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Background: Increased access and utilization of vision care services has the potential to reduce preventable vision loss. The state of Ohio has been uniquely proactive when collecting vision-oriented data through population health surveys, including the Behavioral Risk Factor Surveillance System (BRFSS). These data can be used to better understand vision care utilization patterns and access to insurance. Methods: Responses to 3 items administered in the Ohio BRFSS that assess vision care utilization and insurance coverage were compared between 2 different administration periods, 2005-2011 and 2018-2019, using chi-square tests. Comparable data from 2 items assessing eye care utilization were available in 2005-2011 and 2019. Comparable data for insurance coverage were available in 2005-2011 and in 2018-2019. Responses were further stratified by population characteristics, including age, gender, household income, and education level. Results: The percentages of those reporting eye exams in the previous year were not significantly different between 2005-2011 and 2019 (chi-square, p = 0.06). In Ohio, the primary reason for not seeing a vision care provider in the past 12 months was “No reason to go” in 2005-2011 and in 2019. The second most common reason for not seeing a vision care provider in the past 12 months was “Cost/insurance,” which decreased between 2005-2011 and 2019 (chi-square, p

Despite initial complete remission rates of up to 90%, long-term, disease-free survival remains poor in patients with newly diagnosed acute lymphoblastic leukemia (ALL). Response to salvage chemotherapy is suboptimal; therefore, novel therapeutic agents are being investigated in order to improve outcomes in these patients. Inotuzumab ozogamicin is a CD22-directed antibody-drug conjugate recently approved by the US Food and Drug Administration for the treatment of adults with relapsed or refractory B-cell precursor ALL. Inotuzumab ozogamicin improves response rate, minimal residual disease negativity, and survival compared to standard chemotherapy in this population. In addition, it offers more opportunities to proceed to an allogeneic stem cell transplant in patients who otherwise may not be candidates.

Objective: To evaluate the efficacy and safety of daunorubicin and cytarabine liposome in older adults with newly diagnosed therapy-related acute myeloid leukemia (t-AML) or AML with myelodysplasia-related changes (AML-MRC). Data Source: A literature search of PubMed and MEDLINE (January 2017 to January 2018) was performed using the terms CPX-351, Vyxeos, daunorubicin and cytarabine liposome, and acute myeloid leukemia. Study Selection/Data Extraction: Phase I, II, and III clinical trials evaluating the efficacy and safety of daunorubicin and cytarabine liposome were reviewed with a specific focus on its use in older patients with newly diagnosed AML. All peer-reviewed articles with clinically relevant information were evaluated for inclusion. Data Synthesis: The phase II trial demonstrated that daunorubicin and cytarabine liposome improved response rates (RR), but there was no difference in event-free survival and overall survival in the overall patient population. However, clinical benefit was most pronounced in secondary AML with an increased RR and survival. The phase III trial illustrated that daunorubicin and cytarabine liposome improved survival and RR with tolerable toxicity compared with standard 7 plus 3 (daunorubicin and cytarabine) in patients 60 to 75 years of age with t-AML or AML-MRC. More patients proceeded to a stem cell transplant, and 30-day and 60-day mortality was lower with daunorubicin and cytarabine liposome. Grade 3 to 5 toxicities were similar between the 2 groups, except daunorubicin and cytarabine liposome had prolonged cytopenia and a higher risk of hemorrhage. Conclusions: Daunorubicin and cytarabine liposome improves RR and survival, with tolerable toxicity in older patients with t-AML or AML-MRC.

Acute myeloid leukemia (AML) is a hematologic malignancy that affects predominantly older patients, with a median age of diagnosis around 67. Overall prognosis is poor; however, novel targeted therapies that can potentially improve outcomes in these patients have emerged in recent years. Mutations in isocitrate dehydrogenase (IDH) occur in 20% of AML diagnoses. IDH2 performs a crucial role in cellular metabolism, and when this enzyme is inhibited, the cell cannot rid itself of endogenous products and is thus marked for apoptosis. The US Food and Drug Administration (FDA) approved the first mutant IDH2 inhibitor, enasidenib, for patients with relapsed or refractory IDH2-mutated AML detected by an FDA-approved test.

Acute myeloid leukemia (AML) is a hematologic malignancy that affects predominantly older patients, with a median age of diagnosis around 67. Overall prognosis is poor; however, novel targeted therapies that can potentially improve outcomes in these patients have emerged in recent years. Mutations in isocitrate dehydrogenase (IDH) occur in 20% of AML diagnoses. IDH2 performs a crucial role in cellular metabolism, and when this enzyme is inhibited, the cell cannot rid itself of endogenous products and is thus marked for apoptosis. The US Food and Drug Administration (FDA) approved the first mutant IDH2 inhibitor, enasidenib, for patients with relapsed or refractory IDH2-mutated AML detected by an FDA-approved test.

