Search

Purpose Everolimus is a proliferation signal inhibitor used for triple immunosuppressive therapy following solid organ transplantation. Its positive benefits, such as reduction of acute rejection episodes and reduced nephrotoxicity have been shown in kidney- as well as heart transplantation. However the role of everolimus is less well defined in lung transplantation. We thus wished to study the effect of primary immunosuppression with everolimus in a preclinical large animal lung transplantation model. Methods Left-sided single lung transplantation from MHC-mismatched donors was performed in 11 adult minipigs. Intravenous pharmacologic immunosuppression was maintained for 28 days with 1.5 mg/kg/d methylprednisolone, 1.0 mg/kg/d azathioprine and cyclosporine A (blood levels 300-500 ng/ml; CsA group; n = 5). A further group (CsA + Ev; n = 6) received methylprednisolone, CsA (200–300 ng/ml) and Everolimus (5–10 ng/ml). Immunosuppression was discontinued on postoperative day (POD) 28. Graft survival was monitored by sequential chest X-rays, bronchoscopies and transbronchial biopsy histology. Results All animals survived the 28 day course of immunosuppressive therapy and showed healthy grafts on POD 28. Median allograft survival in the CsA group was 55 ± 15 days. CsA + Ev grafts showed median survival of 49 ± 86 days (p = 0.37). Conclusion Whereas everolimus might be advantageous as maintenance immunosuppressive agent, this data does not support an important role for everolimus in the immunosuppressive induction phase following lung transplantation.

Ex vivo lung perfusion (EVLP) has become routine practice in lung transplantation. Still, running periods exceeding 12 hours have not been undertaken clinically to date, and it remains unclear how the perfusion solution for extended running periods should be composed and which parameters may predict outcomes. Twenty-four porcine lungs underwent EVLP for 24 hours using the Organ Care System (OCS). Lungs were ventilated and perfused with STEEN's solution enriched with erythrocytes (n = 8), acellular STEEN's solution (n = 8), or low-potassium dextran (LPD) solution enriched with erythrocytes (n = 8). After 24 hours, the left lungs were transplanted into recipient pigs. After clamping of the contralateral lung, the recipients were observed for 6 hours. The most favorable outcome was observed in organs utilizing STEEN solution enriched with erythrocytes as perfusate, whereas the least favorable outcome was seen with LPD solution enriched with erythrocytes for perfusion. Animals surviving the observation period showed lower peak airway pressure (PAWP) and pulmonary vascular resistance (PVR) during OCS preservation. The results suggest that transplantation of lungs following 24 hours of EVLP is feasible but dependent on the composition of the perfusate. PAWP and PVR during EVLP are early and late predictors of transplant outcome, respectively.

The purpose of the study was to find a method towards predicting future falls so that healthcare providers can provide interventions. We compared a new Footbed Sensors (FS) platform, which measures foot pressure 5 force sensors and communicates via Bluetooth, and established measures of fall risks: Age, past falls (in 3, 6, and 9 months), Activity-Specific Balance Confidence (ABC), Berg Balance Scale (BBS), Timed up and Go (TUG) and Instrumental Activities of Daily Living (IADL).

Patient satisfaction is viewed as a significant indicator of quality of care. More specifically, improving patient satisfaction related to communication about medications and potential side effects can improve healthcare outcomes. Patient satisfaction scores related to medication side effects on a neuro-medical surgical unit were monitored following a quality improvement program. These patients frequently experience cognitive impairment and functional difficulties that can affect the way they understand and handle medications. The purpose of this quality improvement practice change was to (a) develop an educational approach for post acute neurosurgical patients and (b) evaluate whether the use of the approach is successful in improving patient satisfaction scores related to medication education on side effects. The quality improvement program interventions included (a) patient informational handouts inserted into admission folders, (b) nurse education about the importance of providing education on side effects to patient and discussion of their involvement with the program, (c) unit flyers with nurse education, and (d) various communications with bedside nurses through personal work mail and emails. The primary focus was for nurses to employ the "teach back" method to review and reinforce the medication side-effect teaching with patients. Evaluation of the data showed an increase in patient satisfaction after the implementation of the "Always Ask" program.

