VA Hudson Valley Health Care System

The organochlorine insecticide dichlorodiphenyltrichloroethane (DDT) was initially introduced for control of vector-borne discases It was banned in the United States by the Environmental Protection Agency in 1972 because of potential harmful effects on humans, wildlife and the environment. Since it is a potential human carcinogen, the United Nations Environmental Program (UNEP) has recently restricted the use of DDT in developing countries until alternative methods of vector control are sought. DDT and its metabolite, dichlorodiphenyltrichloroethylene (DDE) are lipid soluble, and bioaccumulate more in human adipose tissue, than breast milk and serum. This article is a review of DDT and DDE levels in human tissues from different countries in the world. Data on p,p'-DDT and p,p'-DDE levels in human adipose tissue, breast milk and serum were selected from more recent literature. It was discovered that countries in Africa, Asia, and Latin America with more recent exposure to DDT and DDE have higher levels in human tissue than in Europe and the United States. The global concern for DDT and DDE is the environmental spread and persistence in the food chain. Hypothetically, there is a potential risk of harmful effects of DDT and DDE to human health. UNEP has cautiously taken action to protect human health, the environment and the earth from further destruction by persistent organic pollutants. Further exposure to DDT should be prevented to achieve this goal.

The authors present direct evidence for Te segregation to the grain boundaries in chalcogenide Ge2Sb2Te5 films by using transmission electron microscopy scans with a 0.5nm diameter focused probe. This finding is consistent with the observed impeded grain growth and with the post-transition relief of a “spikelike” stress, fully to the pretransition level. Te motion shows up in void formation below 200°C, a pileup of Te at the surface and its loss at higher (above 400°C) temperatures. Tuning the driving force for this segregation may be key for the optimal phase-change material design.

BACKGROUND: Chemotherapy-associated thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (C-TTP/HUS) is a condition involving thrombocytopenia, microangiopathic hemolytic anemia, and progressive renal dysfunction that develops in 2-10% of patients with a history of malignant neoplasms treated with certain chemotherapeutic agents. Pathogenesis of the disease may depend on the following: (1) generation of endothelial lesions in the kidney microvasculature, resulting from drug toxic effects and/or generation of small soluble circulating immune complexes (CIC), and (2) generation of autoantibodies and/or CIC that trigger aggregation and deposition of platelets around the lesions. METHODS: Extracorporeal immunoadsorption treatment of plasma (PROSORBA columns, IMRE Corporation, Seattle, WA) to remove immunoglobulin G and CIC was evaluated in 55 patients for the potential to induce significant clinical benefits (increase in platelet count, decrease in hemolysis, stabilization of renal function) and longer survival. RESULTS: Response to therapy was achieved in 25 of 55 patients examined. Response was associated with an estimated 1-year survival rate of 61%, as compared with an estimated survival rate of only 22% in those who did not respond (P = 0.0001). Patients whose malignant neoplasms were in complete or partial remission at the time of development of C-TTP/HUS had a significantly higher estimated 1-year survival rate (74%) as compared with a historic control group of patients receiving other treatments (22%, P = 0.0161). Clinical responses were correlated with normalization of serum levels of CIC and complement components C3c and C4. There were no side effects associated with 75% of treatments. Immunoadsorption therapy was associated with generally mild to moderate manageable side effects, such as fever, chills, nausea/vomiting, respiratory symptoms, pain, hypertension, and hypotension, which were reported in 25% of procedures. CONCLUSIONS: This multicenter study establishes protein A immunoadsorption as an effective and safe treatment for cancer chemotherapy-associated TTP/HUS, an otherwise fatal disease.

We use multi-arm star polymers as model soft colloids with tuneable interactions and explore their behaviour in the glassy state. In particular, we perform a systematic rheological study with a well-defined protocol and address aspects of ageing and shear melting of star glasses. Ageing proceeds in two distinct steps: a fast step of O(10(3) s) and a slow step of O(10(4) s). We focus on creep and recovery tests, which reveal a rich, albeit complex response. Although the waiting time, the time between pre-shear (rejuvenation) of the glassy sample and measurement, affects the material's response, it does not play the same role as in other soft glasses. For stresses below the yield value, the creep curve is divided into three regimes with increasing time: viscoplastic, intermediate steady flow (associated with the first ageing step) and long-time evolving elastic solid. This behaviour reflects the interplay between ageing and shear rejuvenation. The yield behaviour, as investigated with the stress-dependent recoverable strain, indicates a highly nonlinear elastic response intermediate between a low-stress Hookean solid and a high-stress viscoelastic liquid, and exemplifies the distinct characteristics of this class of hairy colloids. It appears that a phenomenological classification of different colloidal glasses based on yielding performance may be possible.