To evaluate the efficacy and safety of midostaurin in combination with standard cytarabine and daunorubicin induction and cytarabine consolidation in newly diagnosed FLT3-mutated acute myeloid leukemia (AML).A literature search of PubMed and MEDLINE (September 2017) was performed using the terms midostaurin, PKC412, FLT3 gene, and acute myeloid leukemia.Clinical trials evaluating the efficacy and safety of midostaurin in combination with standard cytarabine and daunorubicin induction and cytarabine consolidation were reviewed for the treatment of newly diagnosed FLT3-mutated AML. All peer-reviewed articles with clinically relevant information were evaluated for inclusion.Midostaurin is a multikinase inhibitor also targeting FLT3 indicated for the treatment of newly diagnosed FLT3-mutated AML. A phase III trial illustrated that midostaurin in combination with standard chemotherapy improved event-free survival, disease-free survival, and overall survival in patients with newly diagnosed FLT3-mutation-positive AML compared with standard chemotherapy alone. However, midostaurin did not show a difference in the rate of patients who proceeded to receive an allogeneic stem cell transplant compared with placebo. There was no significant difference in toxicity between the midostaurin and placebo groups, except that more patients experienced grade 3 to 5 anemia and rash with midostaurin.Midostaurin in combination with standard induction and consolidation is safe and efficacious in newly diagnosed FLT3-mutated AML.

The authors discuss an interdisciplinary project to reduce the use of restraints in an acute care setting. They describe the process, beginning with initial planning and then working and evaluation phases. Common patient problems often requiring restraint are identified, with suggested solutions. Outcomes of the project were that fall rates did not increase and the use of restraints decreased by 83%.

Objective: To assess the protein and simple sugar content of earwax in pursuit of better ceruminolytic agents. Study Design: Collected earwax specimens were tested in several media for dissolution before being analyzed for amino acid and carbohydrate content. Patients: The samples were obtained from eight random patients requiring ear plug removal. Results: The amino acid composition differs considerably from hair and stratum corneum of glabrous skin. Sugar analysis revealed high levels of galactosamine and galactose. Conclusions: This analysis of proteins and carbohydrates further characterizes earwax. Future ceruminolytic agents must dissolve lipid, keratin, and a monolayer of lipid covalently bound to the epidermal cells, which encourages cellular aggregation.

Nurses must be equipped with skills to support men diagnosed with prostate cancer. Implementation of a unit-specific, evidence-based education program had significant, positive effects on the confidence of nurses who care for veterans who experience a psychosocial impact of prostate cancer treatment.

Implications for Research, Policy or Practice. Hospice care providers can use pre-admission visits as an opportunity to promote accurate understanding of hospice care and to relieve seriously ill individuals’ and families’ anxiety in this often difficult decision-making process. Also, in-depth discussions with doctors regarding diagnosis/prognosis and end-of-life care options are needed for easier transition to hospice care.

The Naval Surface Warfare Center, Carderock Division (NSWCCD) Philadelphia conducted a full scale gas turbine engine test using Rolls Royce engine models 501-K34 and 250-KS4 to assess engine performance and fuel combustion characteristics of an algae based hydroprocessed fuel. The fuel, hereafter described as alternate fuel, consisted of a 50/50 blend of NATO F-76 fuel and the algae based formulation. It is the first time that the U.S. Navy uses a non-petroleum based fuel on a marine gas turbine. The test was conducted at the DDG 51 Land Based Engineering Site (LBES) of NSWCCD during 16–21 January 2011. The alternate fuel test conducted on the 501-K34 engine consisted of 7 cycles of engine operation, one using NATO F-76 fuel to develop a baseline run and six cycles using alternate fuel. Each cycle was 7 hours, twenty minutes in duration and was composed of 27 distinct load scenarios. The total duration of the test was forty four hours. The 250-KS4 engine was used as the starter mechanism for the 501-K34 engine. During the test, parameters for combustion temperature, fuel demand, fuel manifold pressure, engine start time, and operation under various load conditions were recorded. This paper discusses the results of the above test by comparing engine operation using alternate fuel to engine performance using NATO F-76 fuel.

A vegetable oil from algae has been processed into a Hydrotreated Renewable Diesel (HRD) fuel. This HRD fuel was tested in an extensively instrumented legacy military diesel engine along with conventional Navy diesel fuel. Both fuels performed well across the speed-load range of this HMMWV engine. The high cetane value of the HRD (77 v. 43) leads to significantly shorter ignition delays with associated longer combustion durations and modestly lower peak cylinder pressures as compared to diesel fuel operation. Both brake torque and brake fuel consumption are better (5–10%) with HRD due to the cumulative IMEP effect with moderatly longer combustion durations. Carbon dioxide emmisions are considerably lower with HRD due to the improved engine efficiency as well the more advantageous hydrogen-carbon ratio of this HRD fuel.

