Adventist Health Community Care-Hanford

To determine the effect of various amounts of ruminally undegradable protein in the diets of lactating cows fed steam-flaked sorghum, 24 Holstein cows (90 +/- 50 d in milk) were assigned to three treatments: 0.8% urea, 6% soybean meal, or 5% fish meal. Respective percentages of ruminally undegradable protein in the diets (as a percentage of crude protein) were 30, 35, and 39%. All diets contained 37% alfalfa hay; 3 to 5% cottonseed hulls; 10 to 13% whole cottonseed; 39% steam-flaked sorghum (360 g/L); 5% of a molasses, mineral, and vitamin supplement; and the different protein supplements. Intake of dry matter was higher for cows fed urea than for cows fed soybean meal or fish meal diets. In cows that yielded more than 40 kg/d of milk (4 cows per treatment), the soybean meal and fish meal diets resulted in higher yields of milk and 3.5% fat-corrected milk and a greater efficiency of conversion of feed to milk than did the urea diet. Cows that yielded less than 40 kg/d of milk (4 cows per treatment) at the beginning of treatment tended to yield more milk when fed urea than when fed the protein supplements. Nutrient digestibilities were not greatly affected by source of N, suggesting a beneficial effect of urea supplementation on nutrient digestibilities because replacement of protein supplements with cottonseed products caused the neutral detergent fiber content of the urea diet to be about 7% higher than that of the other diets. These data show that response to ruminally undegradable protein in diets of lactating cows fed steam-flaked sorghum was related to milk yield.

The purpose of this study was to determine the magnitude and clinical significance of surface measurement error in the determination of lumbar spinal flexion. Intrarater, inter-rater and intermethod reliability estimates were obtained using single inclinometry, double inclinometry and back range-of-motion inclinometry methods. Eight healthy subjects were examined independently by two experienced observers and three replicates of each measurement were obtained by each observer in a random sequence. In addition, three replicates of lumbar flexion angles were obtained for each subject by a single observer using the B-200. Reliability estimates were determined by intraclass correlation coefficients and were further compared by paired t tests between observation series. The median range of error was 8.5 degrees using the single inclinometer, 10.5 degrees using the double inclinometer and 16 degrees using the back range-of-motion. The intrarater reliability was generally higher than inter-rater reliability and intermethod reliability was low in most cases reflecting the poor cross-validity across inclinometry methods and between each inclinometry method and the B-200. In conclusion, significant measurement error in estimating lumbar flexion by inclinometry may be expected to occur even in a "controlled" setting using experienced observers, standard examination techniques and asymptomatic healthy subjects. These findings appear to undermine the expectation that the clinician can reliably apply surface inclinometry to estimate loss of spinal mobility for purposes of impairment determination.

Abstract Aqueous organic redox flow batteries (AORFBs) have received increasing attention as an emergent battery technology for grid‐scale renewable energy storage. However, physicochemical properties of redox‐active organic electrolytes remain fine refinement to maximize their performance in RFBs. Herein, we report a carboxylate functionalized viologen derivative, N,N′‐dibutyrate‐4,4′‐bipyridinium, (CBu)2V, as a highly stable, high capacity anolyte material under near pH neutral conditions. (CBu)2V can achieve solubility of 2.1 M and display a reversible, kinetically fast reduction at −0.43 V vs NHE at pH 9. DFT studies revealed that the high solubility of (CBu)2V is attributed to its high molecular polarity while its negative reduction potential is benefitted from electron‐donating carboxylate groups. A 0.89 V (CBu)2V/(NH)4Fe(CN)6 AORFB demonstrated exceptional energy storage performance, specifically, 100 % capacity retention with a discharge energy density of 9.5 Wh L−1 for 1000 cycles, power densities of up to 85 mW cm−2, and an energy efficiency of 70 % at 60 mA cm−2. (CBu)2V not only represents the most capacity dense viologen with pendant ionic groups and also exhibits the longest (1200 hours or 50 days) and the most stable flow battery performance to date.

Abstract Slug interference testing may be particularly useful for characterizing hydraulic properties of aquifer sites where disposal of contaminated ground water makes pumping tests undesirable. The design, performance, and analysis of slug interference tests for two field test examples are presented. Results were compared with standard constant‐rate pumping tests. The comparison indicates that slug interference tests provide estimates comparable to those obtained from short duration pumping tests for the determination of transmissivity, storativity, and vertical anisotropy. The close agreement in hydraulic property values obtained using the two test methods suggests that slug interference testing, under favorable test conditions (for example, observation well distances ≤ 30 m), can provide representative aquifer characterization results. The quality and extent of test data obtained also indicate the potential use of slug interference testing for three‐dimensional hydrologic characterization investigations, when conducted using multilevel monitoring facilities.