Background Intraosseous access has been used increasingly with proven efficacy in emergent situations for adults when intravenous access could not be obtained. Objective Our aim was to demonstrate if tibial intraosseous (IO) is an effective route for iodinated contrast administration and pulmonary vasculature visualization. Case Report We report on an obtunded patient requiring a computed tomography angiogram to help with diagnosis and tibial IO was the only viable access appropriate to withstand the pressure of a computed tomography iodinated contrast load. Tibial IO access was used successfully for administration of iodinated contrast to evaluate for massive pulmonary embolism in an obtunded patient in extremis secondary to cardiovascular instability. Conclusions The pulmonary arteries were opacified and demonstrated a high-quality CT angiogram can be done via tibial IO device.

Fish assemblages in rivers of the Midwestern United States are an important component of the region's natural resources and biodiversity. We characterized the physical environment and presence of dams in a series of reaches in three eastern Iowa rivers tributary to the Mississippi River and related these characteristics to the fish assemblages present. Some physical characteristics were similar among the 12 study reaches, whereas others differed substantially. We found a total of 68 species across the 12 study reaches; 56 in the Turkey River, 51 in the Maquoketa River and 50 in the Wapsipinicon River. Seventeen species could be described as ‘downstream-distributed’; 15 being found only in the lowest reach of one or more rivers and the other two being found only in the lowest reaches or two or more contiguous reaches including the lowest reach. Two species could be described as ‘upstream-distributed’, being found only in an uppermost reach. Non-metric multidimensional scaling ordination illustrated similarities among reaches, and five physical variables were significantly correlated with assemblage similarities. Catchment area and number of dams between reaches and the Mississippi River were strongly correlated with assemblage similarities, but the directions of their effects were opposite. Catchment area and number of dams were confounded. The collective evidence to date suggests that the pervasiveness of dams on rivers significantly alters fish assemblages, making underlying patterns of species change and relationships with naturally varying and human-influenced physical characteristics along a river's course difficult to discern. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

A novel and efficient organic waste management strategy currently gaining great attention is fly larvae composting. High resource recovery efficiency can be achieved in this closed-looped system, but pharmaceuticals and pesticides in waste could potentially accumulate in every loop of the treatment system and spread to the environment. This study evaluated the fate of three pharmaceuticals (carbamazepine, roxithromycin, trimethoprim) and two pesticides (azoxystrobin, propiconazole) in a fly larvae composting system and in a control treatment with no larvae. It was found that the half-life of all five substances was shorter in the fly larvae compost (10% of control) and no bioaccumulation was detected in the larvae. Fly larvae composting could thus impede the spread of pharmaceuticals and pesticides into the environment.

The classification of marine habitats is a critical first step towards the protection of marine biodiversity and the sustainable management of the world’s oceans. Recently, the topic has received heightened attention as the 2012 deadline for meeting international commitments under the convention on biological diversity (CBD) approaches. These commitments require the development of a unified approach to identifying high-seas areas in need of protection. To determine the best approach, criteria for identifying sensitive areas proposed by the CBD and the Food and Agriculture Organization of the United Nations were compared to the ecologically and biologically significant areas (EBSAs) criteria developed by Fisheries and Oceans Canada. The comparison demonstrates that, with some minor refinements, the EBSA criteria are parsimonious and encompass all other criteria proposed to date. To identify the most suitable approach for defining EBSAs, 16 classifications of the world’s oceans, ranging from coastal regions to the high-seas, were reviewed for their suitability to define EBSAs. The classifications differed in substantive ways, including analytical methods (from quantitative analyses to subjective interpretations), data sources (either physical or biological), and the realm to which they were applied (high-seas, coastal, or deep-ocean). No method currently provides an integrated, whole-ecosystem approach to identifying a comprehensive set of important marine areas. To move to a singular, multi-attribute, description of EBSAs requires an explicit, reproducible methodology. Here, the EBSA approach is formalised as an adaptive method that integrates existing classifications in an efficient, holistic, and transparent manner, by explicitly considering important marine features (IMFs) and biologically sensitive areas (BSAs). The proposed approach directly addresses the EBSA criteria, and is applicable across the different realms of the world’s oceans.

