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BACKGROUND Retrograde autologous priming (RAP) before cardiopulmonary bypass (CPB) may minimize allogeneic red cell transfusion. We conducted a systematic review of the literature to examine the impact of RAP on perioperative allogeneic red cell transfusions in cardiac surgical patients. METHODS This study involved a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies evaluating the use of RAP in cardiac surgery involving CPB. The primary outcome was intraoperative allogeneic red cell transfusion. Secondary outcomes included whole hospital allogeneic transfusions and adverse events such as acute kidney injury (AKI) and stroke. RESULTS A total of 11 RCTs (n = 1337 patients) were included, comparing RAP patients (n = 674) to control (n = 663). In addition, 10 observational studies (n = 2327) were included, comparing RAP patients (n = 1257) to control (n = 1070). Overall, RAP was associated with a significantly reduced incidence of intraoperative red cell transfusion (n = 18 studies; odds ratio [OR] = 0.34; 95% confidence interval [CI], 0.22-0.55, P < .001) compared to controls. This effect was seen among RCTs (n = 10 studies; OR = 0.19; 95% CI, 0.08-0.45, P < .001) and observational studies (n = 8 studies; OR = 0.66; 95% CI, 0.50-0.87, P = .004) in isolation. RAP was also associated with a significantly reduced incidence of whole hospital red cell transfusion (n = 5 studies; OR = 0.28; 95% CI, 0.19-0.41, P < .001). Among the studies that reported AKI and stroke outcomes, there was no statistically significant increased odds of AKI or stroke in either RAP or control patients. CONCLUSIONS Based on the pooled results of the available literature, RAP is associated with a significant reduction in intraoperative and whole hospital allogeneic red cell transfusion. Use of RAP may prevent hemodilution of cardiac surgical patients and thus, lessen transfusions. Additional high-quality prospective studies are necessary to determine the ideal priming volume necessary to confer the greatest benefit without incurring organ injury.

Erythropoietic-stimulating agents such as erythropoietin have been used as part of patient blood management programs to reduce or even avoid the use of allogeneic blood transfusions. We review the literature to evaluate the effect of preoperative erythropoietin use on the risk of exposure to perioperative allogeneic blood transfusions.The study involved a systematic review and meta-analysis of randomized controlled trials evaluating the use of preoperative erythropoietin. The primary outcome was the reported incidence of allogeneic red blood cell transfusions during inpatient hospitalizations. Secondary outcomes included phase-specific allogeneic red blood cell transfusions (ie, intraoperative, postoperative), intraoperative estimated blood loss, perioperative hemoglobin levels, length of stay, and thromboembolic events.A total of 32 randomized controlled trials (n = 4750 patients) were included, comparing preoperative erythropoietin (n = 2482 patients) to placebo (n = 2268 patients). Preoperative erythropoietin is associated with a significant decrease in incidence of allogeneic blood transfusions among all patients (n = 28 studies; risk ratio, 0.59; 95% CI, 0.47-0.73; P.001) as well as patients undergoing cardiac (n = 9 studies; risk ratio, 0.55; 95% CI, 0.37-0.81; P = .003) and elective orthopedic (n = 5 studies; risk ratio, 0.36; 95% CI, 0.28-0.46; P.001) surgery compared to placebo, respectively. Preoperative erythropoietin was also associated with fewer phase-specific red blood cell transfusions. There was no difference between groups in incidence of thromboembolic events (n = 28 studies; risk ratio, 1.02; 95% CI, 0.78-1.33; P = .68).Preoperative erythropoietin is associated with a significant reduction in perioperative allogeneic blood transfusions. This finding is also confirmed among the subset of patients undergoing cardiac and orthopedic surgery. Furthermore, our study demonstrates no significant increase in risk of thromboembolic complications with preoperative erythropoietin administration.