NORWOOD, W. D. M.D.; WISEHART, D. E. B.S.; EARL, C. A. M.D.; ADLEY, V. E. B.S.; ANDERSON, D. E. B.S. Author Information

BACKGROUND: Overexpression of excision repair cross complementing group 1 (ERCC1), a DNA repair enzyme, is associated with resistance to cisplatin. MATERIALS AND METHODS: Tissues from 73 patients with squamous cell carcinoma of the head and neck (HNSCC) who received concurrent cisplatin and radiation was analyzed immunohistochemically to determine if ERCC1 expression predicted for survival and response. Expression was scored as follows: 0=0% tumor nuclei positive, 1+=<50%, 2+=50-75% and 3+=>75%. RESULTS: ERCC1 expression was 0 in 0%, 1+ (14%), 2+ (42%) and 3+ (44%). In uni- and multivariate analyses, 3+ ERCC1 expression was not a significant predictor of survival or response. Median survival for the ERCC1 3+ patients was 2.9 years versus 2.1 years for the ERCC1 <3+ group (p=0.44). CONCLUSION: In this retrospective review of HNSCC patients receiving concurrent cisplatin and radiation, ERCC1 expression was not a significant predictor of survival or response.

At the Hanford Site in Richland, Washington, the path to site cleanup involves vitrification of the majority of the wastes that currently reside in large underground tanks. A Joule-heated glass melter is the equipment of choice for vitrifying the high-level fraction of these wastes. Even though this technology has general national and international acceptance, opportunities may exist to improve or change the technology to reduce the enormous cost of accomplishing the mission of site cleanup. Consequently, the U.S. Department of Energy requested the staff of the Tanks Focus Area to review immobilization technologies, waste forms, and modifications to requirements for solidification of the high-level waste fraction at Hanford to determine what aspects could affect cost reductions with reasonable long-term risk. The results of this study are summarized in this report.

To vary ruminally degradable starch, sorghum grain was dry-rolled or steam-flaked to different densities and compared with dry-rolled barley in total mixed diets fed to 40 lactating cows (111 d of lactation) assigned to five dietary treatments. Diets contained (percentage of dry matter) 35% alfalfa hay, 4.1% cottonseed hulls, 10% whole cottonseed, 2% fish meal, 4% soybean meal, and 4.9% of a molasses, mineral, and vitamin supplement. Treatments were 40% sorghum grain either dry-rolled or steam-processed at flake densities of 437, 360, and 283 g/L. A fifth diet containing 42% dry-rolled barley was fed. Cows were blocked according to pretreatment (14 d) milk yield and received experimental diets for 56 d. Increasing ruminal starch degradability by including steam-flaked sorghum grain or barley in the diet did not increase milk yield or milk protein percentage and yield, as was shown in eight previous studies. Steam-flaked sorghum or dry-rolled barley in the diet decreased dry matter intake, resulting in a 10 to 19% higher efficiency of conversion of feed dry matter to milk than that for dry-rolled sorghum. Milk urea N was decreased, and milk casein yield tended to be increased, by steam-flaking sorghum at the moderate density compared with dry-rolling or fine flaking. Dietary protein was more efficiently converted to milk protein and casein from flaked sorghum and dry-rolled barley than from dry-rolled sorghum. In this study, increasing ruminal starch degradability resulted in higher feed efficiency and lower feed intakes, bu optimal flake densities for steam-processed sorghum gain to maximize milk and milk protein yield were not clarified.