One hundred bi- or homosexual men as well as 100 heterosexual men of similar age were asked about maternal stressful events that may have occurred during their prenatal life. A significantly increased incidence of prenatal stress was found in bisexual and, particularly, in homosexual men. This finding suggests that prenatal stress in males may represent a risk factor for the etiogenesis of sexual deviations in later life.

Expulsion of surgically implanted radio transmitters is a problem in some fish telemetry studies. We conducted a 109-d experiment to test the hypothesis that variation in relative volume of transmitters surgically implanted in subadult common carp Cyprinus carpio would affect transmitter expulsion. We also necropsied fish at the end of the experiment to evaluate histological evidence for the mechanism of expulsion. Survival rate was high during our experiment; all control fish and 88% of the fish subjected to the implantation surgery survived. Expulsion rate was low; of the 23 fish that received transmitters and survived the experiment, only two (9%) expelled the transmitters. One of these expulsions occurred through a rupture of the incision and the other occurred via the intestine. Retained transmitters were all encapsulated by tissue, and most exhibited multiple adhesions to the intestine, gonads, and body wall. Adhesions were more numerous in fish that received larger transmitters.

Neurologic complications are common side-effects of immunosuppressive medications used in the prevention of graft rejection after organ transplantation. The medications most commonly encountered include the calcineurin inhibitors and mycophenolate mofetil. Depression is the most commonly encountered neurotoxicity; however, severe but rare adverse neurological effects related to these therapies have been reported. Interferons, ribavirin, and protease inhibitors are therapeutic options commonly encountered in the treatment of hepatitis. Nucleoside analogs such as adefovir dipivoxil and entecavir carry significant risks for the development of lactic acidosis and hepatic dysfunction; however, most common adverse effects to these therapies in general are mild. While the mechanisms of action are poorly elucidated, they are discussed along with treatment strategies.

We describe the various steps in calculating the thermal stress in the RHIC beam dump windows, and list the maximum beam intensities for various species and energies to ensure safe operation of the beam dump. Furthermore, we propose a possible upgrade scenario that would increase these limits.

The objective of this note is to (once again) explore the AGS 'ORM' (orbit response matrix) data taken (by Operations) early during the 2007 run with an AGS bare machine and gold beam. Indeed the present motivation is to extract as much information about the AGS inherent transverse coupling as possible - from general arguments and the copious ORM data. And taking this one step further, (though not accomplished yet) the goal really should be to tell the model how to describe this coupling. 'Bare' as used here means the AGS with no quadrupole, sextupole or octupole magnets powered. Only the main (combined-function) magnet string and dipole bumps necessary to optimize beam survival are powered. 'ORM data' means the systematic recording of the equilibrium orbit beam position monitor response to powering individual dipole corrector magnets. The 'matrix' results from looking at the effect of each of the (12 superperiods X 4 dipoles per superperiod) 'kicks' on each of the (12 X 6) pick up electrodes (pues) in each transverse plane. So then we have two (48 X 72) matrices of numbers from the ORM data. (Though 'pue' usually refers to the hardware in the vacuum chamber and 'bpm' to themore » beam position monitoring system, the two labels will be used casually here.) The exercise is carried out at two magnet rigidities, injection (AGS field {approx}434 Gauss) and extraction to RHIC ({approx}9730 Gauss), - a ratio of rigidities of about 22.4. Since we stick with a bare machine, we are also stuck with the bare tunes which means the tunes are rather close together and near 8.75. Injection: (h,v) {approx} (8.73, 8.76).« less