As part of the U.S. Maritime Administration (MARAD) marine application of alternative fuel initiative, the U.S. Navy provided neat hydrotreated renewable diesel (HRD), derived from the hydroprocessing of algal oils, for operational and exhaust emission testing onboard the T/S STATE OF MICHIGAN. This vessel has diesel-electric propulsion with four caterpillar D-398 compression ignition engines; one of these ship service diesel engines was selected as the test engine. The diesel generator sets power both the propulsion motors propelling the ship and provide the electrical power for the hotel loads of the ship. Ultra-low sulfur diesel (ULSD) was blended with the neat HRD fuel in a 50/50-by-volume blend and tested for over 440 hours on the vessel. Exhaust emissions testing was performed while underway on Lake Michigan using the baseline ULSD assessed earlier. A similar profile was run using the blended test fuel. Emission testing was conducted using the ISO 8178 (D2) test cycle. When emissions testing was completed a series of underway and pierside test runs were conducted to accumulate the remaining engine hours, After all testing, the engine conditions were assessed again using a combination of visual inspection and oil analysis. The remainder of the test fuel will be used to conduct a long-term stability test. The setup, test, and results of this testing, currently underway, are reported here with a discussion of MARAD’s alternative fuels test initiative.Copyright © 2012 by ASME

A new Hydrotreated Vegetable Oil (HVO) from the camelina plant has been processed into a Hydrotreated Renewable Jet (HRJ) fuel. This HRJ fuel was tested in an extensively instrumented legacy military diesel engine along with conventional Navy jet fuel JP-5. Both fuels performed well across the speed-load range of this HMMWV engine. The high cetane value of the HRJ leads to modestly shorter ignition delay. The longer ignition delay of JP-5 delivers shorter overall combustion durations, with associated higher indicated engine torque levels. Both brake torque and brake fuel consumption are better with conventional JP-5 by up to ten percent, due to more ideal combustion characteristics.

Emissions were measured for four fuels and six combinations of fuels and additives in the exhaust of a T700-GE-700 helicopter engine. The test matrix consisted of three engine power settings: idle, continuous, and maximum continuous. The four fuels were JP-5, F-76, and two synthesized fuels from the Fischer-Troph process, one containing zero sulfur and zero aromatics (synthetic A), and a second containing zero sulfur and 14 vol% aromatics (synthetic B). The JP-5 was also tested with a solvent that increased the aromatic content, and seeded with copper to simulate contamination from shipboard fuel-distribution systems. The JP-5 and F-76 were also tested with an additive commonly used to increase thermal stability. Carbon-monoxide (CO) emission-indices (EIs) for the JP-5 ranged from 53.4 g/kg at idle to 2.3 g/kg at maximum power. The EI of total hydrocarbons (THCs) ranged from 3.9 g/kg to 0.13 g/kg over the same power settings. The effect of the various fuels and additives on the emissions of CO and THCs was negligible (at the 95% confidence level), except at maximum power where CO from the F-76 was about 25% higher, and from the first synthetic, about 16% lower than the JP-5. At all power settings, the CO for JP-5 with the thermal-stabilizer additive were consistently lower by about 12%. Particulate matter was measured and displayed nearly log-normal distributions with a single-mode for all fuels tested. In all cases, count median-diameters (CMDs) ranged from about 20 to 60 nm, and increased with power setting. Mass emissions also increased with power setting. On a number basis, emissions ranged from 1.6 × 1013 to 1.7 × 1015 particles/kg, and increased with power setting for most of the fuels and fuel-additive combinations. The CMD and mass emissions for the JP-5 ranged from 30 to 50 nm and 0.06 to 0.49 g/kg from idle to maximum power. The F-76 produced the largest CMDs and highest particle mass at all conditions, with a CMD of 60 nm and mass emissions of 0.77g/kg occurring at maximum power. Synthetic A fuel produced the smallest particle CMDs and lowest particle mass at all power settings. The thermal-stability additive and variations in aromatic content, and copper particles, did not significantly affect the particle emissions. Particle mass measured with a filter-gravimetric method correlated well with the particle volume calculated from the measured number size-distributions, where the correlation yielded a particle density of 1000 kg/m3.

Although the effectiveness of restraints is not proven, the dangers of restraints are clear. Many advocate for the reduction of restraint use in tertiary care settings. The Joint Commission on the Accreditation of Healthcare Organizations is setting the standard by insisting that hospital administrations create a culture that emphasizes restraint reduction. Despite the importance of this task, very little is available in the literature to direct or guide this effort. The purpose of this article is to describe a unit-based Restraint Reduction Program that was successful on a neurology/neurosurgery unit.

Nursing diagnosis was introduced into the neuroscience intensive care unit (NSICU) of the Medical College of Virginia in 1984 as a framework for naming the problems nurses treat. During this process, there was concern about using nursing diagnosis terminology to describe common NSICU problems. Of particular concern was increased intracranial pressure (ICP). The staff concluded that "alteration in cerebral perfusion" was the nursing diagnosis from the North American Nursing Diagnosis Association (NANDA) list that best described the patient with increased ICP. A descriptive study of patients who received this nursing diagnosis in our NSICU was designed and implemented one year later. This study identified patient characteristics and independent and interdependent nursing interventions.