American Diabetes Association - 77th Scientific Sessions (June 9-13, 2017 - San Diego, California, USA)

The 77th American Diabetes Association (ADA) Sci-entific Sessions took place in San Diego, California. The meeting brought together scientists and professionals from a wide range of disciplines in the field of diabetes and provided a platform for networking, allowing experts and researchers to share ideas and learn about the significant advances in diabetes research, treatment and care. Over the course of the 5 days, participants received exclusive access to more than 2,500 original research presentations.

Separation of double-wall carbon nanotubes by electronic type and diameter

We introduce a new procedure for the efficient isolation and subsequent separation of double-wall carbon nanotubes (DWCNTs). A simplified, rate zonal ultracentrifugation (RZU) process is first applied to obtain samples of highly-enriched DWCNTs from a raw carbon nanotube material that has both single- and double-wall carbon nanotubes. Using this purified DWCNT suspension, we demonstrate for the first time that DWCNTs can be further processed using aqueous two-phase extraction (ATPE) for sequential separation by electronic structure and diameter. Additionally, we introduce analytical ultracentrifugation (AUC) as a new method for DWCNT characterization to assess DWCNT purity in separated samples. Results from AUC analysis are utilized to compare two DWCNT separation schemes. We find that RZU processing followed by sequential bandgap and diameter sorting via ATPE provides samples of highest DWCNT enrichment, whereas single-step redox sorting of the same raw material through ATPE yields SWCNT/DWCNT mixtures of similar diameter and electronic character. The presented methods offer significant advancement in DWCNT processing and separation while also providing a promising alternative for DWCNT sample analysis.

American Diabetes Association - 76th Scientific Sessions (June 10-14, 2016 - New Orleans, Louisiana, USA)

The 76th American Diabetes Association (ADA) Scientific Sessions took place in New Orleans, Louisiana, USA. The meeting brought together scientists and professionals from a wide range of disciplines in the field of diabetes and provided a platform for networking, allowing experts and researchers to share ideas and learn about the significant advances in diabetes research, treatment and care. Over the course of the 5 days, participants received exclusive access to more than 2,500 original research presentations.

JAK inhibitors: A broadening approach in rheumatoid arthritis

Pfizer's Xeljanz (tofacitinib citrate) was the first Janus kinase (JAK) inhibitor to reach the market for rheumatoid arthritis (RA) following its U.S. approval in November 2012, and it has since gained approval in more than 45 countries as a second-line therapy for RA after failure of disease-modifying antirheumatic drugs (DMARDs). This emerging category has heralded an attractive new class of oral treatment options in RA, with a notable opportunity in patients who stop responding to DMARDs, but they are facing a challenging market. Despite RA affecting approximately 23.7 million people worldwide, Xeljanz faces a market dominated by the anti-tumor necrosis factor (anti-TNF) biologicals, which have robust long-term safety and efficacy. The availability of biosimilars of these market leaders is also intensifying competition, and a high price and uncertainty over long-term safety is currently tempering the market for the JAK inhibitors.

Identification of airway mucosal type 2 inflammation by using clinical biomarkers in asthmatic patients

BACKGROUND

The Airways Disease Endotyping for Personalized Therapeutics (ADEPT) study profiled patients with mild, moderate, and severe asthma and nonatopic healthy control subjects.

OBJECTIVE

We explored this data set to define type 2 inflammation based on airway mucosal IL-13-driven gene expression and how this related to clinically accessible biomarkers.

METHODS

IL-13-driven gene expression was evaluated in several human cell lines. We then defined type 2 status in 25 healthy subjects, 28 patients with mild asthma, 29 patients with moderate asthma, and 26 patients with severe asthma based on airway mucosal expression of (1) CCL26 (the most differentially expressed gene), (2) periostin, or (3) a multigene IL-13 in vitro signature (IVS). Clinically accessible biomarkers included fraction of exhaled nitric oxide (Feno) values, blood eosinophil (bEOS) counts, serum CCL26 expression, and serum CCL17 expression.

