Development of a roof bolter canopy air curtain for respirable dust control

Testing of the roof bolter canopy air curtain (CAC) designed by the U.S. National Institute for Occupational Safety and Health (NIOSH) has gone through many iterations, demonstrating successful dust control performance under controlled laboratory conditions. J.H. Fletcher & Co., an original equipment manufacturer of mining equipment, further developed the concept by incorporating it into the design of its roof bolting machines. In the present work, laboratory testing was conducted, showing dust control efficiencies ranging from 17.2 to 24.5 percent. Subsequent computational fluid dynamics (CFD) analysis revealed limitations in the design, and a potential improvement was analyzed and recommended. As a result, a new CAC design is being developed, incorporating the results of the testing and CFD analysis.

Salivary Biomarkers, Oral Inflammation, and Functional Status in Patients With Heart Failure

AIMS

To describe correlations and agreement between salivary and serum B-type natriuretic peptide (BNP), C-reactive protein (CRP), interleukin (IL)-6, and IL-10 and determine which biomarkers predict worse functional class in patients with heart failure (HF).

METHODS

Serum and saliva were collected from 75 hospitalized patients with HF (57 ± 12 years, 43% female, New York Heart Association [NYHA] Classes I [4%], II [43%], and III [53%]). Oral inflammation was rated as good, fair, or poor. Spearman's ρ and Bland-Altman were used to determine correlations and agreement of the salivary and serum forms of each biomarker. Logistic regressions were used to determine which biomarkers predicted worse NYHA functional class, controlling for depression, body mass index, smoking, and oral inflammation.

RESULTS

Median biomarker concentrations were as follows: BNP (serum 361 pg/ml, saliva 9 pg/ml), CRP (serum 13 ng/ml, saliva 25.6 ng/ml), IL-6 (serum 19.3 pg/ml, saliva 10.5 pg/ml), and IL-10 (serum 64.1 pg/ml, saliva 4.7 pg/ml). There was a moderate-to-strong correlation for serum-salivary CRP, weak correlation for serum-salivary IL-6, and no correlations for serum-salivary BNP and IL-10. The Bland-Altman test showed good salivary-serum agreement for all biomarkers, but as serum concentrations rose, salivary measures underestimated serum levels. Visible oral inflammation was the only predictor of worse NYHA class.

Treatment-limiting renal tubulopathy in patients treated with tenofovir disoproxil fumarate

OBJECTIVES

Tenofovir disoproxil fumarate (TDF) is widely used in the treatment or prevention of HIV and hepatitis B infection. TDF may cause renal tubulopathy in a small proportion of recipients. We aimed to study the risk factors for developing severe renal tubulopathy.

METHODS

We conducted an observational cohort study with retrospective identification of cases of treatment-limiting tubulopathy during TDF exposure. We used multivariate Poisson regression analysis to identify risk factors for tubulopathy, and mixed effects models to analyse adjusted estimated glomerular filtration rate (eGFR) slopes.

RESULTS

Between October 2002 and June 2013, 60 (0.4%) of 15,983 patients who had received TDF developed tubulopathy after a median exposure of 44.1 (IQR 20.4, 64.4) months. Tubulopathy cases were predominantly male (92%), of white ethnicity (93%), and exposed to antiretroviral regimens that contained boosted protease inhibitors (PI, 90%). In multivariate analysis, age, ethnicity, CD4 cell count and use of didanosine or PI were significantly associated with tubulopathy. Tubulopathy cases experienced significantly greater eGFR decline while receiving TDF than the comparator group (-6.60 [-7.70, -5.50] vs. -0.34 [-0.43, -0.26] mL/min/1.73 m²/year, p < 0.0001).

CONCLUSIONS

Older age, white ethnicity, immunodeficiency and co-administration of ddI and PI were risk factors for tubulopathy in patients who received TDF-containing antiretroviral therapy. The presence of rapid eGFR decline identified TDF recipients at increased risk of tubulopathy.

