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Accurate staging of disease is vital in determining appropriate care for patients with pancreatic ductal adenocarcinoma (PDAC). It has been shown that the quality of scans and the experience of a radiologist can impact computed tomography (CT) based assessment of disease. The aim of the current study was to evaluate the impact of the rereading of outside hospital (OH) CT by an expert radiologist and a repeat pancreatic protocol CT (PPCT) on staging of disease. Patients evaluated at the our institute's pancreatic multidisciplinary clinic (2006 to 2014) with OH scan and repeat PPCT performed within 30 days were included. In-house radiologists staged disease using OH scans and repeat PPCT, and factors associated with misstaging were determined. The study included 100 patients, with a median time between OH scan and PPCT of 19 days (IQR: 13–23 days.) Stage migration was mostly accounted for by upstaging of disease (58.8 % to 83.3 %) in all comparison groups. When OH scans were rereviewed, 21.5 % of the misstaging was due to missed metastases, however, when rereads were compared to the PPCT, occult metastases accounted for the majority of misstaged patients (62.5 %). Potential factors associated with misstaging were primarily related to imaging technique. A repeat PPCT results in increased detection of metastatic disease that rereviews of OH scans may otherwise miss. Accessible insurance coverage for repeat PPCT imaging even within 30 days of an OH scan could help optimize delivery of care and alleviate burdens associated with misstaging. [ABSTRACT FROM AUTHOR]

The primary objective was to determine pharmacy students' ability to self-assess sterile compounding technique in a single evaluation three semesters after training in the curriculum. School of pharmacy (SOP) students were trained and assessed on sterile compounding technique during their second year of school, with no additional formal assessments provided later in the curriculum. From 2016 to 2018, 262 students were asked to compound a simulated sterile product in their third year of pharmacy school and self-evaluate their technique, which was compared to an instructor evaluation with both people using the same rubric. Two thresholds were used to define successful assessment: strict (ability to detect ideal technique) and lenient (ability to detect harmful technique). The average match rate was 70.2% and 87.6% in the strict and lenient analyses, respectively, with outcomes varying between categories. In the product preparation and inspecting product categories, students who disagreed with assessors tended to misidentify their incorrect technique as correct. Pharmacy students who assessed themselves on sterile compounding technique three semesters after formal sterile compounding training were able to accurately self-assess in most cases, but when disagreeing with an assessor, commonly identified their incorrect technique as correct. Most students demonstrated the ability to self-assess sterile compounding technique and are prepared to assess their own sterile compounding in practice. SOPs could consider whether sterile compounding training coupled with self-assessment throughout the curriculum would be beneficial to further improve students' sterile compounding ability and accuracy of self-assessment. [ABSTRACT FROM AUTHOR]

Research describes an endoplasmic reiculum protein, INSIG-1, which binds to the sterol-sensing domain of SREBP cleavage-activating (SCAP) protein in the presence of sterols. Data show that the role of INSIG-1 in cholesterol homeostasis is indicated by its sterol-dependent endoplasmic reticulum retention of the SCAP protein.

Background or Purpose: Pancreatic ductal adenocarcinoma (PDAC) is commonly diagnosed by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). However, the diagnostic adequacy of EUS-FNA is often limited by low cellularity leading to inconclusive results. We aimed to investigate the feasibility and added utility of targeted next-generation sequencing (NGS) on PDAC EUS-FNAs. Methods: EUS-FNAs were prospectively performed on 59 patients with suspected PDAC (2014-2017) at a high-volume center. FNAs were analyzed for the presence of somatic mutations using NGS to supplement cytopathologic evaluations and were compared to surgical specimens and circulating tumor DNA (ctDNA). Results: Fifty-nine patients with suspected PDAC were evaluated, and 52 were diagnosed with PDAC on EUS-FNA. Four of the remaining seven patients had inconclusive EUS-FNAs and were ultimately diagnosed with PDAC after surgical resection. Of these 56 cases of PDAC, 48 (85.7%) and 18 (32.1%) harbored a KRAS and/or TP53 mutation on FNA NGS, respectively. Particularly, in the four inconclusive FNA PDAC diagnoses (false negatives), half harbored KRAS mutations on FNA. No KRAS/TP53 mutation was found in remaining three non-PDAC cases. All EUS-FNA detected KRAS mutations were detected in 16 patients that underwent primary tumor NGS (100% concordance), while 75% KRAS concordance was found between FNA and ctDNA NGS. Conclusion: Targeted NGS can reliably detect KRAS mutations from EUS-FNA samples and exhibits high KRAS mutational concordance with primary tumor and ctDNA. This suggests targeted NGS of EUS-FNA samples may enable preoperative ctDNA prognostication using digital droplet PCR and supplement diagnoses in patients with inconclusive EUS-FNA. [ABSTRACT FROM AUTHOR]