RESULTS

Expression of airway mucosal CCL26, periostin, and IL-13-IVS all facilitated segregation of subjects into type 2-high and type 2-low asthmatic groups, but in the ADEPT study population CCL26 expression was optimal. All subjects with high airway mucosal CCL26 expression and moderate-to-severe asthma had Feno values (≥35 ppb) and/or high bEOS counts (≥300 cells/mm³) compared with a minority (36%) of subjects with low airway mucosal CCL26 expression. A combination of Feno values, bEOS counts, and serum CCL17 and CCL26 expression had 100% positive predictive value and 87% negative predictive value for airway mucosal CCL26-high status. Clinical variables did not differ between subjects with type 2-high and type 2-low status. Eosinophilic inflammation was associated with but not limited to airway mucosal type 2 gene expression.

CONCLUSION

A panel of clinical biomarkers accurately classified type 2 status based on airway mucosal CCL26, periostin, or IL-13-IVS gene expression. Use of Feno values, bEOS counts, and serum marker levels (eg, CCL26 and CCL17) in combination might allow patient selection for novel type 2 therapeutics.

Controlled settings for lung cancer screening: why do they matter? Considerations for referring clinicians

The updated guideline on lung cancer screening released in March 2016 by the Canadian Task Force on Preventive Health Care recommends screening for people at high risk for lung cancer.[...]

Enhancing single-wall carbon nanotube properties through controlled endohedral filling

Chemical control of the endohedral volume of single-wall carbon nanotubes (SWCNTs) via liquid-phase filling is established to be a facile strategy to controllably modify properties of SWCNTs in manners significant for processing and proposed applications. Encapsulation of over 20 different compounds with distinct chemical structures, functionalities, and effects is demonstrated in SWCNTs of multiple diameter ranges, with the ability to fill the endohedral volume based on the availability of the core volume and compatibility of the molecule's size with the cross-section of the nanotube's cavity. Through exclusion of ingested water and selection of the endohedral chemical environment, significant improvements to the optical properties of dispersed SWCNTs such as narrowed optical transition linewidths and enhanced fluorescence intensities are observed. Examples of tailoring modified properties towards applications or improved processing by endohedral passivation are discussed.

Development and Implementation of a Novel On-Call Structure for Paediatric Residents

BACKGROUND: At the Alberta Children’s Hospital, residents provide 24-hour coverage of inpatient units through several shifts: a day team, an evening team, an overnight team, and a weekend team. The evening shift was designed to limit consecutive hours worked by the night team, allowing provision of five consecutive nights of coverage. Recently, residents and Hospitalist Pediatricians expressed a desire to optimize the continuity of care provided by our call system. Cross-covering residents working the evening shift felt that they were at higher risk of committing an error during these times. Furthermore, there were external pressures to reduce consecutive resident work hours to less than 15 hours.

OBJECTIVES: To design and implement a novel call system for pediatric residents at the Alberta Children’s Hospital.

DESIGN/METHODS: A committee was established to identify areas for improvement. Based on stakeholder input, a novel system was created that centered on a 12 hour construct (0800-2000) with a primary “day team” and “night team” for each weekday. A key feature of the system ensured that weekday coverage was provided by “on-service” residents (residents on a CTU rotation) and that weekend coverage was provided by “off-service” residents (on other rotations). The first iteration of the new call system was implemented in April of 2015.

RESULTS: A total of 19 residents completed a 6 month follow-up survey in November of 2015;89% of polled residents felt the new system was superior to the previous system. The majority of residents (84%) felt that patient care was improved during the weekdays, with the remaining residents indicating that weekday care was unchanged. Weekend care was felt to be unchanged under the new system by the majority of residents (74%). There were differing opinions on the impact of the new system on resident fatigue level (38% improved, 22% unchanged, 12% worsened, 27% unsure). Surveys indicated that the new system was associated with a lower perceived risk of committing a medical error across all shifts.

CONCLUSION: We were able to successfully implement a novel call system which dose not rely on either an evening “covering” shift, or 24 hour shifts. The new call system was very well received by all stakeholders and was associated with improved resident perception of patient care during the week, and decreased perceived risk of medical error across all shifts. The new system was also associated with a trend toward reduced resident fatigue overall.