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Supplemental Table 3

Supplemental Figure S1. Mean pharmacokinetic profiles for single agent talazoparib (BMN673 in phase I clinical trial PRP-001) versus combination therapy.

Supplemental Table 2

Supplemental Table 1

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BACKGROUND: The enhanced recovery after surgery (ERAS) protocol is a multidisciplinary, multimodal approach which has been shown to facilitate recovery of physiological function, and reduce postoperative pain, complication rates, and length of stay without adversely affecting readmission rates. Design and implementation of ERAS protocols in the recent spine surgery literature has primarily focused on patients undergoing minimally invasive lumbar surgery. However, conventional open transforaminal lumbar interbody fusion (TLIF) remains a common procedure and to date there are no studies assessing an ERAS protocol in this patient population. PURPOSE: This study presents a single surgeon experience implementing an ERAS protocol in patients undergoing 1- or 2-level open TLIF. STUDY DESIGN/SETTING: Retrospective consecutive patient cohort with controls propensity-matched for age, body mass index, sex, and smoking status. PATIENT SAMPLE: Consecutive patients that underwent 1- or 2-level open TLIF for degenerative disease from 12/2018 – 02/2021 and controls from 12/2011–12/2017 by a single surgeon. ERAS was implemented in December 2018. OUTCOME MEASURES: Primary: length of stay; Secondary: first day to ambulate, first day to bowel movement, first day to void, daily average and maximum pain scores, opioid use, discharge disposition, 30-day readmission rate, and re-operations. METHODS: Demographic, perioperative, clinical, radiographic data were collected. Multivariate mixed-linear regression models were developed for length of stay, physiological function, pain scales, and opiate use. RESULTS: There were 114 patients included with 57 in each cohort. After propensity matching, patient characteristics were similar between groups. Operative time decreased significantly after institution of ERAS (170±44 vs. 141±37 minutes, p

OBJECTIVE Postoperative urinary retention (POUR) is a common complication after spine surgery and is associated with prolongation of hospital stay, increased hospital cost, increased rate of urinary tract infection, bladder overdistention, and autonomic dysregulation. POUR incidence following spine surgery ranges between 5.6% and 38%; no reliable prediction tool to identify those at higher risk is available, and that constitutes an important gap in the literature. The objective of this study was to develop and validate a preoperative risk model to predict the occurrence of POUR following routine elective spine surgery. METHODS The authors conducted a retrospective chart review of consecutive adults who underwent lumbar spine surgery between June 1, 2017, and June 1, 2019. Patient characteristics, preexisting ICD-10 codes, preoperative pain and opioid use, preoperative alpha-1 blocker use, details of surgical planning, development of POUR, and management strategies were abstracted from electronic medical records. A binomial logistic model and a multilayer perceptron (MLP) were optimized using training and validation sets. The models’ performance was then evaluated on model-naïve patients (not a part of either cohort). The models were then stacked to take advantage of each model’s strengths and to avoid their weaknesses. Four additional models were developed from previously published models adjusted to include only relevant factors (i.e., factors known preoperatively and applied to the lumbar spine). RESULTS Overall, 891 patients were included in the cohort, with a mean of 59.6 ± 15.5 years of age, 52.7% male, BMI 30.4 ± 6.4, American Society of Anesthesiologists class 2.8 ± 0.6, and a mean of 5.6 ± 5.7 comorbidities. The rate of POUR was found to be 25.9%. The two models were comparable, with an area under the curve (AUC) of 0.737 for the regression model and 0.735 for the neural network. By combining the two models, an AUC of 0.753 was achieved. With a regression model probability cutoff of 0.24 and a neural network cutoff of 0.23, maximal sensitivity and specificity were achieved, with specificity 68.2%, sensitivity 72.9%, negative predictive value 88.2%, and positive predictive value 43.4%. Both models individually outperformed previously published models (AUC 0.516–0.645) when applied to the current data set. CONCLUSIONS This predictive model can be a powerful preoperative tool in predicting patients who will be likely to develop POUR. By using a combination of regression and neural network modeling, good sensitivity, specificity, and NPV are achieved.

INTRODUCTION: National and international trends continue to show greater emphasis on endovascular techniques for the treatment of cerebrovascular disease. The cerebrovascular neurosurgeon however must be adequately equipped to treat these patients via both open and endovascular techniques. METHODS: The decline in open cerebrovascular cases for aneurysm clipping has forced many trainees to pursue open cerebrovascular fellowships to increase case volume. An alternative strategy has been employed at our institution, which is early identification of subspecialty focus with resident driven self-selection of open cerebrovascular cases. RESULTS: This has allowed recent graduates to obtain enfolded endovascular training and a significant number of open cerebrovascular cases in order to obtain competence and exposure. DISCUSSION: We advocate for further self-selection paradigms supplemented with simulation training in order to obviate the need for extended post-residency fellowships.

Electroconvulsive therapy (ECT) is an evidence-based treatment for severe depression and bipolar disorder in pregnant women. Electroconvulsive therapy involves induction of general anesthesia, muscle relaxation, and positive-pressure ventilation. Airway manipulation may lead to complications such as vocal cord injury, aspiration, inability to ventilate, and death. The purpose of this study was to determine whether there were differences in the incidence of airway complications in pregnant patients who underwent mask ventilation (MV) versus endotracheal intubation (ETI) compared with nonpregnant control subjects.We conducted a single-center retrospective chart review of all adult pregnant patients who underwent anesthesia for ECT from June 1, 2011, to June 30, 2020. Each ECT treatment delivered to a pregnant patient was matched with 2 ECT treatments delivered to a nonpregnant female control subject. Charts were queried for airway management (MV vs ETI), gestational age, and airway complications. Each ECT treatment was considered an independent event.Seventy-six ECT treatments from 11 pregnant patients were matched with 154 ECT treatments from 13 nonpregnant patients. In pregnant patients, airway management consisted of MV in 57 of the 76 treatments: 12 of 12 in the first trimester, 33 of 44 in the second trimester, and 12 of 20 in the third trimester. All 154 ECT treatments in the control group used MV. No airway complications were experienced in pregnant or nonpregnant patients with MV or ETI.No airway complications were observed in pregnant patients undergoing MV or ETI regardless of gestational age.