BACKGROUND: Although intravenous (IV) smart pumps with built-in dose-error reduction systems (DERS) can reduce IV medication administration error, most serious adverse events still occur during IV medication administration. Sources of error include overriding DERS and manually bypassing drug libraries and the DERS. METHODS: Our purpose was to use the Regenstrief National Center for Medical Device Informatics data set to better understand IV smart pump drug library and DERS compliance. Our sample consisted of 12 months of data from 7 hospital systems, 44 individual hospitals, and descriptive data from the American Hospital Directory (AHD) for 2015. The aims of the study were (1) to determine whether there are differences in IV smart pump drug library compliance between hospital systems and (2) to provide a broad descriptive overview of relevant trends related to IV smart pump compliance. RESULTS: For aim 1, we found 3 significant relationships among the 7 hospital systems: systems 3 (P < 0.001), 6 (P = 0.003), and 7 (P = 0.002) had significantly higher IV smart compliance as compared with system 4. For aim 2, the number of drug library profiles was positively correlated (P = 0.029) with IV smart pump compliance and the IV smart pump type used was significantly correlated (P = 0.013) with IV smart pump compliance. CONCLUSIONS: Our findings support that there are differences in IV smart pump compliance both within and between hospital systems and that IV smart pump type and the number of drug library profiles may be influencing factors. Further research is required to more accurately identify the impact of these factors in this very important area of patient safety.

The effects of damaged femoral heads on long-term wear in total hip arthroplasties are not well known. In the study reported here, we compared the surface roughness of dislocated femoral heads, retrieved at time of revision, with that of heads revised for reasons other than dislocation. The dislocated heads, including 6 cobalt-chrome (Co-Cr), 2 oxidized zirconium, and 2 alumina (ceramic) heads, were compared with nondislocated Co-Cr and ceramic heads. Scratch marks on the dislocated Co-Cr and alumina heads were considerably smaller and shallow than those on the dislocated oxidized zirconium heads. Mean surface roughness of the dislocated heads was 368 nm (Co-Cr), 376 nm (alumina), and 2137 nm (oxidized zirconium). On the contrary, the mean surface roughness for nondislocated Co-Cr and alumina heads was 307.44 nm (outlier excluded) and 138.8 nm, respectively. Our data suggest that increased surface damage and roughness can occur after dislocation.

Abstract Aqueous organic redox flow batteries (AORFBs) have received increasing attention as an emergent battery technology for grid‐scale renewable energy storage. However, physicochemical properties of redox‐active organic electrolytes remain fine refinement to maximize their performance in RFBs. Herein, we report a carboxylate functionalized viologen derivative, N,N′‐dibutyrate‐4,4′‐bipyridinium, (CBu)2V, as a highly stable, high capacity anolyte material under near pH neutral conditions. (CBu)2V can achieve solubility of 2.1 M and display a reversible, kinetically fast reduction at −0.43 V vs NHE at pH 9. DFT studies revealed that the high solubility of (CBu)2V is attributed to its high molecular polarity while its negative reduction potential is benefitted from electron‐donating carboxylate groups. A 0.89 V (CBu)2V/(NH)4Fe(CN)6 AORFB demonstrated exceptional energy storage performance, specifically, 100 % capacity retention with a discharge energy density of 9.5 Wh L−1 for 1000 cycles, power densities of up to 85 mW cm−2, and an energy efficiency of 70 % at 60 mA cm−2. (CBu)2V not only represents the most capacity dense viologen with pendant ionic groups and also exhibits the longest (1200 hours or 50 days) and the most stable flow battery performance to date.

BACKGROUND: Histologic distinction between well differentiated hepatocellular carcinoma (HCC) and benign hepatocellular mass lesions is a known challenge. Existing biomarkers are of limited diagnostic value. Our previous studies observed an enhanced canalicular expression pattern of clusterin (CLU) in HCC, which was not observed in benign hepatocellular mass lesions such as hepatocellular adenoma. The aim of this study was to further investigate its diagnostic value for HCC by examining the expression pattern of CLU in a large number of non-hepatocellular tumors, and by comparing it with two other commonly used hepatocellular markers pCEA and CD10 that also show a canalicular staining pattern in HCC. METHODS: Enhanced canalicular staining patterns of CLU, pCEA and CD10 were analyzed on 54 surgically resected well to moderately differentiated HCCs on whole tissue sections, of which 37 had surrounding regenerative nodules while the remaining 17 had a non-cirrhotic background. CLU immunostaining was also performed on tissue microarray sections that contained 74 HCCs (40 of which were also stained for pCEA and CD10), 55 normal liver tissue samples, and 1305 non-hepatocellular tumors from multiple organs. RESULTS: Enhanced CLU canalicular staining was observed in 70% (89/128) HCCs but not in regenerative nodules, normal liver tissues or any non-hepatocellular tumors. The sensitivity and specificity for enhanced canalicular staining pattern of CLU in HCCs were 0.70 and 1.00. This enhanced canalicular pattern was observed in only 26 and 23% HCCs for CD10 and pCEA, respectively. These results further demonstrate that the distinctive enhanced canalicular pattern of CLU is unique to HCC. CONCLUSIONS: CLU is superior to pCEA and CD10 as a diagnostic immunomarker in that it can help distinguish well to moderately differentiated HCC not only from non-HCC malignancies but also from benign hepatocellular mass lesions.

