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Objectives: Most patients with advanced head and neck cancer receiving chemoradiotherapy need tube feeding for at least some weeks. For these periods gastrostomy tubes have advantages over nasogastric tubes. Tube feeding may start earlier and thus loss of weight may be limited if the gastrostomy tube already is in place. The objective of this study is to analyse the results of prophylactic percutaneous endoscopic gastrostomy (PEG) tube placement and early tube feeding. Design: Retrospective chart review. Setting: Multidisciplinary head and neck oncology team in a general hospital. Participants: Fifty consecutive patients with unresectable stage III and IV head and neck cancer treated with concurrent chemoradiotherapy. In all patients prophylactic PEG placement was performed. Tube feeding was initiated if food-intake became insufficient or loss of weight occurred. Main outcome measures: Loss of weight during treatment, complication rate, PEG duration. Results: The mean loss of weight during treatment for all patients was only 2.8%. One complication of tube placement occurred: a colon perforation, treated successfully by surgery. The median duration of the PEG was 178 days. Three of the 17 patients (18%) with no evidence of disease (NED) still had a PEG at their last follow-up visit. Of the 26 patients who died of their cancer, 13 used the PEG until death. Conclusions: Loss of weight was limited after prophylactic gastrostomy placement and early tube feeding. Moreover, the complication rate was low. In 82% of the NED patients the PEG could eventually be removed. [ABSTRACT FROM AUTHOR]

Switchgrass (Panicum virgaum L.) is a warm-season (C4) perennial grass and a potential bioenergy crop. On-farm switchgrass field scale trials, which were initiated to obtain economic production information for switchgrass grown as a bioenergy crop in the northern Plains, provided information on establishment year stands and post-establishment year yields and stands both within and across fields and were used to determine if a stand threshold exists for switchgrass grown as a biomass energy crop. Switchgrass was seeded in 10 cropland fields, ranging in size from 3 to 9.5 ha, in Nebraska, South Dakota, and North Dakota in 2000 and 2001. The fields were selected to be representative of their region and eligible for the Conservation Reserve Program (CRP). Twelve sites within each field were geo-referenced, and switchgrass stand frequency was measured at each sample site. Biomass yields were estimated in late summer at the same within-field sites using a clipped quadrat. Fields with low initial switchgrass stand frequencies showed a linear relationship between initial switch-grass stands and second year stands and biomass yields. Results from the 10 field, three-state study indicated that establishment year stand frequency level of 40% or greater, determined by a frequency grid, can be considered an establishment year stand threshold for establishment success and subsequent post-planting year biomass yields for switchgrass. An establishment year stand frequency of 25% would be adequate for a switchgrass conservation planting in which no harvests would be planned for several years. [ABSTRACT FROM AUTHOR]

Quantifying toot structure response to multiple defoliation events in a grazing situation is critical in developing management plans for warm-season tallgrasses. A pasture experiment was conducted in 1999, 2000, and 2001 near Mead, NE. The objective of the experiment was to determine the effect of timing and frequency of grazing on big blue- stem (Andropogon gerardii Vitman) etiolated tiller growth and root and rhizome structure Paddocks were grazed at a stocking rate of 9.9 Animal Unit Month (AUM) ha-1 in two to tour cycles from mid-May to early-September. In April 2002, five 6.6- × 132-cm soil cores were extracted from each paddock. Soil cores were subsampled at 30-cm depth increments for estimates of root mass, root surface area, and root volume. Etiolated tiller tents were used to estimate organic reserves of big bluestem in each paddock in spring 2002. Mean number and weight of etiolated tillers were reduced by up to 40% and 50%, respectively, in paddocks grazed in a sequence of June after internode elongation, early August, and early September. Root structure in the top 30 cm of the soil profile was affected most by multiple defoliation events with <40 d of recovery between grazing periods. Root mass decreased by 25%, while mean surface area and volume of roots declined 10 and 15%, respectively, in the upper 30 cm of the soil profile in paddocks grazed in the sequence of post-internode elongation in June, early-August, and early-September. To maintain vigorous big blue-stem pastures, grazing management should concentrate on the elongation and postelongation periods. Grazing at the elongation stage should be rotated among paddocks in successive years and the recovery period following grazing at internode elongation should be >40 d. [ABSTRACT FROM AUTHOR]