Extension and research professionals in the southeastern United States formed the Southern Nursery Integrated Pest Management working group (SNIPM) to foster collaboration and leverage resources, thereby enhancing extension programming, increasing opportunity, and expanding the delivery of specialized expertise to nursery crop growers across a region. Building a productive and lasting working group requires attracting a group of research and extension faculty with complementary expertise, listening to stakeholders, and translating stakeholder needs into grant priorities to help solve problems, all hallmarks of effective teamwork principles. SNIPM has now grown to include 10 U.S. states and 11 institutions and has been awarded seven grants totaling $190,994 since 2009. A striking benefit of working group membership was observed over time: synergy. Greater awareness of individual expertise among SNIPM members, each of whom were focused on different aspects of the nursery production system stimulated multistate extension publications, electronic books (eBooks), mobile device applications (apps), popular press articles, and spin-off research projects when separate foci were combined and directed toward complex challenges. Deliverables achieved from this faculty collaboration include nine peer-reviewed publications, four manuals and books and 23 book chapters, and a combined total of 11 abstracts, conference proceedings and extension publications. To date, the return on investment for SNIPM is one deliverable produced to every $2265.89 in grant funding. SNIPM has also been honored with multiple American Society for Horticultural Science publication awards as well as the Southern Region Integrated Pest Management Center Bright Idea Award for the quality and originality of their project outputs. Continuing to work together toward common goals that bridge technology and serve the nursery industry while supporting each individual member’s program will be crucial to the long-term success of this working group.

Infectious complications are common after radical cystectomy (RC), and allogeneic blood transfusions may increase infection risk by an immunosuppressive effect. While it has been suggested that perioperative blood transfusion (PBT) may be associated with adverse oncologic outcomes after RC, no large analyses have assessed whether PBT increases the risk of perioperative infection after RC.We used the Nationwide Inpatient Sample (1998 to 2011) to study the rate of PBT during RC for bladder cancer and identify infectious complications. We compared rates of infectious complications in patients who did and did not receive PBT and developed a multivariable model to assess the independent risk of infectious complication associated with PBT controlling for age, year of surgery, obesity, chronic kidney disease, comorbidity score, and type of urinary diversion.We identified 126,454 RCs performed during the study period. A total of 34,203 (27%) received a PBT. The use of PBT increased over the study period, from 18.4% in 1998 to 31.6% in 2011 (p0.0001). Patients who received a PBT had an increased risk of perioperative infectious complications [36.7% versus 27.7%, unadjusted OR (95% CI) = 1.51 (1.43-1.60), p0.0001]. After adjusting for potential confounders, PBT remained an independent predictor of infectious complications [adjusted OR (95% CI) = 1.46 (1.38-1.55), p0.0001].This analysis provides strong observational evidence that PBT is associated with an increased risk of perioperative infectious complications, which may be secondary to transfusion-related immunomodulation. Urologists should aggressively pursue blood conservation strategies and adhere to evidence-based restrictive transfusion thresholds, particularly given the rising rate of PBT.

Xylosandrus germanus (Blandford) and Xylosandrus crassiusculus (Motschulsky) (Coleoptera: Curculionidae: Scolytinae) are two of the most damaging nonnative ambrosia beetle pests in ornamental plant nurseries. Adult females tunnel into the stems and branches of host plants to create galleries with brood chambers. Hosts are infected with symbiotic Ambrosiella spp. fungi that serve as food for the larvae and adults. Plants can also become infected with secondary opportunistic pathogens, including Fusarium spp. Both X. germanus and X. crassiusculus have broad host ranges, and infestations can result in "toothpicks" of extruded chewed wood and sap flow associated with gallery entrances, canopy dieback, stem and trunk cankers, and plant death. Beetles efficiently locate and preferentially attack living, weakened plants, especially those physiologically stressed by flooding, inadequate drainage, frost injury, or winter injury and low temperature. Maintaining plant health is the foundation of a management plan. Vulnerable hosts can be partially protected with preventive pyrethroid applications in the spring before peak flight and attack, which are monitored using ethanol-based trapping tactics. Floriculture and Nursery Research Initiative (USDA-FNRI); Horticultural Research Institute (HRI); USDA-ARS National Program 304-Crop Protection and Quarantine [3607-22000-012-00D]; American Nursery and Landscape Association; USDA-Animal and Plant Health Inspection Service; Virginia Nursery and Landscape Association We thank Jenny Barnett (USDA-ARS), Betsy Anderson (USDA-ARS), Helene Doughty (VT-HRAREC), Elizabeth Barekzi (VT-HRAREC), and Elizabeth Gliem (VT-HRAREC) for technical assistance. We also thank two anonymous reviewers for providing useful comments on an earlier version of the manuscript. This project was funded by the Floriculture and Nursery Research Initiative (USDA-FNRI), Horticultural Research Institute (HRI), USDA-ARS National Program 304-Crop Protection and Quarantine (Project 3607-22000-012-00D), American Nursery and Landscape Association, USDA-Animal and Plant Health Inspection Service, and the Virginia Nursery and Landscape Association. Mention of proprietary products or companies does not imply any endorsement or preferential treatment by the USDA-Agricultural Research Service, The Ohio State University, Virginia Tech, Tennessee State University, North Carolina State University, Clemson University, or the University of Maryland.