Localized losses of gold beam in the AGS during RHIC Run 8 produced vacuum leaks which required the replacement of several vacuum chambers. A review of what happened and why was given by Leif Ahrens at the Run 8 Retreat. The following notes trace the subsequent development of clean dumping of gold beam on the beam dump in the J10 straight. The novel idea of stripping Au77+ ions in order to put them directly into the upstream face of the dump was introduced by Leif Ahrens and developed by all three of us. George Mahler made the actual stripping device and Dave Gassner developed its control. Leif Ahrens successfully commissioned the device with gold beam during Run 10. The reader may find it helpful to first view the figures herein and then refer to the text for details.

Effects of the Booster vertical scraping on the RHIC beam polarization, the RHIC beam emittance, and on the Booster to AGS transfer efficiency and AGS transmission as well, are further studied. In [1], the strong dependence of the RHIC beam polarization and emittance on bunch intensity in proton run 2008 (pp08) is compared with the proton run 2006 (pp06), where the dependence is much weaker. The setting in the AGS Booster, mainly the vertical scraping, is suspected to having played a role in the different patterns in the two runs. In this note, we further study the effects of the Booster vertical scraping on the RHIC beam polarization, and on the RHIC beam emittance as well. With the improvement of the RHIC bunch intensity in mind, the Booster scraping effects on the Booster to AGS transfer (BtA) efficiency and the AGS transmission are also studied. For simplicity and to be more useful, only the RHIC fills after the one-week shutdown in pp06 and the fills using the AGS User 2 in pp08 are shown. For these fills, the machine settings in AGS are similar in pp06 and pp08 runs. Furthermore, this setting might be used for next polarized proton run,more » at least at the beginning of the run.« less

During Run‐8, the Relativistic Heavy Ion Collider (RHIC) provided collisions of spin‐polarized proton beams at two interaction regions. Physics data were taken with vertical orientation of the beam polarization, which in the “Yellow” RHIC ring was significantly lower than in previous years. We present recent developments and improvements as well as the luminosity and polarization performance achieved during Run‐8, and we discuss possible causes of the not as high as previously achieved polarization performance of the “Yellow” ring.

As part of the preparation for the Proton Interrogation Experiment, we have calculated the beam optics for the transport of 4 GeV protons, from the AGS extraction point, to the 'Cross-Section Target Wheel 1' and to the 'Proton Interrogation Target'. In this technical note we present three possible beam-transports each corresponding to a particular Fast Extracted Beam W B setup of the AGS. In addition we present results on the effect of the atmospheric air, (which fills the drift space of the last 100 [m] of the transport line), on the size of the beam, at two locations along the drift space, one location at the middle of the drift space and the other at the end where the 'Proton Interrogation Target' is placed. All the beam transports mentioned above require the removal of the WD1 dipole magnet, which is the first magnet of the W-line, because it acts as a limiting beam aperture, and the magnet is not used in the beam transport. An alternative solution of a beam transport, which does not require the removal of the WD1 magnet, is also presented. In this solution, which models the transport line using the TURTLE computer code[7], the vertical beammore » sizes at the location of the WD1 magnet is minimized to allow 'lossless' beam transport at the location of the WD1 magnet. A similar solution, but using a MAD model of the line, is also presented.« less

Follow up on BtA multiwire beam measurements taken during the 2008 polarized proton run has led to a number of better understandings (for the author) associated with the beam instrumentation involved. This history will be reviewed--some 'beam-based' results noted--and the present state of the application for these monitors described. The BtA multiwire system seems to be fundamentally an excellent diagnostic for allowing us to get the BtA line well under control in a defendable way. When beam is available in BtA, carrying out some systematic measurements with the system can get us there.