Thin films of the phase change material Ge–Sb with Ge concentrations between 7.3 and 81.1 at. % were deposited by cosputtering from elemental targets. Their crystallization behavior was studied using time-resolved x-ray diffraction, Auger electron spectroscopy, differential scanning calorimetry, x-ray reflectivity, profilometry, optical reflectivity, and resistivity versus temperature measurements. It was found that the crystallization temperature increases with Ge content. Calculations of the glass transition temperature (which is a lower limit for the crystallization temperature Tx) also show an increase with Ge concentration closely tracking the measured values of Tx. For low Ge content samples, Sb x-ray diffraction peaks occurred during a heating ramp at lower temperature than Ge diffraction peaks. The appearance of Ge peaks is related to Ge precipitation and agglomeration. For Ge concentrations of 59.3 at. % and higher, Sb and Ge peaks occurred at the same temperature. Upon crystallization, film mass density and optical reflectivity increase as well as electrical contrast (ratio of resistivity in amorphous phase to crystalline phase) all showed a maximum for the eutectic alloy (14.5 at. % Ge). For the alloy with 59.3 at. % Ge there was very little change in any of these parameters, while the alloy with 81.1 at. % Ge behaved opposite to a typical phase change alloy and showed reduced mass density and reflectivity and increased resistivity.

Family members of persons with advanced dementia may be asked to make complex treatment decisions without having adequate knowledge regarding the risks and benefits. This 6-month, prospective, randomized trial tested the effect of an intervention consisting of a face-to-face, structured conversation about end-of-life care options with family members of nursing home residents with advanced dementia. A comparison group received only social contact via telephone. Structured conversations between a palliative care team and intervention group family members included goals of care and how best to achieve those goals, and provision of psychosocial support. Psychosocial support was also provided via telephone at three 2-month intervals. Family members participated in three telephone interviews: baseline, 3, and 6 months. Specific advance directives for persons with dementia were extracted from medical records. Results showed that intervention families had higher satisfaction with care than comparison families at the 6-month time point, and they were more likely to have decided on medical options listed in residents' advance directives (Do Not Resuscitate, Intubate, Hospitalize) over time. Study findings reinforce the need for increased education and support for families around issues of end-of-life care decisions for advanced dementia.

Low back pain is the most common pain symptom experienced by American adults and is the second most common reason for primary care physician visits. There are many structures in the lumbar spine that can serve as pain generators and often the etiology of low back pain is multifactorial. However, the facet joint has been increasingly recognized as an important cause of low back pain. Facet joint pain can be diagnosed with local anesthetic blocks of the medial branches or of the facet joints themselves. Subsequent radiofrequency lesioning of the medial branches can provide more long-term pain relief. Despite some of the pitfalls associated with facet joint blocks, they have been shown to be valid, safe, and reliable as a diagnostic tool. Medial branch denervation has shown some promise for the sustained control of lumbar facet joint-mediated pain, but at this time, there is insufficient evidence that it is a wholly efficacious treatment option. Developing a universal algorithm for evaluating facet joint-mediated pain and standard procedural techniques may facilitate the performance of larger outcome studies. This review article provides an overview of the anatomy, pathophysiology, diagnosis, and treatment of facet joint-mediated pain.

Studies were initiated in Idaho and New York to determine the effects of Surround, a kaolin clay particle film product recently labeled as a crop protectant for agricultural crops, on fruit maturity and quality of `Fuji' and `Honeycrisp' apples ( Malus × domestica ) and fruit mineral concentration of `Fuji' apples. Surround reduced fruit weight, red color, and the incidence of sunburn of `Fuji' apples in Idaho. Sunburn did not occur on `Honeycrisp' in the New York study. In that study, Surround had no effect on fruit weight or red fruit color when applied in May and June but reduced fruit weight and red color when applied later. The reduction in red color development observed in both `Fuji' and `Honeycrisp' was not related to mineral nutrients or to a delay in fruit maturity. Surround applications resulted in undesirable residues in the basin and in the cavity of harvested fruit that were not satisfactorily removed by brushing on a commercial packing line. While effective for reducing sunburn, Surround was ineffective for increasing red fruit color of apples.