In this paper, we use survey data from an international public policy and management program within a large private U. S. university to study sociocultural and academic adjustment of the students, how this is affected by the structure of the program, and its effects on their academic performance. We focus on factors that affect students’ ability to socially integrate successfully during their time in the United States for higher education and attempt to determine if this social integration translates into better academic outcomes.

Objective: This study examined the association between chronic low back pain [CLBP] and the occurrence of post-traumatic stress disorder [PTSD].Methods: The experiences of 161 patients receiving treatment for CLBP were examined with self-report measures for perceived pain severity, traumatic experiences, and symptom levels of PTSD. Participants’ responses determined which of four groups they were placed in to further explore predictor variables.Results: Overall, 51 percent of the patients evidenced PTSD symptoms ranging between mild and severe. Within-group comparisons indicated that between 25 percent and 77 percent of patients reported some level [mild to severe] of PTSD symptoms. Patients who had reported a history of trauma evidenced the highest levels of PTSD symptoms in comparison with the other groups. There was a significant positive association between patients' levels of pain severity and their levels of PTSD symptoms.Conclusion: Findings of this study indicate that there is an increased positive association between CLBP patients’ level of pain severity and symptoms reported of PTSD. Findings highlight the need for pain specialists to assess not only pain severity levels, but also anxiety symptoms. Very vital links, which should not be missed when treating these patients, are to provide treatments that target their physical condition and emotional distress or anxiety and that increase their sense of control over their pain experience and treatments. Such holistic treatments may help these patients to more effectively cope with their pain condition.

This document describes the groundwater monitoring plan for Waste Management Area C located in the 200 East Area of the DOE Hanford Site. This plan is required under Resource Conservation and Recovery Act of 1976 (RCRA).

Postoperative flexion is an important factor in the outcome of total knee arthroplasty. Although normal activities of daily living require a minimum of 105° to 110° of flexion, patients from non-Western cultures often engage in activities such as kneeling and squatting that require higher flexion. The desire to achieve greater flexion serves as the driving force for prosthetic modifications, including high-flexion designs. Techniques used to measure knee flexion and knee position during measurement are not often described or are different depending on the examiner. The purpose of this study was to compare active (self) and passive (assisted) flexion after successful total knee arthroplasty for 5 prostheses (2 standard and 3 high-flexion) using clinical (goniometer) and radiographic (true lateral radiograph) measurement techniques by different independent examiners.At a mean follow-up of 2.7 years (range, 1-5.6 years), a total of 108 patients (144 total knee arthroplasties) had completed the study. Mean postoperative active flexion was 111° clinically and 109° radiographically for the standard designs and 114° clinically and 117° radiographically for the high-flexion designs. Adding passive flexion increased flexion to 115° clinically and 117° radiographically for the standard designs and 119° clinically and 124° radiographically for the high-flexion designs. Flexion differences between the 2 measurement techniques (active vs passive and clinically vs radiographically) were statistically significant (P<.05). These findings demonstrate the importance of describing how flexion is measured in studies and understanding how the method of measurement can affect the findings.

Strip-tillage, a form of conservation tillage, limits soil disruption to a narrow strip down each planting line, thus helping maintain soil structure and minimize dust. Read about equipment and techniques, as well as the many benefits of this method.