INTRODUCTION AND OBJECTIVES: Wound dehiscence is major complication following radical cystectomy. It is a significant cause of readmission, reopearation and potentially delays lifesaving adjuvant therapies. We sought to investigate the incidence and predictors of wound dehiscence in patients undergoing radical cystectomy. METHODS: 2556 patient records with Current Procedural Terminology (CPT) codes for cystectomy between 2005 and 2012 were extracted from the American College of Surgeons National Quality Improvement Program (ACS-NSQIP). Stratification was made on the basis of the occurrence of postoperative wound dehiscence. This was defined as full disintegrity of the skin and fascial layer. Outcomes of interest included overall complication, mortality, prolonged length of stay and prolonged operative time, the latter two defined as measures above the 75th percentile. Descriptive and logistic regression models were performed to identify predictors of postoperative wound dehiscence. RESULTS: Of 2556 patients analyzed, 74 (2.9%) had a documented wound dehiscence. In multivariable analyses, smoking (OR 2.2 p1⁄4.002), prolonged operative time (OR 1.6;p1⁄40.05) and BMI were associated with increased odds of postoperative wound dehiscences. Female gender was associated with decreased odds of dehiscence (OR 0.4; p1⁄40.022). Elevated preoperative creatinine (>1.2 mg/dl), chronic steroid use and diabetes were not independent predictors. CONCLUSIONS: Our study is the first to identify predictors of wound dehiscence following radical cystectomy in a large multi-institutional prospective cohort. Identifying patients at risk for postoperative wound complications may guide the use preventative measures at the time of surgery. Source of Funding: none

This article provides a high level overview of high speed analog circuits and associated failure analysis techniques. It discusses the failure modes and mechanisms of voltage reference circuits, high speed op amps, and digital-to-analog and analog-to-digital converters, the fundamental building blocks used to create high speed analog devices. It also explains how to deal with difficulties involving circuit node access, circuit loading, and performance.

The adjuncts of profound hypothermic circulatory arrest and aortic tailoring are combined with standard graft replacement of the noncritical portions of the aorta. This combination permits single-stage replacement of the arch, thoracic, and abdominal aorta in patients with postdissection aneurysm. Reconstruction is begun with repair of the mid to distal aortic arch and Dacron graft replacement of the proximal descending thoracic aorta, usually under profound hypothermic circulatory arrest. The proximal graft is then cannulated and the patient partially warmed while the middle segment is "tailored." Aortic tailoring consists of longitudinal aortotomy and removal of the dissection membrane(s) from the distal third of the descending thoracic aorta to below the renal arteries. The aorta is then closed creating a single channel 2 to 3 cm in diameter and containing the origins of the important intercostal, lumbar, and visceral arteries. A Dacron graft is used to replace the infrarenal segment. Five patients have successfully undergone single-stage, total repair of the aorta including the arch, thoracic, and abdominal segments. All survival without paraplegia or significant visceral ischemia. Follow-up has not shown dilatation of the tailored segment. We believe that reduction in diameter of the tailored aortic segment and thus wall tension, growth of neointima on all luminal aortic surfaces, and active collagen deposition contribute to the success of this procedure.

BACKGROUND: The Southern Nursery Integrated Pest Management (SNIPM) working group surveyed ornamental nursery crop growers in the southeastern United States to determine their pest management practices. Respondents answered questions about monitoring practices for insects, diseases and weeds, prevention techniques, intervention decisions, concerns about IPM and educational opportunities. Survey respondents were categorized into three groups based on IPM knowledge and pest management practices adopted. RESULTS:Thethreegroupsdifferedintheuseofstandardizedsamplingplansforscoutingpests,inmonitoringtechniques,e.g. sticky cards, phenology and growing degree days, in record-keeping, in the use of spot-spraying and in the number of samples sent to a diagnostic clinic for identification and management recommendation. CONCLUSIONS: Stronger emphasis is needed on deliberate scouting techniques and tools to monitor pest populations to provideearlierpestdetectionandgreaterflexibilityofmanagementoptions.MostrespondentsthoughtthatIPMwaseffective and beneficial for both the environment and employees, but had concerns about the ability of natural enemies to control insectpests,andabouttheavailabilityandeffectivenessofalternativestochemicalcontrols.Researchandfielddemonstration is needed for selecting appropriate natural enemies for augmentative biological control. Two groups utilized cooperative extension almost exclusively, which would be an avenue for educating those respondents. c � 2012 Society of Chemical Industry