Introduction: Robotic pancreaticoduodenectomy is slowly gaining acceptance within pancreatic surgery. Advantages have been demonstrated for robotic surgery in other fields, but robust data for pancreaticoduodenectomy is limited. The aim of this study was to compare the short-term outcomes of robotic pancreaticoduodenectomy (RPD) to open pancreaticoduodenectomy (OPD) and laparoscopic pancreaticoduodenectomy (LPD). Methods: Patients who underwent a pancreaticoduodenectomy between January 2011 and July 2019 at the Johns Hopkins Hospital were included in this retrospective propensity-matched analysis. The RPD cohort was matched to patients who underwent OPD in a 1:2 fashion and LPD in a 1:1 fashion. Short-term outcomes were analyzed for all three cohorts. Results: In total, 1644 patients were included, of which 96 (5.8%) underwent RPD, 131 (8.0%) LPD, and 1417 (86.2%) OPD. RPD was associated with a decreased incidence of delayed gastric emptying (9.4%) compared to OPD (23.5%; P = 0.006). The median estimated blood loss was significantly less in the RPD cohort (RPD vs OPD, 150 vs 487 mL; P < 0.001, RPD vs LPD, 125 vs 300 mL; P < 0.001). Compared to OPD, the robotic approach was associated with a shorter median length of stay (median 8 vs 9 days; P = 0.014) and a decrease in wound complications (4.2% vs 16.7%; P = 0.002). The incidence of other postoperative complications was comparable between RPD and OPD, and RPD and LPD. Conclusion: In the hands of experienced surgeons, RPD may have a modest yet statistically significant reduction in estimated blood loss, postoperative length of stay, wound complications, and delayed gastric emptying comparing to OPD in similar patients. [ABSTRACT FROM AUTHOR]

Background: Nodal involvement has been identified as one of the strongest prognostic factors in patients with nonfunctional pancreatic neuroendocrine tumors (NF-PanNETs). Sufficient lymphadenectomy and evaluation is vital for accurate staging. The purpose of this study was to identify the optimal number of examined lymph nodes (ELN) required for accurate staging. Methods: The SEER database was used to identify patients with resected NF-PanNETs between 2004 and 2014. The distributions of positive lymph nodes (PLN) ratio and total lymph nodes were used to develop a mathematical model. The sensitivity of detecting nodal disease at each cutoff of ELN was estimated and used to identify the optimal cutoff for ELN. Results: A total of 1098 patients were included in the study of which 391 patients (35.6%) had nodal disease. The median ELN was 12 (interquartile range [IQR]: 7–19.5), and the median PLN was 2 (IQR: 1–4) for patients with nodal disease. With an increase in ELN, the sensitivity of detecting nodal disease increased from 12.0% (ELN: 1) to 92.2% (ELN: 20), plateauing at 20 ELN (< 1% increase in sensitivity with an additional ELN). This sensitivity increase pattern was similar in subgroup analyses with different T stages. Conclusions: The sensitivity of detecting nodal disease in patients with NF-PanNETs increases with an increase in the number of ELN. Cutoffs for adequate nodal assessment were defined for all T stages. Utilization of these cutoffs in clinical settings will help with patient prognostication and management. [ABSTRACT FROM AUTHOR]

Background: Introduction of effective systemic therapies for pancreatic ductal adenocarcinoma (PDAC) has demonstrated survival benefit. However, chemotherapy remains underutilized in these patients. We sought to investigate the implications of disparities on the trends in utilization of chemotherapy. Methods: A retrospective study using the Surveillance, Epidemiology, and End Results (SEER) database identified patients who underwent surgical resection for PDAC from 1998 to 2014. Clinicopathologic, demographic, racial, and geographical factors were analyzed to assess associations with receipt of chemotherapy and disease-specific survival. Results: A total of 15,585 patients were included in the study. A majority (N = 9953, 63.9%) received chemotherapy. Factors associated with poorer odds of receiving chemotherapy included older age (p < 0.001), African-American race (p = 0.003), and living in the Southwest region of the USA (p < 0.001). Married patients were at higher odds of receiving chemotherapy (all p < 0.001). Receipt of chemotherapy was independently associated with improved disease-specific survival (p < 0.001). Conclusions: Receipt of chemotherapy results in an improved survival in patients with resected PDAC. Demographic, racial, and geographic factors influence the rate of receipt of chemotherapy. Despite prior reports, these trends have not changed over the recent decades. [ABSTRACT FROM AUTHOR]