Buffalograss [Buchloe dactyloides (Nutt.) Engelm.] use as a turf in the northern USA is limited to a certain extent by its extended winter dormancy. A mixture of buffalograss with cool-season turf-grasses might extend the turf's green appearance and enhance quality. Research was conducted to determine the effects of overseeding fine- leaved fescue (Festuca spp.) in buffalograss turf on turfgrass color and quality and the effects of species, seeding rate and date, and core cultivation on fine-leaved fescue establishment in buffalograss turf. Hard rescue (F. longifolia Thuill.), blue rescue (F. ovina L. var. glauca Lam.), and Chewings rescue (F. rubra L. ssp. commutata Gaud.); seeding rates (10, 20, and 30 g m-2); seeding dates (fall, spring, or split fall-spring); and core cultivation (single or double pass).were evaluated for species composition, turfgrass quality, color, and green cover at the John Seatun Anderson Turfgrass Research Facility located near Mead, NE. Buffalograss turf overseeded with blue rescue in fall had the highest turfgrass quality, color, and green cover ratings. Fall overseeding resulted in the highest shoot density values. Spring overseedings were below acceptable levels. Botanical composition of the mixfures overseeded in fall reached 75 to 80% rescue and 20 to 25% buffalograss after 2 yr. Seeding rate effect was linear with each increment between 10 g m-2 and 30 g m-2 increasing fine-leaved rescue shoot density, tudgrass quality, color, and green cover. Blue fescue- buffalograss mixtures overseeded in the fall exhibited 80% green cover when buffalograss was dormant. Turfgrass green cover in the mixture was extended by 2 months when compared to buffalograss monostands growing in areas adjacent to the study. The results of this study support the use of fine-leaved rescue and buffalograss mixtures to extend turfgrass green appearance and enhance quality. [ABSTRACT FROM AUTHOR]

The safety of glycoprotein (GP) IIb/IIIa inhibitors has been well documented in clinical trials. Although these trials have included a broad patient population, the strict enrollment criteria may have resulted in exclusion of patients at a higher risk of bleeding complications. The authors conducted a retrospective chart review of 1020 consecutive patients who received GP IIb/IIIa inhibitors and underwent percutaneous coronary intervention in a large community hospital. They used Thrombolysis in Myocardial Infarction (TIMI) criteria to define major or minor bleeding complications. Bleeding complications developed in 214 (21%) patients, with major bleeding in 89 (9%). Univariate predictors of bleeding were older age, lower body weight, elevated serum creatinine, higher activated partial thromboplastin time (aPTT) level, history of diabetes mellitus (DM), peripheral vascular disease (PVD), congestive heart failure (CHF), and emergency procedure for acute myocardial infarction (AMI). Multivariate predictors of major bleeding were PVD (20% in bleeding group vs 11% in nonbleeders, odds ratio [OR] = 1.8, 95% confidence interval [CI] = 1.2-2.6, P < .004), age (68 +/- 2 years, 95% CI = 66-70 in bleeding group vs 63 +/- 13 years, 95% CI = 61.2-63 in nonbleeders, P < .001), and higher aPTT level (66 +/- 27 seconds, 95% CI = 63-70 in bleeding group vs 53 +/- 28 seconds, 95% CI = 51-56 in nonbleeders, P < .001). The risk of bleeding in the large community hospital setting may be higher than in randomized clinical trials. This increased risk is associated with higher hospitalization costs. Recognition of predictors of bleeding should further enhance the safety of these antiplatelet agents. [ABSTRACT FROM AUTHOR]