Cancer is a multifactorial disease with contributions from genetic, environmental, and lifestyle factors. Pesticide exposure is recognized as an important environmental risk factor associated with cancer development. The epidemiology of pesticide exposure and cancer in humans has been studied globally in various settings. Insecticides, herbicides, and fungicides are associated with hemopoetic cancers, and cancers of the prostate, pancreas, liver, and other body systems. The involvement of pesticides in breast cancer has not yet been determined. In developing countries, sufficient epidemiologic research and evidence is lacking to link pesticide exposure with cancer development. Agricultural and industrial workers are high-risk groups for developing cancer following pesticide exposure. Children of farm workers can be exposed to pesticides through their parents. Maternal exposure to pesticides can pose a health risk to the fetus and the newborn. The organophosphates are most the commonly used compounds, but the organochlorines are still permitted for limited use in developing countries. Pesticide exposure, independently or in synergism with modifiable risk factors, is associated with several types of cancer.

OBJECTIVES: The aims of this study were to determine the prevalence of hepatitis C virus (HCV) infection and its risk factors, as well as the prevalence of coinfection with HIV and its risk factors, among patients with confirmed HCV infection. METHODS: In a 1-day cross-sectional HCV survey at six Veterans Affairs Medical Centers in the New York City metropolitan area, all 1943 patients undergoing phlebotomy for any reason were asked to be tested for HCV antibody by enzyme immumoassay (EIA). A total of 1098 patients (57%) agreed to HCV testing, 1016 of whom also completed a questionnaire on demographics and HCV risk factors. All HCV EIA(+) samples were confirmed by HCV RNA and HCV recombinant immunoblot assay (RIBA) antibody testing and were also tested for HCV viral load, HCV genotype, and antibodies to HIV in a blinded fashion. RESULTS: The prevalence of confirmed HCV infection was 10.6% (95% CI = 8.7-12.4%), and the prevalence of HCV viremia was 8.2% (95% CI = 6.6-9.8%). The rate of HCV viremia among anti-HCV(+) patients was 77.6%, and HCV genotype 1 was present in 87.5% of viremic patients. Independent risk factors for HCV infection were injection drug use (OR = 35.6, 95% CI = 16.9-75.2), blood exposure during combat (OR = 2.6, 95% CI = 1.2-5.7), alcohol abuse (OR = 2.4; 95% CI = 1.2-4.8), and service in the Vietnam era (OR = 2.1; 95% CI = 1.0-4.5). Coinfection with HIV was present in 24.8% of anti-HCV(+) patients. The only independent risk factor for coinfection was age <50 yr (OR = 3.7, 95% CI = 1.1-12.1). CONCLUSIONS: U.S. veterans who are receiving medical care at VA medical centers in the New York City metropolitan area have a much higher rate of chronic hepatitis C than the general population, with a high frequency of genotype 1. Coinfection with HIV is very common in patients with confirmed HCV infection, and these patients should routinely be offered HIV testing.

BACKGROUND: Owners' perceptions and priorities regarding quality of life (QoL) are important considerations given the unknown efficacy of many commonly administered medications, stress of hospital visits, difficulties providing home care, and personal choices including euthanasia. OBJECTIVE: To describe the relative importance of quality versus quantity of life to owners of cats with heart disease. ANIMALS: Two hundred and thirty-nine cats with heart disease. METHODS: Prospective questionnaire-based clinical study. Cat owners completed a questionnaire to identify important parameters when assessing their cat's QoL, the relative importance of quality versus quantity of life, and willingness to trade survival time for QoL. Variables associated with these parameters were evaluated with multivariate analyses. RESULTS: Appetite, owner interaction, sleep patterns, and litterbox habits were deemed important to QoL. Concern over pet suffering was significantly greater than concern over life expectancy. Ninety-three percent of owners were willing to trade survival time for good QoL; 57% of these were willing to trade up to 6 months. On multivariate analysis, the only factor significantly (P=.002) associated with willingness to trade 6 months was study site. Owner concern regarding stress of administering medications at home increased with number and frequency of medications. CONCLUSIONS AND CLINICAL RELEVANCE: These results indicated that QoL is more important to owners of cats with heart disease than longevity. The various priorities and concerns of cat owners should be taken into account in order to provide optimal care.