Background: Solid pseudopapillary tumors (SPTs) are rare, benign tumors of the pancreas that present as heterogeneous masses. We sought to evaluate the short- and long-term outcomes of surgical resected SPTs. Patients managed via initial surveillance were compared to those who underwent upfront resection.Methods: A prospectively maintained institutional database was used to identify patients who underwent surgical resection for a SPT between 1988 and 2018. Data on clinicopathological features and outcomes were collected and analyzed.Results: Seventy-eight patients underwent surgical resection for SPT during the study period. The mean age was 34.0 ± 14.6 years and a majority were female (N = 67, 85.9%) and white (N = 46, 58.9%). Thirty patients (37.9%) were diagnosed incidentally. Imaging-based presumed diagnosis was SPT in 49 patients (62.8%). A majority were located in the body or tail of the pancreas (N = 47, 60.3%), and 48 patients (61.5%) underwent a distal pancreatectomy. The median tumor size was 4.0 cm (IQR, 3.0-6.0), nodal disease was present in three patients (3.9%), and R0 resection was performed in all patients. No difference was observed in clinicopathological features and outcomes between patients who were initially managed via surveillance and those who underwent upfront resection. None of the patients under surveillance had nodal disease or metastasis at the time of resection; however, one of them developed recurrence of disease 95.1 months after resection. At a median follow-up of 36.1 months (IQR, 8.1-62.1), 77 (%) patients were alive and one patient (1.3%) had a recurrence of disease at 95.1 months after resection and subsequently died due to disease.Conclusions: SPTs are rare pancreatic tumors that are diagnosed most frequently in young females. While a majority are benign and have an indolent course, malignant behavior has been observed. Surgical resection can result in exceptional outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Improvement in imaging has resulted in frequent diagnosis of benign and premalignant pancreatic tumors. Pancreatic nerve sheath (PNS) tumors are one of the rarest pancreatic tumors. Literature on PNS is limited and their biology is poorly understood. Here, we report the largest series of PNS tumors to date and review the literature to evaluate the current data available on PNS tumors.Methods: An institutional database was used to identify patients who underwent resection for PNS tumors. Clinicopathological characteristics and outcomes of these patients were reported. Furthermore, a review of literature was performed.Results: From January 1994 through December 2016, seven patients underwent resection for PNS tumors. The median age was 57.7 years (IQR, 44.9-61.9) and the sex was approximately equally distributed (male = 4; 57.1%). Three (42.9%) patients were diagnosed incidentally and six (85.7%) were misdiagnosed as having other pancreatic tumors. The median tumor size was 2.1 (IQR 1.8-3.0) cm and six (85.7%) had no nodal disease. At a median follow-up of 15.5 (IQR 13.7-49.3) months, six patients were alive without evidence of disease and one patient was lost to follow-up. The literature review identified 49 studies reporting 54 patients with PNS tumors. Forty-six were misdiagnosed as having other pancreatic tumors. The median tumor size was 3.6 (range 1-20) cm, nodal disease was present in six patients (22.2%), and no patient had distant metastatic disease. At the time of last follow-up, all patients were free of disease.Conclusion: This is the largest single institution series on PNS tumors reported to date. These tumors are rare and are often misdiagnosed, given their radiological characteristics. PNS tumors have a benign course of disease and surgical resection results in favorable long-term outcomes. [ABSTRACT FROM AUTHOR]

Patients with high body mass index are associated with a higher risk of complications after open pancreatectomy. We aimed to investigate the perioperative outcome for patients with high body mass index after robotic pancreatectomy. This is a retrospective, propensity-score matched cohort analysis. From our prospectively maintained database, we identified consecutive patients with body mass index >25 who underwent robotic pancreatectomy between January 2016 and December 2018. Propensity score matching with open pancreatectomy was applied in 1:2 fashion based on age, gender, American Society of Anesthesiologists classification, surgery type, histology, neoadjuvant therapy, and body mass index during the same study period. A total of 127 patients were included. The mean age for all patients was 61.7 ± 12.8 years and 65 (51.2%) were male. Median body mass index was 29.9 (interquartile range, 27.0–31.8) for both groups. Propensity score matching provided equally distributed general demographic and clinicopathological factors. Robotic pancreatectomy was associated with decreased blood loss (100 mL vs 300 mL, P <.001) and shorter hospital stay (7 vs 9 days, P =.019). Robotic pancreatectomy is associated with decreased blood loss and shorter length of hospital stay in overweight patients. Robotic approach may help alleviate morbidity in overweight patients undergoing pancreatectomy. [ABSTRACT FROM AUTHOR]

Due to concerns over the effects of oil production activities on groundwater quality in California, chemical, isotopic, dissolved gas and age-dating tracers were analyzed in samples collected from public-supply wells and produced-water sites in the Fruitvale oil field (FVOF). A combination of newly collected and historical data was used to determine whether oil formation fluids have mixed with groundwater used for public supply and what the potential pathways for the migration of oil formation fluids into groundwater may be. Stable isotopes of water (δ2H and δ18O) and age dating (3H, 3He trit , SF 6 and 14C) tracers in groundwater samples were consistent with the Kern River being the main source of recharge to aquifers. The distribution of major ion concentrations and pH with distance from the Kern River indicate that natural processes were the primary controls on groundwater salinity. Two of 14 groundwater samples had δ13C-DIC values (−2.4 to +1.9 per mil) consistent with mixtures of <1 to about 9 percent oil-field water. Concentrations of TDS in groundwater samples were generally much lower (129–1,200 milligrams per liter (mg/l), median 216 mg/l) than produced water samples (586–24,930 mg/l, median 2,717 mg/l), suggesting that any mixing of oil-field water with groundwater has not significantly affected groundwater salinity. Trace concentrations of thermogenic methane were detected in three groundwater samples that did not have dissolved inorganic or isotopic indicators consistent with mixing of oil-field water, suggesting that stray gases may have migrated from the subsurface via preferential pathways such as leaky well bores into groundwater aquifers. Low concentrations of petroleum hydrocarbons were detected in samples that also contained anthropogenic VOCs and components of post- and pre-1950s recharge, indicating that petroleum hydrocarbons could have come from subsurface and/or surface sources. Overall, the results of this study indicated that groundwater currently used for public supply in the FVOF was of good quality with little, if any, effects from oil production activities. This may be due in part to the relatively rapid flushing of the aquifer system by recharge from the Kern River. • Groundwater quality in an aquifer used for public supply in proximity to oil production. • Compiled historical data and collected new groundwater and produced water samples. • Age dating, isotopic and chemical tracers used to determine mixing between groundwater and oil formation fluids. • Effects from oil production activities on groundwater quality appear to be minimal. • Long term oil production has not adversely impacted groundwater quality perhaps due in part to rapid recharge from surface water. [ABSTRACT FROM AUTHOR]