Physicians use perioperative decision-support tools to mitigate risks and maximize benefits to achieve the most successful outcome for patients. Contemporary risk-assessment practices augment surgeon’s judgement and experience with decision-support algorithms driven by big data and machine learning. These algorithms accurately assess risk for a wide range of postoperative complications by parsing large datasets and performing complex calculations that would be cumbersome for busy clinicians. Even with these advancements, large gaps in perioperative risk assessment remain; decision-support algorithms often cannot account for risk-reduction therapies applied during a patient’s perioperative course, and do not quantify tradeoffs between competing goals of care (e.g., balancing postoperative pain control with the risk of respiratory depression or balancing intraoperative volume resuscitation with risk for complications from pulmonary edema). Multi-objective optimization solutions have been applied to similar problems successfully, but have not yet been applied to perioperative decision-support. Given the large volume of data available via electronic medical records, including intraoperative data, it is now feasible to successfully apply multi-objective optimization in perioperative care. Clinical application of multi-objective optimization would require semiautomated pipelines for analytics and reporting model outputs and a careful development and validation process. Under these circumstances, multi-objective optimization has the potential to support personalized, patient-centered, shared decision-making with precision and balance.

Background Women have now surpassed men in the number of medical students currently enrolled in the United States. However, in surgical subspecialties including neurosurgery, women continue to be significantly underrepresented. The objective of this study was to investigate the academic accomplishments of women in academic neurosurgery as measured by academic title, publications, and grant funding. Methods A list of ACGME (Accreditation Council for Graduate Medical Education) accredited neurosurgery departments was utilized and department websites were reviewed to collect data regarding female and male faculty. Scopus and National Institutes of Health (NIH) RePORTER websites were used to collect other variables. Results Women comprise 11.0% of all academic neurosurgeons. Of the 116 neurosurgery residency programs in the United States, 77% have at least 1 female faculty member. There are 172 academic female neurosurgeons in practice in the United States currently. Of academic female neurosurgeons, 61% are assistant professors, 21% are associate professors, and 18% are professors. Only 20 women hold leadership positions in their departments. Women have an average of 39.7 49.6 publications. The average h-index of academic female neurosurgeons is 12.0 11.1. Twenty-two women have or have had NIH funding with an average cumulative total grant value of $3,409,919. Having NIH funding and more publications is associated with higher academic rank and holding a leadership position. Women have significantly less funding and publications than men. Conclusions Women represent younger faculty with expected publication and grant funding productivity. As women continue to advance into more senior positions, the trends for number of publications and grant funding is expected to increase.

Purpose: On the basis of preclinical data, we hypothesized that low doses of chemotherapy (10% of therapeutic doses) with full dose of a PARP inhibitor could have improved efficacy and tolerability. Patients and Methods: In this phase I dose-escalation study, patients with BRCA-normal advanced malignancies were assigned to either talazoparib/temozolomide or talazoparib/irinotecan. Talazoparib was dose-escalated from 500 mcg to 1 mg daily before dose escalation of temozolomide/irinotecan. The starting dose of temozolomide was 25 mg/m2/day orally on days 1 to 5 and irinotecan was 25 mg/m2/day intravenously on days 1 and 15. The primary objectives of this trial were safety and tolerability, dose-limiting toxicities (DLT), and maximum tolerated dose (MTD). Results: Of 40 patients enrolled, 18 (mean: 7 prior therapies) were enrolled in talazoparib + temozolomide and 22 in talazoparib + irinotecan. DLTs were hematologic in both arms, but all hematologic adverse events resolved with either treatment interruption and/or dose reductions of talazoparib. The MTDs were talazoparib 1 mg + temozolomide 37.5 mg/m2 and talazoparib 1 mg + irinotecan 37.5 mg/m2. There were four partial responses in the talazoparib + temozolomide arm and five in the talazoparib + irinotecan arm for a response rate of 23% (9/40). The pharmacokinetic profiles of talazoparib + temozolomide/irinotecan were similar to that of talazoparib monotherapy. Responses were seen independent of homologous recombination (HR) status and HR deficiency score. Conclusions: These results show that talazoparib with low-dose temozolomide or irinotecan is reasonably well tolerated and demonstrates clinical activity in a wide range of cancers. Randomized trials of talazoparib with or without low-dose chemotherapy are ongoing in small cell lung cancer and ovarian cancer.

