Science.gov

Sample records for myeloablative megatherapy procedures

  1. Impact of TBI on late effects in children treated by megatherapy for Stage IV neuroblastoma. A study of the French Society of Pediatric oncology

    SciTech Connect

    Flandin, Isabelle; Michon, Jean; Pinkerton, Ross; Coze, Carole; Stephan, Jean Louis; Fourquet, Bernard; Valteau-Couanet, Dominique; Bergeron, Christophe; Philip, Thierry; Carrie, Christian . E-mail: carrie@lyon.fnclcc.fr

    2006-04-01

    Purpose: To determine the contribution of total body irradiation (TBI) to late sequelae in children treated with high-dose chemotherapy and autologous bone marrow transplantation for Stage IV neuroblastoma. Patients and Methods: We compared two populations that were similar with regard to age, stage, pre-autologous bone marrow transplantation chemotherapy (CT) regimen, period of treatment, and follow-up (12 years). The TBI group (n = 32) received TBI as part of the megatherapy procedure (1982-1993), whereas the CT group (n 30) received conditioning without TBI (1985-1992). Analysis 12 years later focused on growth, weight and corpulence (body mass index) delay; hormonal deficiencies; liver, kidney, heart, ear, eye, and dental sequelae; school performance; and the incidence of secondary tumors. Results: Impact of TBI was most marked in relation to growth and weight delay, although the mean delay was not severe, probably because of treatment with growth hormones. Other consequences of TBI were thyroid insufficiency, cataracts, and a high incidence of secondary tumors. Hearing loss and dental agenesis were more prominent in the group treated with CT alone. No differences were observed in school performance. Conclusion: The most frequent side effects of TBI were cataracts, thyroid insufficiency, and growth delay, but more worrying is the risk of secondary tumors. Because of the young mean age of patients and the toxicity of TBI regimens without any survival advantage, regimens without TBI are preferable in the management of Stage IV neuroblastoma.

  2. Myeloablative chemotherapy for recurrent aggressive oligodendroglioma.

    PubMed Central

    Cairncross, G.; Swinnen, L.; Bayer, R.; Rosenfeld, S.; Salzman, D.; Paleologos, N.; Kaminer, L.; Forsyth, P.; Stewart, D.; Peterson, K.; Hu, W.; Macdonald, D.; Ramsay, D.; Smith, A.

    2000-01-01

    The objective of this study was to ascertain the duration of tumor control and the toxicities of dose-intense myeloablative chemotherapy for patients with recurrent oligodendrogliomas. Patients with previously irradiated oligodendrogliomas, either pure or mixed, that were contrast enhancing, measurable, and behaving aggressively at recurrence were eligible for this study. Only complete responders or major partial responders (75 % reduction in tumor size) to induction chemotherapy--either intensive-dose procarbazine, lomustine, and vincristine or cisplatin plus etoposide-could receive high-dose thiotepa (300 mg/m2/day for 3 days) followed by hematopoietic reconstitution using either bone marrow or peripheral blood stem cells. Thirty-eight patients began induction chemotherapy and 20 (10 men, 10 women; median age 46 years; median Karnofsky score 80) received high-dose thiotepa. For the high-dose group, the median event-free, progression-free, and overall survival times from recurrence were 17, 20, and 49 months, respectively. Tumor control in excess of 2 years was observed in 6 patients (30%). Four patients (20%) are alive and tumor free 27 to 77 months (median, 42 months) from the start of induction therapy; however, fatal treatment-related toxicities also occurred in 4 patients (20%). Three patients died as a result of a progressive encephalopathy which, in 2 instances, was accompanied by a wasting syndrome; 1 patient died as a consequence of an intracerebral (intratumoral) hemorrhage. Fatal toxicities occurred in patients with pretreatment Karnofsky scores of 60 or 70. High-dose thiotepa to consolidate response was a disappointing treatment strategy for patients with recurrent aggressive oligodendroglial neoplasms, although several patients had durable responses. Moreover, as prescribed, high-dose thiotepa had significant toxic effects in previously irradiated patients, especially those with poorer performance status. PMID:11303620

  3. Non-myeloablative bone marrow transplantation.

    PubMed

    Ruiz-Argüelles, Guillermo J

    2003-01-01

    As a result of the evolution of knowledge in the area of allogeneic hematopoietic stem cells (HSC) transplantation, several dogmata have been broken. We now have the following information: a) successful engraftment if allogeneic HSC bone marrow ablation of the recipient is not required; b) HSC create their own space through graft-vs.-host reactions; c) several malignancies are eradicated by the graft-vs.-tumor effect; d) allografting can be conducted on an out-patient basis; e) allografting can be done in aged or debilitated individuals; f) allografting can be achieved without transfusion of blood products, and g) costs of the allografting procedures can be substantially diminished. Breaking all these dogmata has resulted in availability of HSC allografting to a larger number of individuals, thus offering true curative therapeutic options to patients who otherwise would not qualify to receive these opportunities.

  4. Human herpes virus 6 reactivation: important predictor for poor outcome after myeloablative, but not non-myeloablative allo-SCT.

    PubMed

    de Pagter, P J A; Schuurman, R; Keukens, L; Schutten, M; Cornelissen, J J; van Baarle, D; Fries, E; Sanders, E A M; Minnema, M C; van der Holt, B R; Meijer, E; Boelens, J J

    2013-11-01

    Hematopoietic SCT (HSCT) is often complicated by viral reactivations. In this retrospective cohort study (January 2004-August 2008), predictors for human herpes virus 6 (HHV6)-reactivation and associations between HHV6-reactivation and clinical outcomes after allogeneic HSCT were studied. HHV6 DNA load in plasma was monitored weekly by quantitative real-time PCR. Associations between the main end point HHV6-reactivation and other end points, that is, acute GVHD (aGVHD) and NRM were analyzed using Cox proportional hazard models. In total, 108 patients receiving either a myeloablative (MA; n=60) or non-myeloablative (NMA; n=48) conditioning regimen were included. Median age was 40 years (range 17-65); median follow-up was 20 months (range 3-36). In 16/60 (27%) patients with MA conditioning regimen, a HHV6 reactivation was observed (mean viral load 50 323 cp/mL) compared with 2/48 (4%) patients with a NMA conditioning regimen with low viral load (mean 1100 cp/mL). In multivariate analysis, MA conditioning was the only predictor for HHV6 reactivation (P=0.02). In addition, HHV6 reactivation was associated with grades 2-4 aGVHD (P<0.001) and NRM (P=0.03). Regular monitoring of HHV6 reactivation after HSCT might be important in MA HSCT patients to enable early initiation of antiviral treatment or to anticipate aGVHD, all of which may improve clinical outcome.

  5. Hematopoietic stem cell allografts using a non-myeloablative conditioning regimen can be safely performed on an outpatient basis: report of four cases.

    PubMed

    Gómez-Almaguer, D; Ruiz-Argüelles, G J; Ruiz-Argüelles, A; González-Llano, O; Cantú, O E; Hernández, N E

    2000-01-01

    Using a non-myeloablative, immunosuppressive, fludarabine-based conditioning regimen, we performed allogeneic peripheral blood stem cell transplants totally on an outpatient basis in four patients (two with chronic myelogenous leukemia, one with acute myelogenous leukemia and one with thalassemia major). The median granulocyte recovery time to 0.5 x 109/l was 10 days and the lowest absolute neutrophil count was 0.064 x 109/l; only one patient developed thrombocytopenia below 20 x 109/l. No patient required red blood cell transfusions and one was given a single prophylactic platelet transfusion. All patients are alive at 210-390 (median 285) days and have definite evidence of chimerism; one developed biopsy-proven GVHD on day 50, with a limited cutaneous rash. The procedure is less costly than its counterpart using myeloablative conditioning regimens and may represent another approach in the management of patients requiring an allogeneic stem cell transplant. Bone Marrow Transplantation (2000) 25, 131-133.

  6. Comparison of Non-myeloablative Conditioning Regimens for Lymphoproliferative Disorders

    PubMed Central

    Hong, Sanghee; Le-Rademacher, Jennifer; Artz, Andrew; McCarthy, Philip L.; Logan, Brent R.; Pasquini, Marcelo C.

    2014-01-01

    Hematopoietic cell transplantation (HCT) with non-myeloablative conditioning (NMA) for lymphoproliferative diseases (LD) includes fludarabine with and without low-dose total body irradiation (TBI). Transplant outcomes were compared among patients ≥40 years with LD who received a HCT with TBI (N=382) and no-TBI (N=515) NMA from 2001 to 2011. The groups were comparable except for donor, graft, prophylaxis for graft-versus-host disease (GVHD), disease status and year of HCT. Cumulative incidences of grades II–IV GVHD at 100 days, were 29% and 20% (p=0.001), and chronic GVHD at 1 year were 54% and 44% (p=0.004) for TBI and no-TBI, respectively. Multivariate analysis of progression/relapse, treatment failure and mortality showed no outcome differences by conditioning. Full donor chimerism at day 100 was observed in 82% vs. 64% in the TBI and no-TBI groups, respectively (p=0.006). Subset of four most common conditioning/ GVHD prophylaxis combinations demonstrated higher rates of grades II–IV acute (p<0.001) and chronic GVHD (p<0.001) among recipients of TBI-mycophenolate mofetil (MMF) compared to other combinations. TBI-based NMA conditioning induces faster full donor chimerism but overall survival outcomes are comparable to no-TBI regimens. Combination of TBI and MMF are associated with higher rates of GVHD without impact on survival outcomes in patients with LD. PMID:25437248

  7. A Review of Myeloablative vs Reduced Intensity/Non-Myeloablative Regimens in Allogeneic Hematopoietic Stem Cell Transplantations

    PubMed Central

    Atilla, Erden; Ataca Atilla, Pınar; Demirer, Taner

    2017-01-01

    Allogeneic hematopoietic stem cell transplantation (Allo-HSCT) is a curative treatment option for both malignant and some benign hematological diseases. During the last decade, many of the newer high-dose regimens in different intensity have been developed specifically for patients with hematologic malignancies and solid tumors. Today there are three main approaches used prior to allogeneic transplantation: Myeloablative (MA), Reduced Intensity Conditioning (RIC) and Non-MA (NMA) regimens. MA regimens cause irreversible cytopenia and there is a requirement for stem cell support. Patients who receive NMA regimen have minimal cytopenia and this type of regimen can be given without stem cell support. RIC regimens do not fit the criteria of MA and NMA: the cytopenia is reversible and the stem cell support is necessary. NMA/RIC for Allo-HSCT has opened a new era for treating elderly patients and those with comorbidities. The RIC conditioning was used for 40% of all Allo-HSCT and this trend continue to increase. In this paper, we will review these regimens in the setting of especially allogeneic HSCT and our aim is to describe the history, features and impact of these conditioning regimens on specific diseases. PMID:28251017

  8. Allogeneic stem cell transplantation using non-myeloablative conditioning regimens: results of the Mexican approach.

    PubMed

    Ruiz-Argüelles, Guillermo J

    2002-08-01

    We have used a novel method to conduct non-myeloablative stem cell transplantation (NST), making the following changes in previous methods: Use of the cheapest conditioning drugs, tailored number of apheresis sessions in the donors, elimination of ganciclovir and IgG, outpatient conduction when possible, diminished number of transfusions of blood products and diminished number of donor lymphocyte infusions. With this method, we have prospectively conducted 70 allografts in patients with different diseases: Chronic myelogenous leukemia, acute myelogenous leukemia, acute lymphoblastic leukemia, myelodysplasia, thalassemia major, relapsed Hodgkins disease, Blackfan-Diamond syndrome and aplastic anemia. In them, the median granulocyte recovery time to 0.5 x 10(9)/L was 11 d, whereas the median platelet recovery time to 20 x 10(9)/L was 12 d. Twenty patients did not need red blood cell transfusions and 17 did not need platelet transfusions. In 55 individuals (78%), the procedure could be completed fully on an outpatient basis. Follow-up times range between 30 and 800 d.: Four patients failed to engraft and recovered endogenous hemopoiesis; 16 patients (23%) developed acute graft versus-host disease (GVHD) whereas 28 (49%) developed chronic GVHD. Thirty two patients (47%) have died: 21 with a relapsing disease and seven as a result of GVHD; the median post-trasplant survival (SV) was 420 d., whereas the 12-mo. SV was 42%. The 100-day mortality was 3.8% and the transplant-related mortality was 14.2%. The median cost of the allografts was 18,000.00 US dollars. This method could be particularly adequate in developing countries, where very few individuals can afford the cost of a conventional bone marrow transplantation procedure.

  9. Severe Pulmonary Toxicity After Myeloablative Conditioning Using Total Body Irradiation: An Assessment of Risk Factors

    SciTech Connect

    Kelsey, Chris R.; Horwitz, Mitchell E.; Chino, Junzo P.; Craciunescu, Oana; Steffey, Beverly; Folz, Rodney J.; Chao, Nelson J.; Rizzieri, David A.; Marks, Lawrence B.

    2011-11-01

    Purpose: To assess factors associated with severe pulmonary toxicity after myeloablative conditioning using total body irradiation (TBI) followed by allogeneic stem cell transplantation. Methods and Materials: A total of 101 adult patients who underwent TBI-based myeloablative conditioning for hematologic malignancies at Duke University between 1998 and 2008 were reviewed. TBI was combined with high-dose cyclophosphamide, melphalan, fludarabine, or etoposide, depending on the underlying disease. Acute pulmonary toxicity, occurring within 90 days of transplantation, was scored using Common Terminology Criteria for Adverse Events version 3.0. Actuarial overall survival and the cumulative incidence of acute pulmonary toxicity were calculated via the Kaplan-Meier method and compared using a log-rank test. A binary logistic regression analysis was performed to assess factors independently associated with acute severe pulmonary toxicity. Results: The 90-day actuarial risk of developing severe (Grade 3-5) pulmonary toxicity was 33%. Actuarial survival at 90 days was 49% in patients with severe pulmonary toxicity vs. 94% in patients without (p < 0.001). On multivariate analysis, the number of prior chemotherapy regimens was the only factor independently associated with development of severe pulmonary toxicity (odds ratio, 2.7 per regimen). Conclusions: Severe acute pulmonary toxicity is prevalent after TBI-based myeloablative conditioning regimens, occurring in approximately 33% of patients. The number of prior chemotherapy regimens appears to be an important risk factor.

  10. Decreased transfusion requirements in patients given stem cell allografts using a non-myeloablative conditioning regimen: a single institution experience.

    PubMed

    Ruiz-Argüelles, Guillermo J; López-Martínez, Briceida; Gómez-Rangel, David; Estrada, Erick; Marín-López, Antonio; Bravo-Hernández, Gerardo; Manuel Hernández, Juan

    2003-06-01

    We report our experience of allogeneic peripheral blood stem cell transplantation using non-myeloablative conditioning regimens delivered and supported on an outpatient basis. A group of 44 patients underwent 47 allograft procedures using peripheral blood stem cells. Approximately one third of the individuals did not require red blood cells transfusions: the median of transfused red blood cells units was 1 (range 0-10). In addition one out of three did not require platelet transfusions either, the median of platelet transfusions being 1 (range 0-6). In fourteen allografts (30%) neither red blood cells nor platelet transfusions were used. An inverse correlation was found between the number of CD34 cells infused and the PRBC and PLT transfusion requirements, those patients receiving high numbers of CD34 cells needing fewer transfusions of both PRBC and platelets. The possibility of conducting allografts without transfusion of blood products in some patients may result in a decrease in both cost and the risks stemming from exposure to human blood derivatives.

  11. Consolidation treatment for high risk solid tumors in children with myeloablative chemotherapy and autologous hematopoietic progenitor stem cell transplantation

    PubMed Central

    Vargas, Alberto Olaya; Luna, Roberto Rivera; Garcia, Martin Perez; Cardos, Rocio Cárdenas; Hidalgo, Liliana Velasco; Jácome, Doris LordMéndez; Gutiérrez, Mariana Campos

    2013-01-01

    Background In childhood cancer, consolidation treatment with chemotherapy followed by autologous hematopoietic progenitor stem cell transplantation is currently an accepted treatment modality in patients with high-risk solid tumors or in patients who have relapsed after conventional treatment. Objectives The objective of this study was to describe the results of transplantation of a group of children who had high-risk solid tumors or relapsed after conventional chemotherapy regimens. Methods A retrospective analysis was conducted from January 1998 to October 2004 of all children with pathologic diagnoses of high-risk solid tumors or children that had previously relapsed after conventional chemotherapy and that were subsequently submitted to autologous hematopoietic progenitor stem cell transplantation. The analysis included overall survival rates, event-free survival rates, mortality rates and chemotherapy complications. Results Nineteen patients were submitted to this approach. The age range was from 27 to 196 months with a median age of 52 months. The overall survival rate at 100 days was observed in 79%, the three-year event-free survival rate was 63%. The mortality rate secondary to the myeloablative chemotherapy regimen was 21% (n = 4). Only three patients (15.8%) relapsed with tumor progression after transplant. Conclusion Autologous hematopoietic progenitor stem cell transplantation is still a successful procedure in patients with solid tumors refractory to conventional chemotherapy. PMID:24255618

  12. Non-myeloablative autologous haematopoietic stem cell transplantation expands regulatory cells and depletes IL-17 producing mucosal-associated invariant T cells in multiple sclerosis.

    PubMed

    Abrahamsson, Sofia V; Angelini, Daniela F; Dubinsky, Amy N; Morel, Esther; Oh, Unsong; Jones, Joanne L; Carassiti, Daniele; Reynolds, Richard; Salvetti, Marco; Calabresi, Peter A; Coles, Alasdair J; Battistini, Luca; Martin, Roland; Burt, Richard K; Muraro, Paolo A

    2013-09-01

    Autologous haematopoietic stem cell transplantation has been tried as one experimental strategy for the treatment of patients with aggressive multiple sclerosis refractory to other immunotherapies. The procedure is aimed at ablating and repopulating the immune repertoire by sequentially mobilizing and harvesting haematopoietic stem cells, administering an immunosuppressive conditioning regimen, and re-infusing the autologous haematopoietic cell product. 'Non-myeloablative' conditioning regimens to achieve lymphocytic ablation without marrow suppression have been proposed to improve safety and tolerability. One trial with non-myeloablative autologous haematopoietic stem cell transplantation reported clinical improvement and inflammatory stabilization in treated patients with highly active multiple sclerosis. The aim of the present study was to understand the changes in the reconstituted immune repertoire bearing potential relevance to its mode of action. Peripheral blood was obtained from 12 patients with multiple sclerosis participating in the aforementioned trial and longitudinally followed for 2 years. We examined the phenotype and function of peripheral blood lymphocytes by cell surface or intracellular staining and multi-colour fluorescence activated cell sorting alone or in combination with proliferation assays. During immune reconstitution post-transplantation we observed significant though transient increases in the proportion of CD4+ FoxP3+ T cells and CD56(high) natural killer cell subsets, which are cell subsets associated with immunoregulatory function. CD8+ CD57+ cytotoxic T cells were persistently increased after therapy and were able to suppress CD4+ T cell proliferation with variable potency. In contrast, a CD161(high) proinflammatory CD8+ T cell subset was depleted at all time-points post-transplantation. Phenotypic characterization revealed that the CD161(high)CD8+ T cells were mucosal-associated invariant T cells, a novel cell population

  13. Pilot experience with opebacan/rBPI 21 in myeloablative hematopoietic cell transplantation

    PubMed Central

    Guinan, Eva; Avigan, David E; Soiffer, Robert J; Bunin, Nancy J; Brennan, Lisa L; Bergelson, Ilana; Brightman, Spencer; Ozonoff, Al; Scannon, Patrick J; Levy, Ofer

    2015-01-01

    Bacterial infection and inflammation contribute significantly to the morbidity and mortality of myeloablative allogeneic hematopoietic cell transplantation (HCT). Endotoxin, a component of the outer membrane of Gram-negative bacteria, is a potent inflammatory stimulus in humans. Bactericidal/permeability increasing protein (BPI), a constituent of human neutrophil granules, binds endotoxin thereby precluding endotoxin-induced inflammation and also has direct anti-infective properties against bacteria. As a consequence of myeloablative therapy used in preparation for hematopoietic cell infusion, patients experience gastrointestinal leak of bacteria and bacterial toxins into the systemic circulation and a period of inflammatory cytokine elevation associated with subsequent regimen-related toxicities.  Patients frequently become endotoxemic and febrile as well as BPI-deficient due to sustained neutropenia. To examine whether enhancing endotoxin-neutralizing and anti-infective activity by exogenous administration of a recombinant N-terminal fragment of BPI (rBPI 21, generic name opebacan) might ameliorate regimen-related toxicities including infection, we recruited patients scheduled to undergo myeloablative HCT to participate in a proof-of-concept prospective phase I/II trial. After the HCT preparative regimen was completed, opebacan was initiated 18-36 hours prior to administration of allogeneic hematopoietic stem cells (defined as Day 0) and continued for 72 hours. The trial was to have included escalation of rBPI 21 dose and duration but was stopped prematurely due to lack of further drug availability.  Therefore, to better understand the clinical course of opebacan-treated patients (n=6), we compared their outcomes with a comparable cohort meeting the same eligibility criteria and enrolled in a non-interventional myeloablative HCT observational study (n = 35).  Opebacan-treated participants had earlier platelet engraftment (p=0.005), mirroring beneficial effects

  14. Tolerance induction in experimental autoimmune encephalomyelitis using non-myeloablative hematopoietic gene therapy with autoantigen.

    PubMed

    Eixarch, Herena; Espejo, Carmen; Gómez, Alba; Mansilla, María José; Castillo, Mireia; Mildner, Alexander; Vidal, Francisco; Gimeno, Ramón; Prinz, Marco; Montalban, Xavier; Barquinero, Jordi

    2009-05-01

    Experimental autoimmune encephalomyelitis (EAE) constitutes a paradigm of antigen (Ag)-specific T cell driven autoimmune diseases. In this study, we transferred bone marrow cells (BMCs) expressing an autoantigen (autoAg), the peptide 40-55 of the myelin oligodendrocytic glycoprotein (MOG(40-55)), to induce preventive and therapeutic immune tolerance in a murine EAE model. Transfer of BMC expressing MOG(40-55) (IiMOG-BMC) into partially myeloablated mice resulted in molecular chimerism and in robust protection from the experimental disease. In addition, in mice with established EAE, transfer of transduced BMC with or without partial myeloablation reduced the clinical and histopathological severity of the disease. In these experiments, improvement was observed even in the absence of engraftment of the transduced hematopoietic cells, probably rejected due to the previous immunization with the autoAg. Splenocytes from mice transplanted with IiMOG-BMC produced significantly higher amounts of interleukin (IL)-5 and IL-10 upon autoAg challenge than those of control animals, suggesting the participation of regulatory cells. Altogether, these results suggest that different tolerogenic mechanisms may be mediating the preventive and the therapeutic effects. In conclusion, this study demonstrates that a cell therapy using BMC expressing an autoAg can induce Ag-specific tolerance and ameliorate established EAE even in a nonmyeloablative setting.

  15. Tolerance Induction in Experimental Autoimmune Encephalomyelitis Using Non-myeloablative Hematopoietic Gene Therapy With Autoantigen

    PubMed Central

    Eixarch, Herena; Espejo, Carmen; Gómez, Alba; Mansilla, María José; Castillo, Mireia; Mildner, Alexander; Vidal, Francisco; Gimeno, Ramón; Prinz, Marco; Montalban, Xavier; Barquinero, Jordi

    2009-01-01

    Experimental autoimmune encephalomyelitis (EAE) constitutes a paradigm of antigen (Ag)-specific T cell driven autoimmune diseases. In this study, we transferred bone marrow cells (BMCs) expressing an autoantigen (autoAg), the peptide 40–55 of the myelin oligodendrocytic glycoprotein (MOG40–55), to induce preventive and therapeutic immune tolerance in a murine EAE model. Transfer of BMC expressing MOG40–55 (IiMOG-BMC) into partially myeloablated mice resulted in molecular chimerism and in robust protection from the experimental disease. In addition, in mice with established EAE, transfer of transduced BMC with or without partial myeloablation reduced the clinical and histopathological severity of the disease. In these experiments, improvement was observed even in the absence of engraftment of the transduced hematopoietic cells, probably rejected due to the previous immunization with the autoAg. Splenocytes from mice transplanted with IiMOG-BMC produced significantly higher amounts of interleukin (IL)-5 and IL-10 upon autoAg challenge than those of control animals, suggesting the participation of regulatory cells. Altogether, these results suggest that different tolerogenic mechanisms may be mediating the preventive and the therapeutic effects. In conclusion, this study demonstrates that a cell therapy using BMC expressing an autoAg can induce Ag-specific tolerance and ameliorate established EAE even in a nonmyeloablative setting. PMID:19277013

  16. Survival improvements in adolescents and young adults after myeloablative allogeneic transplantation for acute lymphoblastic leukemia.

    PubMed

    Wood, William A; Lee, Stephanie J; Brazauskas, Ruta; Wang, Zhiwei; Aljurf, Mahmoud D; Ballen, Karen K; Buchbinder, David K; Dehn, Jason; Freytes, Cesar O; Lazarus, Hillard M; Lemaistre, Charles F; Mehta, Paulette; Szwajcer, David; Joffe, Steven; Majhail, Navneet S

    2014-06-01

    Adolescents and young adults (AYAs, ages 15 to 40 years) with cancer have not experienced survival improvements to the same extent as younger and older patients. We compared changes in survival after myeloablative allogeneic hematopoietic cell transplantation (HCT) for acute lymphoblastic leukemia (ALL) among children (n = 981), AYAs (n = 1218), and older adults (n = 469) who underwent transplantation over 3 time periods: 1990 to 1995, 1996 to 2001, and 2002 to 2007. Five-year survival varied inversely with age group. Survival improved over time in AYAs and paralleled that seen in children; however, overall survival did not change over time for older adults. Survival improvements were primarily related to lower rates of early treatment-related mortality in the most recent era. For all cohorts, relapse rates did not change over time. A subset of 222 AYAs between the ages of 15 and 25 at 46 pediatric or 49 adult centers were also analyzed to describe differences by center type. In this subgroup, there were differences in transplantation practices among pediatric and adult centers, although HCT outcomes did not differ by center type. Survival for AYAs undergoing myeloablative allogeneic HCT for ALL improved at a similar rate as survival for children.