Introduction: Approximately, 20% of patients with pancreatic ductal adenocarcinoma have resectable disease at diagnosis. Given improvements in locoregional and systemic therapies, some patients with borderline resectable pancreatic cancer (BRPC) can now undergo successful resection. The outcomes of patients with BRPC after neoadjuvant therapy remain unclear.Methods: A prospectively maintained single-institution database was utilized to identify patients with BRPC who were managed at the Johns Hopkins Pancreas Multidisciplinary Clinic (PMDC) between 2013 and 2016. BRPC was defined as any tumor that presented with radiographic evidence of the involvement of the portal vein (PV) or superior mesenteric vein (SMV) that was deemed to be technically resectable (with or without the need for reconstruction), or the abutment (< 180° involvement) of the common hepatic artery (CHA) or superior mesenteric artery (SMA), in the absence of involvement of the celiac axis (CA). We collected data on treatment, the course of the disease, resection rate, and survival.Results: Of the 866 patients evaluated at the PMDC during the study period, 151 (17.5%) were staged as BRPC. Ninety-six patients (63.6%) underwent resection. Neoadjuvant chemotherapy was administered to 142 patients (94.0%), while 78 patients (51.7%) received radiation therapy in the neoadjuvant setting. The median overall survival from the date of diagnosis, of resected BRPC patients, was 28.8 months compared to 14.5 months in those who did not (p < 0.001). Factors associated with increased chance of surgical resection included lower ECOG performance status (p = 0.011) and neck location of the tumor (p = 0.001). Forty-seven patients with BRPC (31.1%) demonstrated progression of disease; surgical resection was attempted and aborted in 12 patients (7.9%). Eight patients (5.3%) were unable to tolerate chemotherapy; six had disease progression and two did not want to pursue surgery. Lastly, four patients (3.3%) were conditionally unresectable due to medical comorbidities at the time of diagnosis due to comorbidities and failed to improve their status and subsequently had progression of the disease.Conclusion: After initial management, 31.1% of patients with BRPC have progression of disease, while 63.6% of all patients successfully undergo resection, which was associated with improved survival. Factors associated with increased likelihood of surgical resection include lower ECOG performance status and tumor location in the neck. [ABSTRACT FROM AUTHOR]

Highlights • Lifejacket wear is strongly correlated to increased survivability of incidents. • Increased fatality rates are associated with winter months and colder seas. • Incidents involving scuba diving and angling from shore have high fatality rates. • Man overboard is the most serious type of vessel incident. Abstract Drowning and fatalities at sea are a large concern globally. In the UK, many sea rescues are performed by the Royal National Lifeboat Institution, and this study investigates 6 years' worth of their rescue data to better understand causation of drowning and what makes an incident at sea high risk. A Poisson model is applied to numerous factors recorded as part of each rescue, including environmental conditions (visibility, sea state, etc.), lifejacket wear, and response times for rescue. Increased lifejacket wear is shown to be significantly correlated with lower fatality rates across all spectrum of activities. Survivability among those casualties wearing life jackets was 94%. A seasonal signal is clearly present, with a higher proportion of life at risk incidents occurring during winter months, and a higher than predicted number of fatalities during this time. The analysis identifies high risk groups of beach/sea users, with one of the most at risk being people fishing from shore. Incident survivability is shown to decrease at different rates per activity, as time to rescue increases. This study provides clear evidence that a co-ordinated approach to sea safety is required, and suggests that increased lifejacket wear among coastal and marine users would have a dramatic effect on reducing the number of drowning related deaths each year. [ABSTRACT FROM AUTHOR]

The mechanism of polycation cytotoxicity and the relationship to polymer molecular weight is poorly understood. To gain an insight into this important phenomenon a range of newly synthesised uniform (near monodisperse) linear polyethylenimines, commercially available poly( l -lysine)s and two commonly used PEI-based transfectants (broad 22 kDa linear and 25 kDa branched) were tested for their cytotoxicity against the A549 human lung carcinoma cell line. Cell membrane damage assays (LDH release) and cell viability assays (MTT) showed a strong relationship to dose and polymer molecular weight, and increasing incubation times revealed that even supposedly “non-toxic” low molecular weight polymers still damage cell membranes. The newly proposed mechanism of cell membrane damage is acid catalysed hydrolysis of lipidic phosphoester bonds, which was supported by observations of the hydrolysis of DOPC liposomes. [ABSTRACT FROM AUTHOR]