OBJECTIVEInhibition of platelet aggregation is universally used to prevent thromboembolic complications related to stent placement in endovascular neurosurgery, but excessive inhibition potentiates hemorrhagic complications. Previously, the authors demonstrated that two different commercially available measures of adenosine diphosphate (ADP)–dependent platelet inhibition—the VerifyNow P2Y12 clopidogrel assay (measured in platelet reactivity units [PRU]) and maximal amplitude (MA) attributable to ADP activity (MA-ADP) derived from thromboelastography (TEG) with platelet mapping (PM)—yielded wildly different results. This study sought to analyze observed complications to quantify the ideal therapeutic windows for both tests.METHODSNinety-one patients with simultaneous or near-simultaneous PRU and TEG-PM results who underwent craniocervical endovascular stenting at the authors’ institution between September 2015 and November 2017 were identified and retrospectively enrolled. From November 2017 until June 2019, 109 additional patients were prospectively enrolled. For this study, in-hospital thrombotic and hemorrhagic complications (both CNS and non-CNS) were tabulated, and receiver operating characteristic (ROC) curve analysis was used to identify threshold values of the PRU and MA-ADP for predicting each type of complication.RESULTSOf the 200 patients enrolled, 7 were excluded because of anemia or thrombocytopenia outside of the test manufacturer’s specified ranges and 1 was excluded because they did not have a TEG-PM result. Including complications of all severities, there were a total of 15 CNS thrombotic complications, 1 access-site thrombotic complication, 3 CNS hemorrhages, 8 access-site hemorrhagic complications, and 3 hemorrhagic complications not affecting either the CNS or the access site. ROC curve analysis yielded therapeutic threshold values of 118–144 PRU. The results demonstrated PRU has a significant dose-dependent effect on the rates of thrombosis and hemorrhage. Logistic regression models did not demonstrate statistically significant relationships between the MA-ADP and either thrombosis or hemorrhage. ROC analysis based on these models is of little value and did not identify significant threshold values for MA-ADP.CONCLUSIONSThere continues to be poor correlation between the results of TEG-PM and PRU. PRU accurately predicted complications, with a relatively narrow ideal value range of 118–144. The MA-ADP alone does not appear able to accurately predict either hemorrhagic or thrombotic complications in this group.

Advancements in computing and data from the near universal acceptance and implementation of electronic health records has been formative for the growth of personalized, automated, and immediate patient care models that were not previously possible. Artificial intelligence (AI) and its subfields of machine learning, reinforcement learning, and deep learning are well-suited to deal with such data. The authors in this paper review current applications of AI in clinical medicine and discuss the most likely future contributions that AI will provide to the healthcare industry. For instance, in response to the need to risk stratify patients, appropriately cultivated and curated data can assist decision-makers in stratifying preoperative patients into risk categories, as well as categorizing the severity of ailments and health for non-operative patients admitted to hospitals. Previous overt, traditional vital signs and laboratory values that are used to signal alarms for an acutely decompensating patient may be replaced by continuously monitoring and updating AI tools that can pick up early imperceptible patterns predicting subtle health deterioration. Furthermore, AI may help overcome challenges with multiple outcome optimization limitations or sequential decision-making protocols that limit individualized patient care. Despite these tremendously helpful advancements, the data sets that AI models train on and develop have the potential for misapplication and thereby create concerns for application bias. Subsequently, the mechanisms governing this disruptive innovation must be understood by clinical decision-makers to prevent unnecessary harm. This need will force physicians to change their educational infrastructure to facilitate understanding AI platforms, modeling, and limitations to best acclimate practice in the age of AI. By performing a thorough narrative review, this paper examines these specific AI applications, limitations, and requisites while reviewing a few examples of major data sets that are being cultivated and curated in the US.

Objective To define the glucose values associated with an increase in complication rates in post-operative brain tumor patients. Patients and Methods Patients who underwent craniotomy for resection of WHO Grade III or IV glioma from 2011 to 2014 were retrospectively reviewed. Post-operative blood glucose values were recorded for post-operative day #0, #1, and #2. Medians were obtained and assessed for significance. Multivariate analysis was performed to assess patient demographics, pre-operative findings, steroid use, and blood glucose values with respect to post-operative complications and to 30-day readmission. Results 108 patients underwent craniotomy for resection of high-grade glioma and had postoperative blood glucose values documented. Median blood glucose values greater than 167 mg/dL were associated with increased serious post-operative complications, and values greater than 163 mg/dL were associated with increased 30-day readmissions. Conclusion Post-operative hyperglycemia in patients with high-grade gliomas places this vulnerable patient population to undue post-operative complications and readmissions, potentially delaying further treatment of their disease.

Given the diversity of vascular surgical procedures, ranging from low-risk angiography to high-risk open aortic repairs, a wide variety of anesthetic techniques may be used, and different monitoring techniques are needed to ensure patient safety. A broad range of techniques ranges from solely regional techniques for angiography and arteriovenous fistula placement to general endotracheal anesthesia for open abdominal aortic aneurysm repairs. This broad range of monitoring techniques is required for patients undergoing vascular surgical procedures and must be considered due to the type and complexity of the surgery and coexisting disease. In addition to the standards for anesthetic monitoring set by the American Society of Anesthesiologists, other neurologic and/or cardiac monitoring techniques may be required.

INTRODUCTION: Drysuits use flexible neck and wrist seals to maintain water-tight seals. However, if the seals exert too much pressure adverse physiological effects are possible, including dizziness, lightheadedness, syncope, and paresthesias in the hands. We aimed to quantify the seal pressures of neck and wrist seals in non-immersed divers. METHODS: We recruited 33 diving volunteers at two dive facilities in High Springs, Florida. After a history and physical exam, we measured vital signs as well as wrist and neck seal pressures using a manometer system. RESULTS: The mean (SD) seal pressure of the right wrist seals was found to be 38.8 (14.9) mmHg, while that of the left wrist seals was 37.6 (14.9) mmHg. The average neck seal pressure was 23.7 (9.4) mmHg. Subgroup analysis of seal material demonstrated higher mean sealing pressure with latex seals compared to silicone; however, this difference was not statistically significant. CONCLUSIONS: Drysuit seal pressures are high enough to have vascular implications and even potentially cause peripheral nerve injury at the wrist. Divers should trim their seals appropriately and be vigilant regarding symptoms of excessive seal pressures. Further research may elucidate if seal material influences magnitude of seal pressure.