  17. Long-term results of related myeloablative stem-cell transplantation to cure sickle cell disease.

    PubMed

    Bernaudin, Françoise; Socie, Gérard; Kuentz, Mathieu; Chevret, Sylvie; Duval, Michel; Bertrand, Yves; Vannier, Jean-Pierre; Yakouben, Karima; Thuret, Isabelle; Bordigoni, Pierre; Fischer, Alain; Lutz, Patrick; Stephan, Jean-Louis; Dhedin, Nathalie; Plouvier, Emmanuel; Margueritte, Geneviève; Bories, Dominique; Verlhac, Suzanne; Esperou, Hélène; Coic, Lena; Vernant, Jean-Paul; Gluckman, Eliane

    2007-10-01

    Allogeneic hematopoietic stem-cell transplantation (HSCT) is the only curative treatment for sickle cell disease (SCD); nevertheless, its use has been limited by the risk of transplantation-related mortality (TRM). Between November 1988 and December 2004, 87 consecutive patients with severe SCD ranging from 2 to 22 years of age received transplants in France. Cerebral vasculopathy was the principal indication for transplantation (55 patients). All the patients received grafts from a sibling donor after a myeloablative conditioning regimen (CR). The only change in the CR during the study period was the introduction of antithymocyte globulin (ATG) in March 1992. The rejection rate was 22.6% before the use of ATG but 3% thereafter. With a median follow-up of 6 years (range, 2.0 to 17.9 years), the overall and event-free survival (EFS) rates were 93.1% and 86.1%, respectively. Graft versus host disease (GVHD) was the main cause of TRM. Importantly, cord blood transplant recipients did not develop GVHD. No new ischemic lesions were detected after engraftment, and cerebral velocities were significantly reduced. The outcome improved significantly with time: the EFS rate among the 44 patients receiving transplants after January 2000 was 95.3%. These results indicate that HLA-identical sibling HSCT after myeloablative conditioning with ATG should be considered as a standard of care for SCD children who are at high risk for stroke.

  18. Myeloablative therapy against high risk Ewing's sarcoma: A single institution experience and literature review

    PubMed Central

    Lopez, Jose Luis; Pérez, Concepcion; Marquez, Catalina; Cabrera, Patricia; Perez, Jose Maria; Ramirez, Gema Lucia; Ordoñez, Rafael; Praena-Fernandez, Juan Manuel; Ortiz, Maria Jose

    2011-01-01

    Background Attempts to improve survival outcomes of patients with high risk Ewing's sarcoma (ES) have focused on chemotherapy dose intensification strategies. Aim The objective of this study is to retrospectively evaluate clinical characteristics and outcome of pediatric patients with high risk ES treated at a single institution. Materials and methods From 1995 to 2008, seventeen patients (male:female, 14:3) were treated with dose-intensive therapy in our institution. Median age at diagnosis was 10 years (range: 2–15). Seven patients had metastases at diagnosis (lung in 6 cases and bone in one case). Eleven patients presented with unresectable disease. Fifteen (88.2%) received the Spanish Society of Pediatric Oncology protocol which includes six cycles of vincristine, doxorubicin, ifosfamide and etoposide. Two out of the six cases that were resectable received postoperative radiation. In addition, eleven patients received definitive radiation therapy. Finally, twelve (70.5%) out of 17 patients received myeloablative therapy with melphalan/etoposide. The rest of patients (N = 5) received busulfan/melphalan. Results Median follow-up was 78 months (range: 15–155 months). Initial responses were complete in all patients, but 9 of them developed progression disease. Seven patients became long-term event-free survivors. No patient died of toxicity after transplantation. The 2- and 5-year overall survival rates for all patients were 93% and 73%, respectively. Event-free survival rates were 74% and 54% at 2 and 5 years, respectively. Conclusion This single-institution experience suggests that myeloablative therapy against high risk ES is effective and safe. PMID:24376974

  19. Chemoselection of Allogeneic HSC After Murine Neonatal Transplantation Without Myeloablation or Post-transplant Immunosuppression

    PubMed Central

    Falahati, Rustom; Zhang, Jianqing; Flebbe-Rehwaldt, Linda; Shi, Yimin; Gerson, Stanton L; Gaensler, Karin ML

    2012-01-01

    The feasibility of allogeneic transplantation, without myeloablation or post-transplant immunosuppression, was tested using in vivo chemoselection of allogeneic hematopoietic stem cells (HSCs) after transduction with a novel tricistronic lentiviral vector (MGMTP140K-2A-GFP-IRES-TK (MAGIT)). This vector contains P140K-O6-methylguanine-methyltransferase (MGMTP140K), HSV-thymidine kinase (TKHSV), and enhanced green fluorescent protein (eGFP) enabling (i) in vivo chemoselection of HSC by conferring resistance to benzylguanine (BG), an inhibitor of endogenous MGMT, and to chloroethylating agents such as 1,3-bis(2-chloroethyl)nitrosourea (BCNU) and, (ii) depletion of proliferating cells such as malignant clones or transduced donor T cells mediating graft versus host disease (GVHD), by expression of the suicide gene TKHSV and Ganciclovir (GCV) administration. Non-myeloablative transplantation of transduced, syngeneic, lineage-depleted (Lin−) BM in neonates resulted in 0.67% GFP+ mononuclear cells in peripheral blood. BG/BCNU chemoselection, 4 and 8 weeks post-transplant, produced 50-fold donor cell enrichment. Transplantation and chemoselection of major histocompatibility complex (MHC)-mismatched MAGIT-transduced Lin− BM also produced similar expansion for >40 weeks. The efficacy of this allotransplant approach was validated in Hbbth3 heterozygous mice by correction of β-thalassemia intermedia, without toxicity or GVHD. Negative selection, by administration of GCV resulted in donor cell depletion without graft ablation, as re-expansion of donor cells was achieved with BG/BCNU treatment. These studies show promise for developing non-ablative allotransplant approaches using in vivo positive/negative selection. PMID:22871662

  20. Myeloablative therapy against high risk Ewing's sarcoma: A single institution experience and literature review.

    PubMed

    Lopez, Jose Luis; Pérez, Concepcion; Marquez, Catalina; Cabrera, Patricia; Perez, Jose Maria; Ramirez, Gema Lucia; Ordoñez, Rafael; Praena-Fernandez, Juan Manuel; Ortiz, Maria Jose

    2011-05-20

    Attempts to improve survival outcomes of patients with high risk Ewing's sarcoma (ES) have focused on chemotherapy dose intensification strategies. The objective of this study is to retrospectively evaluate clinical characteristics and outcome of pediatric patients with high risk ES treated at a single institution. From 1995 to 2008, seventeen patients (male:female, 14:3) were treated with dose-intensive therapy in our institution. Median age at diagnosis was 10 years (range: 2-15). Seven patients had metastases at diagnosis (lung in 6 cases and bone in one case). Eleven patients presented with unresectable disease. Fifteen (88.2%) received the Spanish Society of Pediatric Oncology protocol which includes six cycles of vincristine, doxorubicin, ifosfamide and etoposide. Two out of the six cases that were resectable received postoperative radiation. In addition, eleven patients received definitive radiation therapy. Finally, twelve (70.5%) out of 17 patients received myeloablative therapy with melphalan/etoposide. The rest of patients (N = 5) received busulfan/melphalan. Median follow-up was 78 months (range: 15-155 months). Initial responses were complete in all patients, but 9 of them developed progression disease. Seven patients became long-term event-free survivors. No patient died of toxicity after transplantation. The 2- and 5-year overall survival rates for all patients were 93% and 73%, respectively. Event-free survival rates were 74% and 54% at 2 and 5 years, respectively. This single-institution experience suggests that myeloablative therapy against high risk ES is effective and safe.

  1. Alloimmunization to RhD antigen in RhD-incompatible haemopoietic cell transplants with non-myeloablative conditioning.

    PubMed

    Mijovic, Aleksandar

    2002-11-01

    Following exposure to RhD antigen, anti-D develops in up to 20% of RhD-negative patients on chemotherapy, but seldom in the recipients of haemopoietic cell (HC) or solid-organ transplants. Data on anti-D formation come from HC transplants using myeloablative conditioning; no data are available for the non-myeloablative HC transplants. The two types of transplant have a distinct isohaemagglutinin disappearance rate and different kinetics of post-transplant red-cell engraftment. The objective of the study was to analyse anti-D formation in patients receiving non-myeloablative transplants from RhD-incompatible donors. Sixteen patients were analysed: nine RhD-negative recipients of RhD-positive haemopoietic cells; and seven RhD-positive recipients of a graft from a RhD-negative donor. Patients were sequentially tested for irregular antibodies, as well as donor/recipient chimerism by cytogenetics and analysis of DNA variable-number tandem repeats. Despite having received 7-499 ml of D-positive red cells, none of the RhD-negative recipients developed anti-D. The median follow-up was 202 days. By contrast, anti-D was identified in one of seven RhD-positive recipients of an RhD-negative graft. Non-myeloablative conditioning containing fludarabine and/or Campath 1H, with cyclosporin A given post-transplant, effectively prevents anti-D formation in RhD-negative recipients of a RhD-positive graft. However, anti-D developed in an RhD-positive recipient of an RhD-negative graft, who was also exposed to RhD-positive blood products before and after the transplant. Transfusion of RhD-positive products should be avoided in such patients.

  2. Non-myeloablative conditioning with allogeneic hematopoietic cell transplantation for the treatment of high-risk acute lymphoblastic leukemia

    PubMed Central

    Ram, Ron; Storb, Rainer; Sandmaier, Brenda M.; Maloney, David G.; Woolfrey, Ann; Flowers, Mary E. D.; Maris, Michael B.; Laport, Ginna G.; Chauncey, Thomas R.; Lange, Thoralf; Langston, Amelia A.; Storer, Barry; Georges, George E.

    2011-01-01

    Background Allogeneic hematopoietic cell transplantation is a potentially curative treatment for patients with acute lymphoblastic leukemia. However, the majority of older adults with acute lymphoblastic leukemia are not candidates for myeloablative conditioning regimens. A non-myeloablative preparative regimen is a reasonable treatment option for this group. We sought to determine the outcome of non-myeloablative conditioning and allogeneic transplantation in patients with high-risk acute lymphoblastic leukemia. Design and Methods Fifty-one patients (median age 56 years) underwent allogeneic hematopoietic cell transplantation from sibling or unrelated donors after fludarabine and 2 Gray total body irradiation. Twenty-five patients had Philadelphia chromosome-positive acute lymphoblastic leukemia. Eighteen of these patients received post-grafting imatinib. Results With a median follow-up of 43 months, the 3-year overall survival was 34%. The 3-year relapse/progression and non-relapse mortality rates were 40% and 28%, respectively. The cumulative incidences of grades II and III-IV acute graft-versus-host disease were 53% and 6%, respectively. The cumulative incidence of chronic graft-versus-host disease was 44%. Hematopoietic cell transplantation in first complete remission and post-grafting imatinib were associated with improved survival (P=0.005 and P=0.03, respectively). Three-year overall survival rates for patients with Philadelphia-negative acute lymphoblastic leukemia in first remission and beyond first remission were 52% and 8%, respectively. For patients with Philadelphia chromosome-positive acute lymphoblastic leukemia in first remission who received post-grafting imatinib, the 3-year overall survival rate was 62%; for the subgroup without evidence of minimal residual disease at transplantation, the overall survival was 73%. Conclusions For patients with high-risk acute lymphoblastic leukemia in first complete remission, non-myeloablative conditioning and

  3. Recovery of mucosal-associated invariant T cells after myeloablative chemotherapy and autologous peripheral blood stem cell transplantation.

    PubMed

    Novak, Jan; Dobrovolny, Jan; Brozova, Jitka; Novakova, Lucie; Kozak, Tomas

    2016-11-01

    Immune reconstitution after high-dose chemotherapy and stem cell transplantation plays a key role in restoring immunocompetence including defense against infection, immune regulation, and onco-immune surveillance. In this work, we examined the recovery of mucosal-associated invariant T (MAIT) cells, recently discovered innate-like T cells, after various types of myeloablative chemotherapy and autologous peripheral blood stem cell transplantation in 29 patients. We show that MAIT cells are relatively resistant to myeloablative conditioning. The median amount of MAIT cells rises to 43 % around day +30 and is sustained through further measurements on days +60 and +100. Moreover, MAIT cell recovery reaches 100 % of pre-treatment values in 33 % of patients already by day +60. The only factor affecting recovery of MAIT cells is age, younger age being associated with earlier MAIT cell recovery. The pre-treatment quantity of MAIT cells carries a prognostic impact on the early post-transplantation course. Patients with high levels of MAIT cells pre-treatment have significantly lower peak CRP levels (79.45 vs. 150 mg/L) post-treatment, reflecting a clinical trend of less severe infectious complications (less febrile days and less days on intravenous antibiotics). Altogether these data suggest that a high proportion of MAIT cells survive myeloablative chemotherapy and maintain their capacity to fight against infections probably on mucosal surfaces.

  4. Iron overload in patients with acute leukemia or MDS undergoing myeloablative stem cell transplantation.

    PubMed

    Armand, Philippe; Kim, Haesook T; Rhodes, Joanna; Sainvil, Marie-Michele; Cutler, Corey; Ho, Vincent T; Koreth, John; Alyea, Edwin P; Hearsey, Doreen; Neufeld, Ellis J; Fleming, Mark D; Steen, Hanno; Anderson, Damon; Kwong, Raymond Y; Soiffer, Robert J; Antin, Joseph H

    2011-06-01

    Patients with hematologic malignancies undergoing allogeneic stem cell transplantation (HSCT) commonly have an elevated serum ferritin prior to HSCT, which has been associated with increased mortality after transplantation. This has led to the suggestion that iron overload is common and deleterious in this patient population. However, the relationship between serum ferritin and parenchymal iron overload in such patients is unknown. We report a prospective study of 48 patients with acute leukemia (AL) or myelodysplastic syndromes (MDS) undergoing myeloablative HSCT, using magnetic resonance imaging (MRI) to estimate liver iron content (LIC) and cardiac iron. The median (and range) pre-HSCT value of serum ferritin was 1549 ng/mL (20-6989); serum hepcidin, 59 ng/mL (10-468); labile plasma iron, 0 LPI units (0.0-0.9). Eighty-five percent of patients had hepatic iron overload (HIO), and 42% had significant HIO (LIC ≥5.0 mg/gdw). Only 1 patient had cardiac iron overload. There was a strong correlation between pre-HSCT serum ferritin and estimated LIC (r = .75), which was mostly dependent on prior transfusion history. Serum hepcidin was appropriately elevated in patients with HIO. Labile plasma iron elevation was rare. A regression calibration analysis supported the hypothesis that elevated pre-HSCT LIC is significantly associated with inferior post-HSCT survival. These results contribute to our understanding of the prevalence, mechanism, and consequences of iron overload in HSCT.

  5. Primary Graft Failure after Myeloablative Allogeneic Hematopoietic Cell Transplantation for Hematologic Malignancies

    PubMed Central

    Olsson, Richard F.; Logan, Brent R.; Chaudhury, Sonali; Zhu, Xiaochun; Akpek, Görgün; Bolwell, Brian J.; Bredeson, Christopher N.; Dvorak, Christopher C.; Gupta, Vikas; Ho, Vincent T.; Lazarus, Hillard M.; Marks, David I.; Ringdén, Olle T.H.; Pasquini, Marcelo C.; Schriber, Jeffrey R.; Cooke, Kenneth R.

    2015-01-01

    Clinical outcomes after primary graft failure (PGF) remain poor. Here we present a large retrospective analysis (n=23,272) which investigates means to prevent PGF and early detection of patients at high risk. In patients with hematologic malignancies, who underwent their first myeloablative allogeneic hematopoietic cell transplantation, PGF was reported in 1,278 (5.5%), and there was a marked difference in PGFs using peripheral blood stem cell compared to bone marrow grafts (2.5 vs. 7.3%; P<0.001). A 4-fold increase of PGF was observed in myeloproliferative disorders compared to acute leukemia (P<0.001). Other risk factors for PGF included recipient age below 30, HLA-mismatch, male recipients of female donor grafts, ABO-incompatibility, busulfan/cyclophosphamide conditioning, and cryopreservation. In bone marrow transplants, total nucleated cell doses ≤2.4 × 108/kg were associated with PGF (OR 1.39; P<0.001). The use of tacrolimus-based immunosuppression and granulocyte colony-stimulating factor were associated with decreased PGF risk. These data, allow clinicians to do more informed choices with respect to graft source, donor selection, conditioning and immunosuppressive regimens to reduce the risk of PGF. Moreover, a novel risk score determined on day 21 post-transplant may provide the rationale for an early request for additional hematopoietic stem cells. PMID:25772027

  6. Effect of Cord Blood Processing on Transplant Outcomes after Single Myeloablative Umbilical Cord Blood Transplantation

    PubMed Central

    Ballen, Karen K.; Logan, Brent R.; Laughlin, Mary J.; He, Wensheng; Ambruso, Daniel R.; Armitage, Susan E.; Beddard, Rachel L.; Bhatla, Deepika; Hwang, William Y.K.; Kiss, Joseph E.; Koegler, Gesine; Kurtzberg, Joanne; Nagler, Arnon; Oh, David; Petz, Lawrence D.; Price, Thomas H.; Quinones, Ralph R.; Ratanatharathorn, Voravit; Rizzo, J. Douglas; Sazama, Kathleen; Scaradavou, Andromachi; Schuster, Michael W.; Sender, Leonard S.; Shpall, Elizabeth J.; Spellman, Stephen R.; Sutton, Millicent; Weitekamp, Lee Ann; Wingard, John R.; Eapen, Mary

    2015-01-01

    Variations in cord blood manufacturing and administration are common, and the optimal practice, not known. We compared processing and banking practices at 16 public cord blood banks (CBB) in the United States, and assessed transplant outcomes on 530 single umbilical cord blood (UCB) myeloablative transplantations for hematologic malignancies, facilitated by these banks. UCB banking practices were separated into three mutually exclusive groups based on whether processing was automated or manual; units were plasma and red blood cell reduced or buffy coat production method or plasma reduced. Compared to the automated processing system for units, the day-28 neutrophil recovery was significantly lower after transplantation of units that were manually processed and plasma reduced (red cell replete) (odds ratio [OR] 0.19 p=0.001) or plasma and red cell reduced (OR 0.54, p=0.05). Day-100 survival did not differ by CBB. However, day-100 survival was better with units that were thawed with the dextran-albumin wash method compared to the “no wash” or “dilution only” techniques (OR 1.82, p=0.04). In conclusion, CBB processing has no significant effect on early (day 100) survival despite differences in kinetics of neutrophil recovery. PMID:25543094

  7. Engraftment kinetics and graft failure after single umbilical cord blood transplantation using a myeloablative conditioning regimen.

    PubMed

    Ruggeri, Annalisa; Labopin, Myriam; Sormani, Maria Pia; Sanz, Guillermo; Sanz, Jaime; Volt, Fernanda; Michel, Gerard; Locatelli, Franco; Diaz De Heredia, Cristina; O'Brien, Tracey; Arcese, William; Iori, Anna Paola; Querol, Sergi; Kogler, Gesine; Lecchi, Lucilla; Pouthier, Fabienne; Garnier, Federico; Navarrete, Cristina; Baudoux, Etienne; Fernandes, Juliana; Kenzey, Chantal; Eapen, Mary; Gluckman, Eliane; Rocha, Vanderson; Saccardi, Riccardo

    2014-09-01

    Umbilical cord blood transplant recipients are exposed to an increased risk of graft failure, a complication leading to a higher rate of transplant-related mortality. The decision and timing to offer a second transplant after graft failure is challenging. With the aim of addressing this issue, we analyzed engraftment kinetics and outcomes of 1268 patients (73% children) with acute leukemia (64% acute lymphoblastic leukemia, 36% acute myeloid leukemia) in remission who underwent single-unit umbilical cord blood transplantation after a myeloablative conditioning regimen. The median follow-up was 31 months. The overall survival rate at 3 years was 47%; the 100-day cumulative incidence of transplant-related mortality was 16%. Longer time to engraftment was associated with increased transplant-related mortality and shorter overall survival. The cumulative incidence of neutrophil engraftment at day 60 was 86%, while the median time to achieve engraftment was 24 days. Probability density analysis showed that the likelihood of engraftment after umbilical cord blood transplantation increased after day 10, peaked on day 21 and slowly decreased to 21% by day 31. Beyond day 31, the probability of engraftment dropped rapidly, and the residual probability of engrafting after day 42 was 5%. Graft failure was reported in 166 patients, and 66 of them received a second graft (allogeneic, n=45). Rescue actions, such as the search for another graft, should be considered starting after day 21. A diagnosis of graft failure can be established in patients who have not achieved neutrophil recovery by day 42. Moreover, subsequent transplants should not be postponed after day 42.

  8. Engraftment kinetics and graft failure after single umbilical cord blood transplantation using a myeloablative conditioning regimen

    PubMed Central

    Ruggeri, Annalisa; Labopin, Myriam; Sormani, Maria Pia; Sanz, Guillermo; Sanz, Jaime; Volt, Fernanda; Michel, Gerard; Locatelli, Franco; De Heredia, Cristina Diaz; O’Brien, Tracey; Arcese, William; Iori, Anna Paola; Querol, Sergi; Kogler, Gesine; Lecchi, Lucilla; Pouthier, Fabienne; Garnier, Federico; Navarrete, Cristina; Baudoux, Etienne; Fernandes, Juliana; Kenzey, Chantal; Eapen, Mary; Gluckman, Eliane; Rocha, Vanderson; Saccardi, Riccardo

    2014-01-01

    Umbilical cord blood transplant recipients are exposed to an increased risk of graft failure, a complication leading to a higher rate of transplant-related mortality. The decision and timing to offer a second transplant after graft failure is challenging. With the aim of addressing this issue, we analyzed engraftment kinetics and outcomes of 1268 patients (73% children) with acute leukemia (64% acute lymphoblastic leukemia, 36% acute myeloid leukemia) in remission who underwent single-unit umbilical cord blood transplantation after a myeloablative conditioning regimen. The median follow-up was 31 months. The overall survival rate at 3 years was 47%; the 100-day cumulative incidence of transplant-related mortality was 16%. Longer time to engraftment was associated with increased transplant-related mortality and shorter overall survival. The cumulative incidence of neutrophil engraftment at day 60 was 86%, while the median time to achieve engraftment was 24 days. Probability density analysis showed that the likelihood of engraftment after umbilical cord blood transplantation increased after day 10, peaked on day 21 and slowly decreased to 21% by day 31. Beyond day 31, the probability of engraftment dropped rapidly, and the residual probability of engrafting after day 42 was 5%. Graft failure was reported in 166 patients, and 66 of them received a second graft (allogeneic, n=45). Rescue actions, such as the search for another graft, should be considered starting after day 21. A diagnosis of graft failure can be established in patients who have not achieved neutrophil recovery by day 42. Moreover, subsequent transplants should not be postponed after day 42. PMID:24972767

  9. Nonpermissive HLA-DPB1 mismatch increases mortality after myeloablative unrelated allogeneic hematopoietic cell transplantation

    PubMed Central

    Lee, Stephanie J.; Ahn, Kwang Woo; Spellman, Stephen; Wang, Hai-Lin; Aljurf, Mahmoud; Askar, Medhat; Dehn, Jason; Fernandez Viña, Marcelo; Gratwohl, Alois; Gupta, Vikas; Hanna, Rabi; Horowitz, Mary M.; Hurley, Carolyn K.; Inamoto, Yoshihiro; Kassim, Adetola A.; Nishihori, Taiga; Mueller, Carlheinz; Oudshoorn, Machteld; Petersdorf, Effie W.; Prasad, Vinod; Robinson, James; Saber, Wael; Schultz, Kirk R.; Shaw, Bronwen; Storek, Jan; Wood, William A.; Woolfrey, Ann E.; Anasetti, Claudio

    2014-01-01

    We examined current outcomes of unrelated donor allogeneic hematopoietic cell transplantation (HCT) to determine the clinical implications of donor-recipient HLA matching. Adult and pediatric patients who had first undergone myeloablative-unrelated bone marrow or peripheral blood HCT for acute myelogenous leukemia, acute lymphoblastic leukemia, chronic myelogenous leukemia, and myelodysplastic syndrome between 1999 and 2011 were included. All had high-resolution typing for HLA-A, -B, -C, and -DRB1. Of the total (n = 8003), cases were 8/8 (n = 5449), 7/8 (n = 2071), or 6/8 (n = 483) matched. HLA mismatch (6-7/8) conferred significantly increased risk for grades II to IV and III to IV acute graft vs host disease (GVHD), chronic GVHD, transplant-related mortality (TRM), and overall mortality compared with HLA-matched cases (8/8). Type (allele/antigen) and locus (HLA-A, -B, -C, and -DRB1) of mismatch were not associated with overall mortality. Among 8/8 matched cases, HLA-DPB1 and -DQB1 mismatch resulted in increased acute GVHD, and HLA-DPB1 mismatch had decreased relapse. Nonpermissive HLA-DPB1 allele mismatch was associated with higher TRM compared with permissive HLA-DPB1 mismatch or HLA-DPB1 match and increased overall mortality compared with permissive HLA-DPB1 mismatch in 8/8 (and 10/10) matched cases. Full matching at HLA-A, -B, -C, and -DRB1 is required for optimal unrelated donor HCT survival, and avoidance of nonpermissive HLA-DPB1 mismatches in otherwise HLA-matched pairs is indicated. PMID:25161269

  10. Does Total Body Irradiation Conditioning Improve Outcomes of Myeloablative HLA-Identical Sibling Transplants for Chronic Lymphocytic Leukemia?