Summary The Ouchterlony and Grabar technics have been applied to a study of three fractionated, heated plasma protein solutions. Two of these products, namely, Chalb albumin and SPPS, have been shown previously to produce reactions or antibodies in humans. It was confirmed that Chalb albumin possesses at least one antigen not present in normal unheated human serum. SPPS was shown to be atypical when compared to human serum protein. The possibility that protein complexes or modified proteins in Chalb albumin and SPPS contributed to the sensitization of humans is discussed, as is the application of these immunochemical technics to research in the area of plasma expanders. A recently produced heated plasma fraction, Plasmanate, was shown to be devoid of any antigen foreign to human serum. It was also shown to be nonreactive and nonantigenic in humans. Résumé Les techniques d'ouchterlony et de Grabar ont été appliquées B l'étude de trois solutions de protéines plasmatiques fractionnées et traitées par la chaleur. Parmi ces solutions, deux produits, à savoir l'albumine Chalb et le SPPS étaient connus pour leur aptitude à produire des réactions et des anticorps chez l'homme. Les auteurs ont pu confirmer que l'albumine Chalb possède au moins un antigène qui n'est pas présent dans le sérum humain normal non traité par la chaleur. Si l'on compare le SPPS aux protéines sériques humaines, on constate que le SPPS contient des protéines atypiques. Les auteurs discutent, d'une part du fait cpe les complexes protéiniques et les protéines modifiées de l'albumine Chalb et du SPPS peuvent contribuer à une sensibilisation chez l'homme, et, d'autre part, de l'application des techniques immuno‐chimiques dans l'étude du domaine des dérivés du plasma. Une fraction plasmatique traitée par la chaleur fabriquée récernment, le plasmanate, est connue pour être dépourvue de tout antigbène étranger au sérum humain. Il est aussi connu pour ne pas provoquer de réaction et pour son absence d'antigénicité chez l'homme. Zusammenfassung Drei wärmebehandelte menschliche Plasmaproteinlösungen wurden mit den Agarpräzipitationsmethoden von Oucherlony und Grabar untersucht. Von zwei dieser drei Fraktionierungsprodukte, nämlich dem «ChaIb‐Albumin» und der «SPPS» war bekannt, daß sie beim Menschen Reaktionen sowie die Bildung von Antikörpern auszulösen vermögen. Der Befund, daß «Chalb‐Albumin» zumindest ein Antigen enthält, welches im normalen unerhitzten menschlichen Serum fehlt, wurde bestätigt. Die Proteine der «SPPS» zeigten in der Immunoelektrophorese ein atypisches Verhalten im Vergleich zu den normalen Serumeiweißen Die Möglichkeit wird diskutiert, daß Proteinkomplexe oder modifizierte Proteine des «Chalb‐Albumins» und der «SPPS» beim Zustandekommen von Sensibilisierungen beim Menschen gegen diese Fraktionierungsprodukte eine maßgebende Rolle spielen. Im weiteren wird die Verwendung dieser immunochemischen Methoden beim Studium von Plasmaexpandern diskutiert Es seigte sich, daß eine kürzlich entwickelte wärmestabile Plasma‐fraktion «Plasmanate» kein Antigen enthält, welches nicht auch im normalen menschlichen Serum enthalten ist. Plasmanate wird vom Menschen ohne Reaktion ertragen und bewirkt bei wiederholter Zufuhr keine Antikörperbildung

Acute interstitial nephritis (AIN) classically presents as acute kidney injury most often induced by offending drugs. Less frequently it is secondary to infections, autoimmune disorders, or idiopathic conditions. Development of drug-related AIN is not dose dependent and a recurrence can occur with re-exposure to the drug. We present a 50-year-old male with treatment resistant schizoaffective disorder who developed clozapine-induced AIN, confirmed with kidney biopsy within 2 months of taking this medication. His kidney function improved with removal of the drug and treatment with steroids. However, his kidney function was again significantly impaired when rechallenged with even a lower dose of clozapine a year later. Kidney function returned to baseline after stopping clozapine. Monitoring of kidney function during clozapine therapy is essential to therapy. Prompt diagnosis is imperative as discontinuation of offending agent can prevent acute kidney injury.

Objective: To provide a screening and early intervention model for pain specialists working with Operation Iraqi Freedom/Operation Enduring Freedom returnees presenting with early symptoms of posttraumatic stress disorder [PTSD].Findings: Why should pain specialists learn about PTSD in Operation Iraqi Freedom/Operation Enduring Freedom returnees? As the war continues, American service members face frequent physical threats, which pose strong potential for injuries that result in various forms of chronic pain. Exposure to war-related stressors, combined with chronic pain, may increase the likelihood of PTSD. Upon returning to the United States, service members may not seek psychiatric help due to stigmatization. As such, they are more likely to present in pain clinics to address their physical injuries and pain, as there tends to be less stigma involved in doing so. Posttraumatic stress disorder may hamper therapeutic gains in pain patients.Conclusions: As first-line providers, it is important to be cognizant of psychological symptoms, particularly symptoms of PTSD. Use of the proposed screening and early intervention model in pain clinic settings may decrease chronic pain and help prevent chronic PTSD in America's service members.