Pathological complete response (pCR) has been shown to demonstrate improved outcomes in breast cancer. Often novel treatments, such as taxanes or HER2 based therapies, trastuzumab or pertuzumab, have shown an increase of pCR with possible impact on the prognosis of breast cancer patients. These therapies are usually introduced into the patient population through clinical trials. Therefore, it can be hypothesized participation in neoadjuvant clinical trials might improve the pCR rate in early breast cancer patients. The aim of this study was to explore this association. Methods: This is a retrospective study of consecutive breast cancer patients who were treated with a neoadjuvant chemotherapy at a single institution. Trial participation status was known for all patients. From 1995 to 2012 the institution participated in 10 different neoadjuvant chemotherapy trials. Outside those clinical trials, patients were treated according to national neoadjuvant therapy guidelines. Patients who took part in clinical trials were compared with patients who did not take part in clinical trials with appropriate univariate tests. Additionally, logistic regression was performed with pCR as the dependent variable and commonly known predictors of pCR (tumor size and molecular subtype) as independent variables. The model was adjusted for age at diagnosis, year of treatment and trial participation status. Furthermore, exploratory survival analyses were performed. Results: A total of 281 patients were treated within a neoadjuvant clinical trial and 822 patients outside a clinical trial. There are significant differences in the patient populations with regards to age (p=0.0009) and tumor size ( Conclusions: This study shows an increased chance of pCR in patients taking part in clinical trials; however the statistical test could not show statistical significance. Most likely the effect can be explained by trial participants having access to drugs which improved pCR rates, such as HER2 based therapies or taxanes. Citation Format: Brennan MB, Wang D, Gass P, Hein A, Beckmann MW, Fasching PA. The effect of participation in neoadjuvant clinical trials on outcomes in patients with early breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-16-18.

Soybean rust (SBR) survival and host availability (kudzu, Pueraria spp.) were assessed from November 2006 through April 2007 at six sites from the panhandle to southwest Florida. Micro loggers recorded both temperature and relative humidity hourly at each location. Periods of drought and cumulative hours below 0°C correlated with kudzu defoliation. Inoculum potential from detached kudzu leaves was evaluated in vitro under various temperature and relative humidity levels. Kudzu leaves with SBR kept at 4°C produced viable urediniospores with the highest germination at all moisture levels over time. Freezing temperatures (–4 and –20°C) drastically reduced spore germination. However, when leaves were incubated at low (

Approximately 30% of health care workers (HCWs) fail the respirator fit test. Evidence suggests that addressing face leaks in the 3M respirator enhances its fit and improves its efficacy. Between March 31 and April 9, 2020, HCWs who failed fit tests for 3M 1860 and 1860S respirators were invited to retest with an adhesive modification of the 3M respirator. Sixty-eight percent of HCWs who failed the fit test with their first-choice respirator passed with a modified adhesive respirator. To increase the efficacy and safety of 3M respirators, ineffective face seals need substantial improvement in design.

Background Major postoperative complications are associated with increased cost and mortality. The complexity of electronic health records overwhelms physicians’ abilities to use the information for optimal and timely preoperative risk assessment. We hypothesized that data-driven, predictive-risk algorithms implemented in an intelligent decision-support platform simplify and augment physicians’ risk assessments. Methods This prospective, nonrandomized pilot study of 20 physicians at a quaternary academic medical center compared the usability and accuracy of preoperative risk assessment between physicians and MySurgeryRisk, a validated, machine-learning algorithm, using a simulated workflow for the real-time, intelligent decision-support platform. We used area under the receiver operating characteristic curve to compare the accuracy of physicians’ risk assessment for six postoperative complications before and after interaction with the algorithm for 150 clinical cases. Results The area under the receiver operating characteristic curve of the MySurgeryRisk algorithm ranged between 0.73 and 0.85 and was significantly better than physicians' initial risk assessments (area under the receiver operating characteristic curve between 0.47 and 0.69) for all postoperative complications except cardiovascular. After interaction with the algorithm, the physicians significantly improved their risk assessment for acute kidney injury and for an intensive care unit admission greater than 48 hours, resulting in a net improvement of reclassification of 12% and 16%, respectively. Physicians rated the algorithm as easy to use and useful. Conclusion Implementation of a validated, MySurgeryRisk computational algorithm for real-time predictive analytics with data derived from the electronic health records to augment physicians’ decision-making is feasible and accepted by physicians. Early involvement of physicians as key stakeholders in both design and implementation of this technology will be crucial for its future success.

Objectives This open-label, randomized phase II trial evaluated antitumor efficacy of an antiestrogen, fulvestrant, in combination with human epidermal growth factor receptor (EGFR) inhibitor, erlotinib, in advanced non-small cell lung cancer (NSCLC) patients. Materials and Methods Patients with advanced or metastatic NSCLC, ECOG 0–2, previous chemotherapy unless patient refusal, and no prior EGFR-directed therapy were randomized 2:1 to erlotinib 150 mg oral daily plus 500 mg intramuscular fulvestrant on day 1, 15, 29 and every 28 days thereafter or erlotinib alone 150 mg oral daily. The primary end point was objective response rate (ORR); secondary endpoints included progression free survival (PFS) and overall survival (OS). Results Among 106 randomized patients, 100 received at least one dose of study drug. ORR was 16.4% (11 of 67 patients) for the combination versus 12.1% (4 of 33 patients) for erlotinib (p = 0.77). PFS median 3.5 versus 1.9 months [HR = 0.86, 95% CI (0.52–1.43), p = 0.29] and OS median 9.5 versus 5.8 months [HR = 0.92, 95% CI (0.57–1.48), p = 0.74] numerically favored the combination. In an unplanned subset analysis, among EGFR wild type patients (n = 51), but not EGFR mutant patients (n = 17), median PFS was 3.5 versus 1.7 months [HR = 0.35, 95% CI (0.14-0.86), p = 0.02] and OS was 6.2 versus 5.2 months [HR = 0.72, 95% CI (0.35–1.48), p = 0.37] for combined therapy versus erlotinib, respectively. Notably, EGFR WT patients were more likely to be hormone receptor-positive (either estrogen receptor α- and/or progesterone receptor-positive) compared to EGFR mutant patients (50% versus 9.1%, respectively) (p = 0.03). Treatment was well tolerated with predominant grade 1–2 dermatologic and gastrointestinal adverse effects. Conclusion Addition of fulvestrant to erlotinib was well tolerated, with increased activity noted among EGFR wild type patients compared to erlotinib alone, albeit in an unplanned subset analysis.