    PubMed Central

    Sabloff, Mitchell; Sobecks, Ronald M.; Ahn, Kwang Woo; Zhu, Xiaochun; de Lima, Marcos; Brown, Jennifer R.; Inamoto, Yoshihiro; Holland, H. Kent; Aljurf, Mahmoud D.; Laughlin, Mary J.; Kamble, Rammurti T.; Hsu, Jack W.; Wirk, Baldeep M.; Seftel, Matthew; Lewis, Ian D.; Arora, Mukta; Alyea, Edwin P.; Kalaycio, Matt E.; Cortes, Jorge; Maziarz, Richard T.; Gale, Robert Peter; Saber, Wael

    2014-01-01

    An allogeneic hematopoietic cell transplant (HCT) from an HLA-identical donor after high-dose (myeloablative) pre-transplant conditioning, is an effective therapy for some people with chronic lymphocytic leukemia (CLL). Because CLL is a highly radiosensitive cancer, we hypothesized total body irradiation (TBI) conditioning regimens may be associated with better outcomes than those without TBI. To answer this we analyzed data from 180 subjects with CLL receiving myeloablative doses of TBI (N=126) or not (N=54), transplanted from an HLA-identical sibling donor, between 1995 and 2007 and reported to the Center for International Blood & Marrow Transplant Research (CIBMTR). At 5 years, treatment-related mortality was 48% (95% CI, 39–57%) vs. 50% (95% CI, 36–64%); p=NS. Relapse rates were 17% (95% CI, 11–25%) vs. 22% (95% CI, 11–35%); p=NS. Five-year progression-free survival and overall survival was 34% (95% CI, 26–43%) vs. 28% (95% CI, 15–42%); p=NS and 42% (95% CI, 33–51%) vs. 33% (95% CI, 19–48%); p=NS, respectively. The single most common cause of death in both cohorts was recurrent/progressive CLL. No variable tested in the multivariate analysis was found to significantly affect these outcomes including having failed fludarabine. Within the limitations of this study we found no difference in HLA-identical sibling transplant outcomes between myeloablative TBI and chemotherapy pre-transplant conditioning in persons with CLL. PMID:24321745

  11. In Vivo T Cell Depletion with Myeloablative Regimens on Outcomes after Cord Blood Transplantation for Acute Lymphoblastic Leukemia in Children.

    PubMed

    Ponce, Doris M; Eapen, Mary; Sparapani, Rodney; O'Brien, Tracey A; Chan, Ka Wah; Chen, Junfang; Craddock, John; Schultz, Kirk R; Wagner, John E; Perales, Miguel-Angel; Barker, Juliet N

    2015-12-01

    The inclusion of antithymocyte globulin (ATG) in cord blood transplantation is controversial. We evaluated outcomes according to ATG inclusion in 297 children and adolescents with acute lymphoblastic leukemia (ALL) who received myeloablative total body irradiation-based conditioning and either single-unit (74%) or double-unit (26%) grafts. Ninety-two patients (31%) received ATG and 205 (69%) did not. ATG recipients were more likely to be cytomegalovirus seronegative. The incidences of day 100 grades II to IV acute graft-versus-host disease (GVHD; 30% versus 54%, P = .0002) and chronic GVHD (22% versus 43%, P = .0008) were lower with ATG compared with non-ATG regimens. However, day 100 grades III to IV acute GVHD was comparable (11% versus 17%, P = .15). The 3-year incidences of transplant-related mortality (16% versus 17%, P = .98), relapse (17% versus 27%, P = .12), and leukemia-free survival (66% versus 55%, P = .23) in ATG and non-ATG recipients were similar. There were no differences in viral reactivation between treatment groups (60% versus 58%, P = .83). Therefore, the data suggest that incorporation of ATG with myeloablative conditioning regimens may be useful in reducing the risk of acute and chronic GVHD without any deleterious effect on transplant-related mortality, relapse, or leukemia-free survival in children and adolescents with ALL.

  12. Myeloablative Versus Reduced-Intensity Hematopoietic Cell Transplantation for Acute Myeloid Leukemia and Myelodysplastic Syndromes.

    PubMed

    Scott, Bart L; Pasquini, Marcelo C; Logan, Brent R; Wu, Juan; Devine, Steven M; Porter, David L; Maziarz, Richard T; Warlick, Erica D; Fernandez, Hugo F; Alyea, Edwin P; Hamadani, Mehdi; Bashey, Asad; Giralt, Sergio; Geller, Nancy L; Leifer, Eric; Le-Rademacher, Jennifer; Mendizabal, Adam M; Horowitz, Mary M; Deeg, H Joachim; Horwitz, Mitchell E

    2017-04-10

    Purpose The optimal regimen intensity before allogeneic hematopoietic cell transplantation (HCT) is unknown. We hypothesized that lower treatment-related mortality (TRM) with reduced-intensity conditioning (RIC) would result in improved overall survival (OS) compared with myeloablative conditioning (MAC). To test this hypothesis, we performed a phase III randomized trial comparing MAC with RIC in patients with acute myeloid leukemia or myelodysplastic syndromes. Patients and Methods Patients age 18 to 65 years with HCT comorbidity index ≤ 4 and < 5% marrow myeloblasts pre-HCT were randomly assigned to receive MAC (n = 135) or RIC (n = 137) followed by HCT from HLA-matched related or unrelated donors. The primary end point was OS 18 months post-random assignment based on an intent-to-treat analysis. Secondary end points included relapse-free survival (RFS) and TRM. Results Planned enrollment was 356 patients; accrual ceased at 272 because of high relapse incidence with RIC versus MAC (48.3%; 95% CI, 39.6% to 56.4% and 13.5%; 95% CI, 8.3% to 19.8%, respectively; P < .001). At 18 months, OS for patients in the RIC arm was 67.7% (95% CI, 59.1% to 74.9%) versus 77.5% (95% CI, 69.4% to 83.7%) for those in the MAC arm (difference, 9.8%; 95% CI, -0.8% to 20.3%; P = .07). TRM with RIC was 4.4% (95% CI, 1.8% to 8.9%) versus 15.8% (95% CI, 10.2% to 22.5%) with MAC ( P = .002). RFS with RIC was 47.3% (95% CI, 38.7% to 55.4%) versus 67.8% (95% CI, 59.1% to 75%) with MAC ( P < .01). Conclusion OS was higher with MAC, but this was not statistically significant. RIC resulted in lower TRM but higher relapse rates compared with MAC, with a statistically significant advantage in RFS with MAC. These data support the use of MAC as the standard of care for fit patients with acute myeloid leukemia or myelodysplastic syndromes.

  13. Peritransplant Serum Albumin Decline Predicts Subsequent Severe Acute Graft-versus-Host Disease after Mucotoxic Myeloablative Conditioning.

    PubMed

    Rashidi, Armin; DiPersio, John F; Westervelt, Peter; Abboud, Camille N; Schroeder, Mark A; Cashen, Amanda F; Pusic, Iskra; Romee, Rizwan

    2016-06-01

    Conditioning-related gut toxicity can result in a protein-losing enteropathy manifesting as a decline in serum albumin in the peritransplant period. Inspired by the pathogenesis of acute graft-versus-host disease (aGVHD), we hypothesized that the magnitude of decline in serum albumin from the day of conditioning initiation until its nadir in the first 2 weeks after hematopoietic cell transplantation HCT (DeltaAlb) predicts the risk for subsequent severe aGVHD. We reviewed the medical records of all 88 patients with acute myeloid leukemia or myelodysplastic syndrome who underwent highly mucotoxic myeloablative (busulfan/cyclophosphamide or cyclophosphamide/total body irradiation) allogeneic HCT from a matched related donor (MRD) or matched unrelated donor (MUD) at our institution between January 1, 2012 and January 1, 2015. Severe aGVHD was associated with MUD (47% versus 14% with MRD; P = .001) and DeltaAlb, which was significantly greater among patients who developed versus did not develop severe aGVHD (1.2 ± .5 versus .8 ± .4 g/dL, respectively; P < .001). In multivariate analysis DeltaAlb remained a significant predictor of severe aGVHD (odds ratio, 5.68; 95% CI, 1.65 to 19.64; P = .006; area under the ROC curve, .74; 95% CI, .63 to .86; P < .001). The best cutoff for DeltaAlb to predict severe aGVHD was .9, with a sensitivity, specificity, and overall classification accuracy of 77%, 66%, and 69%, respectively. The model was validated using the bootstrap technique, with no significant change in its performance. These results were not generalizable to a cohort of 30 patients who received less mucotoxic myeloablative or reduced-intensity conditioning. In conclusion, with mucotoxic myeloablative HCT, each .1-g/dL increase in DeltaAlb was associated with an approximately 23% increase in the odds of developing severe aGVHD. As an early biomarker of gut damage, DeltaAlb can be incorporated in composite risk models for aGVHD prediction, with hopes for

  14. A non-myeloablative conditioning regimen in allogeneic stem cell transplantation from related and unrelated donors in elderly patients.

    PubMed

    Tsirigotis, Panagiotis; Bitan, Reuven OrMenachem; Resnick, Igor B; Samuel, Simcha; Ackerstein, Aliza; Eladì, Sharon; Gesundheit, Benjamin; Zilberman, Irina; Miron, Svetlana; Leubovic, Alexander; Slavin, Shimon; Shapira, Michael Y

    2006-06-01

    We describe our experience with the use of a single non-myeloablative preparative regimen in stem-cell transplantation (NST) in 37 heavily pretreated patients > or =55 years. The conditioning regimen consisted of fludarabine, low-dose busulfan, and antithymocyte globulin. Acute graft-versus-host disease (GVHD) grade III-IV and chronic GVHD developed in 15.6% and 44.4% of cases, respectively. With a median follow-up period of 22 (range 3-113) months, the 1-year overall survival and disease-free-survival were 55% and 53%, respectively, while the overall non-relapse mortality was 35%. In conclusion, reduced intensity stem cell transplantation is feasible and effective in patients > or =55 years. Age per se, should no longer be considered as a contra-indication to stem cell transplantation.

  15. Prognostic Limitations of Donor T Cell Chimerism after Myeloablative Allogeneic Stem Cell Transplantation for Acute Myeloid Leukemia and Myelodysplastic Syndromes.

    PubMed

    Wong, Eric; Mason, Kate; Collins, Jenny; Hockridge, Barbara; Boyd, Janis; Gorelik, Alexandra; Szer, Jeffrey; Ritchie, David S

    2017-02-06

    Donor T cell chimerism is associated with relapse outcomes after allogeneic stem cell transplantation (alloSCT) for acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS). However, measures of statistical association do not adequately assess the performance of a prognostic biomarker, which is best characterized by its sensitivity and specificity for the chosen outcome. We analyzed donor T cell chimerism results at day 100 (D100chim) after myeloablative alloSCT for AML or MDS in 103 patients and determined its sensitivity and specificity for relapse-free survival at 6 months (RFS6) and 12 months (RFS12) post-alloSCT. The area under the receiver operating characteristic curve for RFS6 was .68, demonstrating only modest utility as a predictive biomarker, although this was greater than RFS12 at .62. Using a D100chim threshold of 65%, the specificity for RFS6 was 96.6%; however, sensitivity was poor at 26.7%. This equated to a negative predictive value of 88.5% and positive predictive value of 57.1%. Changing the threshold for D100chim to 75% or 85% modestly improved the sensitivity of D100chim for RFS6; however, this was at the expense of specificity. D100chim is specific but lacks sensitivity as a prognostic biomarker of early RFS after myeloablative alloSCT for AML or MDS. Caution is required when using D100chim to guide treatment decisions including immunologic manipulation, which may expose patients to unwarranted graft-versus-host disease.

  16. Unmanipulated haploidentical bone marrow transplantation and post-transplant cyclophosphamide for hematologic malignanices following a myeloablative conditioning: an update.

    PubMed

    Bacigalupo, A; Dominietto, A; Ghiso, A; Di Grazia, C; Lamparelli, T; Gualandi, F; Bregante, S; Van Lint, M T; Geroldi, S; Luchetti, S; Grasso, R; Pozzi, S; Colombo, N; Tedone, E; Varaldo, R; Raiola, A M

    2015-06-01

    This is a report of 148 patients with hematologic malignancies who received an unmanipulated haploidentical bone marrow transplant (BMT), followed by post-transplant high-dose cyclophosphamide (PT-CY). All patients received a myeloablative conditioning consisting of thiotepa, busulfan, fludarabine (n=92) or TBI, fludarabine (n=56). The median age was 47 years (17-74); 47 patients were in first remission (CR1), 37 in second remission (CR2) and 64 had an active disease; all patients were first grafts. The diagnosis was acute leukemia (n=75), myelodisplastic syndrome (n=24), myelofibrosis (n=16), high-grade lymphoma (n=15) and others (n=18). GVHD prophylaxis consisted in PT-CY on days +3 and +5, cyclosporine (from day 0), and mycophenolate (from day +1). The median day for neutrophil engraftment was day +18 (13-32). The cumulative incidence of grades II-IV acute GVHD was 24%, and of grades III-IV GVHD 10%. The incidence of moderate-severe chronic GVHD was 12%. With a median follow-up for the surviving patients of 313 days (100-1162), the cumulative incidence of transplant-related mortality (TRM) is 13%, and the relapse-related death is 23%. The actuarial 22 months overall survival is 77% for CR1 patients, 49% for CR2 patients and 38% for patients grafted in relapse (P<0.001). Major causes of death were relapse (22%), GVHD (2%) and infections (6%). We confirm our initial results, suggesting that a myeloablative conditioning regimen followed by unmanipulated haploidentical BMT with PT-CY, results in a low risk of acute and chronic GVHD and encouraging rates of TRM and overall survival, also for patients with active disease at the time of transplant.

  17. Similar Survival for Patients Undergoing Reduced-Intensity Total Body Irradiation (TBI) Versus Myeloablative TBI as Conditioning for Allogeneic Transplant in Acute Leukemia

    SciTech Connect

    Mikell, John L.; Waller, Edmund K.; Switchenko, Jeffrey M.; Rangaraju, Sravanti; Ali, Zahir; Graiser, Michael; Hall, William A.; Langston, Amelia A.; Esiashvili, Natia; Khoury, H. Jean; Khan, Mohammad K.

    2014-06-01

    Purpose: Hematopoietic stem cell transplantation (HSCT) is the mainstay of treatment for adults with acute leukemia. Total body irradiation (TBI) remains an important part of the conditioning regimen for HCST. For those patients unable to tolerate myeloablative TBI (mTBI), reduced intensity TBI (riTBI) is commonly used. In this study we compared outcomes of patients undergoing mTBI with those of patients undergoing riTBI in our institution. Methods and Materials: We performed a retrospective review of all patients with acute leukemia who underwent TBI-based conditioning, using a prospectively acquired database of HSCT patients treated at our institution. Patient data including details of the transplantation procedure, disease status, Karnofsky performance status (KPS), response rates, toxicity, survival time, and time to progression were extracted. Patient outcomes for various radiation therapy regimens were examined. Descriptive statistical analysis was performed. Results: Between June 1985 and July 2012, 226 patients with acute leukemia underwent TBI as conditioning for HSCT. Of those patients, 180 had full radiation therapy data available; 83 had acute lymphoblastic leukemia and 94 had acute myelogenous leukemia; 45 patients received riTBI, and 135 received mTBI. Median overall survival (OS) was 13.7 months. Median relapse-free survival (RFS) for all patients was 10.2 months. Controlling for age, sex, KPS, disease status, and diagnosis, there were no significant differences in OS or RFS between patients who underwent riTBI and those who underwent mTBI (P=.402, P=.499, respectively). Median length of hospital stay was shorter for patients who received riTBI than for those who received mTBI (16 days vs 23 days, respectively; P<.001), and intensive care unit admissions were less frequent following riTBI than mTBI (2.22% vs 12.69%, respectively, P=.043). Nonrelapse survival rates were also similar (P=.186). Conclusions: No differences in OS or RFS were seen between

  18. The risk of polyomavirus BK-associated hemorrhagic cystitis after allogeneic hematopoietic SCT is associated with myeloablative conditioning, CMV viremia and severe acute GVHD.

    PubMed

    Uhm, J; Hamad, N; Michelis, F V; Shanavas, M; Kuruvilla, J; Gupta, V; Lipton, J H; Messner, H A; Seftel, M; Kim, D D

    2014-12-01

    Hemorrhagic cystitis (HC) is a common complication after allogeneic hematopoietic SCT (allo-HSCT). Several risk factors have been suggested including BU-containing myeloablative conditioning, unrelated donors and GVHD, but these have not been consistently reported. We conducted a retrospective study including 339 allo-HSCT recipients between 2009 and 2012. Of 339 patients, 79 (23.3%) developed HC with 2-year cumulative incidence of 24.0% (95% confidence interval, 19.4-28.9). The median onset time was 45 days (range, 16-430) after allo-HSCT. Sixty-two patients (84%) out of 74 evaluated for urine BK virus PCR testing showed a positive result (mean 2.0 × 10(10) copies of DNA per mL). In univariate analysis, myeloablative conditioning, HLA-mismatched donor, CMV viremia and acute GVHD (aGVHD) grade 3-4 were significantly associated with the risk of HC. Multivariate analysis confirmed all associating factors identified in univariate analysis except for HLA-mismatched donor: myeloablative conditioning (hazard ratio (HR) 2.63, P=0.003), CMV viremia (HR 1.88, P=0.014) and aGVHD grade 3-4 (HR 1.71, P=0.029). HC did not affect OS or non-relapse mortality. Symptomatic HC is a frequent complication following allo-HSCT, with a 2-year cumulative incidence of 24.0%. Three clinical factors associated with HC were identified including myeloablative conditioning, CMV viremia and severe aGVHD.

  19. A paediatric case of successful non-myeloablative bone marrow transplantation after azacitidine therapy for non-Down syndrome acute megakaryoblastic leukaemia with monosomy 7.

    PubMed

    Koga, Yuhki; Oba, Utako; Kato, Wakako; Ono, Hiroaki; Nakashima, Kentaro; Takada, Hidetoshi

    2016-09-01

    We report a patient with non-Down syndrome AML, also known as AMKL, with monosomy 7, who was also obese and had a hearing impairment and mental retardation. Non-myeloablative bone marrow transplantation was performed successfully after the patient received less aggressive azacitidine treatment, without the usual intensive induction chemotherapy regimen for AML. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  20. Evaluation of the Pharmacokinetics and Efficacy of a Busulfan Test Dose in Adult Patients Undergoing Myeloablative Hematopoietic Cell Transplantation.

    PubMed

    Weil, Elizabeth; Zook, Felicia; Oxencis, Carolyn; Canadeo, Angela; Urmanski, Angela; Waggoner, Mindy; Eastwood, Daniel; Pasquini, Marcelo; Hamadani, Mehdi; Hari, Parameswaran

    2017-03-10

    Owing to interpatient variability in busulfan exposure, therapeutic monitoring of busulfan is often used in myeloablative allogeneic transplantation to ensure that patients are near the optimal steady-state goal of 900 ng/mL. One challenge in therapeutic monitoring of busulfan is the brief course of busulfan treatment, requiring prompt analysis and dose adjustments as needed. Pharmacokinetic evaluation of a busulfan test dose before the start of the conditioning regimen would allow for all conditioning regimen doses to be given at the calculated optimized dose. An observational study was completed to evaluate the effects of a busulfan test dose of .9 mg/kg administered before the start of a myeloablative intravenous busulfan-based conditioning regimen. Sixty adult patients who received a busulfan conditioning regimen were reviewed, including 30 patients who had not yet received the busulfan test dose (pretest dose group) and 30 patients who had received the busulfan test dose (posttest dose group). The primary objective was a pharmacokinetic evaluation of the percentage of patients who achieved the desired steady-state goal using the test dose strategy. The safety and efficacy of the busulfan test dose were evaluated as well. The average busulfan steady-state level after the first dose of the conditioning regimen was significantly lower in the pre-test dose group compared with the post-test dose group (660 ng/mL versus 879.9 ng/mL; P < .001). Compared with the post-test dose group, significantly fewer patients in the pre-test dose group were within 10% of the busulfan steady-state goal (10% versus 73.3%; P < .001) or within 5% of the goal (0% versus 53%; P < .001). Requirements for parenteral nutrition and/or patient-controlled analgesia owing to mucositis and veno-occlusive disease rates were not significantly different between the pre-test dose group and the post-test dose group. The rates of disease relapse, mortality, and acute graft

  1. Extramedullary relapses after allogeneic non-myeloablative stem cell transplantation in multiple myeloma patients do not negatively affect treatment outcome.

    PubMed

    Minnema, M C; van de Donk, N W C J; Zweegman, S; Hegenbart, U; Schonland, S; Raymakers, R; Zijlmans, J M J M; Kersten, M J; Bos, G M J; Lokhorst, H M

    2008-05-01

    Recent literature suggests that after non-myeloablative allogeneic (NMA) stem cell transplantation (SCT), the incidence of extramedullary (EM) relapse in multiple myeloma (MM) patients is increased and that these relapses have a poor prognosis. However, numbers on incidence and treatment outcome are scarce. We collected data from 54 relapsed MM patients from a total group of 172 treated with sequential autologous and allogeneic NMA SCT at seven transplantation centres. There were 43 (79.6%) systemic relapses, including 6 with concurrent EM localisation. Five patients had a local EM relapse only. Six patients relapsed with only bone involvement. Patients with deletion of chromosome 13 had a higher incidence of EM relapse (30.8 versus 5.6%, P=0.06). EM relapses were treated with donor lymphocyte infusion, radiotherapy, or chemotherapy, especially with novel agents. The response rate was 45.5%, which was not different when compared to patients without EM disease (54.1%). Overall survival and progression-free survival were not significantly different in patients with EM disease, when compared to those without EM disease. In conclusion, the incidence of relapse with EM disease following allogeneic NMA SCT was 20.4%. There was no negative impact of EM relapse on response rate, overall survival and progression-free survival.

  2. New-onset microalbuminuria following allogeneic myeloablative SCT is a sign of near-term decrease in renal function.

    PubMed

    Morito, T; Ando, M; Kobayashi, T; Kakihana, K; Ohashi, K; Akiyama, H; Tsuchiya, K; Nitta, K; Sakamaki, H

    2013-07-01

    The emergence of microalbuminuria following conditioning chemotherapy may predict the development of renal dysfunction. To confirm this, a 1-year retrospective cohort study was conducted in 31 myeloablative allogeneic SCT patients who received five consecutive measurements of albuminuria before conditioning therapy and on days 0, 7, 14 and 28 following SCT. The cohort had neither microalbuminuria nor renal dysfunction at baseline. Microalbuminuria was defined as an albumin-creatinine (Cr) ratio over 30 mg/g, and renal dysfunction was as an estimated glomerular filtration rate <60 mL/min per 1.73 m(2). Cumulative incidence of renal dysfunction over time was analyzed by the Kaplan-Meier method. Multivariate Cox proportional hazards analysis was used to examine an association of de novo microalbuminuria with the incidence of renal dysfunction. In all, 16 patients (52%) developed microalbuminuria that was positive at least two times among the four measurements after SCT. The actuarial occurrence of chronic kidney disease was significantly higher in patients who developed microalbuminuria than in those who did not. Incidence of microalbuminuria had a significant risk of subsequent renal dysfunction (hazard ratio (95% confidence interval), 7.3 (1.2-140)). In conclusion, de novo microalbuminuria following conditioning therapy is a warning of near-term loss of renal function.

  3. Fludarabine-based reduced intensity conditioning transplants have a higher incidence of cytomegalovirus reactivation compared with myeloablative transplants.

    PubMed

    George, B; Kerridge, I; Gilroy, N; Huang, G; Hertzberg, M; Gottlieb, D; Bradstock, K

    2010-05-01

    Two hundred and ten adult CMV seropositive patients undergoing myeloablative conditioning (MAC) [n=127] or reduced intensity conditioning (RIC) [n=83] transplants (HCT) were serially monitored for CMV reactivation and disease, using a qualitative polymerase chain reaction (PCR) followed by quantitation with pp65 antigen or quantitative PCR. CMV reactivation occurred in 53 RIC (63.9%) and 61 MAC (48%; P=0.03) transplants at a median of 47 days (range: 24-1977). Risk factors identified included acute GVHD (P=0.001), RIC regimen (P=0.03), unrelated donor (P=0.02), use of anti-thymocyte globulin/alemtuzumb (P=0.02) and use of bone marrow in MAC transplants (P=0.011). On multivariate analysis, RIC transplants and acute GVHD remained independent predictors. Treatment with antiviral drugs resulted in CMV negativity rates of 86.8% in MAC and 88.6% in RIC transplants. CMV disease occurred in 10.8% of RIC and 4.7% of MAC transplants (P=0.15). At a median follow-up of 26 months (range: 3-88), 48.1% of RIC and 50.3% of MAC transplants are alive. The higher incidence of CMV reactivation among RIC transplants suggests the need for novel prophylactic or pre-emptive strategies in this high-risk group of patients.

  4. Recovery of ovarian function and pregnancy in a patient with AML after myeloablative busulphan-based conditioning regimen.

    PubMed

    Balashov, Dmitry N; Papusha, Ludmila I; Nazarenko, Tatiana A; Trakhtman, Pavel E; Revishvili, Nino A; Maschan, Alexei A; Persiantseva, Marina I; Andriutsa, Anna V; Skorobogatova, Elena V; Skvortsova, Yulia V; Rumiantsev, Alexander G

    2011-05-01

    We report a rare case of ovarian function recovery and pregnancy after hormone-replacement therapy (HRT) in the acute myeloblastic leukemia (AML) patient in third complete remission received hematopoietic stem cell transplantation (HSCT) with busulphan-based conditioning regimen. Successful engraftment of the donor cells and full donor's chimerism was achieved without the signs of leukemia. One year after HSCT the patient received a course of HRT as a treatment of hypergonadotropic hypogonadism. After 12 months of HRT the recovery of ovarian function was confirmed. Eight years after the HSCT spontaneous pregnancy occurred; heartbeat of the fetus was registered on week 7. Three weeks later a nonsevere vaginal bleeding occurred and the ultrasound examination showed a nondeveloping pregnancy. Genetic examination of the abortion material showed a full triploid genotype (69 XXX). To our knowledge this is a first case of ovarian function restoration and spontaneous pregnancy in a AML patient after multiple courses of high-dose chemotherapy and busulphan-based myeloablative conditioning for HSCT.

  5. Similar and Promising Outcomes in Lymphoma Patients Treated with Myeloablative or Nonmyeloablative Conditioning and Allogeneic Hematopoietic Cell Transplantation

    PubMed Central

    Tomblyn, Marcie; Brunstein, Claudio; Burns, Linda J.; Miller, Jeffrey S.; MacMillan, Margaret; DeFor, Todd E.; Weisdorf, Daniel J.

    2008-01-01

    We compared the outcomes of 141 consecutive patients who received allogeneic transplantation with either myeloablative (MA) or nonmyeloablative/reduced intensity (NMA) conditioning for non-Hodgkin and Hodgkin lymphoma at the University of Minnesota. All patients were transplanted between 1997 and 2004. NMA transplant recipients were older and received umbilical cord blood grafts more frequently (MA: 6 [9%]; NMA: 33 [43%], P < .001). NMA patients had more advanced disease and 30 (39%) patients had undergone prior autologous transplantation. The 4-year overall survival (OS) (MA: 46% versus NMA: 49%; p = .34) and the 3-year progression-free survival (PFS) (MA: 44% versus NMA: 31%; P = 0.82) were similar after MA or NMA conditioning. However, MA conditioning resulted in significantly higher 1-year treatment-related mortality (TRM) (MA: 43% versus NMA: 17%; P < .01) but a lower risk of relapse at 3 years (MA: 11% versus NMA: 36%; P < .01). We conclude that similar transplant outcomes are achieved after allogeneic hematopoietic stem cell transplantation using MA conditioning in younger patients and NMA conditioning in older patients or those with prior autologous transplantation not eligible for MA conditioning. Modifications to refine patient assignment to the preferred conditioning intensity and reduce relapse risks with NMA approaches are needed. PMID:18410896

  6. Sirolimus is associated with veno-occlusive disease of the liver after myeloablative allogeneic stem cell transplantation.

