Search

Abstract FISPACT-II is an advanced activation/transmutation and inventory code that employs the most up-to-date and sophisticated nuclear data forms, including the full TENDL-2017 library. TENDL includes residual nuclide production for incident particle energies up to 200 MeV. To address the needs of activation–transmutation simulation in incident-particle fields with energies up to and above 1 GeV, FISPACT-II has been extended to splice TENDL standard ENDF-6 nuclear data with extended nuclear data forms. Comparisons between JENDL-2007/HE, HEAD-2009, and the most recent intra-nuclear cascade models found within Geant4 led to an updated method for residual nuclide nuclear data production. This has been achieved with an automated INCL++/ABLA process that produces complete residual cross section format (MF=10) for activation/transmutation and inventory calculations. The current High-Energy Intra-Nuclear Cascade Liège-based Residual (HEIR-0.1) library includes proton-induced cross sections up to 1 GeV for 2095 targets. These data are available with the most recent release 4.0 of FISPACT-II. [ABSTRACT FROM AUTHOR]

Background: Myasthenia gravis (MG) is an uncommon autoimmune disorder affecting the neuromuscular junction and manifesting as muscle weakness. A multitude of stressors can exacerbate MG. When symptoms are exacerbated, muscle weakness can be severe enough to result in respiratory failure, a condition known as myasthenic crisis (MC).Objective: This review discusses risk factors, diagnosis, management, and iatrogenic avoidance of MC.Discussion: MC can affect any age, ethnicity, or sex and can be precipitated with any stressor, infection being the most common. MC is a clinical diagnosis defined by respiratory failure caused by exacerbation of MG. Muscle weakness can involve any voluntary muscle. MC can be differentiated from other neuromuscular junction diseases by the presence of normal reflexes, normal sensation, lack of autonomic symptoms, lack of fasciculations, and worsening weakness with repetitive motion. Treatment should target the inciting event and airway support. All acetylcholinesterase inhibitors should be avoided in crisis, including edrophonium testing and corticosteroids initially. Respiratory support can begin with noninvasive positive-pressure ventilation, as this has been successful even in patients with bulbar weakness. If intubation is necessary, consider avoiding paralytics or use a reduced dose of nondepolarizing agents.Conclusions: MC should be in the differential of any patient with muscular weakness and respiratory compromise. Emergency department management of MC should focus on ruling out infection and respiratory support. Strong consideration should be given to beginning with noninvasive positive-pressure ventilation for ventilatory support. Corticosteroids, depolarizing paralytics, and acetylcholinesterase inhibitors should be avoided in patients with MC in the emergency department. [ABSTRACT FROM AUTHOR]

Opioid misuse and prescription drug diversion remain challenges in Europe, Australia and North America. Pharmacists queries increased from 1,093,228 to 2,000,705 from 2017-2018 and the mean (M) number of pharmacists querying increased from 97.3 in 2017 to 158.3 in 2018 (p<.001). Considering the potential time and cost savings associated with delegate access to PMPs, more research is needed to determine cost savings, and increasing delegation, especially as many states move towards mandatory use. [Extracted from the article]

Abstract: Previous research with both brain-damaged and neurologically intact individuals suggests that the right cerebral hemisphere (RH) is superior to the left cerebral hemisphere (LH) at detecting anomalies in objects. The current research assesses whether experience with a category is necessary for this RH advantage to emerge. Participants were taught the diagnostic criteria necessary to categorize two fictitious species of animals (“Dleebs” and “Tazes”). After training, participants were given a test in which half of the items were congruent with the diagnostic rules and half of the items were incongruent. Participants were tested on two occasions—once after the initial training session and once after five training sessions. The results demonstrated that experience is required for the RH advantage for anomaly detection to occur. On the first test, reaction times were faster when items were presented to the LH. After 5 days of training, reaction times were faster when items were presented to the RH. This interaction could be due to the fact that participants reported analyzing the items in terms of a series of features during the initial test, but analyzed the items as a configural whole as experience with the category increased. [Copyright &y& Elsevier]