Our study was designed to evaluate the efficacy and safety of everolimus in patients with pre-treated metastatic gastric and esophagus cancers in a US-based population focusing on biomarker correlation. Patients with advanced upper GI adenocarcinomas who progressed after 1–2 prior regimens received everolimus 10 mg PO daily. The primary endpoint was disease control rate (DCR). Secondary endpoints included progression-free survival (PFS), toxicity, overall survival (OS) and biomarker correlatives of the mTOR pathway. Target accrual was 50 patients based on one-sided type I error of 10 % and power of 90 %. Forty-five patients were evaluable, 21 gastric, 11 esophagus and 13 from the GEJ. The median age was 64 (range 38–73); all patients had an ECOG of 0 or 1; and 18 patients (40 %) had only 1 prior regimen. The most common grade 3–4 adverse events included fatigue (24 %) and thrombocytopenia (22 %). We observed 1 partial response with 39 % of evaluable patients having stable disease. Median OS was 3.4 months (95 % CI 2.7–5.6 months), and PFS was 1.8 months (95 % CI 1.7–2.2 months). There was a strong correlation between ≥2 + IHC staining for p-S6 in tumor samples with better PFS (p

Background In some fluoroscopy machines, the dose-rate output of the fluoroscope is tied to a selectable patient size. Although patient size may play a significant role in visceral or cardiac procedures, head morphology is less variable, and high dose outputs may not be necessary even in very obese patients. We hypothesized that very small patient size setting can be used to reduce dose for cerebral angiography without compromising image quality. Methods Patients who underwent endovascular neurosurgical procedures during the 2015–2016 academic year were identified, and estimated procedural air kerma (AK) was tabulated retrospectively. Technologists were instructed to begin using the very small patient size setting for all procedures performed using our Philips Allura Xper FD20 biplane fluoroscopy system beginning in March 2016. No changes were made in a second procedure room using a Toshiba Infinix system. Student t tests and logistic regression models were used to compare radiation exposure before and after March 1, 2016, for both machines. Results For diagnostic cerebral angiograms performed on the Philips system (n = 302), AK was reduced by approximately 17% (1277 vs. 1061 mGy; P = 0.0006.) Changes in table height, total fluoroscopy time, patient weight, and body mass index did not contribute to this difference. No significant change was seen in total AK using the Toshiba system (n = 237). Blinded review by a neuroradiologist did not demonstrate any change in image quality. Conclusions Using the very small patient size reduces fluoroscopy dose by 17% for cerebral angiography without impacting image quality.

AIMS Axitinib is a potent and selective second generation inhibitor of vascular endothelial growth factor receptors 1, 2 and 3 approved for second line treatment of advanced renal cell carcinoma. The objectives of this analysis were to assess plasma pharmacokinetics and identify covariates that may explain variability in axitinib disposition following single dose administration in healthy volunteers.