Transfusion of red blood cells (RBCs) is vitally important for the care of patients (pts) undergoing myelosuppressive therapy for acute leukemia (AL). At diagnosis and before bone marrow recovery, RBCs are given liberally with hemoglobin (Hb) transfusion triggers of 8-9 g/dL or higher, often with two RBC units given at a time. Research in a variety of non-oncologic settings suggests that lower Hb triggers (7-8 g/dL) do not increase mortality whereas higher Hb triggers (9 g/dL) may increase mortality. For pts with hematologic malignancies, the ideal Hb threshold is unknown. Also, there is literature to suggest that higher Hb values force platelets to the periphery of capillaries and reduce bleeding events. A study of red cell triggers in pts with thrombocytopenia (as in AL) is important as we may not be able to rely on trigger data from others in this setting. This feasibility study was designed to determine whether a randomized trial of Hb triggers could be performed and what challenges may be encountered with this select population. In this prospective randomized study, we enrolled adult pts with AL (myeloid and lymphoid) undergoing intensive induction therapy to evaluate both patient and physician tolerance for a transfusion threshold of 7g/dL (LOW) compared to the standard threshold of 8g/dL (HIGH), as well as operationalize transfusion to a single unit per episode. Pts were randomized with a 2:1 ratio of LOW threshold to HIGH threshold. Pts were ineligible if there was clinical concern for acute coronary syndrome or active blood loss. Pts were monitored from the study enrollment date through the next marrow evaluation after completion of induction therapy. Vital status at Day 60, accrual rate, and safety endpoints (mortality, length of stay, infection, fatigue scores, renal, respiratory, thrombotic, bleeding events) were monitored. Total transfusions, length of inpatient stay, and percentage of pts who crossed over to HIGH threshold for symptomatic reasons were also monitored. Between April 15, 2014 and July 23, 2015, 162 acute leukemia pts would have been eligible for this trial. Of the eligible pts, 112 (69%) were approached and 90 (of planned 90) have enrolled to date. Twenty-two pts (19.6%) of those offered the trial declined. Seventy-four pts are currently evaluable for response (13 pts have not been on-study long enough to evaluate and 3 pts are not eligible for data analysis): 51 pts in LOW arm and 23 in HIGH arm. Interim data is shown in Table 1. In the LOW arm, three pts withdrew consent due to self-reported fatigue and one patient was removed by physician due to clinical scenario. Seventeen pts (33%) in the LOW arm and six pts (26%) in the HIGH arm were transfused outside their hemoglobin trigger without meeting criteria to discontinue the study. No deaths were attributable to Hb thresholds in this study. Significant bleeding events (Grade 3 or 4 by CTCAE 4.0) were comparable with 4 in LOW arm and 3 in HIGH arm. More minor bleeding events (Grade 1 or 2 by CTCAE 4.0) were higher in LOW (24 events) than in HIGH arm (15 events). Acute leukemia and its therapies carry a significant mortality risk and it is not clear how transfusion thresholds and number of PRBC units transfused impact this mortality. Furthermore, blood is an expensive and scarce resource. Without a clear benefit of higher Hb thresholds, the added risks and costs of transfusion may not be justified. This pilot study shows that both pts and leukemia physicians will tolerate randomization between Hb thresholds and there is not a signal for harm in either Hb threshold at present. Pts in the LOW arm receive fewer transfusions and do not experience higher fatigue scores nor increased significant bleeding events. Length of hospitalization was similar in both arms. This safety data will serve as a platform for a larger mortality study in leukemia and possibly additional studies in other oncologic diseases. Table 1. LOW HIGH P value Patients (n) 51 (69%) 23 (31%) Gender Male 23 (45%) 11 (48%) Median Age (Years) 58 63 0.35 AML 44 (86%) 18 (78%) ALL 5 (10%) 5 (22%) APL 2 (4%) 0 Patients Alive at Day 60 46 (90%) 21 (91%) Red Cell Transfusions in Units (Median) 8 (IQR: 5) 10 (IQR: 4) 0.008* Platelet Transfusions in Episodes (Median) 9 (IQR: 6.5) 9 (IQR: 5) 0.86 Length of Stay (Median) 35 (IQR: 10) 36 (IQR: 15) 0.72 Fatigue Scale Score (Median) 4.33 (IQR: 1) 4.54 (IQR: 1.25) 0.40 AML: acute myeloid leukemia; ALL: acute lymphoid leukemia; APL: acute promyelocytic leukemia Disclosures No relevant conflicts of interest to declare.

