhabit temperate zones. Here, we explore the relationship between rainfall and migration timing in a tropical species, Gecarcoidea natalis (Christmas Island red crab). We find that the timing of the annual crab breeding migration is closely related to the amount of rain that falls during a 'migration window' period prior to potential egg release dates, which is in turn related to the Southern Oscillation Index, an atmospheric El Niño-Southern Oscillation Index. As reproduction in this species is conditional on successful migration, major changes in migration patterns could have detrimental consequences for the survival of the species. This study serves to broaden our understanding of the effects of climate change on migratory species and will hopefully inspire future work on rainfall and tropical migrations.

Lead tetrakis(imidazolyl)borate solids: anion exchange, solvent intercalation, and self assembly of an organic anion.

The coordination polymer Pb[B(Im)(4)](NO(3))(xH(2)O), constructed by using sodium tetrakis(imidazolyl)borate and lead(II) nitrate solutions, is a layered material with the metal centers facing the interlayer spacing. As in naturally occurring layered minerals, this compound can readily undergo anion exchange and reversible intercalation of solvent water in the solid state with retention of crystallinity. We observed changes in solvent intercalation by (207)Pb solid state NMR (SSNMR) and thermogravimetric analysis (TGA). Stoichiometric exchange of (15)N nitrate for nitrate and iodide for nitrate is monitored by (15)N and (207)Pb SSNMR, and single crystals of the iodide-exchanged material Pb[B(Im)(4)]I were isolated. While the iodide compound can be obtained through facile exchange from the nitrate parent compound, the organic anion benzoate is placed in the interlayer spacing for nitrate under self-assembly conditions and forms an alternating monolayer in Pb[B(Im)(4)](C(6)H(5)COO)(0.5H(2)O). The ion exchange versus self-assembly behavior correlates with the structural differences in the three compounds. In both Pb[B(Im)(4)]I and Pb[B(Im)(4)](C(6)H(5)COO)(0.5H(2)O), the lead sites act as Lewis acids for the iodide and benzoate, respectively.

A quaternary temperament model and defense cluster preferences.

A quaternary model of temperament constructed from orthogonal axes defined by Extraversion-Introversion and Thinking-Feeling resulted in four groups: Introverted Thinking, Introverted Feeling, Extraverted Thinking, and Extraverted Feeling. Hypothesized relationships between quaternary groups and defense cluster preferences were tested by giving 158 female college students the Myers-Briggs Type Indicator and the Defense Mechanisms Inventory. There was little support for hypothesized relationships between the quaternary model and defense preferences. The only hypothesized significant group difference showed the Extraverted Feeling group recording a greater preference for the Reversal defense cluster than the Introverted Feeling group.

Tetrakis(imidazolyl)borate-based coordination polymers: group II network solids, M[B(Im)4]2(H2O)2 (M = Mg, Ca, Sr).

We are using the coordinating anion tetrakis(imidazolyl)borate to construct new metal-organic framework structures. In this report, we present three alkaline earth metal network solids incorporating this anion. All three compounds have the same formula, M[B(Im)(4)](2)(H(2)O)(2) (M = Mg, Ca, Sr), and the same coordination environment about the metal. However, the three compounds have different network structures with different degrees of hydrogen bonding; the Mg material forms a two-dimensional network and the Ca and Sr compounds form one-dimensional chains. In addition, we present the structure of the protonated anion B(HIm)(Im)(3) as a model for the default structure of this anion and discuss how the conformation of tetrakis(imidazolyl)borate can affect the structure of network solids.

Construction of a functional layered solid using the tetrakis(imidazolyl)borate coordinating anion.

The coordination polymer Pb[B(Im)(4)](NO(3)), constructed by using tetrakis(imidazolyl)borate and lead(II) nitrate solutions, is a layered material with the metal centers facing the interlayer spacing. As in naturally occurring layered minerals, this compound can readily undergo anion exchange in the solid state with retention of crystallinity. We examined stoichiometric exchange of (15)N-nitrate for nitrate and iodide for nitrate by (15)N and (207)Pb SSNMR and confirmed retention of crystallinity by IR and powder XRD diffraction.

Evaluation of a nonintrusive monitor to reduce falls in nursing home patients.

OBJECTIVE: A clinical study was conducted to measure the effectiveness and operational characteristics of a new device intended to reduce the incidence of falls in elderly patients at high risk of falling. The NOC.watch device consists of a credit-card size device contained within an adhesive "patch"worn on the thigh continuously for many days. The patch is small, wireless, disposable, waterproof, shockproof, and unobtrusive. When a patient's leg becomes weight-bearing (such as when a patient gets out of bed or stands up unassisted), the receiver emits an audible signal which both alerts the patient to sit down and also summons a caregiver. DESIGN: A crossover design was used to compare the fall rate of patients while wearing the NOC.watch device with the fall rate while not wearing it. Patients (n = 47) wore the device for one week, and were monitored for fall activity before, during, and after this week. The three time periods were referred to as the "Pre," "During," and "Post" periods, respectively. PARTICIPANTS: The study was conducted between November 1, 2000, and April 1, 2001, in the Medicare unit of a skilled nursing facility in northern California. Forty-seven patients admitted to the unit with a fall risk assessment (FRA) score of at least 6 were entered into the study, with a mean FRA of 11.4. MEASUREMENTS: The main outcome measure was fall rate per 100 patient days. Qualitative observations of adverse effects on skin integrity, degree of staff and patient acceptance of the system, and lack of false alarms are also reported. Poisson regression with generalized estimating equations was used for analysis of fall rates. RESULTS: Forty-seven patients wore the device. Total number of patient-days of observation were 273, 299, and 497 in the Pre, During, and Post periods, respectively, for a total of 1,069 days of observation. These patients had 11 falls in the Pre period (4.0 falls per 100 days), 1 fall in the During period (0.3 falls per 100 days) and 17 falls in the Post period (3.4 falls per 100 days). This 91% reduction in fall rate while wearing the NOC.watch is statistically significant with P = 0.02. False alarms were qualitatively reported to be low or nonexistent, and patient and caregiver acceptance of the device was reported to be high. No adverse effects on skin integrity were noted. Cognitively impaired patients, who have difficulty remembering to call for assistance, appeared to respond particularly well to the device alarm. CONCLUSIONS: The prototype NOC.watch device appears to have a large impact on reducing fall risk in nursing home patients, with minimal adverse effects. However, due to the lack of an equivalent control group, these results should be confirmed with a larger, randomized, controlled study to better estimate the true magnitude of the effect of the NOC.watch device on fall rates.