Stannous fluoride (SF) is an antibacterial compound that has been successfully used to treat gingivitis in people and dogs, and cutaneous bacterial infections in horses. The purpose of this prospective, double-blinded, placebo-controlled clinical trial was to investigate the efficacy of 0.2% SF spray (BacDerm®; Emerald 3 Enterprises Inc., Camdenton, MO, USA) for the treatment of canine superficial pyoderma. Twenty-six privately owned dogs with bacterial skin infections diagnosed on clinical signs, cytology and aerobic culture were enrolled. Dogs were randomly assigned to vehicle only or active ingredient treatment groups. The product was applied topically to affected areas once daily for 28 days, with assessments at days 0, 14, 28 and 42. Clinical and cytological evaluations were performed by the same investigators at each visit. Owners scored the improvement of hair coat, odour, pruritus and overall improvement at each recheck. Linear mixed models showed significant effects of treatment (P 0.05). Spearman’s rho correlation coefficients revealed a significant negative correlation between investigator’s scores and all categories of owners’ assessment scores in dogs of both groups. Although some dogs improved on SF, this study does not support the use of 0.2% SF as sole therapy for canine superficial pyoderma. Resume Le fluorure d’etain (SF) est un antibacterien utilise avec succes dans le traitement des gingivites humaines et canines et des infections bacteriennes equines. L’objectif de cette etude clinique prospective, en double-aveugle, contre placebo, etait d’etudier l’efficacite d’un spray a 0.2% de SF (BacDerm®; Emerald 3 Enterprises Inc., Camdenton, MO, USA) dans le traitement des pyodermites bacteriennes canines. Les vingt-six chiens inclus etaient atteints de pyodermite bacterienne diagnostiquee sur les signes cliniques, la cytologie et une culture aerobie. Les chiens ont ete repartis au hasard dans le groupe recevant l’excipient ou le groupe recevant le compose actif. Le produit a ete applique en topique sur les zones atteintes une fois par jour pendant 28 jours avec des reevaluations a jours 0, 14, 28 et 42. Les evaluations cliniques et cytologiques etaient realisees par le meme investigateur a chaque visite. Les proprietaires evaluaient le pelage, l’odeur, le prurit et l’amelioration globale a chaque visite. Les modeles lineaires ont montres des effets significatifs du traitement (P 0.05). Les coefficients de correlation de Spearman ont montre une correlation negative significative entre les scores de l’investigateur et toutes les categories d’evaluation des proprietaires des chiens des deux groupes. Bien que certains chiens s’ameliorent avec le SF, cette etude ne soutient pas l’utilisation de SF a 0.2% en tant que therapie unique des pyodermites bacteriennes canines. Resumen El fluoruro de estano (SF) es un compuesto antibacteriano que se ha utilizado de forma satisfactoria para el tratamiento de gingivitis en personas y en perros, asi como infecciones cutaneas bacterianas en caballos. El proposito de este estudio clinico prospectivo, doble ciego, controlado con placebo fue investigar la eficacia de un pulverizado con 0,2% de SF (BacDerm®; Emerald 3 Enterprises Inc., Camdenton, MO, USA) para el tratamiento de la pioderma canina superficial. Se utilizaron veintiseis perros de particulares con infecciones bacterianas diagnosticadas segun los signos clinicos, citologia y cultivo aerobico. Los perros se asignaron al azar al grupo con vehiculo solo o al grupo de tratamiento. El producto se aplico topicamente en las areas afectadas una vez al dia durante 28 dias, con evaluacion en los dias 0, 14, 28 y 42. Se realizaron evaluaciones citologicas y clinicas por el mismo investigador en cada visita. Los duenos valoraron la mejora en el pelaje, olor, prurito y mejora general en cada chequeo. Modelos lineares mixtos mostraron un efecto significativo del tratamiento (P 0,05). Los coeficientes de correlacion rho de Spearman indicaron una correlacion significativa negativa entre los valores del investigador y todas las categorias de la valoracion de los duenos en los perros de ambos grupos. Aunque algunos perros mejoraron con SF, este estudio no apoya el uso de 0,2% de SF como unica terapia en pioderma canina superficial. Zusammenfassung Bei Zinnfluorid (SF) handelt es sich um eine antibakterielle Verbindung, die erfolgreich eingesetzt wurde, um Gingivitis bei Menschen und bei Hunden, sowie bakterielle Infektionen bei Pferden zu behandeln. Das Ziel dieser prospektiven, doppelblinden, Plazebo-kontrollierten klinischen Studie war es, die Wirksamkeit eines 0,2%igen SF Sprays (BacDerm®, Emerald 3 Enterprises Inc., Camdenton, MO, USA) fur die Behandlung der caninen oberflachlichen Pyodermie zu untersuchen. Sechsundzwanzig Privathunde mit bakterieller Hautinfektion, die anhand der klinischen Symptomatik, der Zytologie und mittels anaerober Kulturen diagnostiziert worden waren, wurden in die Studie aufgenommen. Die Hunde wurden zufallig der Behandlungsgruppe mit Tragermedium oder der Behandlungsgruppe mit aktiven Inhaltsstoffen zugeteilt. Das Produkt wurde einmal taglich an den betroffenen Stellen 28 Tage lang topisch angewendet, mit einer Beurteilung der Veranderungen an den Tagen 0, 14, 28 und 42. Klinische und zytologische Evaluierungen wurden bei jedem Besuch von denselben UntersucherInnen durchgefuhrt. Die BesitzerInnen beurteilten bei jedem Kontrolltermin die Verbesserung des Haarkleides, des Geruchs, des Juckreizes, sowie die allgemeine Verbesserung. Lineare gemischte Modelle zeigten einen signifikanten Unterschied im Bezug auf die Bewertung der Behandlung (P 0,05). Spearman-Rho-Korrelationskoeffizienten zeigten in beiden Gruppen eine signifikante negative Korrelation zwischen den Bewertungen der UntersucherInnen und allen Kategorien der Beurteilungen durch die BesitzerInnen. Obwohl sich einige Hunde mit SF besserten, unterstutzt diese Studie die Verwendung von 0,2%igem SF als alleinige Behandlung fur die canine oberflachliche Pyodermie nicht.

A 68‐day study was conducted in North Florida to evaluate forage and beef cattle serum, liver, and urine mineral concentrations, emphasizing magnesium (Mg). Forty‐two Angus, Brangus, and Romosinuano cows in early lactation were divided into two groups and placed on ryegrass or oat pasture. Samples were collected every 2 weeks except for liver biopsies, which were collected only on day 68. Mineral concentrations were determined for forage, plasma, urine, and liver samples. All forage mineral concentrations except Mg, calcium (Ca), copper (Cu), cobalt (Co), selenium (Se), and zinc (Zn) were greater than critical levels for a beef cow in lactation. Forage Mg and Cu were severely deficient in both oats and ryegrass. All blood plasma mineral levels were greater than critical levels, but plasma Mg was borderline to slightly deficient. There should be special attention given to Mg supplementation because forages are deficient and contain excess potassium (K).

Aluminum (Al) applied to land in the form of water treatment residuals (Al‐WTR) can reduce soluble soil phosphorus (P). Two experiments (145 and 148 d) using 36 grazing Holstein steers were conducted to determine effects of Al‐WTR applications to pasture on mineral status of cattle and bahiagrass (Paspalum notatum). Four treatments were with and without Al‐WTR and P‐free mineral supplementation. Total pasture application of Al‐WTR over 2 years was 75.8 metric tons dry weight/ha. There were few treatment effects on weight gains and mineral tissue concentrations. Forage mineral concentrations were generally unaffected by treatment but were affected (P < 0.05) by collection dates. Most forage samples were deficient in sodium (Na), copper (Cu), selenium (Se), and cobalt (Co) and at various collections deficient in calcium (Ca), P, iron (Fe), and zinc (Zn). Applications of Al‐WTR are effective in reducing P contamination without affecting forage or cattle mineral concentrations.