    PubMed

    Cutler, Corey; Stevenson, Kristen; Kim, Haesook T; Richardson, Paul; Ho, Vincent T; Linden, Erica; Revta, Carolyn; Ebert, Ruth; Warren, Diane; Choi, Sung; Koreth, John; Armand, Philippe; Alyea, Edwin; Carter, Shelly; Horowitz, Mary; Antin, Joseph H; Soiffer, Robert

    2008-12-01

    Sirolimus is an effective agent used in graft-versus-host disease (GVHD) prophylaxis after allogeneic transplantation. It also has antiproliferative effects on vascular endothelium when used to coat coronary artery stents. We noted an excess of veno-occlusive disease (VOD) in a clinical trial, and retrospectively reviewed the records of 488 patients to determine the association between sirolimus and VOD. When used with cyclophosphamide/total body irradiation (Cy/TBI) conditioning, sirolimus is associated with an increased incidence of VOD (OR 2.35, P = .005). The concomitant use of methotrexate further increased this rate (OR 3.23, P < .001), while sirolimus without methotrexate was not associated with an increased risk of VOD (OR 1.55, P = .33). Mortality after VOD diagnosis was unaffected, and overall treatment-related mortality was lowest when sirolimus was used without methotrexate. Similar findings were noted in matched, related, and unrelated as well as mismatched donor subgroups. When used with busulfan-based conditioning, sirolimus use was associated with an even higher rate of VOD (OR 8.8, P = .008). Our findings suggest that sirolimus use is associated with VOD after TBI-based transplantation when used with methotrexate after transplantation. Sirolimus-based GVHD prophylaxis without methotrexate is associated with the greatest overall survival. Myeloablative doses of busulfan should not be used with sirolimus-based immunosuppression.

  7. Pre-transplant MRD predicts outcome following reduced-intensity and myeloablative allogeneic hemopoietic SCT in AML.

    PubMed

    Anthias, C; Dignan, F L; Morilla, R; Morilla, A; Ethell, M E; Potter, M N; Shaw, B E

    2014-05-01

    The presence of minimal residual disease (MRD) by multiparametric flow cytometry (MFC) has been associated with adverse outcomes in AML patients treated with chemotherapy alone, but its impact in the setting of allogeneic hematopoietic SCT (HSCT) is less clear. We studied 88 patients who underwent myeloablative (MA) or reduced-intensity conditioned allogeneic HSCT for AML in first or subsequent remission at our center. MRD status was determined using three-color MFC on pre-HSCT BM aspirates, and patients were stratified by MRD status into MRD-negative, low-level MRD-positive (<1%) or high-level MRD-positive groups (1-4.9%). Two-year survival estimates in these groups were 66.8%, 51% and 30%, respectively (P=0.012), and 2-year estimates of relapse were 7.6, 37 and 70% (P<0.001). Pre-HSCT MRD was related to disease characteristics including secondary AML (P=0.002) and primary induction failure (P=0.005), but, despite these strong correlations, MRD remained independently associated with poorer survival in multivariate analysis (hazard ratio, 1.92; P=0.014). Pre-HSCT MRD is associated with adverse clinical outcomes in AML patients undergoing reduced-intensity or MA HSCT in first or subsequent remission and should be integrated into transplant strategies for patients with AML.

  8. Outcome of myeloablative allogeneic peripheral blood hematopoietic stem cell transplantation for refractory/relapsed AML patients in NR status.

    PubMed

    Liu, Na; Ning, Hong-Mei; Hu, Liang-Ding; Jiang, Min; Xu, Chen; Hu, Jiang-Wei; Wang, Jun; Li, Yu-Hang; Li, Bo-Tao; Lou, Xiao; Yang, Fan; Chen, Jian-Lin; Su, Yong-Feng; Li, Meng; Wang, Hong-Ye; Ren, Jing; Feng, Yue-Qian; Zhang, Bin; Wang, Dan-Hong; Chen, Hu

    2015-12-01

    To further find effective method to improve the long term survival of refractory or relapsed acute myeloid leukemia (AML) patients, we retrospectively analyzed the outcomes of myeloablative hematopoietic stem cell transplantation (HSCT) for 133 consecutive patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) therapy related AML(t-AML) in not remission status. The overall 3-year OS and DFS were 40.9% and 35.6% respectively. The variables associated with improved long term DFS were a bone marrow blast cell count less than 20% and an intensified conditioning regimen. In addition, the t-AML group had higher rates of relapse and III-IV acute GVHD than the primary AML group. The unrelated donor group had similar OS and DFS with sibling groups. Our study suggested that decreasing bone marrow blast cell counts before HSCT and strengthening the conditioning regimen may improve long-term DFS for refractory/relapsed AML patients, and unrelated donor group can get similar effect when compared to the sibling group.

  9. Effect on lifespan of high yield non-myeloablating transplantation of bone marrow from young to old mice

    PubMed Central

    Kovina, Marina V.; Zuev, Viktor A.; Kagarlitskiy, German O.; Khodarovich, Yuriy M.

    2013-01-01

    Tissue renewal is a well-known phenomenon by which old and dying-off cells of various tissues of the body are replaced by progeny of local or circulating stem cells (SCs). An interesting question is whether donor SCs are capable to prolong the lifespan of an aging organism by tissue renewal. In this work, we investigated the possible use of bone marrow (BM) SC for lifespan extension. To this purpose, chimeric C57BL/6 mice were created by transplanting BM from young 1.5-month-old donors to 21.5-month-old recipients. Transplantation was carried out by means of a recently developed method which allowed to transplant without myeloablation up to 1.5 × 108 cells, that is, about 25% of the total BM cells of the mouse. As a result, the mean survival time, counting from the age of 21.5 months, the start of the experiment, was +3.6 and +5.0 (±0.1) months for the control and experimental groups, respectively, corresponding to a 39 ± 4% increase in the experimental group over the control. In earlier studies on BM transplantation, a considerably smaller quantity of donor cells (5 × 106) was used, about 1% of the total own BM cells. The recipients before transplantation were exposed to a lethal (for control animals) X-ray dose which eliminated the possibility of studying the lifespan extension by this method. PMID:23967009

  10. Improved survival of children with advanced tumors by myeloablative chemotherapy and autologous peripheral blood stem cell transplantation in complete remission.

    PubMed

    Sato, A; Imaizumi, M; Saisho, T; Saito, T; Yoshinari, M; Cui, Y; Suzuki, H; Koizumi, Y; Ito, T; Takai, Y; Hayashi, Y; Tamura, M; Iinuma, K

    1998-12-01

    Five children with neuroblastoma (NB) stage IV and five children with rhabdomyosarcoma (RMS) stage III were treated with myeloablative chemotherapy and autologous peripheral blood stem cell transplantation (MCT/PBSCT) in the state of complete remission (CR) achieved by conventional therapy. PBSCs were collected in CR status using a cell separator with blood access through a double-lumen central venous catheter. PBSCs with 1.9+/-0.8x10(5) of CFU-GM per patient weights (kg) were infused following MCT after a period of conventional therapy for 11.1+/-2.1 or 9.7+/-0.9 months in NB or RMS patients, respectively. Regimen-related toxicity of MCT was tolerable and peripheral white blood cell count recovered beyond 1.0x10(3)/microl 10-12 days after infusion of PBSCs in all patients. All of RMS patients and three of five NB patients survived for an average of 31.6 months (ranged 10.8-58.1). The survival rate of these patients was improved as compared with our historical controls, and presumably, with that of conventional chemotherapy previously reported. Despite a limited number of patients, it appears that MCT/PBSCT may be effective in improving survival by preventing relapse which may occur thereafter if treated with conventional therapy alone. Furthermore, MCT/PBSCT reduced the duration of treatment, as compared with that of conventional chemo-therapy. Therefore, this study may suggest the feasibility and promise of the therapy including MCT/PBSCT for children with advanced stages of NB and RMS.

  11. 131I-tositumomab myeloablative radioimmunotherapy for non-Hodgkin’s lymphoma: radiation dose to the testes

    SciTech Connect

    Hattori, Naoya; Gopal, Ajay K.; Shields, Andrew T.; Fisher, Darrell R.; Gooley, Ted; Pagel, John M.; Press, Oliver W.; Rajendran, Joseph G.

    2012-12-01

    Purpose: To investigate radiation doses to the testes delivered by a radiolabeled anti-CD20 antibody and its effects on male sex hormone levels. Materials and methods: Testicular uptake and retention of 131I-tositumomab were measured, and testicular absorbed doses were calculated for 67 male patients (54+/-11 years of age) with non-Hodgkin's lymphoma who had undergone myeloablative radioimmunotherapy (RIT) using 131I-tositumomab. Time-activity curves for the major organs, testes, and whole body were generated from planar imaging studies. In a subset of patients, male sex hormones were measured before and 1 year after the therapy. Results: The absorbed dose to the testes showed considerable variability (range=4.4-70.2 Gy). Pretherapy levels of total testosterone were below the lower limit of the reference range, and post-therapy evaluation demonstrated further reduction [4.6+/-1.8 nmol/l (pre-RIT) vs. 3.8+/-2.9 nmol/l (post-RIT), P<0.05]. Patients receiving higher radiation doses to the testes (>=25 Gy) showed a greater reduction [4.7+/-1.6 nmol/l (pre-RIT) vs. 3.3+/-2.7 nmol/l (post-RIT), P<0.05] compared with patients receiving lower doses (<25 Gy), who showed no significant change in total testosterone levels. Conclusion: The testicular radiation absorbed dose varied highly among individual patients. Finally, patients receiving higher doses to the testes were more likely to show post-RIT suppression of testosterone levels.

  12. Late Effects after Umbilical Cord Blood Transplantation in Very Young Children after Busulfan-Based, Myeloablative Conditioning.

    PubMed

    Allewelt, Heather; El-Khorazaty, Jill; Mendizabal, Adam; Taskindoust, Mahsa; Martin, Paul L; Prasad, Vinod; Page, Kristin; Sanders, Jean; Kurtzberg, Joanne

    2016-09-01

    Infants and young children who undergo allogeneic cord blood transplantation (CBT) are at increased risk for late effects because of exposure of developing organs to chemotherapy and radiation therapy typically used in transplant conditioning regimens. Busulfan (Bu)-based myeloablative regimens were developed to eliminate radiation exposure in these young children with the hope that late effects would be minimized. We now describe the late effects in 102 consecutive patients surviving a minimum of 5 years (median follow-up, 12.9 years) post-CBT. Patients were conditioned with high-dose chemotherapy using Bu-containing regimens. No patient received total body irradiation. The median age at transplant was 1 year (range, .1 to 2). Diagnoses included inherited metabolic diseases (59.8%), leukemia (17.6%), congenital immune deficiency (20.2%), bone marrow failure/myelodysplastic syndrome (3.9%), and hemoglobinopathy (2%). Among patients surviving 5 years, the overall survival rate at 10 years post-CBT was 93% (95% CI, 84.9 to 96.8). Virtually all patients (98%) experienced at least 1 significant late effect. Most (83.3%) experienced 2 or more late effects, and more than half of the patients (64.7%) experienced 3 or more late effects. The most commonly observed late effects included dental problems (92.2%), short stature (55.9%), cognitive deficits (53.6%), pulmonary dysfunction (18.6%), and abnormal pubertal development (27.9%). This is the first report of late effects of Bu-based conditioning in a cohort of very young patients at the time of transplant. These results will inform clinical care guidelines for long-term follow-up and add to the growing information regarding outcomes of hematopoietic stem cell transplantation.

  13. The Sequence of Cyclophosphamide and Myeloablative Total Body Irradiation in Hematopoietic Cell Transplant for Patients with Acute Leukemia

    PubMed Central

    Holter-Chakrabarty, Jennifer L.; Pierson, Namali; Zhang, Mei-Jie; Zhu, Xiaochun; Akpek, Görgün; Aljurf, Mahmoud D.; Artz, Andrew S.; Baron, Frédéric; Bredeson, Christopher N.; Dvorak, Christopher C.; Epstein, Robert B.; Lazarus, Hillard M.; Olsson, Richard F.; Selby, George B.; Williams, Kirsten M.; Cooke, Kenneth R.; Pasquini, Marcelo C.; McCarthy, Philip L.

    2015-01-01

    Limited clinical data are available to assess whether the sequencing of cyclophosphamide (Cy) and total body irradiation (TBI) changes outcomes. We evaluated the sequence in 1769 (CyTBI N=948, TBICy N=821) recipients of related or unrelated hematopoietic cell transplantation (HCT) who received TBI (1200-1500cGY) for acute leukemia from 2003 to 2010. The two cohorts were comparable for median age, performance score, type of leukemia, first complete remission, Ph+ ALL, HLA matched siblings, stem cell source, anti-thymocyte globulin use, TBI dose, and type of graft-versus-host disease (GVHD) prophylaxis. The sequence of TBI did not significantly affect TRM (24% vs. 23% at 3y, p=0.67; relative risk [RR] 1.01, p=0.91), leukemia relapse (27% vs. 29% at 3y, p=0.34; RR 0.89, p=0.18), leukemia-free survival (49% vs. 48% at3y, p=0.27; RR 0.93, p=0.29), chronic GVHD (45% vs. 47% at 1y, p=0.39; RR 0.9, p=0.11) or overall survival (53% vs. 52% at 3y, p=0.62; RR 0.96, p=0.57) for CyTBI and TBICy respectively. Corresponding cumulative incidences of sinusoidal obstruction syndrome were 4% and 6% at 100 days (p=0.08). This study demonstrates that the sequence of Cy and TBI does not impact transplant outcomes and complications in patients with acute leukemia undergoing HCT with myeloablative conditioning. PMID:25840335

  14. A randomized phase II trial of tacrolimus, mycophenolate mofetil and sirolimus after non-myeloablative unrelated donor transplantation.

    PubMed

    Kornblit, Brian; Maloney, David G; Storer, Barry E; Maris, Michael B; Vindeløv, Lars; Hari, Parameswaran; Langston, Amelia A; Pulsipher, Michael A; Bethge, Wolfgang A; Chauncey, Thomas R; Lange, Thoralf; Petersen, Finn B; Hübel, Kai; Woolfrey, Ann E; Flowers, Mary E D; Storb, Rainer; Sandmaier, Brenda M

    2014-10-01

    The study is a randomized phase II trial investigating graft-versus-host disease prophylaxis after non-myeloablative (90 mg/m(2) fludarabine and 2 Gy total body irradiation) human leukocyte antigen matched unrelated donor transplantation. Patients were randomized as follows: arm 1 - tacrolimus 180 days and mycophenolate mofetil 95 days (n=69); arm 2 - tacrolimus 150 days and mycophenolate mofetil 180 days (n=71); arm 3 - tacrolimus 150 days, mycophenolate mofetil 180 days and sirolimus 80 days (n=68). All patients had sustained engraftment. Grade II-IV acute graft-versus-host disease rates in the 3 arms were 64%, 48% and 47% at Day 150, respectively (arm 3 vs. arm 1 (hazard ratio 0.62; P=0.04). Owing to the decreased incidence of acute graft-versus-host disease, systemic steroid use was lower at Day 150 in arm 3 (32% vs. 55% in arm 1 and 49% in arm 2; overall P=0.009 by hazard ratio analysis). The Day 150 incidence of cytomegalovirus reactivation was lower in arm 3 (arm 1, 54%; arm 2, 47%; arm 3, 22%; overall P=0.002 by hazard ratio analysis). Non-relapse mortality was comparable in the three arms at two years (arm 1, 26%; arm 2, 23%; arm 3, 18%). Toxicity rates and other outcome measures were similar between the three arms. The addition of sirolimus to tacrolimus and mycophenolate mofetil is safe and associated with lower incidence of acute graft-versus-host disease and cytomegalovirus reactivation. (clinicaltrials.gov identifier: 00105001). Copyright© Ferrata Storti Foundation.

  15. Post-transplantation Cyclophosphamide and Sirolimus after Haploidentical Hematopoietic Stem Cell Transplantation Using a Treosulfan-based Myeloablative Conditioning and Peripheral Blood Stem Cells.

    PubMed

    Cieri, Nicoletta; Greco, Raffaella; Crucitti, Lara; Morelli, Mara; Giglio, Fabio; Levati, Giorgia; Assanelli, Andrea; Carrabba, Matteo G; Bellio, Laura; Milani, Raffaella; Lorentino, Francesca; Stanghellini, Maria Teresa Lupo; De Freitas, Tiago; Marktel, Sarah; Bernardi, Massimo; Corti, Consuelo; Vago, Luca; Bonini, Chiara; Ciceri, Fabio; Peccatori, Jacopo

    2015-08-01

    Haploidentical hematopoietic stem cell transplantation (HSCT) performed using bone marrow (BM) grafts and post-transplantation cyclophosphamide (PTCy) has gained much interest for the excellent toxicity profile after both reduced-intensity and myeloablative conditioning. We investigated, in a cohort of 40 high-risk hematological patients, the feasibility of peripheral blood stem cells grafts after a treosulfan-melphalan myeloablative conditioning, followed by a PTCy and sirolimus-based graft-versus-host disease (GVHD) prophylaxis (Sir-PTCy). Donor engraftment occurred in all patients, with full donor chimerism achieved by day 30. Post-HSCT recovery of lymphocyte subsets was broad and fast, with a median time to CD4 > 200/μL of 41 days. Cumulative incidences of grade II to IV and III-IV acute GVHD were 15% and 7.5%, respectively, and were associated with a significant early increase in circulating regulatory T cells at day 15 after HSCT, with values < 5% being predictive of subsequent GVHD occurrence. The 1-year cumulative incidence of chronic GVHD was 20%. Nonrelapse mortality (NRM) at 100 days and 1 year were 12% and 17%, respectively. With a median follow-up for living patients of 15 months, the estimated 1-year overall and disease-free survival (DFS) was 56% and 48%, respectively. Outcomes were more favorable in patients who underwent transplantation in complete remission (1-year DFS 71%) versus patients who underwent transplantation with active disease (DFS, 34%; P = .01). Overall, myeloablative haploidentical HSCT with peripheral blood stem cells (PBSC) and Sir-PTCy is a feasible treatment option: the low rates of GVHD and NRM as well as the favorable immune reconstitution profile pave the way for a prospective comparative trial comparing BM and PBSC in this specific transplantation setting.

  16. Breaking dogmata to help patients: non-myeloablative haematopoietic stem cell transplantation.

    PubMed

    Ruiz-Argüelles, Guillermo J; Gómez-Almaguer, David

    2004-10-01

    Various dogmata have been broken as a consequence of the evolution of knowledge in the area of allogeneic haematopoietic stem cell (HSC) transplantation. The following is now clear: for the successful engraftment of allogeneic HSC, bone marrow ablation of the recipient is not required; HSCs create their own space through graft-versus-host reactions; several malignancies can be eradicated by the graft-versus-tumour effect; HSC allografting can be conducted on an out-patient basis; HSC allografting can be done in aged or debilitated individuals; HSC allografting can be achieved without transfusion of blood products; and the costs of the allografting procedures can be substantially diminished. Despite the fact that HSC allografting with reduced intensity conditioning may be related to several disadvantages, such as mixed chimaerism and relapse of the malignancy, breaking these dogmata has resulted in availability of HSC allografting to a larger number of individuals worldwide, thus offering true curative therapeutic options to patients who otherwise would not qualify to be given these opportunities.

  17. Long-term outcomes of myeloablation and autologous transplantation of relapsed acute myeloid leukemia in second remission: a British Society of Blood and Marrow Transplantation registry study.

    PubMed

    Chantry, Andrew D; Snowden, John A; Craddock, Charles; Peggs, Karl; Roddie, Claire; Craig, Jenny I O; Orchard, Kim; Towlson, Keiren E; Pearce, Rachel M; Marks, David I

    2006-12-01

    Relapsed acute myeloid leukemia (AML) in adults has a poor prognosis if treated with chemotherapy alone. Case series have previously supported the role of myeloablation and autologous transplantation as a potentially curative treatment. This study aimed to use the large numbers and extended follow-up data in the British Society of Blood and Marrow Transplantation (BSBMT) registry database to establish long-term outcomes and relate these to biological and procedural factors. The BSBMT registry database was used to retrospectively identify 152 adult patients (age, 16-69 years) with AML in second remission treated with autologous transplantation in 1982-2003. Cytogenetic data were available for 68% of the patients; of these, at diagnosis, 42% had good risk features, 57% had standard risk features, and 1% had poor risk features. Conditioning regimens varied; autologous rescue was provided with bone marrow (BM) (71%), peripheral blood stem cells (PBSCs) (18%), or both (11%), which were harvested during first complete remission (CR1) and/or second CR (CR2). Median follow-up was 84 months (range, 2-200 months). At 10 years, actuarial overall survival (OS) was 32%, progression-free survival (PFS) was 28%, and relapse rate (RR) was 57%. The 100-day nonrelapse mortality (NRM) was 7%, rising to 11% at 1 year and to 14% at 10 years. OS was significantly related to M3 subtype (5-year OS, 66%; P = .005), patient age at diagnosis (P = .005) and transplantation (P = .026), and length of CR1, with greatest significance if the patient was dichotomized at CR1 duration of < 8 months or > or = 8 months (P = .0001). There was no difference in OS between regimens containing total body irradiation (TBI) and chemotherapy alone (P = .7). In relation to the nature of autologous graft material, there was improved OS (P = .025) and PFS (P = .009) with the use of cells harvested entirely in CR1 compared with cells harvested in CR2 or in both CR1 and CR2. Engraftment times were significantly

  18. In vivo T-cell depletion with myeloablative regimens on outcomes after cord blood transplantation for acute lymphoblastic leukemia in children

    PubMed Central

    Ponce, Doris M.; Eapen, Mary; Sparapani, Rodney; O'Brien, Tracey A.; Chan, Ka Wah; Chen, Junfang; Craddock, John; Schultz, Kirk R.; Wagner, John E.; Perales, Miguel-Angel; Barker, Juliet N.

    2015-01-01

    The inclusion of anti-thymocyte globulin (ATG) in cord blood transplantation is controversial. We evaluated outcomes according to ATG inclusion in 297 children and adolescents with acute lymphoblastic leukemia (ALL) who received myeloablative total body irradiation-based conditioning and either single (74%) or double-unit (26%) grafts. Ninety-two patients (31%) received ATG and 205 (69%) did not. ATG recipients were more likely to be cytomegalovirus seronegative. The incidence of day-100 grade II-IV acute GVHD (30% versus 54%, p = 0.0002), and chronic GVHD (22% versus 43%, p = 0.0008) were lower with ATG compared to non-ATG regimens. However, day 100 grade III-IV acute GVHD was comparable (11% versus 17%, p = 0.15). The 3-year incidences of transplant-related mortality (16% versus 17%, p = 0.98) and relapse (17% versus 27%, p = 0.12), and leukemia-free survival (66% versus 55%, p = 0.23) in ATG and non-ATG recipients were similar. There were no differences in viral reactivation between treatment groups (60% versus 58%, p=0.83). Therefore, the data suggest that incorporation of ATG with myeloablative conditioning regimens may be useful in reducing the risk of acute and chronic GVHD without any deleterious effect on transplant-related mortality, relapse or leukemia-free survival in children and adolescents with ALL. PMID:26327630

  19. Multicenter phase II study of temozolomide and myeloablative chemotherapy with autologous stem cell transplant for newly diagnosed anaplastic oligodendroglioma.

    PubMed

    Thomas, Alissa A; Abrey, Lauren E; Terziev, Robert; Raizer, Jeffrey; Martinez, Nina L; Forsyth, Peter; Paleologos, Nina; Matasar, Matthew; Sauter, Craig S; Moskowitz, Craig; Nimer, Stephen D; DeAngelis, Lisa M; Kaley, Thomas; Grimm, Sean; Louis, David N; Cairncross, J Gregory; Panageas, Katherine S; Briggs, Samuel; Faivre, Geraldine; Mohile, Nimish A; Mehta, Jayesh; Jonsson, Philip; Chakravarty, Debyani; Gao, Jianjiong; Schultz, Nikolaus; Brennan, Cameron W; Huse, Jason T; Omuro, Antonio

    2017-10-01

    Anaplastic oligodendroglioma (AO) and anaplastic oligoastrocytoma (AOA) are chemotherapy-sensitive tumors with prolonged survival after radiochemotherapy. We report a prospective trial using induction temozolomide (TMZ) followed by myeloablative high-dose chemotherapy (HDC) with autologous stem-cell transplant (ASCT) as a potential strategy to defer radiotherapy. Patients with AO/AOA received 6 cycles of TMZ (200 mg/m2 × 5/28 day). Responding patients were eligible for HDC (thiotepa 250 mg/m2/day × 3 days, then busulfan 3.2 mg/kg/day × 3 days), followed by ASCT. Genomic characterization was performed using next-generation sequencing. Forty-one patients were enrolled; 85% had 1p/19q codeleted tumors. After induction, 26 patients were eligible for HDC-ASCT and 21 agreed to proceed. There were no unexpected adverse events or toxic deaths. After median follow-up of 66 months, 2-year progression-free survival (PFS) for transplanted patients was 86%, 5-year PFS 60%, and no patient has died. Among all 1p/19q codeleted patients (N = 33), 5-year PFS was 50% and 5-year overall survival (OS) 93%, with median time to radiotherapy not reached. Next-generation sequencing disclosed typical oligodendroglioma-related mutations, including IDH1, TERT, CIC, and FUBP1 mutations in 1p/19q codeleted patients, and glioblastoma-like signatures in 1p/19q intact patients. Aside from IDH1, potentially oncogenic/actionable mutations were variable, depicting wide molecular heterogeneity within oligodendroglial tumors. TMZ followed by HDC-ASCT can be safely administered to patients with newly diagnosed 1p/19q codeleted AO. This strategy was associated with promising PFS and OS, suggesting that a chemotherapy-based approach may delay the need for radiotherapy and radiation-related toxicities. Raw data for further genomic and meta-analyses are publicly available at http://cbioportal.org/study?id=odg_msk_2017, accessed 6 January 2017. NCT00588523.