Hexavalent chromium, Cr(VI), in 918 wells sampled throughout California between 2004 and 2012 by the Groundwater Ambient Monitoring and Assessment-Priority Basin Project (GAMA-PBP) ranged from less than the study reporting limit of 1 microgram per liter (μg/L) to 32 μg/L. Statewide, Cr(VI) was reported in 31 percent of wells and equaled or exceeded the recently established (2014) California Maximum Contaminant Level (MCL) for Cr(VI) of 10 μg/L in 4 percent of wells. Cr(VI) data collected for regulatory purposes overestimated Cr(VI) occurrence compared to spatially-distributed GAMA-PBP data. Ninety percent of chromium was present as Cr(VI), which was detected more frequently and at higher concentrations in alkaline (pH ≥ 8), oxic water; and more frequently in agricultural and urban land uses compared to native land uses. Chemical, isotopic (tritium and carbon-14), and noble-gas data show high Cr(VI) in water from wells in alluvial aquifers in the southern California deserts result from long groundwater-residence times and geochemical reactions such as silicate weathering that increase pH, while oxic conditions persist. High Cr(VI) in water from wells in alluvial aquifers along the west-side of the Central Valley results from high-chromium in source rock eroded to form those aquifers, and areal recharge processes (including irrigation return) that can mobilize chromium from the unsaturated zone. Cr(VI) co-occurred with oxyanions having similar chemistry, including vanadium, selenium, and uranium. Cr(VI) was positively correlated with nitrate, consistent with increased concentrations in areas of agricultural land use and mobilization of chromium from the unsaturated zone by irrigation return. [ABSTRACT FROM AUTHOR]

In spite of its long demonstrated potential, microbeam radiosurgery (MBRS) has yet to be developed into a clinical tool. This article examines the problems associated with MBRS, and potential solutions. It is shown that a path to a clinically useful device is emerging. [ABSTRACT FROM AUTHOR]

Objectives GPR40 (FFAR1), a clinically proven anti-diabetes target, is a Gq-coupled receptor for long chain fatty acids (LCFA) stimulating insulin secretion directly and mediating a major part of the dietary triglyceride-induced secretion of the incretins GLP-1 and GIP. In phase-II studies the GPR40 agonist TAK-875 decreased blood glucose but surprisingly without stimulating incretins. Methods and results Here we find that GPR40 can signal through not only Gq and IP3 but also Gs and cAMP when stimulated with certain agonists such as AM-1638 and AM-5262 in contrast to the endogenous LCFA ligands and agonists such as TAK-875 and AM-837, which only signal through Gq. In competition binding against [3H]AM-1638 and [3H]L358 the Gq + Gs and the Gq-only agonists either competed for or showed positive cooperativity by increasing the binding of the two different radio-ligands, in opposite ways. Nevertheless, both the Gq-only and the Gq + Gs agonists all docked surprisingly well into the binding site for TAK-875 in the X-ray structure of GPR40. In murine intestinal primary cell-cultures the endogenous LCFAs and the Gq-only agonists stimulated GLP-1 secretion with rather poor efficacy as compared with the high efficacy Gq + Gs GPR40 agonists and a prototype GPR119 agonist. Similarly, in fasting both male and female mice the Gq + Gs agonists showed significantly higher efficacy than the Gq-only agonists in respect of increasing plasma GLP-1 and plasma GIP in a GPR40-dependent manner. Conclusions It is concluded that stimulation of GPR40 by endogenous LCFAs or by Gq-only synthetic agonists result in a rather limited incretin response, whereas Gq + Gs GPR40 agonists stimulate incretin secretion robustly. [ABSTRACT FROM AUTHOR]

The solubility controls on vanadium (V) in groundwater were studied due to concerns over possible harmful health effects of ingesting V in drinking water. Vanadium concentrations in the northeastern San Joaquin Valley ranged from <3 μg/L to 70 μg/L with a median of 21 μg/L. Concentrations of V were highest in samples collected from oxic groundwater (49% > 25 μg/L) and lowest in samples collected from anoxic groundwater (70% < 0.8 μg/L). In oxic groundwater, speciation modeling (SM) using PHREEQC predicted that V exists primarily as the oxyanion H 2 VO 4 − . Adsorption/desorption reactions with mineral surfaces and associated oxide coatings were indicated as the primary solubility control of V 5+ oxyanions in groundwater. Environmental data showed that V concentrations in oxic groundwater generally increased with increasing groundwater pH. However, data from adsorption isotherm experiments indicated that small variations in pH (7.4–8.2) were not likely as an important a factor as the inherent adsorption capacity of oxide assemblages coating the surface of mineral grains. In suboxic groundwater, accurate SM modeling was difficult since Eh measurements of source water were not measured in this study. Vanadium concentrations in suboxic groundwater decreased with increasing pH indicating that V may exist as an oxycationic species [e.g. V(OH) 3 + ]. Vanadium may complex with dissolved inorganic and organic ligands under suboxic conditions, which could alter the adsorption behavior of V in groundwater. Speciation modeling did not predict the existence of V-inorganic ligand complexes and organic ligands were not collected as part of this study. More work is needed to determine processes governing V solubility under suboxic groundwater conditions. Under anoxic groundwater conditions, SM predicts that aqueous V exists as the uncharged V(OH) 3 molecule. However, exceedingly low V concentrations show that V is sparingly soluble in anoxic conditions. Results indicated that V may be precipitating as V 3+ - or mixed V 3+ /Fe 3+ -oxides in anoxic groundwater, which is consistent with results of a previous study. The fact that V appears insoluble in anoxic (Fe reducing) redox conditions indicates that the behavior of V is different than arsenic (As) in aquifer systems where the reductive dissolution of Fe-oxides with As adsorbed to the surface is a well-documented mechanism for increasing As concentrations in groundwater. This hypothesis is supported by the relation of V to As concentrations in oxic versus anoxic redox conditions. Sequential extraction procedures (SEP) applied to aquifer material showed that the greatest amount of V was recovered by the nitric acid (HNO 3 ) extract (37–71%), followed by the oxalate-ascorbic acid extract (19–60%) and the oxalate extract (3–14%). These results indicate that V was not associated with the solid phase as an easily exchangeable fraction. Although the total amount of V recovered was greatest for the HNO 3 extract that targets V adsorbed to sorption sites of crystalline Al, Fe and Mn oxides, the greatest V saturation of sorption sites appeared to occur on the amorphous and poorly crystalline oxide solid phases targeted by the oxalate and oxalate-ascorbic acid extracts respectively. Adsorption isotherm experiments showed no correlation between V sorption and any of the fractions identified by the SEP. This lack of correlation indicates the application of an SEP alone is not adequate to estimate the sorption characteristics of V in an aquifer system. [ABSTRACT FROM AUTHOR]