The survival and quality of shrubs planted in the landscape from containers is dependent on irrigation to ensure the development of a healthy root system. This study determined the effect of irrigation frequency on survival, quality, canopy growth index, root to canopy spread ratio, and dry root and shoot biomass of Viburnum odoratissimum Ker-Gawl. (sweet viburnum) planted in Florida in USDA hardiness Zones 8b (Citra, FL), 9a (Balm, FL), and 10b (Ft. Lauderdale, FL). Sweet viburnum shrubs were planted into the landscape from 11.4-L (#3) containers and irrigated with 3 L every 2, 4, or 8 days. Shrubs were planted on eight dates over a 2-year period (2004 to 2006). Irrigation frequency during the 12- to 22-week irrigation period had no significant effect on sweet viburnum survival or aesthetic quality at any location. In addition, there was no irrigation effect on root spread, root to shoot biomass ratio, or root biomass for shrubs planted in Zones 8b or 9a. However, sweet viburnum irrigated every 2 days had greater canopy growth index at 28 and 104 weeks after planting than shrubs irrigated every 4 or 8 days in Zone 8b and every 8 days in Zone 9a. When planted in Zone 10b, sweet viburnum irrigated every 2 days exhibited greater growth index, shoot biomass, and root biomass than plant receiving irrigation every 4 days. Although more frequent irrigation (every 2 days) resulted in more plant growth in Zones 8b and 10b, sweet viburnum survived and grew after planting under natural rainfall conditions provided they were irrigated with 3 L of water every 8 days during establishment until roots reached the canopy edge in hardiness Zones 8b and 9a and every 4 days in hardiness Zone 10b. Subsequent supplemental irrigation (hand-watering) was only needed after irrigation was ended when plants exhibited visible signs of drought stress and there was no measurable rainfall for 30 consecutive days.

Irrigation frequency and volume effects were evaluated on recently installed #3 container grown shrubs of three taxa, Ilex cornuta Lindl. & Paxt. ‘Burfordii Nana’, Pittosporum tobira Thunb. ‘Variegata’, and Viburnum odorotissimum Ker Gawl. Irrigation frequency and volume had no effect on Pittosporum at any time for any measured root or shoot parameter. Irrigation frequency and volume had no effect on Ilex and Viburnum canopy biomass, root biomass, root dry weight:canopy dry weight ratio, and stem water potential at any time after planting. Canopy growth was affected by irrigation treatment only for Viburnum plants installed in May 2004, and growth response to more frequent irrigation only occurred while plants were irrigated, with no lasting impact on growth once irrigation ceased. Root spread and root spread:canopy spread ratio for only one species, Ilex, were influenced by irrigation treatment. Applying excessive irrigation volume (in this case 9L) reduced root dry weight: shoot dry weight ratio for Ilex and could increase the time needed for plants to grow enough roots to survive without irrigation. Our study found only slight influences on shrub growth from the tested values of irrigation frequency and volume regardless of the time of year when data was collected. This indicates that these shrubs can be established with 3 liters irrigation applied every 4 days until roots reach the edge of the canopy under the mostly above normal rainfall conditions of this study. Applying more volume or irrigating more frequently did not increase survival or growth. Canopy growth and plant quality data combined with past research suggest that establishment of these shrub species may be more influenced by environmental conditions such as rainfall than by the irrigation frequency and volume used in this test.

Irrigation for establishing landscape plants is restricted to the first 60 days after planting by most water management districts in Florida, yet woody plants may require between 6 and 12 months to become established. Survival and growth of shrubs planted into landscapes depend on adequate irrigation until shrubs develop a root system capable of compensating for evapotranspiration losses. This study examined the effect of irrigation frequency on survival, quality, and growth of Ilex cornuta Lindl. & Paxt. ‘Burfordii Nana’ and Pittosporum tobira [Dryand] ‘Variegata’ planted in north (Citra, FL; USDA hardiness zone 8b) and central (Balm, FL; USDA hardiness zone 9b) Florida. Shrubs were planted into the landscape from 11.4-L (#3) containers at 3-month intervals for a total of eight planting dates over 2 years and irrigated every 2, 4, or 8 days with 3 L of water at each irrigation event. Scheduled irrigation was discontinued once roots grew to the canopy edge [12 to 22 weeks after planting (WAP)] and survival, quality, and growth were evaluated from that point through 104 WAP. Ilex cornuta ‘Burfordii Nana’ irrigated every 2 days had greater canopy growth index (52 through 88 WAP), canopy dry mass (52 and 104 WAP), and maximum root spread (20 through 64 and 88 WAP) when compared with shrubs irrigated every 8d in hardiness zone 8b. Pittosporum tobira ‘Variegata’ irrigated every 2 days had greater canopy growth index (12 through 104 WAP), maximum root spread (20 through 28 and 64 through 88 WAP), and canopy dry mass (52 and 104 WAP) when compared with shrubs irrigated every 8 days in hardiness zone 8b. However, there were no differences in shoot or root growth resulting from irrigation frequency for these shrubs planted in hardiness zone 9a. Irrigation frequency did not affect shrub survival or aesthetic quality at either location. Although more frequent irrigation (every 2 days) resulted in greater plant growth in zone 8b, the two shrub species tested survived and grew after planting in hardiness zones 8b and 9a on natural rainfall alone provided they were irrigated during establishment with 3 L every 4 to 8 days until roots reached the canopy edge. Subsequent supplemental irrigation was only needed in the following 18 months when plants showed visible signs of drought stress, which occurred when there was no measurable rainfall for 30 consecutive days.