  20. Myeloablative versus Reduced-Intensity Conditioning in Patients with Myeloid Malignancies: A Propensity Score-Matched Analysis.

    PubMed

    Sibai, Hassan; Falcone, Umberto; Deotare, Uday; Michelis, Fotios V; Uhm, Jieun; Gupta, Vikas; Kuruvilla, John; Lipton, Jeffrey H; Seftel, Matthew D; Messner, Hans A; Kim, Dennis Dong Hwan

    2016-12-01

    Reduced-intensity conditioning (RIC) has been shown to have similar overall survival (OS) but higher relapse rates compared with myeloablative (MAC) regimens in patients with myeloid malignancies undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). Using propensity score matching (PSM) analysis, well-balanced pairs of different variables can be compared effectively. We retrospectively compared allo-HSCT recipients with acute myeloid leukemia or myelodysplasia receiving a RIC regimen (FBT200; fludarabine 30 mg/m(2)/day for 4 days, busulfan 3.2 mg/kg/day for 2 days, and total body irradiation [TBI] 200 cGy) or MAC regimen (FBT400; fludarabine 50 mg/m(2)/day for 4 days, busulfan 3.2 mg/kg/day for 4 days, and TBI 400 cGy). A total of 248 patients (121 in the RIC group and 127 in the MAC group) were included in the analysis. No statistically significant difference was observed in 2-year OS (RIC group, 45.2 ± 5.0%; MAC group, 51.7 ± 5.2%; P = .541), nonrelapse mortality (NRM; RIC group, 28.7 ± 2.8% MAC group, 34.7 ± 4.6%; P = .368), and acute graft-versus-host disease (GVHD) (P = .171) or chronic GVHD (P = .605) at 1 year. The cumulative incidence of relapse (CIR) at 2 years was statistically significantly different between the 2 groups, however (RIC, 26.1 ± 2.6%; MAC, 14.2 ± 3.5%; P = .033). When PSM was applied to the study population, 42 case-control pairs were evenly matched. PSM analysis confirmed no statistically significant difference in 2-year OS (RIC, 49.0 ± 9.1%; MAC, 54.9 ± 7.7%; P = .718), NRM (RIC, 22.2 ± 2.3%; MAC, 33.3 ± 2.8%; P = .238), or CIR (RIC, 25.7 ± 2.6%; MAC, 9.5 ± 1.1%; P = .315) in the PSM pairs. Our findings demonstrate that after applying PSM, FBT 200 RIC conditioning has comparable OS, NRM, and CIR to FBT 400 MAC conditioning before allo-HSCT.

  1. Myeloablative Hematopoietic Cell Transplantation for Acute Lymphoblastic Leukemia: Analysis of Graft Sources and Long-Term Outcome

    PubMed Central

    Tomblyn, Michael B.; Arora, Mukta; Baker, K. Scott; Blazar, Bruce R.; Brunstein, Claudio G.; Burns, Linda J.; DeFor, Todd E.; Dusenbery, Kathryn E.; Kaufman, Dan S.; Kersey, John H.; MacMillan, Margaret L.; McGlave, Philip B.; Miller, Jeffrey S.; Orchard, Paul J.; Slungaard, Arne; Tomblyn, Marcie R.; Vercellotti, Gregory M.; Verneris, Michael R.; Wagner, John E.; Weisdorf, Daniel J.

    2009-01-01

    Purpose Analysis of hematopoietic cell transplantation (HCT) for high-risk or recurrent acute lymphoblastic leukemia (ALL) using different donor sources is confounded by variable conditioning and supportive care. Patients and Methods We studied 623 consecutive ALL myeloablative HCT (1980 to 2005). Donors were autologous (n = 209), related (RD; n = 245), unrelated (URD; n = 100), and umbilical cord blood (UCB; n = 69). Results After median of 8.3 years of follow-up, 5-year overall survival (OS), leukemia-free survival (LFS), and relapse were 29% (95% CI, 26% to 32%), 26% (95% CI, 23% to 29%), and 43% (95% CI, 39% to 47%), respectively. Treatment-related mortality (TRM) at 2 years was 28% (95% CI, 25% to 31%). Mismatched URD sources yielded higher TRM (relative risk [RR], 2.2; P < .01) and lower OS (RR, 1.5; P = .05) than RD or UCB HCT. Autografting yielded significantly more relapse (68%; 95% CI, 59% to 77%; P < .01) and poorer LFS (14%; 95% CI, 10% to 18%; P = .01). HCT in first complete remission (CR1) yielded significantly better outcomes than later HCT. In a 1990 to 2005 allogeneic CR1/second complete response cohort, 5-year OS, LFS, and relapse rates were 41% (95% CI, 35% to 47%), 38% (95% CI, 32% to 44%), and 25% (95% CI, 19% to 31%), respectively; 2-year TRM was 34% (95% CI, 28% to 40%). With RD, well-matched URD and UCB sources, 5-year LFS was 40% (95% CI, 31% to 49%), 42% (95% CI, 14% to 70%), and 49% (95% CI, 34% to 64%), respectively, while relapse was 31% (95% CI, 22% to 40%), 17% (95% CI, 0% to 37%), and 27% (95% CI, 13% to 41%). Acute graft-versus-host disease was associated with fewer relapses. Since 1995, we noted progressive improvements in OS, LFS, and TRM. Conclusion Allogeneic, but not autologous, HCT for ALL results in durable LFS. Importantly, HCT using UCB led to similar outcomes as either RD or well-matched URD. HCT in early remission can best exploit the potent antileukemic efficacy of allografting from UCB, RD, or URD sources. PMID:19581540

  2. Kinetics of dendritic cells reconstitution and costimulatory molecules expression after myeloablative allogeneic haematopoetic stem cell transplantation: implications for the development of acute graft-versus host disease.

    PubMed

    Horváth, Rudolf; Budinský, Vít; Kayserová, Jana; Kalina, Tomás; Formánková, Renata; Starý, Jan; Bartůnková, Jirina; Sedlácek, Petr; Spísek, Radek

    2009-04-01

    Allogeneic hematopoetic stem cell transplantation (HSCT) represents a unique opportunity to monitor the kinetics of reconstitution of dendritic cells (DCs) and their dynamics in distinct pathologies. We analyzed DCs reconstitution after myeloablative HSCT. We separately analyzed patients with acute GVHD. DCs were monitored from the earliest phase of hematopoetic reconstitution until day +365. Both myeloid DCs and plasmacytoid DCs appeared at earliest stages after engraftment and relative numbers within white blood cells compartment peaked between days 19-25 after HSCT. Their proportion then gradually declined and absolute numbers of both DC subsets remained lower than in controls during the whole follow-up. Patients with acute GVHD had significantly lower numbers of circulating DCs. Decrease in DC counts preceded onset of clinical symptoms by at least 24 h and was independent of corticosteroids administration. This study reveals quantification of plasmacytoid and myeloid DCs as a potential biomarker for the prediction of acute GVHD development.

  3. Mycophenolate-based graft versus host disease prophylaxis is not inferior to methotrexate in myeloablative-related donor stem cell transplantation.

    PubMed

    Hamad, Nada; Shanavas, Mohamed; Michelis, Fotios V; Uhm, Jieun; Gupta, Vikas; Seftel, Matthew; Kuruvilla, John; Lipton, Jeffrey H; Messner, Hans A; Kim, Dennis Dong Hwan

    2015-05-01

    We retrospectively reviewed 242 patients who received related donor myeloablative peripheral blood hematopoietic cell transplantation. We compared patients who received mycophenolate (MMF)/cyclosporine (CSA) (n = 71), to historical controls who received methotrexate (MTX)/CSA (n = 172). There were no differences in overall survival, nonrelapse mortality, and relapse. The MMF/CSA group had significantly faster neutrophil and platelet engraftment: medians of 13 versus 18 days and 10 versus 14 days, respectively (P = 0.001). The cumulative incidence of acute graft versus host disease (GVHD) (Grades, 2-4) was significantly lower in the MMF/CSA group (45.1 vs. 74.4%, P < 0.001). The MMF/CSA group showed a lower incidence of skin (51.5 vs. 72.1%, P < 0.001) and liver acute GVHD (11.3 vs. 54.2%, P < 0.001) and a higher incidence of lung (42.2 vs. 19.0%, P = 0.045), eye (59.7 vs. 30.1%, P < 0.001), and mouth (72.8 vs. 56.4%, P = 0.001) chronic GVHD but only eye chronic GVHD was confirmed in propensity score matching (PSM) analysis. The incidence of cytomegalovirus (CMV) viremia was higher in the MMF/CSA group (55.8 vs. 39.6%, P < 0.001) but this was not confirmed in PSM analysis. MMF/CSA was identified as an independent favorable factor for acute GVHD (P < 0.001, hazard ratio, 0.41) but as a possible adverse risk factor for CMV viremia as this was not found to be statistically significant in PSM analysis. MMF/CSA in myeloablative matched related donor peripheral blood stem cell transplant is not inferior as GVHD prophylaxis in comparison with MTX/CSA and is associated with faster engraftment but a potentially higher risk of CMV viremia.

  4. Myeloablative Transplantation using either Cord Blood or Bone Marrow leads to Immune Recovery, High Long-Term Donor Chimerism and Excellent Survival in Chronic Granulomatous Disease

    PubMed Central

    Tewari, Priti; Martin, Paul L.; Mendizabal, Adam; Parikh, Suhag H.; Page, Kristin M.; Driscoll, Timothy A.; Malech, Harry L.; Kurtzberg, Joanne; Prasad, Vinod K.

    2012-01-01

    The curative potential of hematopoietic stem cell transplantation (HSCT) in patients with chronic granulomatous disease (CGD) depends upon availability of a suitable donor, successful donor engraftment and maintenance of long-term donor chimerism. Twelve consecutive children (median age 59.5 months; range, 8–140) with severe CGD (serious bacterial/fungal infections pre-transplant, median 3; range, 2–9) received myeloablative HSCT using sibling bone marrow (SibBM; n=5), unrelated cord blood (UCB; n=6), and sibling cord blood (SibCB; n=1) at our center between 1997–2010. SibBM and SibCB were HLA matched at 6/6 while UCB were 5/6 (n=5) or 6/6 (n=1). Recipients of SibBM were conditioned with Busulfan and Cyclophosphamide (Bu/Cy) + ATG while 6 of 7 CB recipients received Fludarabine/Bu/Cy/ATG. Seven patients received G-CSF-mobilized granulocyte transfusions from directed donors. The first 2 UCB recipients had primary graft failure but were successfully re-transplanted with UCB. Highest acute GvHD was grade III (n=1). Extensive chronic GvHD developed in 3 patients. All patients are alive with median follow-up of 70.5 (range 12–167) months with high donor chimerism (>98%, n=10; 94%, n=1; and 92%, n=1). Myeloablative HSCT led to correction of neutrophil dysfunction, durable donor chimerism, excellent survival, good quality of life, and low incidence of GvHD regardless of graft source. PMID:22326631

  5. Impact of Pre-Transplant Anti-T Cell Globulin (ATG) on Immune Recovery after Myeloablative Allogeneic Peripheral Blood Stem Cell Transplantation.

    PubMed

    Servais, Sophie; Menten-Dedoyart, Catherine; Beguin, Yves; Seidel, Laurence; Gothot, André; Daulne, Coline; Willems, Evelyne; Delens, Loïc; Humblet-Baron, Stéphanie; Hannon, Muriel; Baron, Frédéric

    2015-01-01

    Pre-transplant infusion of rabbit anti-T cell globulin (ATG) is increasingly used as prevention of graft-versus-host disease (GVHD) after allogeneic peripheral blood stem cell transplantation (PBSCT). However, the precise impact of pre-transplant ATG on immune recovery after PBSCT is still poorly documented. In the current study, we compared immune recovery after myeloablative PBSCT in 65 patients who either received (n = 37) or did not (n = 28) pre-transplant ATG-Fresenius (ATG-F). Detailed phenotypes of circulating T, B, natural killer (NK) and invariant NKT (iNKT) cells were analyzed by multicolor flow cytometry at serial time-points from day 40 to day 365 after transplantation. Thymic function was also assessed by sjTREC quantification. Serious infectious events were collected up to 2 years post-transplantation. Pre-transplant ATG-F had a prolonged (for at least up to 1-year) and selective negative impact on the T-cell pool, while it did not impair the recovery of B, NK nor iNKT cells. Among T cells, ATG-F selectively compromised the recovery of naïve CD4+, central memory CD4+ and naïve CD8+ cells, while it spared effector memory T and regulatory T cells. Levels of sjTRECs were similar in both cohorts at 1-year after PBSCT, suggesting that ATG-F unlikely impaired thymopoiesis at long-term after PBSCT. Finally, the incidence and rate of serious infections were similar in both groups, while ATG-F patients had a lower incidence of grade II-IV acute graft-versus-host disease. Pre-transplant ATG-F induces long-lasting modulation of the circulating T-cell pool after myeloablative PBSCT, that may participate in preventing graft-versus-host disease without deeply compromising anti-pathogen defenses.

  6. A Phase IIb, Multicenter, Open-Label, Safety, and Efficacy Study of High-Dose, Propylene Glycol-Free Melphalan Hydrochloride for Injection (EVOMELA) for Myeloablative Conditioning in Multiple Myeloma Patients Undergoing Autologous Transplantation.

    PubMed

    Hari, Parameswaran; Aljitawi, Omar S; Arce-Lara, Carlos; Nath, Rajneesh; Callander, Natalie; Bhat, Gajanan; Allen, Lee F; Stockerl-Goldstein, Keith

    2015-12-01

    Autologous stem cell transplantation (ASCT) after high-dose melphalan conditioning is considered a standard of care procedure for patients with multiple myeloma (MM). Current formulations of melphalan (eg, Alkeran for Injection [melphalan hydrochloride]; GlaxoSmithKline, Research Triangle Park, NC, USA) have marginal solubility and limited chemical stability upon reconstitution. Alkeran requires the use of propylene glycol as a co-solvent, which itself has been reported to cause such complications as metabolic/renal dysfunction and arrhythmias. EVOMELA (propylene glycol-free melphalan HCl; Spectrum Pharmaceuticals, Inc., Irvine, CA, USA) is a new i.v. melphalan formulation that incorporates Captisol (Ligand Pharmaceuticals, Inc., La Jolla, CA, USA), a specially modified cyclodextrin that improves the solubility and stability of melphalan and eliminates the need for propylene glycol. This new formulation has been shown to be bioequivalent to Alkeran. EVOMELA (200 mg/m(2)) was administered as 2 doses of 100 mg/m(2) each in a phase IIb, open-label, multicenter study to confirm its safety and efficacy as a high-dose conditioning regimen for patients with MM undergoing ASCT. At 5 centers, 61 patients (26 women) with a median age of 62 years (range, 32-73) were enrolled. All patients achieved myeloablation with a median time of 5 days post-ASCT, and all successfully achieved neutrophil and platelet engraftment with median times of 12 days post-ASCT and 13 days post-ASCT, respectively; treatment-related mortality on day 100 was 0%. Overall response rate (according to independent, blinded review) was high (100%), with an overall complete response rate of 21% (13% stringent complete response; 8% complete response) and overall partial response rate of 79% (61% very good partial response; 18% partial response). The incidence of grade 3 mucositis and stomatitis was low (10% and 5%, respectively) with no grade 4 mucositis or stomatitis reported (graded according to National

  7. Total Body Irradiation-Based Myeloablative Haploidentical Stem Cell Transplantation Is a Safe and Effective Alternative to Unrelated Donor Transplantation in Patients Without Matched Sibling Donors.

    PubMed

    Solomon, Scott R; Sizemore, Connie A; Sanacore, Melissa; Zhang, Xu; Brown, Stacey; Holland, H Kent; Morris, Lawrence E; Bashey, Asad

    2015-07-01

    We enrolled 30 patients on a prospective phase II trial utilizing a total body irradiation (TBI)-based myeloablative preparative regimen (fludarabine 30 mg/m2/day × 3 days and TBI 150 cGy twice per day on day -4 to -1 [total dose 1200 cGy]) followed by infusion of unmanipulated peripheral blood stem cells from a haploidentical family donor (haplo). Postgrafting immunosuppression consisted of cyclophosphamide 50 mg/kg/day on days 3 and 4, mycophenolate mofetil through day 35, and tacrolimus through day 180. Median patient age was 46.5 years (range, 24 to 60). Transplantation diagnosis included acute myelogenous leukemia (n = 16), acute lymphoblastic leukemia (n = 6), chronic myelogenous leukemia (n = 5), myelodysplastic syndrome (n = 1), and non-Hodgkin's lymphoma (n = 2). Using the Dana Farber/Center for International Blood and Marrow Transplant Research/Disease Risk Index (DRI), patients were classified as low (n = 4), intermediate (n = 12), high (n = 11), and very high (n = 3) risk. All patients engrafted with a median time to neutrophil and platelet recovery of 16 and 25 days, respectively. All evaluable patients achieved sustained complete donor T cell and myeloid chimerism by day +30. Acute graft-versus-host disease (GVHD) grades II to IV and III and IV was seen in 43% and 23%, respectively. The cumulative incidence of chronic GVHD was 56% (severe in 10%). After a median follow-up of 24 months, the estimated 2-year overall survival (OS), disease-free survival (DFS), nonrelapse mortality, and relapse rate were 78%, 73%, 3%, and 24%, respectively. Two-year DFS and relapse rate in patients with low/intermediate risk disease was 100% and 0%, respectively, compared with 39% and 53% for patients with high/very high risk disease. When compared with a contemporaneously treated cohort of patients at our institution receiving myeloablative HLA-matched unrelated donor (MUD) transplantation (acute myelogenous leukemia [n = 17], acute lymphoblastic leukemia [n = 15

  8. Comparison of Radiation Dose Estimation for Myeloablative Radioimmunotherapy for Relapsed or Recurrent Mantle Cell Lymphoma using 131I Tositumomab to that of Other Types of Non-Hodgkin's Lymphoma

    SciTech Connect

    Rajendran, Joseph G.; Gopal, Ajay K.; Durack, Larry; Fisher, Darrell R.; Press, Oliver W.; Eary, Janet F.

    2004-12-01

    Patients with relapsed or refractory mantle cell lymphoma (MCL) demonstrate poor survival after standard treatment. Myeloablative radioimmunotherapy (RIT) using 131I tositumomab (anti-CD20) has the ability to deliver specific radiation absorbed dose to antigen bearing tumor. We reviewed normal organ radiation absorbed doses in MCL patients. METHODS: Records of patients with MCL (n = 25), who received myeloablative RIT between January 1996 and December 2003 were reviewed. Individual patient radiation dosimetry was performed on all patients after a trace labeled infusion of 131I tositumomab (mean = 348 MBq), to calculate the required amount of radioactivity for therapy, based on MIRD schema. RESULTS: Mean organ residence times (hr) corrected for CT derived organ volumes for MCL, were as follows: Lungs:9.0; Liver:12.4; Kidneys:1.7; Spleen:2.17; Whole Body:62.4 and mean radiation absorbed doses mGy/Mbq were: Lungs:1.2; Liver:1.1; Kidneys:0.85; Spleen:1.7; Whole Body: 0.21. This is similar to patients with other NHL. Patients received a mean activity of 21 GBq of 131I (range = 11.5 - 41.4) for therapy estimated to deliver 25 Gy to the normal organ receiving the highest radiation absorbed dose. CONCLUSION: Myeloablative RIT using 131I tositumomab results in normal organ radiation absorbed doses similar to those in patients with other non-Hodgkin's lymphoma, and is suitable for treating patients with relapsed or refractory MCL.

  9. The Pentostatin Plus Cyclophosphamide (PC) Non-myeloablative Regimen Induces Durable Host T Cell Functional Deficits and Prevents Murine Marrow Allograft Rejection

    PubMed Central

    Mariotti, Jacopo; Taylor, Justin; Massey, Paul R.; Ryan, Kaitlyn; Foley, Jason; Buxhoeveden, Nicole; Felizardo, Tania C.; Amarnath, Shoba; Mossoba, Miriam E.; Fowler, Daniel H.

    2010-01-01

    In this manuscript, we characterize for the first time an animal model of non-myeloablative bone marrow transplantation (BMT) using the purine analog pentostatin [P]. Other cohorts of mice received a distinct purine analog, fludarabine [F], which we and others have previously evaluated in non-myeloablative murine models. In this project, we have characterized pentostatin for its ability to: (1) operate synergistically with cyclophosphamide [C] to induce host T cell depletion; (2) induce host T cell suppression, as defined by modulation of cytokine secretion in vitro and abrogation of host-versus-graft reactivity (HVGR) in vivo; (3) constrain host T cell recovery post-chemotherapy; and (4) prevent the rejection of T-cell depleted (TCD), fully MHC mismatched bone marrow allografts. Relative to single-agent regimens, combination PC or FC regimens worked synergistically to deplete host CD4+ and CD8+ T cells; PC and FC regimens were developed that yielded similar levels of host T cell and myeloid cell depletion. In the setting of these generally comparable states of host T and myeloid cell depletion, the PC regimen was found to be highly immune suppressive, as evidenced by reduced host T cell capacity to: (1) secrete IL-2 and IFN-γ in vitro; (2) mediate HVGR in vivo; and (3) recover numerically and functionally during a two-week observation period post-chemotherapy. Finally, using B6 hosts treated with the 14-day chemotherapy regimens, the PC regimen more consistently prevented the rejection of BALB/c TCD-allografts than the FC regimen (rate of alloengraftment, 14/15 [93%] of PC-treated recipients vs. 8/14 [57%] of FC-treated recipients; p<0.05); similar results were observed using an 8-day conditioning regimen. These data suggest that host T cell suppression, distinct from T cell depletion, may therefore represent a critical determinant of engraftment after purine analog-based regimens and may also be preferentially attained by use of pentostatin. PMID:21130889

  10. Immune reconstitution following myeloablative allogeneic hematopoietic stem cell transplantation: the impact of expanding CD28negative CD8+ T cells on relapse.

    PubMed

    Yakoub-Agha, Ibrahim; Saule, Pasquine; Magro, Leonardo; Cracco, Pascale; Duhamel, Alain; Coiteux, Valérie; Bruno, Bénédicte; Dufossé, Françoise; Jouet, Jean-Pierre; Dessaint, Jean-Paul; Labalette, Myriam

    2009-04-01

    Allogeneic stem cell transplantation has become standard therapy for hematologic malignancies through the positive immunologic graft-versus-leukemia effect. Initial immune recovery relies on peripheral expansion of infused T cells, which switch to a memory-like phenotype. This study prospectively investigated whether changes in subset composition precedes complications after myeloablative HLA-matched transplantation for hematologic malignancies. Of 80 allograft recipients, 18 were still free of clinical complication throughout 395 to 1564 days of follow-up. Compared with this complication-free subgroup, patients who developed chronic graft-versus-host disease (cGVHD) without relapsing recovered similar numbers of circulating T cells with predominance of CD8+ T cells lacking CC-chemokine receptor-7 and CD28 expression throughout the first year after transplantation. Conversely, poor CD8+ T cell recovery with diminished numbers of CD28neg CD8+ T cells (approximately 1/4th of that of relapse-free patients) preceded occurrence of malignant relapse. In multivariate analysis, lower CD28neg CD8+ T cell counts by day 60 postallograft were associated with a greater risk of subsequent relapse (hazard ratio [HR] 0.33; 95% confidence interval [CI]: 0.14-0.76; P = .01). Enumeration of CD28neg CD8+ T cells in patients could assist in predicting risk of relapse and help build an algorithm for accelerating the immune recovery by reducing the immunosuppressive treatment and considering the introduction of preemptive donor lymphocyte infusions.

  11. Feasibility of low dose interleukin-2 therapy following T cell-depleted non-myeloablative allogeneic hematopoietic stem cell transplantation from HLA matched or mismatched family member donors

    PubMed Central

    Rizzieri, David A.; Crout, Christopher; Storms, Robert; Golob, Jared; Long, Gwynn D.; Gasparetto, Cristina; Sullivan, Keith M.; Horwitz, Mitchell; Chute, John; Lagoo, Anand S.; Morris, Ashley; Beaven, Anne; Yang, Yiping; Peterson, Bercedis; Li, Zhiguo; Chao, Nelson J.