Arthropod Pest Control for UK Oilseed Rape - Comparing Insecticide Efficacies, Side Effects and Alternatives

Oilseed rape (Brassica napus) is an important combinable break crop in the UK, which is largely protected from arthropod pests by insecticidal chemicals. Despite ongoing debate regarding the use of neonicotinoids, the dominant seed treatment ingredients used for this crop, there is little publicly available data comparing the efficacy of insecticides in controlling key arthropod pests or comparing the impacts on non-target species and the wider environment. To provide an insight into these matters, a UK-wide expert survey targeting agronomists and entomologists was conducted from March to June 2015. Based on the opinions of 90 respondents, an average of 20% yield loss caused by the key arthropod pests was expected to have occurred in the absence of insecticide treatments. Relatively older chemical groups were perceived to have lower efficacy for target pests than newer ones, partly due to the development of insecticide resistance. Without neonicotinoid seed treatments, a lack of good control for cabbage stem flea beetle was perceived. Wide spectrum foliar insecticide sprays were perceived to have significantly greater negative impacts than seed treatments on users' health, natural enemies, pollinators, soil and water, and many foliar active ingredients have had potential risks for non-target arthropod species in UK oilseed rape fields for the past 25 years. Overall, 72% of respondents opposed the neonicotinoid restriction, while 10% supported it. Opposition and support of the restriction were largely based on concerns for pollinators and the wider environment, highlighting the uncertainty over the side effects of neonicotinoid use. More people from the government and research institutes leaned towards neutrality over the issue, compared to those directly involved in growing the crop. Neonicotinoid restriction was expected to result in greater effort and expenditure on pest control and lower production (0-1 t/ha less). Alternatives for future oilseed rape protection were then discussed.

The Role of Charcoal Ash Content in the Performance of Air Purification Filters

A nutshell-based activated carbon was treated with hydrochloric acid to partially de-ash it. The de-ashed sample was then treated with bromine water and subsequently hydrogenated. The base sample was also treated with bromine water and then hydrogenated. The surface areas and pore volumes available to water vapour were unchanged by these treatments, although the polar surface area was considerably reduced in each case. The sample with the lowest surface polarity had the worst performance (shortest penetration time) when pre-humidified at 80% RH and tested with hexane. Examination of the humidity leaving the bed during the adsorption of hexane vapour suggested that the rate-determining step was the surface transport of displaced water and that removing the ash content hindered this transport considerably. Bromination followed by hydrogenation, although reducing the polarity, did not remove the ash content and may even have improved its ability to transport displaced water.

Adaptors and Innovators: Selection versus Induction

The hypothesis that predictable differences would exist between the mean cognitive style of new entrants and those of the longer serving “established” employees in certain departments while not in others was tested. Data from 99 employees from four departments of a large British pharmaceuticals company who completed the Kirton Adaption-Innovation Inventory provided results broadly in line with the expectations of adaption-innovation theory and past research. The mean innovative cognitive style of new entrants to adaptive departments regressed towards the mean of the establishment and the occupational mean over time. In departments where there was no initial significant difference between the mean cognitive style of the new entrants and the established group, no significant shift was shown over time. Implications of these findings are suggested. The data also indicated norms for two occupational groups where previously they did not exist.

The Role of Mesoporosity in the Transport of Displaced Water during the Adsorption of Benzene by Prehumidified Charcoal Filters

Active carbons have been characterised by nitrogen adsorption isotherms and mercury intrusion. Penetration tests with benzene vapour have been made on carbon filters in dry and humid conditions. The filter efficiency under humid conditions was found to be greater for carbons having a greater number of meso- and small macro-pores (2–100 nm). The effect is probably related to the storage and transport of displaced water in the carbon filter bed.

A Novel Approach for Determining the Position of Primary Water-Adsorbing Centres within the Porous Structure of Active Carbons

A novel application of adsorption isotherms has been developed to determine the position of the primary water-adsorbing centres within the porous structure of active carbons. Naphthalene was pre-adsorbed to partially fill the micropores. The number of primary adsorption centres was determined by application of the Langmuir and modified Dubinin–Serpinsky equations to water isotherm data measured on the pretreated carbons.