The survival of shrubs planted into the landscape depends on sufficient irrigation during the establishment period. Few studies have investigated the effect of irrigation frequency on the posttransplant growth of landscape shrubs. We conducted two studies in U.S. Department of Agriculture hardiness zone 10b over a 2-year period in which we compared canopy growth index (GI), root extension to canopy spread ratio, canopy dry weight, and root dry weight of shrubs irrigated at different frequencies. In the first experiment, wild coffee (Psychotria nervosa) and ‘Lakeview’ orange jasmine (Murraya paniculata) shrubs were planted in Sept. 2004, Dec. 2004, Mar. 2005, and June 2005 and irrigated for 28 weeks after planting (WAP) every 2, 4, or 8 days with 3 L of water per irrigation event. In the second experiment, ‘Macafeeana’ copperleaf (Acalypha wilkesiana) and orange jasmine shrubs were planted in Sept. 2005, Dec. 2005, Mar. 2006, and June 2006 and irrigated for 28 WAP every 1, 2, or 4 days with 3 L of water per irrigation event. Canopy GI and root extension to canopy spread ratio were determined at 28, 52, and 104 WAP. The entire canopy and roots were harvested 52 and 104 WAP to determine dry weight. In Expt. 1, wild coffee and orange jasmine plants irrigated every 2 days had greater GI than plants irrigated every 8 days at 28 WAP, but GI was not different at 52 or 104 WAP. Canopy dry weight at 52 WAP was greater for plants irrigated every 2 days than every 8 days, but there was no difference at 104 WAP. There was no difference in wild coffee or orange jasmine root dry weight or root extension to canopy spread ratio among the irrigation frequencies. In Expt. 2, there were no differences in GI, canopy dry weight, root dry weight, or root extension to canopy spread ratio of copperleaf or orange jasmine irrigated everyday compared with plants irrigated every 2 or 4 days. From the data collected in these studies, it appears that irrigating wild coffee or orange jasmine every 8 days during the first 28 WAP limited canopy growth but not root development. However, after 52 WAP, rainfall events appeared to be sufficient to eliminate any initial effects from irrigation frequency. Our data suggest that wild coffee, orange jasmine, and copperleaf from 3-gal containers can be successfully established in the landscape when irrigated with 3 L of water every 4 days for the first 28 WAP.

A 100 d experiment was conducted to determine the effects of aluminum (Al) source and concentration on mineral status, emphasizing phosphorus (P), of 50 feeder lambs. Six treatments, fed at 10% of the total diet, were formulated using two sources of Al, AlCl3 and an Al-based water treatment residual (WTR, 11.1% Al), with varying levels of Al and P: (1) control (10% sand, C), (2) low WTR (2.5% WTR and 7.5% sand, L-WTR), (3) AlCl3 with added P (1% AlCl3, 9% sand, and 0.4% P, AlCl3 + P), (4) high WTR (10% WTR, H-WTR), (5) AlCl3 (1% AlCl3 and 9% sand, AlCl3), and (6) high WTR with added P (10% WTR and 0.4% P, H-WTR + P). The total Al varied from 0.037 to 1.2% among diets. Only lambs fed the high WTR diet without P supplementation (H-WTR) decreased feed intakes. These lambs consumed about half as much feed as lambs on all the other treatments, and had lower (P 0.05). Diets containing 1.2% Al as WTR without P supplementation depressed feed intakes, weight gains, plasma P concentrations (P 0.05) in feed intakes, weight gains, or BMC.

Salt-tolerant landscape plants are important to ornamental growers, landscapers, and residents in coastal communities. Ornamental grasses are frequently recommended for low-maintenance landscape situations and may be candidates for coastal plantings after they are evaluated for their salt spray tolerance. ‘Gracillimus’ maiden grass (Miscanthus sinensis) and ‘Hamelin’ fountain grass (Pennisetum alopecuroides) were subjected to four treatments [100% seawater salt spray, 50% seawater salt spray, 25% seawater salt spray, or 0% seawater salt spray (100% deionized water)] applied as a foliar spray. As seawater concentration increased, root, shoot, whole-plant biomass gain, height, inflorescence number, and visual quality decreased for both cultivars; however, fountain grass appears to be slightly more tolerant of salt spray than maiden grass.

Although new and innovative measures to reduce landscape water consumption are being sought, traditional methods of water restrictions and plant selection prevail. Species native to North America are often promoted as drought tolerant with little information to support or refute such claims. Furthermore, species performance is unknown in maintained environments such as commercial and residential landscapes. Thus, 10 native and 10 exotic species, commonly used in landscapes, were evaluated independently for postestablishment growth and aesthetics under irrigated and nonirrigated landscape conditions. Growth indices were recorded monthly, with dieback and plant density evaluated at termination of the experiment. At termination of the experiment, canopy size of eight native [beautyberry (Callicarpa americana), fringe tree (Chionanthus virginicus), yaupon holly (Ilex vomitoria ‘Nana’), virginia sweetspire (Itea virginica), wax myrtle (Myrica cerifera), chickasaw plum (Prunus angustifolia), saw palmetto (Serenoa repens), and coontie (Zamia floridana)] and eight exotic [golden dewdrop (Duranta erecta), cape jasmine (Gardenia augusta), crape myrtle (Lagerstroemia indica), oleander (Nerium oleander), japanese pittosporum (Pittosporum tobira), indian hawthorn (Rhaphiolepis indica), sweet viburnum (Viburnum odoratissimum), and sandankwa viburnum (V. suspensum)] species were similar for irrigated and nonirrigated treatments. Irrigation resulted in larger canopy sizes for two native [walter's viburnum (V. obovatum) and inkberry (I. glabra)] and two nonnative [japanese privet (Ligustrum japonicum) and fringe flower (Loropetalum chinensis)] species. Among the native species with larger canopy sizes under irrigated conditions, all are indigenous to swamps and streams. With the exception of virginia sweetspire, plant density and dieback were similar for irrigated and nonirrigated plants of all taxa examined. Irrigated virginia sweetspire plants had higher plant density and dieback ratings than nonirrigated plants. Results indicate that, aesthetically, irrigated and nonirrigated plants were similar. Data emphasize the importance of selecting plant material adapted to existing environmental landscape conditions.