AVG was evaluated for its effect on controlling preharvest drop and influencing ripening of `McIntosh' apples in Maine and Massachusetts. AVG consistently and effectively retarded preharvest drop. AVG was superior to NAA and comparable to daminozide in drop control. Dilute or 2× applications were more effective than applications made at lower water volumes. One application of AVG made 4 weeks before anticipated normal harvest was more effective in controlling preharvest drop than split applications of the same amount made earlier or later. In general, AVG delayed ripening as assessed by a retardation in the development of red color, maintenance of flesh firmness, delayed degradation of starch, and a delayed onset of the ethylene climacteric. We conclude that AVG is an effective drop control compound that is also useful as a management tool to extend the harvest window for blocks of `McIntosh' that would otherwise ripen simultaneously. Chemical names used: aminoethoxyvinylglycine (AVG), naphthaleneacetic acid (NAA), succinic acid-2,2-dimethylhydrazide (daminozide, Alar).

Control of bitter pit in `Honeycrisp' apples ( Malus × domestica ) from trees treated during the growing season with foliar sprays of trifloxystrobin fungicide and calcium was evaluated in four replicated trials over 2 years. All trials were in commercial orchards of `Honeycrisp' trees that were 3 to 6 years old. The effectiveness of combining boron with foliar applications of calcium chloride (CaCl 2 ) was evaluated in two trials, and effectiveness of harpin protein, used either alone or in alternating sprays with CaCl 2 was assessed in one trial. Trifloxystrobin applied twice during the 30 days before harvest reduced bitter pit incidence at harvest in one of the four trials, but the reduction was transitory, no longer being evident when fruit were re-evaluated after 63 days of cold storage. Harpin protein did not affect disorder incidence. Calcium sprays failed to control bitter pit in treatments where the total elemental calcium applied was less than 2.7 lb/acre (3.03 kg·ha –1 ) per year for tree canopies that were sprayed to drip using 100 gal/acre (935.4 L·ha –1 ) of spray solution. In the two trials where some treatments involved application of at least 2.9 lb/acre (3.25 kg·ha –1 ) of elemental calcium per season, the incidence of fruit with bitter pit at harvest was reduced by 76% to 90%. Effectiveness of calcium sprays for bitter pit control was not enhanced by superimposing trifloxystrobin, boron, or harpin protein treatments. Flesh firmness at harvest was lower in calcium-treated than in non-treated fruit, and fruit maturity was more advanced on trees receiving boron sprays than on trees receiving no boron. In one trial, where the first calcium application was made approximately 2 weeks after petal fall and 4 days prior to a fruit thinning spray, crop load of trees that received calcium sprays, measured as number of fruit per cm 2 trunk cross-sectional area, was 38% greater than on trees that received no calcium sprays. CaCl 2 provided better control of bitter pit in `Honeycrisp' than any of the other materials tested.

Client-owned pet dogs represent exceptional translational models for advancement of cancer research because they reflect the complex heterogeneity observed in human cancer. We have recently shown that a genetic vaccine targeting dog telomerase reverse transcriptase (dTERT) and based on adenovirus DNA electro-gene-transfer (Ad/DNA-EGT) technology can induce strong cell-mediated immune responses against this tumor antigen and increase overall survival of dogs affected by B-cell lymphosarcoma (LSA) in comparison with historical controls when combined with a cyclophosphamide, vincristine, and prednisone (COP) chemotherapy regimen. Here, we have conducted a double-arm clinical trial with an extended number of LSA patients, measured the antigen-specific immune response, and evaluated potential toxic effects of the immunotherapy along with a follow-up of patients survival for 3.5 years. The immune response was measured by enzyme-linked immunospot assay. The expression of dTERT was quantified by quantitative polymerase chain reaction. Changes in hematological parameters, local/systemic toxicity or organic dysfunction and fever were monitored over time during the treatment. dTERT-specific cell-mediated immune responses were induced in almost all treated animals. No adverse effects were observed in any dog patient that underwent treatment. The overall survival time of vaccine/COP-treated dogs was significantly increased over the COP-only cohort (>76.1 vs. 29.3 weeks, respectively, p<0.0001). There was a significant association between dTERT expression levels in LSA cells and overall survival among vaccinated patients. In conclusion, Ad/DNA-EGT-based cancer vaccine against dTERT in combination with COP chemotherapy is safe and significantly prolongs the survival of LSA canine patients. These data confirm the therapeutic efficacy of dTERT vaccine and support the evaluation of this approach for other cancer types as well as the translation of this approach to human clinical trials.