Abstract P6-12-08: Healthcare barrier profiles in patients navigated for cancer screening and treatment and the impact of the affordable care act

Background: The underserved community experiences barriers to cancer screening that result in overall greater mortality rates across all cancers. Insurance coverage brought forth by the Affordable Care Act has the potential to significantly impact these barriers through reducing the burden of health care cost on the patient. In this study the authors observe the impact of the Affordable Care Act on the barrier profiles presented by the patients navigated for cancer screening and treatment.

Methods: Patient navigation encounters were recorded for a total of 1146 patients navigated for cancer screening and treatment at the Cleveland Clinic Foundation from the years 2012 through 2015. A total of 3259 encounters were classified into barrier types. Health care billed encounters were retrieved from EPIC for this group of patients from the time they entered patient navigation and classified in terms of insurance coverage. Patients were categorized according to their barrier profile. Appropriate generalized linear regression models were used to test for association of these profiles to number and types of navigation and health care encounters and cost, and to test for change in types of encounters and patient barrier profiles through time.

Results: The insurance barrier is present in 23% of all navigation encounters. Patients presenting with an insurance barrier had a greater mean number of navigation (p&lt;0.001) and health care encounters (p&lt;0.006), had a greater proportion of self-paid health care encounters (p&lt;0.001) and a lower total cost billed for health care encounters after controlling for number of encounters (p&lt;0.001) . The access barrier is present in 53% of navigation encounters while patients that present with only the access barrier account for 42% of the entire sample. Patients that present with only the access barrier have doubled every year (OR 2.2 per year, 95% CI [1.8 2.6]) from 2012 to 2015, while the proportion of self-paid health care encounters (OR 0.26 per year, 95% CI [0.25 0.28]) and the presence of the insurance barrier (OR 0.55 per year, 95% CI [ 0.49 0.62]) have more than halved during this time period.

Conclusion: Although the Affordable Care Act has clearly had an impact by lowering the number of insurance barrier navigation encounters through time, it has uncovered access as the predominant remaining barrier. Understanding and targeting the access barrier will be the most effective way to potentiate the effects of the ACA on patients being navigated for cancer screening and treatment.

Citation Format: Raska P, Ott MA, Steele A, Bailey A, Hickman D, Allen D, Urbanek D, Glass K, Bailey J, Bell K, Montero A, Abraham J. Healthcare barrier profiles in patients navigated for cancer screening and treatment and the impact of the affordable care act. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-12-08.

Rhabdomyolysis precipitated by possible interaction of ticagrelor with high-dose atorvastatin

OBJECTIVE

To report a case of rhabdomyolysis possibly caused by interaction of ticagrelor with high-dose atorvastatin.

SUMMARY

A 62-year-old woman originally from India underwent uncomplicated percutaneous coronary intervention following ST-elevation myocardial infarction. The patient was discharged on a secondary prevention drug regimen that included ticagrelor 90 mg twice daily, atorvastatin 80 mg once daily, metoprolol 25 mg twice daily, and aspirin 81 mg daily. Two months later, the patient was readmitted with complaints of muscle pain, nausea, vomiting, and poor oral intake. The patient was diagnosed with rhabdomyolysis based on her symptoms combined with elevated creatine kinase, urine myoglobin, and serum creatinine. Intravenous fluids were initiated and atorvastatin held. Throughout the second hospital stay, serial laboratory values revealed a decrease in creatine kinase and resolution of acute kidney injury and muscle pain. The patient was discharged on aspirin and clopidogrel. Low-dose statin therapy was started at a follow-up appointment with close monitoring without recurrence of rhabdomyolysis.

RESULTS

A drug interaction between the cytochrome P450 3A4 inhibitor ticagrelor and substrate atorvastatin 80 mg may have precipitated development of rhabdomyolysis in this patient. The probability of this drug interaction is rated as "possible" on both the Naranjo Adverse Drug Reaction Probability Scale and the Drug Interaction Probability Scale.