B Background: b Environmental cleaning is critical to prevent transmission of pathogens in the hospital, particularly for organisms that persist on inanimate surfaces such as C. difficile. Items that do enter patient rooms such as scales, lifts, ECGs, line carts and ultrasound should be cleaned after each use and may require reminders. [Extracted from the article]

The present work proposes a Bayesian method to combine theoretical fission yields with a set of reference data. These two sources of information are merged using a Monte Carlo process, and leads to a so-called Bayesian Monte Carlo update. Examples are presented for the independent fission yields of four major actinides, using the GEF code as a source of theoretical calculations and an evaluated library of fission yields for the reference data. The impact of the updated fission yields and their covariances is shown for two distinct applications: a UO 2 pincell with burn-up up to 40 GWD/tHM and decay heat calculations of a thermal neutron pulse on 235 U and 239 Pu. [ABSTRACT FROM AUTHOR]

Background: AT-101 (A), a small molecule oral inhibitor of the Bcl-2 family, has activity alone and in combination with docetaxel (Taxotere) and prednisone (DP) in metastatic castration-resistant prostate cancer (mCRPC). A randomized, double-blind, placebo-controlled phase II trial compared DP combined with either AT-101 (A) or placebo in chemonaive mCRPC.Patients and methods: Men with progressive mCRPC despite androgen deprivation were eligible and randomized 1 : 1. Patients received docetaxel (75 mg/m2 day 1) and prednisone 5 mg orally twice daily every 21 days with either AT-101 (40 mg) or placebo twice daily orally on days 1–3. The primary end point was overall survival (OS).Results: Two hundred and twenty-one patients were randomly assigned. Median OS for AT-101 plus docetaxel–prednisone (ADP) and placebo–DP was 18.1 versus 17.8 months [hazard ratio (HR) 1.07, 95% confidence interval 0.72–1.55, P = 0.63]. Secondary end points were also not statistically different. Grade 3/4 toxic effects for ADP versus placebo–DP were cardiac events (5% versus 2%), lymphopenia (23% versus 16%), neutropenia (47% versus 40%), ileus (2% versus 0%) and pulmonary embolism (6% versus 2%). In a subgroup of high-risk mCRPC (n = 34), outcomes appeared to favor ADP (median OS 19 versus 14 months).Conclusions: AT-101 was tolerable but did not extend OS when combined with DP in mCRPC; a potential benefit was observed in high-risk patients. [ABSTRACT FROM PUBLISHER]

Background: Systemic therapy options are limited for metastatic castration-resistant prostate cancer (CRPC) patients who progress following docetaxel (Taxotere). This phase II trial evaluated sunitinib malate in patients with progressing metastatic CRPC following prior docetaxel. Patients and methods: Patients with metastatic CRPC progressing following one to two chemotherapy regimens including docetaxel were included. The primary end point was progression-free survival (PFS) per radiographic and clinical evaluations. Oral sunitinib was administered 50 mg/day 4-weeks on followed by 2-weeks off per cycle up to a maximum of eight cycles or until clinical progression or intolerable toxicity. Results: Thirty-six patients with a median age of 69.5 years were accrued. The median PFS was 19.4 weeks with a 12-week PFS of 75.8%. Four patients (12.1%) had a ≥50% prostate-specific antigen (PSA) decline and seven (21.2%) had a ≥30% PSA decline. Two of 18 patients (11.1%) with measurable disease demonstrated 30% declines by RECIST and eight (44.4%) displayed some shrinkage. A decline in pain score ≥2 points occurred in 13.6% of 22 assessable patients. Drug discontinuation due to toxic effects occurred in 52.8% of patients. Conclusion: Sunitinib malate demonstrated promising activity in metastatic CRPC progressing after prior docetaxel. [ABSTRACT FROM AUTHOR]

Opioid overdose and misuse of prescription opioids remain a clinical and economic burden. Conclusions Considering that less than 60% of waivered clinicians listed on the treatment locater provide buprenorphine, an accurate, publicly available list of waivered-clinicians is needed. [Extracted from the article]