We present evidence for the instability in the crystalline (metallic) state of binary Te-free phase-change Ge–Sb thin films considered for integration into nonvolatile nanosized memory cells. We find that while the amorphous (semiconducting) phase of eutectic Sb–15at.% Ge is very robust until Sb crystallization at 240°C, at about 350°C, germanium rapidly precipitates out. Ge precipitation, visualized directly with transmission electron microscopy, is exothermic and is found to affect the films’ reflectivity, resistance, and stress. It converts melting into a two-step process, which may seriously impact the switching reliability of a device.

Abstract In 3 ‘McIntosh’ apple ( Malus domestica Borkh.) orchards, yield was positively related to fruit numbers, but negatively related to fruit size. Increases in fruit size from thinning were proportionately less than decreases in fruit numbers. Fruit thinning increased the percentage of larger fruits, but reductions in yield were such that the actual number of large fruits was either unchanged or reduced.

We consider a six-port triangular arrangement of beam splitters designed to couple three electromagnetic fields through U(3) unitary transformations. We present conditions for Hong-Ou-Mandel destructive interference of output triple coincidences when single photons are presented, one at each of the three input ports. Unlike the corresponding four-port effect, three-photon Hong-Ou-Mandel interference is sensitive to mixer phases and input-output port reversal.

Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter Facebook Reddit LinkedIn Tools Icon Tools Reprints and Permissions Cite Icon Cite Search Site Citation Brian M. Erwin, Simon A. Rogers, Michel Cloitre, Dimitris Vlassopoulos; Examining the validity of strain-rate frequency superposition when measuring the linear viscoelastic properties of soft materials. J. Rheol. 1 March 2010; 54 (2): 187–195. https://doi.org/10.1122/1.3301247 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentThe Society of RheologyJournal of Rheology Search Advanced Search |Citation Search

BACKGROUND: The primary objective of this pilot study is to understand the relationship between physicians' characteristics and physicians' management decisions about pain. The secondary aim is to understand how patient characteristics, including race/ethnicity and socioeconomic status (SES) may affect these treatment decisions in chronic low back pain. METHODS: We conducted a double-blinded randomized controlled study using a survey instrument. Ninety physicians were randomly allocated one of two scenarios of a patient with chronic low back and lower extremity pain. In one version, the patient is a Caucasian male with Blue Cross health insurance. In the other version, the patient is an African American male with Medicaid. All other aspects of the survey scenarios are identical. The physicians were subsequently presented with questionnaires about their treatment plans. We analyzed the physician demographic variables in addition to patient ethnicity and SES to differentiate which variables affected treatment preferences. RESULTS: Based on bivariate analysis, physician specialty, gender, ethnicity, and professional status significantly affected treatment plans, including analgesic prescription and referrals for invasive therapy. Patient ethnicity/SES trended toward significance for the prescription of opioids. CONCLUSION: Our study is the first randomized controlled study assessing patient and treatment variables in the management of chronic pain. It suggests that physicians' demographic variables and perhaps patient demographic variables influence pain management decisions.

OBJECTIVES: To obtain preliminary estimates of the acceptance rate and the frequency of adverse outcomes, and to identify issues related to acceptance, associated with management of asymptomatic pediatric coin ingestion by home observation, in preparation for a large-scale prospective study. METHODS: Scripted telephone follow-up of callers who had reported asymptomatic pediatric coin ingestions to one of five poison control centers six to 36 months previously, which had been managed by home observation. RESULTS: Of the 67 callers enrolled, 41 (67%) reported contacting a physician regarding the coin ingestion, despite home observation instruction by poison control center personnel. Those who did not recall being instructed in home observation were more likely to have contacted a physician than those who did. Nearly all, however, were satisfied with the advice they had been given. One child developed subsequent symptoms; as per the instructions that had been given by poison control center personnel, his parent sought physician evaluation, revealing an esophageal coin, which was removed uneventfully. No other child developed complications. CONCLUSIONS: Although all of the 67 children managed by home observation did well, most of their caretakers had not accepted this management strategy. Acceptance, while unrelated to satisfaction, may be related to comprehension of the instructions caregivers are given. A prospective study of home observation for asymptomatic pediatric coin ingestion would be safe and would allow further examination of factors affecting acceptance.