    2013-01-01

    High relapse rates and infections remain primary causes of failure in non-myeloablative transplantation. Interleukin-2 (IL-2) may stimulate the immune system and improve outcomes. The primary objective of this pilot study was to evaluate the feasibility of administering IL-2 following a T cell-depleted nonmyeloablative hematopoietic stem cell transplant. Methods Patients received T cell depleted nonmyeloablative transplant from a matched or mismatched related donor. Those with allogeneic engraftment, < grade 2 acute GVHD at time of study entry, and no severe end organ damage were eligible and received IL2 starting 6 weeks after the first day of stem cell infusion. Patients received 1 mu/m2 daily for 5 days each week for 4 weeks followed by a 2 week rest period for a 6 week cycle to continue for up to 1 year. Results Eight patients aged 28–69 were treated. Significant toxicities were limited to GVHD of the skin ≤ grade 2 in 3 patients and severe fatigue in 4 patients, limiting the duration of therapy. Two of the 8 patients died of relapsed disease and one from CMV. With a median overall duration of follow up of survivors of 48 months, five patients (63%) remain alive and in continuous complete remission. PMID:21166499

  12. (GT)n Repeat Polymorphism in Heme Oxygenase-1 (HO-1) Correlates with Clinical Outcome after Myeloablative or Nonmyeloablative Allogeneic Hematopoietic Cell Transplantation

    PubMed Central

    Køllgaard, Tania; Kornblit, Brian; Petersen, Jesper; Klausen, Tobias Wirenfeldt; Mortensen, Bo Kok; Brændstrup, Peter; Sengeløv, Henrik; Høgdall, Estrid; Müller, Klaus; Vindeløv, Lars; Andersen, Mads Hald; thor Straten, Per

    2016-01-01

    Allogeneic hematopoietic cell transplantation (HCT) is a treatment for various hematologic diseases where efficacy of treatment is in part based on the graft versus tumour (GVT) activity of cells in the transplant. The cytoprotective enzyme heme oxygenase-1 (HO-1) is a rate-limiting enzyme in heme degradation and it has been shown to exert anti-inflammatory functions. In humans a (GT)n repeat polymorphism regulates the expression of HO-1. We conducted fragment length analyses of the (GT)n repeat in the promotor region of the gene for HO-1 in DNA from donors and recipients receiving allogeneic myeloablative- (MA) (n = 110) or nonmyeloablative- (NMA-) (n = 250) HCT. Subsequently, we compared the length of the (GT)n repeat with clinical outcome after HCT. We demonstrated that transplants from a HO-1high donor after MA-conditioning (n = 13) is associated with higher relapse incidence at 3 years (p = 0.01, n = 110). In the NMA-conditioning setting transplantation of HO-1low donor cells into HO-1low recipients correlated significantly with decreased relapse related mortality (RRM) and longer progression free survival (PFS) (p = 0.03 and p = 0.008, respectively). Overall, our findings suggest that HO-1 may play a role for the induction of GVT effect after allogeneic HCT. PMID:27997582

  13. Ovarian Function after Hematopoietic Cell Transplantation: A Descriptive Study Following the Use of GnRH Agonists for Myeloablative Conditioning and Observation Only for Reduced-Intensity Conditioning

    PubMed Central

    Phelan, Rachel; Mann, Elizabeth; Napurski, Char; DeFor, Todd E; Petryk, Anna; Miller, Weston P; Wagner, John E; Verneris, Michael R; Smith, Angela R

    2017-01-01

    Gonadal failure is a health and quality of life concern in hematopoietic cell transplant (HCT) survivors. While ovarian dysfunction is nearly universal following myeloablative (MA) conditioning, risk is unclear after reduced-intensity conditioning (RIC). Gonadotropin-releasing hormone agonists decrease ovarian failure rates following conventional chemotherapy but little is known about its effectiveness with HCT. We investigated the impact of leuprolide on ovarian function after MA conditioning and monitored ovarian function after RIC in this descriptive pilot study. Post-menarchal females <50 years undergoing HCT with adequate baseline ovarian function (FSH level <40 mIU/mL and normal menstruation) were eligible. Prior to MA conditioning, leuprolide was administered. Those undergoing RIC were observed. FSH was measured at various time points. Seventeen women aged 12–45 years were evaluated (7 in the intervention group and 10 observation group). Compared to the historical high rate of ovarian failure after MA conditioning, 3 of 7 evaluable Lupron recipients had ovarian failure at a median of 703 days post-transplant. Ovarian failure occurred in 1 of 10 recipients of RIC at median follow-up of 901 days. In conclusion, leuprolide may protect ovarian function after MA conditioning. Additionally, RIC with cyclophosphamide, fludarabine and low-dose TBI has a low risk of ovarian failure. PMID:27272448

  14. Single-unit umbilical cord blood transplantation from unrelated donors in patients with hematological malignancy using busulfan, thiotepa, fludarabine and ATG as myeloablative conditioning regimen.

    PubMed

    Sanz, J; Boluda, J C H; Martín, C; González, M; Ferrá, C; Serrano, D; de Heredia, C D; Barrenetxea, C; Martinez, A M; Solano, C; Sanz, M A; Sanz, G F

    2012-10-01

    Attempts to optimize outcomes in cord blood transplantation (CBT) by using new conditioning regimens and standardization of cord blood unit selection are warranted. In all, 88 patients (18 children and 70 adults) with hematological malignancy from nine Spanish institutions underwent a single-unit CBT after an i.v. BU-based myeloablative conditioning regimen. All evaluable patients except one engrafted. The overall cumulative incidence (CI) of myeloid engraftment was 94% at a median time of 19 days. In multivariate analysis, nonadvanced disease stage was the only factor with a favorable impact on myeloid engraftment. The CI of acute GVHD grades II-IV and chronic extensive GVHD were 24% each. The CI of nonrelapse mortality at 100 days, 180 days and 5 years was 14, 23 and 44%, respectively. The 5-year CI of relapse was 18%, whereas disease-free survival (DFS) was 46%, 39% and 11% for patients transplanted in early, intermediate and advanced stages of the disease, respectively. Our study shows high rates of engraftment with fast neutrophil recovery in patients undergoing single-unit CBT using a BU-based conditioning regimen. Long-term DFS can be achieved in a substantial number of patients with high-risk hematological malignancies, particularly when transplanted in an early stage of the disease.

  15. Myeloablative allogeneic hematopoietic stem cell transplantation in patients who experience relapse after autologous stem cell transplantation for lymphoma: a report of the International Bone Marrow Transplant Registry.

    PubMed

    Freytes, César O; Loberiza, Fausto R; Rizzo, J Douglas; Bashey, Asad; Bredeson, Christopher N; Cairo, Mitchell S; Gale, Robert Peter; Horowitz, Mary M; Klumpp, Thomas R; Martino, Rodrigo; McCarthy, Philip L; Molina, Arturo; Pavlovsky, Santiago; Pecora, Andrew L; Serna, Derek S; Tsai, Tsuong; Zhang, Mei-Jie; Vose, Julie M; Lazarus, Hillard M; van Besien, Koen

    2004-12-01

    Myeloablative allogeneic hematopoietic stem cell transplantation (allo-HSCT) is increasingly used in patients with lymphoma who experience disease relapse after autologous hematopoietic stem cell transplantation (auto-HSCT) because the allograft is tumor free and may induce a graft-versus-tumor effect. We analyzed 114 patients treated with this approach from 1990 to 1999 to assess disease progression, progression-free survival (PFS), and overall survival (OS). Cumulative incidence of disease progression at 3 years was 52%, whereas treatment-related mortality was 22%, lower than previously reported. Three-year probabilities of OS and PFS were 33% and 25%, respectively. With prolonged follow-up, however, nearly all patients experienced disease progression, and 5-year probabilities were 24% and 5%, respectively. Complete remission at the time of allo-HSCT and use of total body irradiation (TBI) in patients with non-Hodgkin lymphoma (NHL) were associated with lower rates of disease progression and higher rates of OS. In summary, allo-HSCT is feasible for patients with lymphoma who have relapses after auto-HSCT and can result in prolonged survival for some, but it is usually not curative. Most likely to benefit are patients who have HLA-matched sibling donors, are in remission, and have good performance status.

  16. Donor-specific differences in long-term outcomes of myeloablative transplantation in adults with Philadelphia-negative acute lymphoblastic leukemia.

    PubMed

    Lee, S; Chung, N-G; Cho, B-S; Eom, K-S; Kim, Y-J; Kim, H-J; Min, C-K; Cho, S-G; Kim, D-W; Lee, J-W; Min, W-S; Park, C-W; Kim, C-C

    2010-12-01

    We analyzed long-term outcomes of myeloablative stem cell transplantation (SCT) in 292 adults with Philadelphia (Ph)-negative acute lymphoblastic leukemia (ALL). Donors were related (RD; n=132), unrelated (URD; n=68; 30 well-matched (WM), 19 partially matched (PM), 19 mismatched (MM)) and autologous (AUTO; n=92). After a median follow-up of 85 months, the risk of relapse was higher for AUTO-SCT than for RD-SCT (P<0.001). MM-URD-SCT yielded higher risk of non-relapse mortality than RD-SCT (P=0.010). As a result, disease-free survival (DFS) at 5 years was inferior using AUTO (46.1%; P=0.010) or MM-URD (26.3%; P=0.036), whereas DFS from other donor sources was approximately equivalent (53.5% for RD, 63.3% for WM-URD and 57.0% for PM-URD). Other factors associated with poorer DFS included SCT beyond first complete remission (CR), older age and adverse cytogenetics. In a pairwise comparison of outcomes between RD-SCT and AUTO-SCT for patients in first CR, the inferiority of AUTO-SCT was observed, particularly in high-risk patients. Conversely, in standard-risk patients, AUTO-SCT yielded comparable outcomes to RD-SCT. SCT using RD, WM-URD or PM-URD may be considered the best donor sources for adult high-risk Ph-negative ALL.

  17. Follow up of hemopoietic chimerism in individuals given allogeneic hemopoietic stem cell allografts using an immunosuppressive, non-myeloablative conditioning regimen: a prospective study in a single institution.

    PubMed

    Ruiz-Argüelles, Guillermo J; López-Martíneza, Briceida; Santellán-Olea, Ma Rayo; Abreu-Díaz, Glexsy; Reyes-Núñez, Virginia; Ruiz-Argüelles, Alejandro; Garcés-Eisele, Javier

    2002-07-01

    Thirty consecutive patients were given non-myeloablative stem cell transplants (NST) and posttransplant chimerism was studied by several methods. In 16 individuals definitive proofs of chimerism have been shown: In 10 cases sex chimerism, in 7 cases chimerism shown by means of microsatellites, in 4 cases ABO chimerism, in two cases Rh chimerism and in one HLA-DR chimerism. In addition, in 9 individuals the disappearance of the molecular marker of the leukemia is an indirect evidence of the chimerism, as well as the presence of graft versus host disease (GVHD) in 17 allografted patients. Only in 6 patients no evidence of chimerism could be shown; all of them died as a result of either persistent or relapsing malignancy. Since the early patterns of chimerism may be predictive of either GVHD or graft loss in NST and, since therapeutic intervention (such as donor lymphocytes infusions) is based in the patterns of chimerism, it is possible that chimerism studies in these types of allografts should be ideally done more frequently than in conventional allotransplants.

  18. Circulating IL-17 levels during the peri-transplant period as a predictor for early leukemia relapse after myeloablative allogeneic stem cell transplantation.

    PubMed

    Cho, Byung-Sik; Lim, Ji-Young; Yahng, Seung-Ah; Lee, Sung-Eun; Eom, Ki-Seong; Kim, Yoo-Jin; Chung, Nak-Gyun; Jeong, Dae-Chul; Lee, Seok; Kim, Hee-Je; Cho, Seok-Goo; Kim, Dong-Wook; Lee, Jong-Wook; Min, Woo-Sung; Park, Chong-Won; Min, Chang-Ki

    2012-03-01

    IL-17 is involved in inducing and mediating pro-inflammatory responses. The association of IL-17 with tumor growth or graft-versus-host disease (GVHD) has become a subject of controversy. We hypothesized that serum IL-17 (sIL-17) levels during the peri-transplant period may affect alloreactive responses after allogeneic stem cell transplantation (SCT). sIL-17 levels of 95 patients with leukemia who had undergone myeloablative allogeneic SCT were measured using ELISA before conditioning and on day 0, +7, and +14 after transplantation. With a median follow-up of 17 months, the overall survival, disease-free survival, non-relapse mortality, and relapse incidence were 70.9%, 66.3%, 10.3%, and 23.4%, respectively. Ten patients relapsed within 180 days (early relapse, 10.5%) post-transplant. The cumulative incidence of acute GVHD over grade II and chronic GVHD was 55.8% and 69.0%, respectively. Analyses using repeated measures of ANOVA and mean values of sIL-17 revealed that patients relapsed within 180 days had higher sIL-17 levels, whereas no association existed between sIL-17 levels and other clinical outcomes, including acute GVHD. Receiver operating characteristic curve analyses also revealed that sIL-17 levels were available for the prediction of early relapse and that patients with higher sIL-17 levels at each time point had a significantly higher early relapse. Multivariate analyses and subgroup analyses with only standard disease status suggest the association of sIL-17 levels with subsequent early relapse independent of disease status at transplantation. This study is the first one demonstrating the early change in sIL-17 during the peri-transplant period and the association with early relapse in humans.

  19. Results of a prospective multicentre myeloablative double-unit cord blood transplantation trial in adult patients with acute leukaemia and myelodysplasia.

    PubMed

    Barker, Juliet N; Fei, Mingwei; Karanes, Chatchada; Horwitz, Mitchell; Devine, Steven; Kindwall-Keller, Tamila L; Holter, Jennifer; Adams, Alexia; Logan, Brent; Navarro, Willis H; Riches, Marcie

    2015-02-01

    Double-unit cord blood (CB) grafts may improve engraftment and relapse risk in adults with haematological malignancies. We performed a prospective high-dose myeloablative double-unit CB transplantation (CBT) trial in adults with high-risk acute leukaemia or myelodysplasia (MDS) between 2007 and 2011. The primary aim was to establish the 1-year overall survival in a multi-centre setting. Fifty-six patients (31 acute myeloid leukaemia, 19 acute lymphoblastic leukaemia, 4 other acute leukaemias, 2 myelodysplastic syndrome [MDS]) were transplanted at 10 centres. The median infused total nucleated cell doses were 2·62 (larger unit) and 2·02 (smaller unit) x 10(7) /kg. The cumulative incidence of day 100 neutrophil engraftment was 89% (95% confidence interval [CI]: 80-96). Day 180 grade II-IV acute graft-versus-host disease (GVHD) incidence was 64% (95%CI: 51-76) and 36% (95%CI: 24-49) of patients had chronic GVHD by 3-years. At 3-years post-transplant, the transplant-related mortality (TRM) was 39% (95%CI: 26-52), and the 3-year relapse incidence was 11% (95%CI: 4-21). With a median 37-month (range 23-71) follow-up of survivors, the 3-year disease-free survival was 50% (95%CI: 37-63). Double-unit CBT is a viable alternative therapy for high-risk acute leukaemia/ MDS in patients lacking a matched unrelated donor. This is especially important for minority patients. The relapse incidence was low but strategies to ameliorate TRM are needed. © 2014 John Wiley & Sons Ltd.

  20. Non-myeloablative Allogeneic Hematopoietic Stem Cell Transplantation for Adults with Relapsed and Refractory Mantle Cell Lymphoma: A Single Center Analysis in the Rituximab Era

    PubMed Central

    Mussetti, Alberto; Devlin, Sean M.; Castro-Malaspina, Hugo R; Barker, Juliet N.; Giralt, Sergio A.; Zelenetz, Andrew D.

    2015-01-01

    Relapsed and refractory (rel/ref) mantle cell lymphoma (MCL) portends a dismal prognosis. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) represents the only potentially curative therapy in this setting. We analyzed survival outcomes of 29 recipients of non-myeloablative allo-HSCT for rel/ref MCL, and studied possible prognostic factors in this setting. The cumulative incidence of disease progression and non-relapse mortality at 3 years were 28% (95% confidence interval [CI]: 13-46%) and 29% (95%CI: 13-47%), respectively. The cumulative incidence of grade II-IV acute graft-versus-host disease (GVHD) at days +100 and +180 were 34% (95%CI: 18-52%) and 45% (95%CI: 26-62%), respectively. With a median follow-up in survivors of 53 (range 24-83) months, the 3-year overall survival (OS) and progression-free survival (PFS) were 54% (95%CI: 38-76%) and 41% (95%CI: 26-64%), respectively. In vivo T-cell depletion with alemtuzumab (n=6) was associated with inferior 3-year PFS (0% vs. 51%, p=0.007) and OS (17% vs. 64%, p=0.014). Conversely, a second line international prognostic index (sIPI) at transplantation equal to 0 (no risk factors) was associated with an improved 3-year PFS (52% vs. 22%, p=0.020) and OS (71% vs. 22%, p=0.006) compared to sIPI ≥1. Performing an allo-HSCT before 2007 was associated with a decreased 3-year OS (25% vs. 76%, p=0.015) but not with a significantly inferior PFS (17% vs. 59%, p=0.058). In this single center series, we report encouraging results with allo-HSCT for patients with rel/ref MCL. High alemtuzumab doses should probably be avoided in this context. PMID:26146802

  1. Ph+ ALL patients in first complete remission have similar survival after reduced intensity and myeloablative allogeneic transplantation: impact of tyrosine kinase inhibitor and minimal residual disease.

    PubMed

    Bachanova, V; Marks, D I; Zhang, M-J; Wang, H; de Lima, M; Aljurf, M D; Arellano, M; Artz, A S; Bacher, U; Cahn, J-Y; Chen, Y-B; Copelan, E A; Drobyski, W R; Gale, R P; Greer, J P; Gupta, V; Hale, G A; Kebriaei, P; Lazarus, H M; Lewis, I D; Lewis, V A; Liesveld, J L; Litzow, M R; Loren, A W; Miller, A M; Norkin, M; Oran, B; Pidala, J; Rowe, J M; Savani, B N; Saber, W; Vij, R; Waller, E K; Wiernik, P H; Weisdorf, D J

    2014-03-01

    The efficacy of reduced intensity conditioning (RIC) allogeneic hematopoietic cell transplantation (HCT) for Philadelphia chromosome positive (Ph+) acute lymphoblastic leukemia (ALL) is uncertain. We analyzed 197 adults with Ph+ ALL in first complete remission; 67 patients receiving RIC were matched with 130 receiving myeloablative conditioning (MAC) for age, donor type and HCT year. Over 75% received pre-HCT tyrosine kinase inhibitors (TKIs), mostly imatinib; 39% (RIC) and 49% (MAC) were minimal residual disease (MRD)(neg) pre-HCT. At a median 4.5 years follow-up, 1-year transplant-related mortality (TRM) was lower in RIC (13%) than MAC (36%; P=0.001) while the 3-year relapse rate was 49% in RIC and 28% in MAC (P=0.058). Overall survival (OS) was similar (RIC 39% (95% confidence interval (CI) 27-52) vs 35% (95% CI 27-44); P=0.62). Patients MRD(pos) pre-HCT had higher risk of relapse with RIC vs MAC (hazard ratio (HR) 1.97; P=0.026). However, patients receiving pre-HCT TKI in combination with MRD negativity pre-RIC HCT had superior OS (55%) compared with a similar MRD population after MAC (33%; P=0.0042). In multivariate analysis, RIC lowered TRM (HR 0.6; P=0.057), but absence of pre-HCT TKI (HR 1.88; P=0.018), RIC (HR 1.891; P=0.054) and pre-HCT MRD(pos) (HR 1.6; P=0.070) increased relapse risk. RIC is a valid alternative strategy for Ph+ ALL patients ineligible for MAC and MRD(neg) status is preferred pre-HCT.

  2. Ph+ ALL patients in first complete remission have similar survival after reduced intensity and myeloablative allogeneic transplantation: Impact of tyrosine kinase inhibitor and minimal residual disease

    PubMed Central

    Bachanova, Veronika; Marks, David I.; Zhang, Mei-Jie; Wang, Hailin; de Lima, Marcos; Aljurf, Mahmoud D.; Arellano, Martha; Artz, Andrew S.; Bacher, Ulrike; Cahn, Jean-Yves; Chen, Yi-Bin; Copelan, Edward A.; Drobyski, William R.; Gale, Robert Peter; Greer, John P; Gupta, Vikas; Hale, Gregory A.; Kebriaei, Partow; Lazarus, Hillard M.; Lewis, Ian D.; Lewis, Victor A.; Liesveld, Jane L.; Litzow, Mark R.; Loren, Alison W.; Miller, Alan M.; Norkin, Maxim; Oran, Betul; Pidala, Joseph; Rowe, Jacob M.; Savani, Bipin N.; Saber, Wael; Vij, Ravi; Waller, Edmund K.; Wiernik, Peter H.; Weisdorf, Daniel J.

    2014-01-01

    The efficacy of reduced intensity conditioning (RIC) allogeneic hematopoietic cell transplantation (HCT) for Ph+ acute lymphoblastic leukemia (ALL) is uncertain. We analyzed 197 adults with Ph+ ALL in first complete remission; 67 patients receiving RIC were matched with 130 receiving myeloablative conditioning (MAC) for age, donor type, and HCT year. Over 75% received pre-HCT tyrosine kinase inhibitors (TKI), mostly imatinib; 39% (RIC) and 49% (MAC) were MRDneg pre-HCT. At a median 4.5 years follow-up, 1-year transplant-related mortality (TRM) was lower in RIC (13%) than MAC (36%;p=0.001) while the 3-year relapse rate was 49% in RIC and 28% in MAC (p=0.058). Overall survival was similar (RIC 39% [95% CI:27–52] vs. 35% [95% CI:270–44];p=0.62). Patients MRDpos pre-HCT had higher risk of relapse with RIC versus MAC (HR 1.97;p=0.026). However, patients receiving pre-HCT TKI in combination with MRD negativity pre-RIC HCT had superior OS (55%) compared to a similar MRDneg population after MAC (33%; p=0.0042). In multivariate analysis, RIC lowered TRM (HR 0.6; p=0.057), but absence of pre-HCT TKI (HR 1.88;p=0.018), RIC (HR 1.891;p=0.054) and pre-HCT MRDpos (HR 1.6; p=0.070) increased relapse risk. RIC is a valid alternative strategy for Ph+ ALL patients ineligible for MAC and MRDneg status is preferred pre-HCT. PMID:23989431

  3. Results of a Prospective Multicentre Myeloablative Double-Unit Cord Blood Transplantation Trial in Adult Patients with Acute Leukaemia and Myelodysplasia

    PubMed Central

    Barker, Juliet N.; Fei, Mingwei; Karanes, Chatchada; Horwitz, Mitchell; Devine, Steven; Kindwall-Keller, Tamila L.; Holter, Jennifer; Adams, Alexia; Logan, Brent; Navarro, Willis H.; Riches, Marcie

    2017-01-01

    Summary Double-unit cord blood (CB) grafts may improve engraftment and relapse risk in adults with haematological malignancies. We performed a prospective high-dose myeloablative double-unit CB transplantation (CBT) trial in adults with high-risk acute leukaemia or myelodysplasia (MDS) between 2007 and 2011. The primary aim was to establish the one-year overall survival in a multi-centre setting. Fifty-six patients (31 acute myeloid leukaemia, 19 acute lymphoblastic leukaemia, 4 other acute leukaemias, 2 myelodysplastic syndrome [MDS]) were transplanted at 10 centres. The median infused total nucleated cell doses were 2.62 (larger unit) and 2.02 (smaller unit) × 107/kg. The cumulative incidence of day 100 neutrophil engraftment was 89% (95% confidence interval [CI]: 80–96). Day 180 grade II-IV acute graft-versus-host disease (GVHD) incidence was 64% (95%CI: 51–76) and 36% (95%CI: 24–49) of patients had chronic GVHD by 3-years. At 3-years post-transplant, the transplant-related mortality (TRM) was 39% (95%CI: 26–52), and the 3-year relapse incidence was 11% (95%CI: 4–21). With a median 37-month (range 23–71) follow-up of survivors, the 3-year disease-free survival was 50% (95%CI: 37–63). Double-unit CBT is a viable alternative therapy for high-risk acute leukaemia/MDS in patients lacking a matched unrelated donor. This is especially important for minority patients. The relapse incidence was low but strategies to ameliorate TRM are needed. PMID:25272241

  4. A myeloablative conditioning regimen for patients with impaired cardiac function undergoing allogeneic stem cell transplantation: reduced cyclophosphamide combined with etoposide and total body irradiation.

    PubMed

    Yoshimi, Akihide; Nannya, Yasuhito; Sakata-Yanagimoto, Mamiko; Oshima, Kumi; Takahashi, Tsuyoshi; Kanda, Yoshinobu; Motokura, Toru; Chiba, Shigeru; Kurokawa, Mineo

    2008-08-01

    To circumvent the cardiac toxicity of high-dose cyclophosphamide (CY) in the myeloablative conditioning for those with cardiac comorbidity, we developed a new cardiac sparing conditioning regimen (VP/rCY/TBI) composed of 12 Gy of total body irradiation (TBI), etoposide (VP-16) (40 mg/kg), and reduced CY (40 mg/kg). We assessed the feasibility of this regimen by retrospectively comparing the outcome of VP/rCY/TBI recipients (n = 18) with that of CY/TBI recipients (n = 140). VP/rCY/TBI recipients had significantly higher cumulative dose of anthracyclines, lower ejection fraction (EF), and poorer Karnofsky performance scales (KPS) than CY/TBI recipients. The cumulative incidences of disease progression were 34.9% in VP/rCY/TBI recipients and 19.0% in CY/TBI recipients (P = 0.33). Despite poorer KPS and more cardiac comorbidity in the VP/rCY/TBI recipients, no difference in the nonprogression mortality rates was observed among recipients of the two regimens (17.5 and 14.3%, respectively, P = 0.96). Severe cardiac toxicity within 28 days after transplantation occurred in 5.9 and 3.6% of VP/rCY/TBI and CY/TBI recipients, respectively (P = 0.64). Graft rejection was not observed in VP/rCY/TBI recipients. There is a possibility that VP/rCY/TBI regimen can be safely administered for patients with pretransplantation cardiac comorbidity while preserving antineoplastic effects. These observations merit further prospective study.

  5. Impact of outpatient non-myeloablative haematopoietic stem cell transplantation in quality of life vs. conventional therapy.

    PubMed

    Cantú-Rodríguez, Olga Graciela; Sánchez-Cárdenas, Mónica; Treviño-Montemayor, Oscar Rubén; Gutiérrez-Aguirre, Cesar Homero; Tarín-Arzaga, Luz; Jaime-Pérez, José Carlos; Gómez-Almaguer, David

    2016-01-01

    The role of outpatient hematopoietic stem cell transplantation (HSCT) as a therapeutic tool has been strengthened significantly because of the increasing number of patients undergoing this treatment. Due the very nature of this procedure, one of the aspects that should not be overlooked is the quality of life (QOL) of patients undergoing HSCT. Thus, one must consider not only health status after treatment, but also, the psychosocial implications for the patient. This is an observational, longitudinal, and prospective study to assess QOL in patients undergoing outpatient HSCT vs. similar patients receiving medical treatment (MxTx). By applying the COOP/WONKA charts on five occasions (pre-HSCT/initial, post-HSCT/first month, and at 3, 6, and 9 months), thirty-eight patients were analysed, 19 with HSCT and 19 with MxTx with no differences in age, gender or diagnosis. The initial survey found significant differences only in pain perception, which was higher in the HSCT group (p = .08); at the first month, there was a greater tendency for feelings of depression or anxiety in the HSCT group (p = .016), with more limitations in social (p = .003) and daily (p = .044) activities. From 3 months post-HSCT, the results were very similar. The differences persisted only in the area of social activities. Four patients developed graft-versus-host disease with no significant difference in the scores obtained compared to other transplant patients at 3, 6, and 9 months (p = .26) of follow-up.

  6. Associations between gastrointestinal toxicity, micro RNA and cytokine production in patients undergoing myeloablative allogeneic stem cell transplantation.