Abstract: Here we report on the synthesis of a synthetic, stable biotin-c10-AppCH2ppA conjugate involving an unusual Cannizzaro reaction step. This conjugate is used to bind prospective Ap4A binding proteins from Escherichia coli bacterial cell lyzates. Following binding, identities of these proteins are then determined smoothly by a process of magnetic bio-panning and electrospray mass spectrometry. Protein hits appear to be a definitive set of stress protein related targets. While this hit list may not be exclusive, and may vary with the nature of sampling conditions and organism status, nevertheless hits do appear to correspond with bona fide Ap4A-binding proteins. Therefore these hits represent a sound basis on which to construct new hypotheses concerning the cellular importance of Ap4A to bacterial cells and the potential biological significance of Ap4A-protein binding interactions. [Copyright &y& Elsevier]

Abstract: Recombinant Escherichia coli lysyl-tRNA synthase (LysU) has been previously utilised in the production of stabile, synthetic diadenosine polyphosphate (Ap n A) analogues. Here we report on the extended use of a new recombinant histidine residue-tagged LysU as a tool for highly controlled phosphate phosphate bond formation between nucleotides, avoiding the need for complex protecting group chemistries. Resulting high yielding tandem LysU-based biosynthetic–synthetic/synthetic–biosynthetic strategies emerge for the preparation of varieties of Ap n A analogues directly from inexpensive natural nucleotides and nucleosides. Analogues so formed make a useful small library with which to probe Ap n A activities in vitro and in vivo leading to the discovery of new, potentially potent biopharmaceuticals active against chronic pain and other chronic, high-burden disease states. [Copyright &y& Elsevier]

Abstract: A major contributor to the overall vehicle mass of re-entry vehicles is the afterbody thermal protection system. This is due to the large acreage (equal or bigger than that of the forebody) to be protected. The present predictive capabilities for base flows are comparatively lower than those for windward flowfields and offer therefore a substantial potential for improving the design of future re-entry vehicles. To that end, it is essential to address the accuracy of high fidelity CFD tools exercised in the US and EU, which motivates a thorough investigation of the present status of hypersonic flight afterbody heating. This paper addresses the predictive capabilities of afterbody flow fields of re-entry vehicles investigated in the frame of the NATO/RTO—RTG-043 task group. First, the verification of base flow topologies on the basis of available wind-tunnel results performed under controlled supersonic conditions (i.e. cold flows devoid of reactive effects) is performed. Such tests address the detailed characterization of the base flow with particular emphasis on separation/reattachment and their relation to Mach number effects. The tests have been performed on an Apollo-like re-entry capsule configuration. Second, the tools validated in the frame of the previous effort are exercised and appraised against flight-test data collected during the Apollo AS-202 re-entry. [Copyright &y& Elsevier]

Abstract: Palliative care is coming to be regarded as a human right. Yet globally, palliative care development appears patchy and comparative data about the distribution of services are generally unavailable. Our purpose is to categorize hospice-palliative care development, country by country, throughout the world, and then depict this development in a series of world and regional maps. We adopt a multimethod approach, which involves the synthesis of evidence from published and grey literature, regional experts, and a task force of the European Association of Palliative Care. Development is categorized using a four-part typology constructed during a previous review of palliative care in Africa. The four categories are (1) no identified hospice-palliative care activity, (2) capacity building activity but no service, (3) localized palliative care provision, and (4) countries where palliative care activities are approaching integration with mainstream service providers. We found palliative care services in 115/234 countries. Total countries in each category are as follows: (1) no identified activity 78 (33%), (2) capacity building 41 (18%), (3) localized provision 80 (34%), and (4) approaching integration 35 (15%). The ratio of services to population among Group 4 countries ranges from 1:43,000 (in the UK) to 1:4.28 million (in Kenya); among Group 3 countries it ranges from 1:14,000 (in Gibraltar) to 1:158 million (in Pakistan). The typology differentiates levels of palliative care development across the four hemispheres and in rich and poor settings. Although half of the world''s countries have a palliative care service, far more are needed before such services are generally accessible worldwide. [Copyright &y& Elsevier]