An interceptor is a software mechanism that provides the hooks that are needed to introduce additional code dynamically into the execution path of an application. By exploiting interceptors, developers can enhance and potentially modify the behavior of an application at runtime without having to revise or recompile the application code. We have identified three distinct interception points for the Java Remote Method Invocation (JavaRMI) model, at the proxy level, the transport level and the shared library level of the JavaRMI model. The interceptors implemented at these interception points employ the DynamicProxy API, the RMISocketFactory API, and a library mediation approach, respectively. Our interceptor implementations are novel in that they are transparent to the application, add nominal latency overheads and are easy to deploy, requiring only minimal modifications to the application. We describe how the interceptors can be exploited to introduce additional services (such as logging and profiling mechanisms) to the JavaRMI runtime. In particular, we describe the use of interceptors in the Aroma System to enhance the existing JavaRMI model with support for fault-tolerance through the consistent replication of JavaRMI objects. Copyright © 2001 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Multicast group communication is needed for fault-tolerant distributed systems and, in particular, for the new Fault Tolerant CORBA standard, to maintain strong replica consistency. However, different multicast group communication protocols are appropriate for different environments, which makes it difficult to define a single standard multicast protocol. In this paper, we present a multicast group communication engine and bridge for CORBA that allows multiple group communication protocols to be used concurrently. We also present the Fault Tolerant Multicast Protocol, a group communication protocol that allows different fault tolerance systems to interoperate. The group communication engine and bridge places Lamport timestamps on messages, and multicasts messages to groups, using one or more group communication protocols. The group communication protocols reliably deliver the timestamped messages in timestamp order to the group communication engine, which integrates these streams of messages into a single stream for delivery in timestamp order. The Fault Tolerant Multicast Protocol operates over IP Multicast, and consists of the Reliable Multicast Protocol which provides reliable source-ordered message delivery, the Reliable Ordered Multicast Protocol which provides reliable totally ordered message delivery, and the Host Group Membership Protocol which provides host group membership services. Copyright © 2001 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Titanium alloys of 10 wt%-72 wt% Cu, 10 wt%-80 wt% Co and 20 wt%-84 wt% Ni were investigated. Ingots were fabricated in a vacuum/argon tungsten arc furnace. The surfaces of the alloys were examined by optical microscopy and SEM/EDS, and the Knoop hardness values of the alloys were measured. The corrosion resistance of the alloys was determined by a potentiodynamic polarization technique in buffered Ringer's solution. When a threshold composition of 30 wt% alloy was reached, a large decrease in corrosion resistance was found to occur. Knoop hardness measurements showed that similar hardness values of approximately 300 KHN can be obtained in all systems with lower alloy content. These values are similar to those obtained with a commercial dental titanium alloy. [ABSTRACT FROM AUTHOR]

Background: Percutaneous closure of patent foramen ovale (PFO) is conventionally performed under continuous transesophageal echocardiographic (TEE) guidance. We aimed to evaluate whether a simplified procedural approach, including pure fluoroscopy-guidance and final TEE control, as well as an aimed 'next-day-discharge' is comparable with the conventional TEE-guided procedure in terms of periprocedural and intermediate-term outcomes., Methods: All patients who underwent a PFO closure at our center between 2010 and 2022 were retrospectively included. Prior to June 2019 cases were performed with continuous TEE guidance (TEE-guided group). Since June 2019, only pure fluoroscopy-guided PFO closures have been performed with TEE insertion and control just prior to device release (fluoroscopy-guided group). We analyzed procedural aspects, as well as long term clinical and echocardiographic outcomes., Results: In total 291 patients were included in the analysis: 197 in the TEE-guided group and 94 in the fluoroscopy-guided group. Fluoroscopy-guided procedures were markedly shorter (48 ± 20 min vs. 25 ± 9 min; p < .01). There was no difference in procedural complications, including death, major bleeding, device dislodgement, stroke or clinically relevant peripheral embolization between the two groups (.5% vs. 0%; p = .99). Hospital stay was also shorter with the simplified approach (2.5 ± 1.6 vs. 3.5 ± 1.2 days; p < .01), allowing 85% same-day discharges during the last 12 months of observation period. At 6 ± 3 months echocardiographic follow-up a residual leakage was described in 8% of the TEE-guided cases and 2% of the fluoroscopy-guided cases (p = .08)., Conclusion: While a complete TEE-free PFO closure might have potential procedural risks, our approach of pure fluoroscopy-guided with a brisk final TEE check seems to be advantageous in terms of procedural aspects with no sign of any acute or intermediate-term hazard and it could offer an equitable compromise between the two worlds: a complete TEE procedure and a procedure without any TEE., (© 2023 The Authors. Echocardiography published by Wiley Periodicals LLC.)