In a porcine model, we demonstrated that laparoscopic Nissen fundoplication causes a significant drop in cardiac output (30%) because it exposes both the peritoneal cavity and the mediastinum to CO(2) under pressure. To determine if this occurs in humans, we examined cardiovascular physiology during laparoscopic Nissen fundoplication. Because of invasiveness required in this pilot trial, only six patients were studied.The arterial blood pressure (via radial arterial catheter) and the pulmonary artery diastolic pressure and cardiac index (via pulmonary artery thermodilution catheter) were measured at seven points in time during each laparoscopic Nissen fundoplication.The systolic blood pressure decreased in all patients, and the cardiac index decreased in all but one patient. The exception was a patient with Huntington disease, in whom the cardiac output did not decrease. In four of the five patients, the cardiac output was lowest during hiatal dissection, and in the fifth, it was lowest after reverse Trendelenburg positioning. No significant change in the pulmonary artery diastolic pressure was noted. All patients received adequate intravenous fluid replacement (average, 58 +/- 16 mL/kg) to support blood pressure. In one patient, with a particularly large paraesophageal hernia, profound hypotension (40/25 mm Hg) developed during the mediastinal phase of the procedure, and this patient required alpha-adrenergic support followed by laparotomy to eliminate a surgical cause (none found).Although it is a tremendous advance for patients, laparoscopic Nissen fundoplication can be associated with a significant reduction in cardiac output and blood pressure. Surgeons and anesthesiologists must be alert to changes reflecting these decreases during procedures, which violate both the peritoneal cavity and the mediastinum. We propose careful hemodynamic monitoring during these procedures, especially in patients with coronary artery disease or significant left ventricular dysfunction.

Vegard's law describes the empirical relationship between the crystal lattice parameter of a mixture and its components. This relationship holds for some sodalites, in particular those containing mixtures of Li, K and Na as the charge balancing cations. By utilizing previously published lattice parameters for Li/Na and K/Na mixed cation chloride sodalites, linear curves were drawn allowing the composition of the mixed cation sodalites to be determined from their lattice parameters. Further, by mathematical addition of the curves for Li/Na and K/Na mixed cation chloride sodalites, a linear curve was developed and tested for the mixed tri-cation Li/Na/K chloride sodalites. This provides a simple way to monitor the composition of mixed cation sodalites and has an application in monitoring the composition of multi-phase materials where the sodalite phase cannot be easily separated for elemental analysis.

Student run survey projects are recommended in the instructor's manuals of many introductory American National Government texts. However, the suggested exercises are for non-random student surveys and/or contain few, if any instructions. James Bindley's instructor's manual for Burnham's Democracy In the Making, 2nd Ed. is typical when he writes:Have your students conduct a poll. If they can go out in the community, the experience is valuable. Even a campus poll can be meaningful, particularly if you utilize actual questions from a national survey to enable your students to compare and contrast local student opinions with the national norms.In the Summer, 1980 edition of News John Seltz described in “Public Opinion: Polling and Data Analysis,” his experiences using personal surveys developed and carried out by his Presidency and Congress courses. He contended that such exercises provided many benefits to students, especially in upper level undergraduate courses.

The theoretical merits of a tightly coupled multiple-processor/shared-memory architecture have long been recognized. Two major problems in designing such an architecture are the performance limitations imposed by shared-memory bus contention in cached processors and multiple-processor data coherency. In the Synapse system, memory contention was significantly reduced by designing a processor cache employing a non-write-through algorithm, which minimized bandwidth between cache and shared memory. The multicache coherency problem was solved by a new bussing scheme, the Synapse Expansion Bus, which includes an ownership level protocol between processor caches. Using a non-write-through cache and the Synapse Expansion Bus, Synapse has designed a symmetric, tightly coupled multiprocessor system, capable of being expanded on line and under power from two through twenty-eight processors with a linear improvement in system performance.