Abstract: There is a paucity of information on hospice and palliative care provision in Africa and only a weak evidence base upon which to build policy and practice development. We set out to assess the current state of provision across the continent, mapping the existence of services country by country and exploring the perspectives and experiences of those involved. A multi-method review was conducted involving a synthesis of evidence from published and gray literature, ethnographic field visits to seven countries, qualitative interviews with 94 individuals from 14 countries, and the collation of existing public health data. Forty-seven African countries were reviewed, involving the assistance of numerous hospice and palliative care activists, including clinicians, managers, volunteers, policy makers, and staff of donor organizations. The 47 countries of Africa could be grouped into four categories: no identified hospice or palliative care activity (21 countries); capacity building activity is underway to promote hospice and palliative care delivery (11 countries); localized provision of hospice and palliative care is in place, often heavily supported by external donors (11 countries); and hospice and palliative care services are approaching some measure of integration with mainstream service providers and gaining wider policy recognition (four countries). Overall, services remain scattered and piecemeal in most African countries, and coverage is poor. Nongovernmental organizations are the predominant source of provision. Major difficulties relate to opioid availability, workforce development, and achieving sustainable critical mass. Models exist in Uganda, Kenya, South Africa, and Zimbabwe for the development of affordable, sustainable community-based hospice and palliative care services, but sensitivity is required in adopting Western models of hospice and palliative care for implementation in the African cultural context. Overall, interest in the development of hospice and palliative care in Africa has never been greater. [Copyright &y& Elsevier]

Abstract: The International Observatory on End of Life Care (IOELC) was established at Lancaster University, UK, in 2003. Its aims are to provide clear and accessible research-based information about hospice and palliative care provision in the international context. Dissemination is via the Observatory web site (www.eolc-observatory.net), as well as through published articles, monographs, reports, and other media, in ways that facilitate cross-national comparative analysis and stimulate practical development. Primary research studies and reviews are undertaken to generate relevant information. We describe the methods adopted by the IOELC and the range of projects recently undertaken. In particular, we give details of the IOELC categorization of hospice and palliative care development, which can be applied at the country level to facilitate international comparison. We show how this has been used to create a “world map” of hospice and palliative care provision and indicate some of the uses to which this can be put and the ways in which it can be refined over time. [Copyright &y& Elsevier]

Abstract: High affinity and discriminating specificity are important parameters for any successful antibody based targeting strategy. We herein describe a system for the construction and subsequent selection of affinity-optimised chelating recombinant antibodies (CRAbs) from a randomised filamentous phage-display inter-scFv linker library. Using a simple, robust and highly degenerate tandem scFv cloning strategy a phage-display library of CRAbs with varied inter-scFv linkers was constructed and characterised. The library consisted of two single-chain Fvs (scFvs) of well characterised anti-lysozyme antibodies D1.3 and HyHEL-10TF, specific for distinct non-overlapping epitopes, separated by flexible polypeptide linkers of varying lengths and sequences. The use of a stringent affinity-based selection strategy quickly led to the enrichment of CRAbs with a restricted set of linker lengths (16–21 amino acids) which agrees very closely with previously described crystal structure data, affinity measurements and mathematical modelling. This CRAb linker phage-display selection strategy is a widely applicable approach for the selection of very high affinity CRAbs for pairs of scFvs against potentially any target antigen, complementing the more arbitrary affinity maturation approaches based on random mutagenesis. [Copyright &y& Elsevier]

Abstract: Highly crystalline phenyl 2,5-dichlorobenzenesulfonate (PDBS, T melt =86–87°C) and pentafluorophenyl 2,5-dichlorobenzenesulfonate (FPDBS, T melt =120–122°C) were synthesized. Single-crystal X-ray molecular structure determinations show that both compounds have similar three-dimensional molecular structures; however, PDBS crystals are thin platelets and FPDBS crystals form hexagonal tube-like structures that are predominately hollow at one end. PDBS crystals exhibit offset π-stacking of the phenoxy-rings that form complete two-dimensional layers each two molecules thick. Hydrogen-bonding interactions are calculated at ∼3.2Å between the C6-hydrogen and the sulfonyl-oxygen of a neighboring molecule. On the other hand, for FPDBS, π-stacking of the dichloro-substituted ring as well as dipole–dipole interactions of the fluorinated-phenoxy rings appears to be the predominate intermolecular interactions. Neither structure exhibits any kind of side-on interaction of the phenyl rings. PDBS and FPDBS exhibit melting point depressions of 26 and 40°C, respectively, in the presence of supercritical CO2. Although both sulfonates exhibit high solubility in CO2, much lower pressures are needed to dissolve FPDBS compared to PDBS. For example, at 100°C FPDBS dissolves at 4750psia and PDBS dissolves at 11,000psia. The solubility data reinforce the observation that fluorinating a compound can significantly lower the conditions needed to dissolve that compound in CO2. [Copyright &y& Elsevier]

Abstract: Tandem synthetic–biosynthetic procedures were used to prepare two novel fluorescent labelled affinity probes for diadenosine-5′,5‴-P 1,P 4-tetraphosphate (Ap4A)-binding studies. These compounds (dial-mant-Ap4A and azido-mant-Ap4A) are shown to clearly distinguish known Ap4A-binding proteins from Escherichia coli (LysU and GroEL) and a variety of other control proteins. Successful labelling of chaperonin GroEL appears to be allosteric with respect to the well-characterized adenosine 5′-triphosphate (ATP)-binding site, suggesting that GroEL possesses a distinct Ap4A-binding site. [Copyright &y& Elsevier]