ABO incompatibility affects approximately 40% of allogeneic stem cell transplants in Caucasian patient populations. Because bone marrow (BM), the preferred graft from paediatric sibling donors and for non-malignant diseases, has a red blood cell (RBC) content similar to blood, anti-donor isoagglutinins must either be depleted from the recipient or RBCs removed from the graft. To achieve tolerability of unmanipulated BM grafts, we used controlled infusions of donor ABO-type RBC units to deplete isoagglutinins before the transplant. This retrospective study evaluates the outcomes of 52 ABO major incompatible BM transplants performed at our centre between 2007 and 2019. The use of donor-type RBC transfusions was well tolerated. They effectively reduced isoagglutinins levels, typically achieving target titres after one (60%) or two (29%) transfusions. The approach allowed for successful and uneventful infusions of unmanipulated BM which provided timely engraftment. The transplant outcomes were not inferior to those of a matched-pair control group of patients with ABO-identical donors., (© 2023 The Authors. British Journal of Haematology published by British Society for Haematology and John Wiley & Sons Ltd.)

Aims: Oral opioid preparations combined with naloxone are intended to induce a transient acute withdrawal syndrome to avoid intravenous misuse. This trial aimed to establish an appropriate morphine-naloxone dose ratio for an abuse-deterrent oral opioid formulation., Methods: In a randomized, double-blinded, 2 × 2 cross-over trial, 43 patients with opioid use disorder were challenged with intravenous morphine HCl Ph.Eur. (75 mg; [morphine mono]) or morphine HCl Ph.Eur. and naloxone HCl Ph.Eur. at ratios of 100:1 (75 mg: 0.75 mg; [morphine-naloxone 100:1]) or 200:1 (75 mg: 0.375 mg; [morphine-naloxone 200:1]). Acute naloxone-induced opioid withdrawal was evaluated using subjective (Short Opiate Withdrawal Scale-German [SOWS-G]) and observer-rated (Objective Opiate Withdrawal Scale [OOWS], Wang scale) questionnaires, and physiological parameters. For statistical analysis, the area under the curve between baseline and 20 minutes after drug administration of the outcome variables was calculated., Results: Intravenous morphine-naloxone caused rapid withdrawal symptoms. Coadministration of naloxone dose-dependently (morphine-naloxone 100:1 > morphine-naloxone 200:1) increased SOWS-G, OOWS and Wang Scale area under the curve when compared to morphine mono, respectively (all P < .0001). A similar response was detectable for changes of pupil diameter. Blood pressure and respiratory rate changed heterogeneously, and heart rate was unaltered by morphine without or with naloxone., Conclusion: Morphine-naloxone 100:1 effectively suppresses the pleasurable effects of intravenous morphine and results in an aversive withdrawal reaction. A lower naloxone concentration as used in morphine-naloxone 200:1 does not appear to be appropriate to prevent intravenous morphine misuse., (© 2020 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.)

Progressive, sustained bradycardia resulting in asystole and subsequent death is reported in a 70-year-old woman with hyperkalemia and suspected digoxin toxicity following a 0.25 mg/kg intravenous diltiazem dose for treatment of atrial fibrillation with a rapid ventricular response. The possible pharmacodynamic and pharmacokinetic interactions between diltiazem, digoxin, and an elevated plasma potassium concentration are discussed and related to the outcome of the case. The routine practice of concomitant administration of diltiazem for rapid ventricular rate control and digoxin for long-term control may be dangerous in a subset of patients.