CONCLUSION

Rhabdomyolysis was observed possibly because of a drug interaction between once-daily ticagrelor and atorvastatin 80 mg. Clinicians need to be aware of this possible drug interaction via CYP3A4 and potential complications.

Infusion of Reconstituted High-Density Lipoprotein, CSL112, in Patients With Atherosclerosis: Safety and Pharmacokinetic Results From a Phase 2a Randomized Clinical Trial

Background

CSL112 is a new formulation of human apolipoprotein A-I (apoA-I) being developed to reduce cardiovascular events following acute coronary syndrome. This phase 2a, randomized, double-blind, multicenter, dose-ranging trial represents the first clinical investigation to assess the safety and pharmacokinetics/pharmacodynamics of a CSL112 infusion among patients with stable atherosclerotic disease.

Methods and Results

Patients were randomized to single ascending doses of CSL112 (1.7, 3.4, or 6.8 g) or placebo, administered over a 2-hour period. Primary safety assessments consisted of alanine aminotransferase or aspartate aminotransferase elevations >3× upper limits of normal and study drug–related adverse events. Pharmacokinetic/pharmacodynamic assessments included apoA-I plasma concentration and measures of the ability of serum to promote cholesterol efflux from cells ex vivo. Of 45 patients randomized, 7, 12, and 14 received 1.7-, 3.4-, and 6.8-g CSL112, respectively, and 11 received placebo. There were no clinically significant elevations (>3× upper limit of normal) in alanine aminotransferase or aspartate aminotransferase. Adverse events were nonserious and mild and occurred in 5 (71%), 5 (41%), and 6 (43%) patients in the CSL112 1.7-, 3.4-, and 6.8-g groups, respectively, compared with 3 (27%) placebo patients. The imbalance in adverse events was attributable to vessel puncture/infusion-site bruising. CSL112 resulted in rapid (T_max≈2 hours) and dose-dependent increases in apoA-I (145% increase in the 6.8-g group) and total cholesterol efflux (up to 3.1-fold higher than placebo) (P<0.001).

Conclusions

CSL112 infusion was well tolerated in patients with stable atherosclerotic disease. CSL112 immediately raised apoA-I levels and caused a rapid and marked increase in the capacity of serum to efflux cholesterol. This potential novel approach for the treatment of atherosclerosis warrants further investigation.

Clinical Trial Registration

URL: http://www.ClinicalTrials.gov. Unique identifier: NCT01499420.

Abstract 1801: Biological validation of a novel high-throughput irradiator for predictive radiation sensitivity bioassays

Purpose: To improve our ability to study radiation response and screen for radiosensitizing compounds, we have developed a high-throughput variable dose rate microirradiator. We sought to use several assays of radiation induced cellular damage to validate the ability of this system to be used for high-throughput assays.

Methods: Immortalized human tonsillar epithelial cells were cultured in 96-well microtiter plates and irradiated in groups of eight wells to absorbed doses of 0, 1, 2, 4, and 8 Gy. Chloromethyl-H2DCFDA, a fluorescent reactive oxygen species (ROS) marker, was used to measure relative changes in ROS. Single cell gel electrophoresis (aka Comet assay, neutral) was used to detect physical DNA double-strand breaks. High-throughput immunofluorescent microscopy was used to detect γH2AX foci, a early marker of DNA double-strand breaks.

Results: Over the range of radiation doses tested, we confirmed increasing ROS generation as measured by CM-H2DCFDA fluorescence (R2 = 0.969). Over 1,450 comets were analyzed over a range of radiation doses and the Olive Tail Moment (OTM) calculated. A linear increase in OTM with radiation dose was seen (R2 = 0.991). A linear increase in γH2AX foci was seen with increasing radiation dose as measured by cell average γH2AX fluorescence (R2 = 0.999) Conclusions: We have developed a robust platform for high-throughput assays of radiation sensitivity allowing rapid assessment of effects over a range of radiation doses. This system provides a powerful tool for increasing the efficacy of genetic and pharmacologic modifiers of radiation response.