    PubMed

    Pontoppidan, Peter L; Jordan, Karina; Carlsen, Anting Liu; Uhlving, Hilde Hylland; Kielsen, Katrine; Christensen, Mette; Ifversen, Marianne; Nielsen, Claus Henrik; Sangild, Per; Heegaard, Niels Henrik Helweg; Heilmann, Carsten; Sengeløv, Henrik; Müller, Klaus

    2015-03-01

    Allogeneic hematopoietic stem cell transplantation (HSCT) is a procedure with a high risk of treatment related mortality. The primary aim of the present study was to examine associations between markers of gastrointestinal toxicity, markers of systemic inflammation, and plasma levels of microRNA (miRNA) -155 and -146a during the first month after HSCT. The secondary aim was to characterize the impact of the toxic-inflammatory response on the function of circulating leukocytes during immune recovery. Thirty HSCT patients were included. Gastrointestinal injury was monitored by toxicity scores, lactulose-mannitol test and plasma citrulline, as a measure of the enterocyte population. Nadir of citrulline and maximum of oral toxicity scores, intestinal permeability, CRP and plasma levels of IL-6 and IL-10 was seen at day +7 post-HSCT. miRNA-155 and mi-RNA-146a showed an inverse relation with significantly elevated miRNA-155 and decreased miRNA-146a levels, from day 0 to day +28 compared with pre-conditioning levels. Citrulline levels below the median at day +7 were associated with higher spontaneous production of IL-6 and TNF-α as well as higher in vitro stimulated production of IL-17A at day +21. This study is the first to demonstrate that toxic responses to chemotherapy are accompanied by differential regulation of miRNAs with opposing effects on immune regulation. We find that a proinflammatory miRNA profile is sustained during the first three weeks after the transplantation, indicating that these miRNAs may play a role in the regulation of the inflammatory environment during immune reconstitution after HSCT.

  7. Single center experience with total body irradiation and melphalan (TBI-MEL) myeloablative conditioning regimen for allogeneic stem cell transplantation (SCT) in patients with refractory hematologic malignancies.

    PubMed

    Bhatnagar, Bhavana; Rapoport, Aaron P; Fang, Hong-Bin; Ilyas, Can; Marangoz, Deniz; Akbulut, Vinil; Ruehle, Kathleen; Badros, Ashraf; Yanovich, Saul; Akpek, Görgün

    2014-04-01

    We retrospectively evaluated the tolerability and efficacy of fractionated total body irradiation (TBI) (1,200 cGy) and melphalan (MEL) (100-110 mg/m(2)) myeloablative conditioning in 48 patients with nonremission AML (n = 14), ALL (n = 10), NHL (n = 18), and other refractory hematologic malignancies (n = 6) who received allogeneic stem cell transplantation (SCT) between 2002 and 2011. Median age was 48 years (22 to 68); 14 out of 26 leukemia patients (54 %) had circulating blasts at transplant, 20 (50 %) evaluable patients had poor-risk cytogenetics, 12 (25 %) had prior SCT, and 10 (21 %) received stem cells from a mismatch donor. All patients received tacrolimus with or without methotrexate for GVHD prophylaxis. At the time of analysis, 13 patients (27 %) were alive and disease free. Engraftment was complete in all patients. The median time to ANC recovery (>500) was 12 days (range, 6-28). The most common grade III and IV toxicities were mucositis and infections. Eighteen patients (43 %) developed grade II-IV acute GVHD, and eight (26 %) had extensive chronic GVHD. Of 44 evaluable patients for response, 28 (64 %) achieved a complete remission (CR), and seven (15 %) had a partial remission after the transplant. With a median follow-up of 30 months (4 to 124 months) for surviving patients, the cumulative incidence of relapse was 45 % at 1 year, and the probability of overall survival (OS) at 5 years was 22.5 %. Multivariate analysis showed that platelet count (<80,000/mL) and lactic dehydrogenase (>500 IU/L) at SCT were associated with relapse. Age less than 53 years and CR after SCT were associated with better OS. Our data suggest that TBI-MEL can result in CR in two thirds, durable remission in one third, and 5-year survival in about one quarter of patients with nonremission hematologic malignancies. Further studies with TBI-MEL in standard risk transplant patients are warranted.

  8. Myeloablative 131I-Tositumomab Radioimmunotherapy in Treating Non-Hodgkin’s Lymphoma: Comparison of Dosimetry Based on Whole-Body Retention and Dose to Critical Organ Receiving the Highest Dose

    SciTech Connect

    Rajendran, Joseph G.; Gopal, Ajay K.; Fisher, Darrell R.; Durack, L. D.; Gooley, Ted; Press, Oliver W.

    2008-05-01

    Objectives: Myeloablative radioimmunotherapy (RIT) using 131I tositumomab (anti-CD 20) monoclonal antibodies is an effective new therapy for B-cell non-Hodgkins lymphoma (NHL). The goal of this work is to determine optimum methods to deliver maximal myeloablative radioactivity without exceeding the radiation tolerance of critical normal organs such as liver and lungs, and avoiding serious toxicity. Methods: We reviewed dosimetry records for 100 consecutive patients who underwent biodistribution and dosimetry after a test infusion of 131I- tositumomab. Serial gamma camera images were used to determine organ and tissue activities over time and to calculate radiation-absorbed doses. Volumes of critical normal organs were determined from CT scans to adjust the dose estimates for the individual patient. These dose estimates helped us determine an appropriate therapy based on projected dose to the critical normal organ receiving a maximum tolerable radiation dose. We compared our method of organ-specific dosimetry for treatment planning with the standard clinical approaches using a whole-body dose-assessment method by assessing the difference in projected amounts of radiation-absorbed doses, as well as the ratios of projected amounts, that would be prescribed for therapy by each of these two strategies. Results: The mean organ doses (mGy/MBq) estimated by both methods were (1) Whole body method: liver = 0.33 and lungs = 0.33; and (2) Organ-specific method: liver 1.52 and lungs 1.72 (p = .0001). The median difference between the radiation-absorbed dose estimates was 3.40 (range of 1.37 to 7.96) for the lungs, 3.05 (range of 1.04 to 6.20) for the liver, and –0.05 for whole body (range of –0.18 to 0.16). The median ratio (OS divided by WB method) of radiation-absorbed dose estimates was 5.12 (range of 2.33 to 10.01) for the lungs, 4.14 (range of 2.16 to 6.67) for the liver, and 0.94 (range of 0.79 to 1.22) for whole body. There was significant difference between the

  9. Dental Procedures.

    PubMed

    Ramponi, Denise R

    2016-01-01

    Dental problems are a common complaint in emergency departments in the United States. There are a wide variety of dental issues addressed in emergency department visits such as dental caries, loose teeth, dental trauma, gingival infections, and dry socket syndrome. Review of the most common dental blocks and dental procedures will allow the practitioner the opportunity to make the patient more comfortable and reduce the amount of analgesia the patient will need upon discharge. Familiarity with the dental equipment, tooth, and mouth anatomy will help prepare the practitioner for to perform these dental procedures.

  10. Recipient Myeloid-derived Immunomodulatory Cells Induce PD-1 Ligand-Dependent Donor CD4+Foxp3+ Treg Proliferation and Donor-Recipient Immune Tolerance After Murine Non-myeloablative Bone Marrow Transplantation§

    PubMed Central

    van der Merwe, Marie; Abdelsamed, Hossam A.; Seth, Aman; Ong, Taren; Vogel, Peter; Pillai, Asha B.

    2013-01-01

    We have previously shown that non-myeloablative total lymphoid irradiation/rabbit anti-thymocyte serum (TLI/ATS) conditioning facilitates potent donor-recipient immune tolerance following bone marrow transplantation (BMT) across major histocompatibility complex (MHC) barriers via recipient invariant natural killer T cell (iNKT cell)-derived IL-4-dependent expansion of donor Foxp3+ naturally occurring Treg (nTreg). Here we report a more specific mechanism. Wild-type (WT) BALB/c (H-2d) hosts were administered TLI/ATS and BMT from WT or STAT6−/− C57BL/6 (H-2b) donors. Donor nTreg following STAT6−/− BMT demonstrated no loss of proliferation in vivo, indicating that an IL-4 responsive population in the recipient rather than the donor drives donor nTreg proliferation. In GVHD target organs, three recipient CD11b+ cell subsets (Gr-1highCD11cneg; Gr-1intCD11cneg; and Gr-1lowCD11c+) were enriched early after TLI/ATS + BMT versus TBI/ATS + BMT. Gr-1lowCD11c+ cells induced potent H-2Kb+CD4+Foxp3+ nTreg proliferation in vitro in 72-hr MLR. Gr-1lowCD11c+ cells were significantly reduced in STAT6−/− and iNKT cell-deficient Jα18−/− BALB/c recipients after TLI/ATS + BMT. Depletion of CD11b+ cells resulted in severe acute GVHD, and adoptive transfer of WT Gr-1lowCD11c+ cells to Jα18−/− BALB/c recipients of TLI/ATS + BMT restored day 6 donor Foxp3+ nTreg proliferation and protection from CD8 effector T cell-mediated GVHD. Blockade of PD-L1 or PD-L2, but not CD40, TGF-β, Arginase 1, or iNOS inhibited nTreg proliferation in co-cultures of recipient-derived Gr-1lowCD11c+ cells with donor nTreg. Through iNKT-dependent Th2 polarization, myeloid-derived immunomodulatory DCs are expanded after non-myeloablative TLI/ATS conditioning and allogeneic BMT, induce PD-1 ligand dependent donor nTreg proliferation, and maintain potent graft-versus-host immune tolerance. PMID:24190658

  11. Grievance Procedures.

    ERIC Educational Resources Information Center

    Eisenhower, R. Warren

    Because grievances are unavoidable, it is essential for organizations, such as the schools, to utilize an efficient, effective procedure to handle friction between employers and employees. Through successive steps, representatives of labor and management attempt to resolve the grievance, first with meetings of lower level representatives (such as…

  12. Sequential myeloablative autologous stem cell transplantation and reduced intensity allogeneic hematopoietic cell transplantation is safe and feasible in children, adolescents and young adults with poor-risk refractory or recurrent Hodgkin and non-Hodgkin lymphoma.

    PubMed

    Satwani, P; Jin, Z; Martin, P L; Bhatia, M; Garvin, J H; George, D; Chaudhury, S; Talano, J; Morris, E; Harrison, L; Sosna, J; Peterson, M; Militano, O; Foley, S; Kurtzberg, J; Cairo, M S

    2015-02-01

    The outcome of children, adolescents and young adults (CAYA) with poor-risk recurrent/refractory lymphoma is dismal (⩽30%). To overcome this poor prognosis, we designed an approach to maximize an allogeneic graft vs lymphoma effect in the setting of low disease burden. We conducted a multi-center prospective study of myeloablative conditioning (MAC) and autologous stem cell transplantation (AutoSCT), followed by a reduced intensity conditioning (RIC) and allogeneic hematopoietic cell transplantation (AlloHCT) in CAYA, with poor-risk refractory or recurrent lymphoma. Conditioning for MAC AutoSCT consisted of carmustine/etoposide/cyclophosphamide, RIC consisted of busulfan/fludarabine. Thirty patients, 16 Hodgkin lymphoma (HL) and 14 non-Hodgkin lymphoma (NHL), with a median age of 16 years and median follow-up of 5years, were enrolled. Twenty-three patients completed both MAC AutoSCT and RIC AlloHCT. Allogeneic donor sources included unrelated cord blood (n=9), unrelated donor (n=8) and matched siblings (n=6). The incidence of transplant-related mortality following RIC AlloHCT was only 12%. In patients with HL and NHL, 10 year EFS was 59.8% and 70% (P=0.613), respectively. In summary, this approach is safe, and long-term EFS with this approach is encouraging considering the poor-risk patient characteristics and the use of unrelated donors for RIC AlloHCT in the majority of cases.

  13. Reduced-intensity and non-myeloablative allogeneic stem cell transplantation from alternative HLA-mismatched donors for Hodgkin lymphoma: a study by the French Society of Bone Marrow Transplantation and Cellular Therapy.

    PubMed

    Gauthier, J; Castagna, L; Garnier, F; Guillaume, T; Socié, G; Maury, S; Maillard, N; Tabrizi, R; Marchand, T; Malfuson, J; Gac, A; Gyan, E; Mercier, M; Béguin, Y; Delage, J; Turlure, P; Marçais, A; Nguyen, S; Dulery, R; Bay, J; Huynh, A; Daguindau, E; Cornillon, J; Régny, C; Michallet, M; Peffault de Latour, R; Yakoub-Agha, I; Blaise, D

    2017-05-01

    Allogeneic stem cell transplantation (allo-SCT) following a non-myeloablative (NMA) or reduced-intensity conditioning (RIC) is considered a valid approach to treat patients with refractory/relapsed Hodgkin lymphoma (HL). When an HLA-matched donor is lacking a graft from a familial haploidentical (HAPLO) donor, a mismatched unrelated donor (MMUD) or cord blood (CB) might be considered. In this retrospective study, we compared the outcome of patients with HL undergoing a RIC or NMA allo-SCT from HAPLO, MMUD or CB. Ninety-eight patients were included. Median follow-up was 31 months for the whole cohort. All patients in the HAPLO group (N=34) received a T-cell replete allo-SCT after a NMA (FLU-CY-TBI, N=31, 91%) or a RIC (N=3, 9%) followed by post-transplant cyclophosphamide. After adjustment for significant covariates, MMUD and CB were associated with significantly lower GvHD-free relapse-free survival (GRFS; hazard ratio (HR)=2.02, P=0.03 and HR=2.43, P=0.009, respectively) compared with HAPLO donors. In conclusion, higher GRFS was observed in Hodgkin lymphoma patients receiving a RIC or NMA allo-SCT with post-transplant cyclophosphamide from HAPLO donors. Our findings suggest they should be favoured over MMUD and CB in this setting.

  14. Procedural knowledge

    NASA Technical Reports Server (NTRS)

    Georgeff, Michael P.; Lansky, Amy L.

    1986-01-01

    Much of commonsense knowledge about the real world is in the form of procedures or sequences of actions for achieving particular goals. In this paper, a formalism is presented for representing such knowledge using the notion of process. A declarative semantics for the representation is given, which allows a user to state facts about the effects of doing things in the problem domain of interest. An operational semantics is also provided, which shows how this knowledge can be used to achieve particular goals or to form intentions regarding their achievement. Given both semantics, the formalism additionally serves as an executable specification language suitable for constructing complex systems. A system based on this formalism is described, and examples involving control of an autonomous robot and fault diagnosis for NASA's Space Shuttle are provided.

  15. Comparison of Reduced-Intensity and Myeloablative Conditioning Regimens for Allogeneic Hematopoietic Stem Cell Transplantation in Patients with Acute Myeloid Leukemia and Acute Lymphoblastic Leukemia: A Meta-Analysis

    PubMed Central

    Ismail, Nor-Azimah; Mohd-Idris, Mohd-Razif; Jamaluddin, Fariza Wan; Tumian, NorRafeah; Sze-Wei, Ernie Yap; Muhammad, Norasiah; Nai, Ming Lai

    2014-01-01

    Currently, the indications to perform reduced-intensity conditioning allogeneic hematopoietic stem cell transplant (RIC-HCT) are based on data derived mainly from large registry and single-centre retrospective studies. Thus, at the present time, there is limited direct evidence supporting the current practice in selecting patients with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) for RIC versus myeloablative conditioning (MAC) transplants. To determine the relationship between dose intensity of conditioning regimen and survival outcomes after allografting in AML/ALL patients, we performed a meta-analysis of 23 clinical trials reported between 1990 and 2013 involving 15,258 adult patients that compare survival outcomes after RIC-HCT versus MAC-HCT. RIC-HCT resulted in comparable <2-year and 2–6 year overall survival (OS) rates post-transplantation even though the RIC-HCT recipients were older and had more active disease than MAC-HCT recipients. The 2–6 year progression-free survival (PFS), nonrelapse mortality, acute graft-versus-host disease (GvHD) and chronic GvHD rates were reduced after RIC-HCT, but relapse rate was increased. Similar outcomes were observed regardless of disease type and status at transplantation. Odds ratio for all outcomes remained comparable with or without performing separate analyses for the year of HCT and for retrospective versus prospective studies. Among RIC-HCT recipients, survival rates were superior if patients were in CR at transplantation. Significant inter-study heterogeneity for aGvHD data and publication bias for PFS data were observed. This meta-analysis showed no OS benefit of MAC-HCT over RIC-HCT across the entire cohort of patients suggesting that RIC-HCT could be an effective therapeutic option for AML/ALL patients who are ineligible for MAC-HCT and CR status is preferred before RIC-HCT. PMID:25072307

  16. High levels of B cell activating factor during the peritransplantation period are associated with a reduced incidence of acute graft-versus-host disease following myeloablative allogeneic stem cell transplantation.

    PubMed

    Cho, Byung-Sik; Min, Chang-Ki; Kim, Hee-Je; Lee, Seok; Kim, Yoo-Jin; Lim, Ji-Young; Jeong, Dae-Chul; Cho, Bin; Kim, Hack-Ki; Eom, Ki-Seong; Cho, Seok-Goo; Kim, Dong-Wook; Lee, Jong-Wook; Min, Woo-Sung; Kim, Chun-Choo; Chung, Nak-Gyun

    2010-05-01

    B cell activating factor (BAFF), also known as B cell survival and activation factor, is associated with autoimmune disease and chronic graft-versus-host disease (cGVHD). T cells are known to be modulated by soluble BAFF (sBAFF). Considering the possible association of sBAFF with T cell as well as B cell function, sBAFF during the peritransplantation period may affect the development of acute GVHD (aGVHD). To test this hypothesis, we evaluated 45 patients who had undergone myeloablative (MA) allogeneic stem cell transplantation (SCT) for hematologic malignancy. Serum sBAFF levels were measured before conditioning and on day 0, day +7, and day +14. Thirty-three of the 45 patients (cumulative incidence, 73%) developed aGVHD between 16 days and 98 days posttransplantation. Repeated-measures analysis of variance revealed significantly lower sBAFF levels during the peritransplantation period in patients with aGVHD than in those without aGVHD (P=.001). Receiver operating characteristic curve analysis revealed that sBAFF levels at every time point were available for the prediction of aGVHD development, and that patients with a sBAFF level >43 pg/mL at each time point (which could ensure 75% sensitivity and 73%-82% specificity for the prediction of aGVHD at every time point) had a significantly lower cumulative incidence of aGVHD. This study is the first to demonstrate that sBAFF level during the peritransplantation period not only may be predictive of aGVHD, but also may have a protective effect against aGVHD in humans. Further investigation is needed to confirm our findings. Copyright 2010 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

  17. Neuropsychological functioning of children treated with intensive chemotherapy followed by myeloablative consolidation chemotherapy and autologous hematopoietic cell rescue for newly diagnosed CNS tumors: an analysis of the Head Start II survivors.

    PubMed

    Sands, Stephen A; Oberg, Jennifer A; Gardner, Sharon L; Whiteley, Jennifer A; Glade-Bender, Julia L; Finlay, Jonathan L

    2010-03-01

    To evaluate the neuropsychological late effects amongst survivors treated on the Head Start II protocol between 1997 and 2003. Forty-nine patients (mean age 2.9 years) diagnosed with a malignant brain tumor underwent baseline neuropsychological assessment prior to autologous hematopoietic cell transplantation (AuHCT). Twenty-six survivors were retested after 3 years of follow-up as 20 patients did not survive. Patients were evaluated for intelligence, academic achievement, receptive language, visual-motor integration (VMI), learning/memory, social-emotional and behavioral functioning based upon age at testing. Overall intelligence and VMI at baseline were low average while verbal and non-verbal intelligence, academic achievement, and receptive vocabulary were in average range. Parents reported social-emotional and behavioral functioning within normal limits. Serial testing revealed Full Scale (FSIQ)/Mental Development Index (MDI), Verbal (VIQ), and Performance (PIQ) Intelligence to be generally stable over 3-year follow-up. Group-average analysis at follow-up demonstrated low average intelligence, academic achievement, receptive language, and VMI. Age at diagnosis was positively correlated with internalizing symptoms and visual immediate memory, while time since diagnosis was inversely correlated with FSIQ, VIQ, PIQ, reading and delayed verbal memory. Craniospinal irradiation (CSI) was avoided in two-thirds of patients. Induction, with or without intensification using intravenous methotrexate, followed by myeloablative consolidation chemotherapy with AuHCT, may avoid or delay CSI, with possible stabilization of neuropsychological functioning, including those younger at diagnosis. Continued follow-up is necessary to determine the preservation of neuropsychological, academic, social-emotional and behavioral functioning. Copyright 2009 Wiley-Liss, Inc.

  18. Myeloablative chemotherapy and autologous stem cell transplantation in patients with relapsed or progressed central nervous system germ cell tumors: results of Korean Society of Pediatric Neuro-Oncology (KSPNO) S-053 study.

    PubMed

    Baek, Hee Jo; Park, Hyeon Jin; Sung, Ki Woong; Lee, Soo Hyun; Han, Jung Woo; Koh, Kyung Nam; Im, Ho Joon; Kang, Hyoung Jin; Park, Kyung Duk

    2013-09-01

    The present study evaluated the feasibility and effectiveness of myeloablative high-dose chemotherapy and autologous stem cell transplantation in patients with relapsed or progressed central nervous system germ cell tumors (CNS-GCTs). Eleven patients with non-germinomatous germ cell tumors and nine patients with germinomas were enrolled. Patients received between two and eight cycles of conventional chemotherapy prior to HDCT/autoSCT with or without radiotherapy. Overall, 16 patients proceeded to the first HDCT/autoSCT, and nine proceeded to the second HDCT/autoSCT. CTE (carboplatin-thiotepa-etoposide) and cyclophosphamide-melphalan (CM) regimens were used for the first and second HDCT, respectively. Toxicities during HDCT/autoSCT were acceptable, and there were no treatment-related deaths. Twelve patients experienced relapse or progression; however, four patients with germinomas remain alive after subsequent RT. Therefore, a total of 12 patients (four NGGCTs and eight germinomas) remain alive with a median follow-up of 47 months (range 22-90) after relapse or progression. The probability of 3-year overall survival was 59.1 ± 11.2 % (36.4 ± 14.5 % for NGGCTs vs. 88.9 ± 10.5 % for germinomas, P = 0.028). RT, particularly craniospinal RT, was associated with a better tumor response prior to HDCT/autoSCT and a better final outcome. In conclusion, HDCT/autoSCT was feasible, and survival rates were encouraging. Further study with a larger cohort of patients is needed to elucidate the role of HDCT/autoSCT in the treatment of relapsed or progressed CNS-GCTs.

  19. Thiotepa-based versus total body irradiation-based myeloablative conditioning prior to allogeneic stem cell transplantation for acute myeloid leukaemia in first complete remission: a retrospective analysis from the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation.

    PubMed

    Eder, Sandra; Labopin, Myriam; Arcese, William; Or, Reuven; Majolino, Ignazio; Bacigalupo, Andrea; de Rosa, Gennaro; Volin, Liisa; Beelen, Dietrich; Veelken, Hendrik; Schaap, Nicolaas P M; Kuball, Jurgen; Cornelissen, Jan; Nagler, Arnon; Mohty, Mohamad

    2016-01-01

    Thiotepa is an alkylating compound with an antineoplastic and myeloablative activity and can mimic the effect of radiation. However, it is unknown whether this new regimen could safely replace the long-established ones. This retrospective matched-pair analysis evaluated the outcome of adults with acute myeloid leukaemia in first complete remission who received myeloablative conditioning either with a thiotepa-based (n = 121) or a cyclophosphamide/total body irradiation-based (TBI; n = 358) regimen for allogeneic hematopoietic stem cell transplantation from an HLA-matched sibling or an unrelated donor. With a median follow-up of 44 months, the outcome was similar in both groups. Acute graft-versus-host disease grade II-IV was observed in 25% after thiotepa-containing regimen versus 35% after TBI (P = 0.06). The 2-yr cumulative incidence of chronic graft-versus-host disease was 40.5% for thiotepa and 41% for TBI (P = 0.98). At 2 yrs, the cumulative incidences of non-relapse mortality and relapse incidence were 23.9% (thiotepa) vs. 22.4% (TBI; P = 0.66) and 17.2% (thiotepa) vs. 23.3% (TBI; P = 0.77), respectively. The probabilities of leukaemia-free and overall survival at 2 yrs were not significantly different between the thiotepa and TBI groups, at 58.9% vs. 54.2% (P = 0.95) and 61.4% vs. 58% (P = 0.72), respectively. Myeloablative regimens using combinations including thiotepa can provide satisfactory outcomes, but the optimal conditioning remains unclear for the individual patient in this setting. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  20. Antithymocyte globulins and chronic graft-vs-host disease after myeloablative allogeneic stem cell transplantation from HLA-matched unrelated donors: a report from the Sociéte Française de Greffe de Moelle et de Thérapie Cellulaire.

    PubMed

    Mohty, M; Labopin, M; Balère, M L; Socié, G; Milpied, N; Tabrizi, R; Ifrah, N; Hicheri, Y; Dhedin, N; Michallet, M; Buzyn, A; Cahn, J-Y; Bourhis, J-H; Blaise, D; Raffoux, C; Espérou, H; Yakoub-Agha, I

    2010-11-01

    This retrospective report assessed the impact of rabbit antithymocyte globulins (ATG), incorporated within a standard myeloablative conditioning regimen prior to allogeneic stem cell transplantation (allo-SCT) using human leukocyte antigen-matched unrelated donors (HLA-MUD), on the incidence of acute and chronic graft-vs-host disease (GVHD). In this series of leukemia patients, 120 patients (70%) did not receive ATG ('no-ATG' group), whereas 51 patients received ATG ('ATG' group). With a median follow-up of 30.3 months, the cumulative incidence of grade 3-4 acute GVHD was 36% in the no-ATG group and 20% in the ATG group (P = 0.11). The cumulative incidence of extensive chronic GVHD was significantly lower in the ATG group as compared to the no-ATG group (4 vs 32%, respectively; P = 0.0017). In multivariate analysis, the absence of use of ATG was the strongest parameter associated with an increased risk of extensive chronic GVHD (relative risk) = 7.14, 95% CI: 1.7-33.3, P = 0.008). At 2 years, the probability of nonrelapse mortality, relapse, overall and leukemia-free survivals was not significantly different between the no-ATG and ATG groups. We conclude that the addition of ATG to GVHD prophylaxis resulted in decreased incidence of extensive chronic GVHD without an increase in relapse or nonrelapse mortality, and without compromising survival after myeloablative allo-SCT from HLA-MUD.

  1. Haploidentical transplantation using T cell replete peripheral blood stem cells and myeloablative conditioning in patients with high-risk hematologic malignancies who lack conventional donors is well tolerated and produces excellent relapse-free survival: results of a prospective phase II trial.