The capacity of short-term visual memory (VSTM) was assessed in a two-interval spatial frequency (SF) discrimination task. The cued Gabor target in a multi-element array either increased or decreased in SF across a 2 s inter-stimulus interval (ISI). Distracters as well as target were made to change across ISI so that memory of the individual SF of Gabor elements was required to solve the discrimination. The dynamics of the information loss from visual memory were analysed by manipulating the timing of spatial cues and masks. Cueing the target position before the first display gave thresholds comparable with those for a single Gabor patch. Cues placed after the first display gave higher thresholds indicating some loss of information. Within the ISI there was little increase in threshold or set size effect with cue delay. However there was a sharp rise in thresholds for cue positions after the second display. Gabor masks placed before a mid-ISI cue were more effective than noise masks or Gabor masks placed after the cue. With a cue placed late in the ISI, preceded by a Gabor mask, the masking effect decreased with increasing delay of the mask after the first display. This suggests a selective, dynamic but increasingly durable representation of the initial stimulus is built up in memory, and there is a graded form of “overwriting” of this representation by new stimuli. [Copyright &y& Elsevier]

A novel tandem synthetic–biosynthetic procedure is described for the synthesis of four new fluorescent dinucleoside polyphosphates: mant–Ap4A, mant–AppCH2ppA, TNP–Ap4A and TNP–AppCH2ppA. These compounds are expected to supplement the existing etheno (&epsiv;) and 4,4-difluoro-4-bora-3a,4a-diaza-s-indacene (BODIPY) labelled derivatives, being the fluorescent probes of choice to investigate polyphosphate/enzyme binding behaviour. [Copyright &y& Elsevier]

Background: Chronic elevation of low-density lipoprotein cholesterol is a major risk factor for developing atherosclerosis. The purpose of this study was to examine the correlation and predictive power of low-density lipoprotein cholesterol for calcified atheromatous disease as measured by electron beam computed tomography. Methods: Six-thousand and ninety-three subjects underwent electron beam computed tomography of their coronary arteries, serum lipid testing, body fat determination and assessment of health status by questionnaire. Predictive power of low-density lipoprotein cholesterol for calcified atherosclerotic plaque was determined by correlations and multivariate logistic regression. Results: The correlation between low-density lipoprotein cholesterol and calcified plaque score was very modest (r=0.055, P<0.001). There was a trend toward increasing calcified plaque with increasing levels of low-density lipoprotein cholesterol. Multivariate logistic regression revealed that low-density lipoprotein cholesterol is a modest but significant predictor of calcified coronary plaque. After adjusting for age, gender and high-density lipoprotein cholesterol, the risk of having any calcified plaque was 1.05-times higher for each 10 mg/dl increase in low-density lipoprotein cholesterol (P<0.001). Individuals with a low-density lipoprotein cholesterol level above 160 mg/dl had a 62% increase in odds for the presence of calcified plaque. Conclusions: Low-density lipoprotein cholesterol is weakly correlated with and predictive of calcified atherosclerotic plaque burden as measured by electron beam computed tomography. Higher levels of low-density lipoprotein cholesterol are associated with increased risk for the presence of calcified atheromas. [Copyright &y& Elsevier]

The purpose of this study is to determine the occurrence, movement, and sources of perchlorate in groundwater using a comprehensive set of environmental tracers coupled with discrete borehole data. Potential sources of perchlorate to groundwater at the study site have been attributed to waste disposal and industrial activities as well as to past agricultural operations. Perchlorate concentrations in samples ranged from <1 to 40 μg/l, with a median of 6.1 μg/l. Concentrations were relativity consistent with depth except at one site where dilution may be occurring due to the infiltration of surface water from Pyrite Creek. Well-bore flow profiles indicated that perchlorate redistribution was occurring via intra-well bore flow at one site where up to 14,000 mg/year of perchlorate could be moving from the shallower to the deeper zones of the alluvial aquifer. Natural attenuation processes of perchlorate do not appear to be widespread in groundwater but do occur in portions of the aquifer adjacent to the Santa Ana River, likely limiting the mobility of perchlorate from the southernmost extent of the mapped plume to areas farther down-gradient. Age dating tracers indicate that the advective transport of perchlorate originating from the waste disposal ponds has largely moved through the zones of the aquifer sampled. Age distributions, noble gas temperature, delta neon values and stable isotopes of water indicate that a substantial fraction of perchlorate in groundwater may have been mobilized from the unsaturated zone and/or is from the infiltration of storm water runoff originating from Pyrite Canyon. • Perchlorate in groundwater at concentrations above health-based thresholds. • Well-bore flow and depth dependent water quality data provides detailed distribution of tracers and perchlorate in aquifers. • Age dating, stable isotopic and chemical tracers used to determine source and movement of perchlorate in aquifer systems. • Multiple sources appear to have contributed to perchlorate contamination. • Perchlorate fluxes from the unsaturated zone appear to be an important contributor to contamination. [ABSTRACT FROM AUTHOR]