Citation Format: Alison Bailey, Tyler Fowler, Kwangok P. Nickel, Bryan Bednarz, Randall J. Kimple. Biological validation of a novel high-throughput irradiator for predictive radiation sensitivity bioassays. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 1801. doi:10.1158/1538-7445.AM2015-1801

A Practical ECG Criterion to Unmask Left Accessory AV Connections in Patients With Subtle Preexcitation

BACKGROUND

Accessory AV-connections capable of antegrade conduction need to be recognized because of the potential for life-threatening arrhythmias. However, the preexcited ECG pattern may be subtle, especially among left-sided AV-connections. We explored whether additional ECG criteria might help identify left-sided AV-connections.

METHODS

We analyzed 156 patients who underwent an electrophysiology study (EPS) and ablation for paroxysmal supraventricular tachycardias (PSVT). Patients were divided into 2 groups: those with left-sided AV-connections (Group 1) and all other PSVT (Group 2). Various ECG parameters were compared before and after ablation in both groups.

RESULTS

The EPS identified left-sided AV-connections among 43 patients (Group 1) and excluded it among 113 (Group 2). Baseline ECG in Group 1 demonstrated obvious preexcitation among 24/43 patients (55.8%), the remaining 19/43 missing obvious preexcitation. R/S ratio > 0.5 in V1 was noted in 38/43 (88.4%) patients in Group 1 before ablation (median 1.00; IQR 0.58-2.20), including 16/19 (84.2%) patients lacking obvious left-sided AVconnections. Conversely, only 10/113 (8.8%) patients in Group 2 had R/S ratios in V1 ≥ 0.5 (0.20; 0.10-0.31), P < 0.0001. After ablation, the R/S ratio decreased significantly in Group 1 (0.29; 0.17-0.45), P < 0.0001. Thus, a combined criterion of classic preexcitation or R/S ratio ≥ 0.5 on ECG identified 40/43 left-sided AV-connections (sensitivity 93.0%). The negative predictive value of this combined criterion was 103/106 (97.2%).

CONCLUSIONS

In symptomatic patients, combining the R/S ratio (≥ 0.5) in lead V1 with the classic preexcitation pattern on ECG markedly improved the sensitivity to diagnose left-sided AV-connections. This ratio may be particularly useful among patients lacking obvious preexcitation.

Examination of the potential association of stress with morbidity and mortality outcomes in patient with heart failure

Objectives:

The high mortality and morbidity rates associated with heart failure are still not well explained. A few psychosocial factors have been studied and explain some of this risk, but other factors, like stress, remain largely unexplored in heart failure. This study aimed to (1) examine the association of stress with 6-month cardiac event-free survival, (2) examine the relationship of stress with salivary cortisol, and (3) examine the association of salivary cortisol level with 6-month cardiac event-free survival.

Method:

A total of 81 heart failure patients participated. Stress was measured using the brief Perceived Stress Scale. Cortisol was measured from unstimulated whole expectorated saliva. Cox regression analyses were used to determine whether stress predicted event-free survival, and if salivary cortisol predicted event-free survival. Linear and multiple regressions were used to determine the association of stress with salivary cortisol.

Results:

Stress was not a significant predictor of event-free survival in heart failure (heart rate = 1.06; 95% confidence interval = 0.95–1.81; p = 0.32). Salivary cortisol was a significant predictor of event-free survival in the unadjusted model (heart rate = 2.30; 95% confidence interval = 0.99–5.927; p = 0.05), but not in the adjusted model. Stress (β 1.06; 95% confidence interval = 0.95–1.18; p = 0.32) was not a significant predictor of salivary cortisol level.

Conclusion:

Stress is a complex phenomenon, and our measure of stress may not have captured it well. Alternatively, the physical stressors acting in heart failure produce levels of neurohormonal activation that mask the effects of psychosocial stressors or an indirect association of stress with outcomes that is mediated through another construct. Future studies are needed to investigate stress in patients with heart failure to provide definitive answers.