    PubMed

    Solomon, Scott R; Sizemore, Connie A; Sanacore, Melissa; Zhang, Xu; Brown, Stacey; Holland, H Kent; Morris, Lawrence E; Bashey, Asad

    2012-12-01

    Haploidentical hematopoietic stem cell transplant (HSCT) provides an opportunity for nearly all patients to benefit from HSCT. We conducted a trial of haploidentical T cell replete allografting using a busulfan-based myeloablative preparative regimen, peripheral blood stem cells (PBSCs) as the graft source, and posttransplantation cyclophosphamide (Cy). Eligibility was limited to patients at high risk of relapse after nonmyeloablative haploidentical bone marrow transplant (BMT). Twenty patients were enrolled in the study (11 with relapsed/refractory disease and 9 who underwent transplantation while in remission and considered standard risk). Donor engraftment occurred in all 20 patients with full donor T cell and myeloid chimerism by day +30. The cumulative incidence of grades II-IV and III-IV acute graft-versus-host disease (aGVHD) was 30% and 10%, respectively. The cumulative incidence of chronic GVHD (cGVHD) was 35%. Nonrelapse mortality (NRM) at 100 days and 1 year was 10% for all patients and 0% for standard-risk patients. With a median follow-up of 20 months, the estimated 1-year overall survival (OS) and disease-free survival (DFS) was 69% and 50%, respectively, for all patients, and 88% and 67% for standard-risk patients. Myeloablative haploidentical HSCT is associated with excellent rates of engraftment, GVHD, NRM, and DFS, and is a valid option in patients with high-risk malignancies who lack timely access to a conventional donor. Copyright © 2012 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

  2. Acute and long-term alterations in the granulocyte/macrophage progenitor cell (GM-CFC) compartment of dogs after partial-body irradiation: irradiation of the upper body with a single myeloablative dose

    SciTech Connect

    Nothdurft, W.; Calvo, W.; Klinnert, V.; Steinbach, K.H.; Werner, C.; Fliedner, T.M.

    1986-06-01

    The acute and long-term effects of a single dose of partial-body irradiation on the granulocyte/macrophage progenitor cell compartment were studied in dogs. A myeloablative dose of 11.7 Gy (dose rate 6.5 cGy/min) was given to the upper body which contains approximately 70% of the total bone marrow mass. The lower part of the body was shielded by a lead box. In the non-irradiated bone marrow, the concentration of the GM-CFC/10(5) mononuclear cells was slightly decreased within the first 7 days and showed some fluctuations around the normal value for several weeks thereafter. In the irradiated bone marrow, virtually no GM-CFC could be detected on day 1 after exposure. Beginning on day 7, a continuous increase took place up to day 21 when the GM-CFC concentration reached between 25% (sternum) and 43% (humerus) of the initial value. No further increase took place up to day 80. Between day 120 and 380 a secondary increase was observed which reached near-normal bone marrow GM-CFC concentrations. The blood GM-CFC concentration first showed a strong depression followed by a transient increase between day 10 and 30. This coincided with GM-CFC normalization in the protected bone marrow as well as with the initial phase of regeneration in the irradiated sites. A prolonged secondary long-lasting depression between day 33 and 120 amounted to 20 to 50% of normal values. This depression was closely related to the stagnation in the GM-CFC recovery in the irradiated bone marrow sites. The GM-CFC concentration in the blood was supranormal at day 380 when the bone marrow GM-CFC had recovered. The colony stimulating activity in the serum showed an increase within the first 20 days after exposure. Within the same interval the bone marrow GM-CFC concentration experienced the strongest alterations, and was inversely related to the changes in the blood granulocyte values.

  3. Human leukocyte antigen supertype matching after myeloablative hematopoietic cell transplantation with 7/8 matched unrelated donor allografts: a report from the Center for International Blood and Marrow Transplant Research

    PubMed Central

    Lazaryan, Aleksandr; Wang, Tao; Spellman, Stephen R.; Wang, Hai-Lin; Pidala, Joseph; Nishihori, Taiga; Askar, Medhat; Olsson, Richard; Oudshoorn, Machteld; Abdel-Azim, Hisham; Yong, Agnes; Gandhi, Manish; Dandoy, Christopher; Savani, Bipin; Hale, Gregory; Page, Kristin; Bitan, Menachem; Reshef, Ran; Drobyski, William; Marsh, Steven GE; Schultz, Kirk; Müller, Carlheinz R.; Fernandez-Viña, Marcelo A.; Verneris, Michael R.; Horowitz, Mary M.; Arora, Mukta; Weisdorf, Daniel J.; Lee, Stephanie J.

    2016-01-01

    The diversity of the human leukocyte antigen (HLA) class I and II alleles can be simplified by consolidating them into fewer supertypes based on functional or predicted structural similarities in epitope-binding grooves of HLA molecules. We studied the impact of matched and mismatched HLA-A (265 versus 429), -B (230 versus 92), -C (365 versus 349), and -DRB1 (153 versus 51) supertypes on clinical outcomes of 1934 patients with acute leukemias or myelodysplasia/myeloproliferative disorders. All patients were reported to the Center for International Blood and Marrow Transplant Research following single-allele mismatched unrelated donor myeloablative conditioning hematopoietic cell transplantation. Single mismatched alleles were categorized into six HLA-A (A01, A01A03, A01A24, A02, A03, A24), six HLA-B (B07, B08, B27, B44, B58, B62), two HLA-C (C1, C2), and five HLA-DRB1 (DR1, DR3, DR4, DR5, DR9) supertypes. Supertype B mismatch was associated with increased risk of grade II–IV acute graft-versus-host disease (hazard ratio =1.78, P=0.0025) compared to supertype B match. Supertype B07-B44 mismatch was associated with a higher incidence of both grade II–IV (hazard ratio=3.11, P=0.002) and III–IV (hazard ratio=3.15, P=0.01) acute graft-versus-host disease. No significant associations were detected between supertype-matched versus -mismatched groups at other HLA loci. These data suggest that avoiding HLA-B supertype mismatches can mitigate the risk of grade II–IV acute graft-versus-host disease in 7/8-mismatched unrelated donor hematopoietic cell transplantation when multiple HLA-B supertype-matched donors are available. Future studies are needed to define the mechanisms by which supertype mismatching affects outcomes after alternative donor hematopoietic cell transplantation. PMID:27247320

  4. Filgrastim-Stimulated Bone Marrow Compared with Filgrastim-Mobilized Peripheral Blood in Myeloablative Sibling Allografting for Patients with Hematologic Malignancies: A Randomized Canadian Blood and Marrow Transplant Group Study.

    PubMed

    Couban, Stephen; Aljurf, Mahmoud; Lachance, Sylvie; Walker, Irwin; Toze, Cynthia; Rubinger, Morel; Lipton, Jeffrey H; Lee, Stephanie J; Szer, Richard; Doocey, R; Lewis, Ian D; Huebsch, Lothar; Howson-Jan, Kang; Lalancette, Michel; Almohareb, Fahad; Chaudhri, Nadeem; Ivison, Sabine; Broady, Raewyn; Levings, Megan; Fairclough, Diane; Devins, Gerald; Szwajcer, David; Foley, Ronan; Smith, Clayton; Panzarella, Tony; Kerr, Holly; Kariminia, Amina; Schultz, Kirk R

    2016-08-01

    In adult hematopoietic cell transplantation (HCT), filgrastim-mobilized peripheral blood (G-PB) has largely replaced unstimulated marrow for allografting. Although the use of G-PB results in faster hematopoietic recovery, it is also associated with more chronic graft-versus-host disease (cGVHD). A potential alternative allograft is filgrastim-stimulated marrow (G-BM), which we hypothesized may be associated with prompt hematopoietic recovery but with less cGVHD. We conducted a phase 3, open-label, multicenter randomized trial of 230 adults with hematologic malignancies receiving allografts from siblings after myeloablative conditioning to compare G-PB with G-BM. The primary endpoint was time to treatment failure, defined as a composite of extensive cGVHD, relapse/disease progression, and death. With a median follow-up of 36 months (range, 9.6 to 48), comparing G-BM with G-PB, there was no difference between the 2 arms with respect to the primary outcome of this study (hazard ratio [HR], .91; 95% confidence interval [CI], .68 to 1.22; P = .52). However, the cumulative incidence of overall cGVHD was lower with G-BM (HR, .66; 95% CI, .46 to .95; P = .007) and there was no difference in the risk of relapse or progression (P = .35). The median times to neutrophil recovery (P = .0004) and platelet recovery (P = .012) were 3 days shorter for recipients allocated to G-PB compared with those allocated to G-BM, but there were no differences in secondary engraftment-related outcomes, such as time to first hospital discharge (P = .17). In addition, there were no graft failures in either arm. This trial demonstrates that, compared with G-PB, the use of G-BM allografts leads to a significantly lower rate of overall cGVHD without a loss of the graft-versus-tumor effect and comparable overall survival. Our findings suggest that further study of this type of allograft is warranted.

  5. Centre characteristics and procedure-related factors have an impact on outcomes of allogeneic transplantation for patients with CLL: a retrospective analysis from the European Society for Blood and Marrow Transplantation (EBMT).

    PubMed

    Schetelig, Johannes; de Wreede, Liesbeth C; Andersen, Niels S; Moreno, Carol; van Gelder, Michel; Vitek, Antonin; Karas, Michal; Michallet, Mauricette; Machaczka, Maciej; Gramatzki, Martin; Beelen, Dietrich; Finke, Jürgen; Delgado, Julio; Volin, Liisa; Passweg, Jakob; Dreger, Peter; Schaap, Nicolaas; Wagner, Eva; Henseler, Anja; van Biezen, Anja; Bornhäuser, Martin; Iacobelli, Simona; Putter, Hein; Schönland, Stefan O; Kröger, Nicolaus

    2017-08-01

    The best approach for allogeneic haematopoietic stem cell transplantations (alloHCT) in patients with chronic lymphocytic leukaemia (CLL) is unknown. We therefore analysed the impact of procedure- and centre-related factors on 5-year event-free survival (EFS) in a large retrospective study. Data of 684 CLL patients who received a first alloHCT between 2000 and 2011 were analysed by multivariable Cox proportional hazards models with a frailty component to investigate unexplained centre heterogeneity. Five-year EFS of the whole cohort was 37% (95% confidence interval [CI], 34-42%). Larger numbers of CLL alloHCTs (hazard ratio [HR] 0·96, P = 0·002), certification of quality management (HR 0·7, P = 0·045) and a higher gross national income per capita (HR 0·4, P = 0·04) improved EFS. In vivo T-cell depletion (TCD) with alemtuzumab compared to no TCD (HR 1·5, P = 0·03), and a female donor compared to a male donor for a male patient (HR 1·4, P = 0·02) had a negative impact on EFS, but not non-myeloablative versus more intensive conditioning. After correcting for patient-, procedure- and centre-characteristics, significant variation in centre outcomes persisted. In conclusion, further research on the impact of centre and procedural characteristics is warranted. Non-myeloablative conditioning appears to be the preferable approach for patients with CLL. © 2017 John Wiley & Sons Ltd.

  6. Designing Flightdeck Procedures

    NASA Technical Reports Server (NTRS)

    Barshi, Immanuel; Mauro, Robert; Degani, Asaf; Loukopoulou, Loukia

    2016-01-01

    The primary goal of this document is to provide guidance on how to design, implement, and evaluate flight deck procedures. It provides a process for developing procedures that meet clear and specific requirements. This document provides a brief overview of: 1) the requirements for procedures, 2) a process for the design of procedures, and 3) a process for the design of checklists. The brief overview is followed by amplified procedures that follow the above steps and provide details for the proper design, implementation and evaluation of good flight deck procedures and checklists.

  7. Computerized procedures system

    DOEpatents

    Lipner, Melvin H.; Mundy, Roger A.; Franusich, Michael D.

    2010-10-12

    An online data driven computerized procedures system that guides an operator through a complex process facility's operating procedures. The system monitors plant data, processes the data and then, based upon this processing, presents the status of the current procedure step and/or substep to the operator. The system supports multiple users and a single procedure definition supports several interface formats that can be tailored to the individual user. Layered security controls access privileges and revisions are version controlled. The procedures run on a server that is platform independent of the user workstations that the server interfaces with and the user interface supports diverse procedural views.

  8. Cardiac Procedures and Surgeries

    MedlinePlus

    ... Angioplasty and Coronary Artery Balloon Dilation. ( View an animation of angioplasty ) What the Procedure Does Special tubing ... Angioplasty and Coronary Artery Balloon Dilation. ( View an animation of angioplasty ) What the Procedure Does Special tubing ...

  9. A single apheresis procedure in the donor may be enough to complete an allograft using the "Mexican method" of non-ablative allografting.

    PubMed

    Ruiz-Delgado, Guillermo J; Gutiérrez-Riveroll, Karla I; Gutiérrez-Aguirre, César H; Gómez-Almaguer, David; Eyzaguirre-Zapata, Renee; Priesca-Marin, Manuel; González-Carrillo, Martha L; Ruiz-Argüelles, Guillermo J

    2009-04-01

    Since 1999, in Mexico we have been using a regimen to conduct allografts that involves non-myeloablative conditioning and peripheral blood stem cells (PBSC) and have introduced some changes with the main goal of decreasing the cost of the procedure. We analysed the salient apheresis features of a group of 175 allogeneic peripheral blood stem cell transplants conducted in two institutions in a 7-year period. The grafts were conducted using the "Mexican" non-myelo ablative conditioning regimen employing oral busulphan, i.v. cyclophosphamide and i.v. fludarabine. In all instances, the apheresis machine employed was the Baxter CS3000 Plus and donors were mobilised with filgrastim. The apheresis procedures were performed on days 0, +1 and +2, the end-point of collection being 5,000 mL of blood/m2 in each procedure. Three apheresis sessions were planned but the number was adjusted according to the cell yield. The final number of allografted CD34 cells ranged between 0.5 and 25.4 x 10(6)/Kg of the recipient's body weight (median, 5.2 x 10(6)/Kg). One to three apheresis procedures were needed to obtain a product containing more than 0.5 x 10(6) CD34 cells/Kg of the recipient, the median being two procedures; in 72 cases (41%) a single apheresis procedure was sufficient to obtain the target number of CD34 cells. The volumes of apheresis ranged between 50 and 600 mL (median, 400 mL). Since the median cost of each apheresis procedure is 900 USD, the fact that two apheresis procedures was spared in 72 cases and one apheresis was spared in another 65 cases, led to a total saving of approximately 188,100 USD. It can be concluded that, in many cases, allogeneic transplants can be completed with a single apheresis session and that there are considerable financial benefits from this practice.

  10. Crew procedures development techniques

    NASA Technical Reports Server (NTRS)

    Arbet, J. D.; Benbow, R. L.; Hawk, M. L.; Mangiaracina, A. A.; Mcgavern, J. L.; Spangler, M. C.

    1975-01-01

    The study developed requirements, designed, developed, checked out and demonstrated the Procedures Generation Program (PGP). The PGP is a digital computer program which provides a computerized means of developing flight crew procedures based on crew action in the shuttle procedures simulator. In addition, it provides a real time display of procedures, difference procedures, performance data and performance evaluation data. Reconstruction of displays is possible post-run. Data may be copied, stored on magnetic tape and transferred to the document processor for editing and documentation distribution.

  11. Pyroshock prediction procedures

    NASA Astrophysics Data System (ADS)

    Piersol, Allan G.

    2002-05-01

    Given sufficient effort, pyroshock loads can be predicted by direct analytical procedures using Hydrocodes that analytically model the details of the pyrotechnic explosion and its interaction with adjacent structures, including nonlinear effects. However, it is more common to predict pyroshock environments using empirical procedures based upon extensive studies of past pyroshock data. Various empirical pyroshock prediction procedures are discussed, including those developed by the Jet Propulsion Laboratory, Lockheed-Martin, and Boeing.

  12. Candidate CDTI procedures study

    NASA Technical Reports Server (NTRS)

    Ace, R. E.

    1981-01-01

    A concept with potential for increasing airspace capacity by involving the pilot in the separation control loop is discussed. Some candidate options are presented. Both enroute and terminal area procedures are considered and, in many cases, a technologically advanced Air Traffic Control structure is assumed. Minimum display characteristics recommended for each of the described procedures are presented. Recommended sequencing of the operational testing of each of the candidate procedures is presented.

  13. Procedural pediatric dermatology.

    PubMed

    Metz, Brandie J

    2013-04-01

    Due to many factors, including parental anxiety, a child's inability to understand the necessity of a procedure and a child's unwillingness to cooperate, it can be much more challenging to perform dermatologic procedures in children. This article reviews pre-procedural preparation of patients and parents, techniques for minimizing injection-related pain and optimal timing of surgical intervention. The risks and benefits of general anesthesia in the setting of pediatric dermatologic procedures are discussed. Additionally, the surgical approach to a few specific types of birthmarks is addressed.

  14. Modified arthroscopic Brostrom procedure.

    PubMed

    Lui, Tun Hing

    2015-09-01

    The open modified Brostrom anatomic repair technique is widely accepted as the reference standard for lateral ankle stabilization. However, there is high incidence of intra-articular pathologies associated with chronic lateral ankle instability which may not be addressed by an isolated open Brostrom procedure. Arthroscopic Brostrom procedure with suture anchor has been described for anatomic repair of chronic lateral ankle instability and management of intra-articular lesions. However, the complication rates seemed to be higher than open Brostrom procedure. Modification of the arthroscopic Brostrom procedure with the use of bone tunnel may reduce the risk of certain complications.

  15. Enucleation Procedure Manual.

    ERIC Educational Resources Information Center

    Davis, Kevin; Poston, George

    This manual provides information on the enucleation procedure (removal of the eyes for organ banks). An introductory section focuses on the anatomy of the eye and defines each of the parts. Diagrams of the eye are provided. A list of enucleation materials follows. Other sections present outlines of (1) a sterile procedure; (2) preparation for eye…

  16. Connectionist Learning Procedures.

    ERIC Educational Resources Information Center

    Hinton, Geoffrey E.

    A major goal of research on networks of neuron-like processing units is to discover efficient learning procedures that allow these networks to construct complex internal representations of their environment. The learning procedures must be capable of modifying the connection strengths in such a way that internal units which are not part of the…

  17. Enucleation Procedure Manual.

    ERIC Educational Resources Information Center

    Davis, Kevin; Poston, George

    This manual provides information on the enucleation procedure (removal of the eyes for organ banks). An introductory section focuses on the anatomy of the eye and defines each of the parts. Diagrams of the eye are provided. A list of enucleation materials follows. Other sections present outlines of (1) a sterile procedure; (2) preparation for eye…

  18. Procedural Learning and Dyslexia

    ERIC Educational Resources Information Center

    Nicolson, R. I.; Fawcett, A. J.; Brookes, R. L.; Needle, J.

    2010-01-01

    Three major "neural systems", specialized for different types of information processing, are the sensory, declarative, and procedural systems. It has been proposed ("Trends Neurosci.",30(4), 135-141) that dyslexia may be attributable to impaired function in the procedural system together with intact declarative function. We provide a brief…

  19. Minimally invasive procedures

    PubMed Central

    Baltayiannis, Nikolaos; Michail, Chandrinos; Lazaridis, George; Anagnostopoulos, Dimitrios; Baka, Sofia; Mpoukovinas, Ioannis; Karavasilis, Vasilis; Lampaki, Sofia; Papaiwannou, Antonis; Karavergou, Anastasia; Kioumis, Ioannis; Pitsiou, Georgia; Katsikogiannis, Nikolaos; Tsakiridis, Kosmas; Rapti, Aggeliki; Trakada, Georgia; Zissimopoulos, Athanasios; Zarogoulidis, Konstantinos

    2015-01-01

    Minimally invasive procedures, which include laparoscopic surgery, use state-of-the-art technology to reduce the damage to human tissue when performing surgery. Minimally invasive procedures require small “ports” from which the surgeon inserts thin tubes called trocars. Carbon dioxide gas may be used to inflate the area, creating a space between the internal organs and the skin. Then a miniature camera (usually a laparoscope or endoscope) is placed through one of the trocars so the surgical team can view the procedure as a magnified image on video monitors in the operating room. Specialized equipment is inserted through the trocars based on the type of surgery. There are some advanced minimally invasive surgical procedures that can be performed almost exclusively through a single point of entry—meaning only one small incision, like the “uniport” video-assisted thoracoscopic surgery (VATS). Not only do these procedures usually provide equivalent outcomes to traditional “open” surgery (which sometimes require a large incision), but minimally invasive procedures (using small incisions) may offer significant benefits as well: (I) faster recovery; (II) the patient remains for less days hospitalized; (III) less scarring and (IV) less pain. In our current mini review we will present the minimally invasive procedures for thoracic surgery. PMID:25861610

  20. CATS EYES Adjustment Procedures

    DTIC Science & Technology

    1993-04-01

    AL-TR-1 993-0025 AD-A264 069 CATS EYES ADJUSTMENT PROCEDURES A R M Joseph C. Antonio DTIC S ELECTET University of Dayton Research Institute MAY 13...Final November 1992 - January 1993 4. TITLE AND SUBTITLE S. FUNDING NUMBERS C F33615-90-C-0005 CATS EYES Adjustment Procedures PE - 62205F 6. AUTHOR(S) PR...the loss of NVG performance resulting from improper goggle adjustments. This report describes correct adjustment procedures for the CATS EYES NVG system

  1. Special Blood Donation Procedures

    MedlinePlus

    ... Procedures By Ravindra Sarode, MD, The University of Texas Southwestern Medical Center at Dallas NOTE: This is ... hemoglobin The liquid component that consists mostly of water The component that fights infection The component that ...

  2. Periodontal Treatments and Procedures

    MedlinePlus

    ... Alcohol Consumption and Gum Health Workshop on Regeneration Periodontal Disease More Prevalent among Ethnic Minorities Dental Implants Periodontal ... Procedures Periodontists are dentistry's e​xperts in treating periodontal disease. They receive up to three additional years of ...

  3. Periodontal Plastic Surgery Procedures

    MedlinePlus

    ... Alcohol Consumption and Gum Health Workshop on Regeneration Periodontal Disease More Prevalent among Ethnic Minorities Dental Implants Periodontal ... a result of a variety of causes, including periodontal diseases. Gum graft surgery and other root coverage procedures ...

  4. Dynamic alarm response procedures

    SciTech Connect

    Martin, J.; Gordon, P.; Fitch, K.

    2006-07-01

    The Dynamic Alarm Response Procedure (DARP) system provides a robust, Web-based alternative to existing hard-copy alarm response procedures. This paperless system improves performance by eliminating time wasted looking up paper procedures by number, looking up plant process values and equipment and component status at graphical display or panels, and maintenance of the procedures. Because it is a Web-based system, it is platform independent. DARP's can be served from any Web server that supports CGI scripting, such as Apache{sup R}, IIS{sup R}, TclHTTPD, and others. DARP pages can be viewed in any Web browser that supports Javascript and Scalable Vector Graphics (SVG), such as Netscape{sup R}, Microsoft Internet Explorer{sup R}, Mozilla Firefox{sup R}, Opera{sup R}, and others. (authors)

  5. Short Nuss bar procedure

    PubMed Central

    2016-01-01

    The Nuss procedure is now the preferred operation for surgical correction of pectus excavatum (PE). It is a minimally invasive technique, whereby one to three curved metal bars are inserted behind the sternum in order to push it into a normal position. The bars are left in situ for three years and then removed. This procedure significantly improves quality of life and, in most cases, also improves cardiac performance. Previously, the modified Ravitch procedure was used with resection of cartilage and the use of posterior support. This article details the new modified Nuss procedure, which requires the use of shorter bars than specified by the original technique. This technique facilitates the operation as the bar may be guided manually through the chest wall and no additional stabilizing sutures are necessary. PMID:27747185

  6. Bariatric Surgery Procedures

    MedlinePlus

    ... is a Candidate for Bariatric Surgery? Childhood and Adolescent Obesity Find a Provider Benefits of Bariatric Surgery Life ... FAQs Bariatric Surgery Procedures BMI Calculator Childhood and Adolescent Obesity 100 SW 75th Street, Suite 201, Gainesville, FL, ...

  7. Lithotripsy procedure (image)

    MedlinePlus

    Extracorporeal shock wave lithotripsy (ESWL) is a procedure used to shatter simple stones in the kidney or upper urinary tract. Ultrasonic waves are passed through the body until they strike the dense stones. Pulses of ...

  8. Hemodialysis access procedures

    MedlinePlus

    ... this page: //medlineplus.gov/ency/article/007641.htm Hemodialysis access procedures To use the sharing features on ... An access is needed for you to get hemodialysis. The access is where you receive hemodialysis . Using ...

  9. The Genotype of the Donor for the (GT)n Polymorphism in the Promoter/Enhancer of FOXP3 Is Associated with the Development of Severe Acute GVHD but Does Not Affect the GVL Effect after Myeloablative HLA-Identical Allogeneic Stem Cell Transplantation

    PubMed Central

    Buces, Elena; Pion, Marjorie; Sánchez-Hernández, Noemí; Martín-Antonio, Beatriz; Guillem, Vicent; Bosch-Vizcaya, Anna; Bento, Leyre; González-Rivera, Milagros; Balsalobre, Pascual; Kwon, Mi; Serrano, David; Gayoso, Jorge; de la Cámara, Rafael; Brunet, Salut; Rojas-Contreras, Rafael; Nieto, José B.; Martínez, Carmen; Gónzalez, Marcos; Espigado, Ildefonso; Vallejo, Juan C.; Sampol, Antonia; Jiménez-Velasco, Antonio; Urbano-Ispizua, Alvaro; Solano, Carlos; Gallardo, David; Díez-Martín, José L.; Buño, Ismael

    2015-01-01

    The FOXP3 gene encodes for a protein (Foxp3) involved in the development and functional activity of regulatory T cells (CD4+/CD25+/Foxp3+), which exert regulatory and suppressive roles over the immune system. After allogeneic stem cell transplantation, regulatory T cells are known to mitigate graft versus host disease while probably maintaining a graft versus leukemia effect. Short alleles (≤(GT)15) for the (GT)n polymorphism in the promoter/enhancer of FOXP3 are associated with a higher expression of FOXP3, and hypothetically with an increase of regulatory T cell activity. This polymorphism has been related to the development of auto- or alloimmune conditions including type 1 diabetes or graft rejection in renal transplant recipients. However, its impact in the allo-transplant setting has not been analyzed. In the present study, which includes 252 myeloablative HLA-identical allo-transplants, multivariate analysis revealed a lower incidence of grade III-IV acute graft versus host disease (GVHD) in patients transplanted from donors harboring short alleles (OR = 0.26, CI 0.08–0.82, p = 0.021); without affecting chronic GVHD or graft versus leukemia effect, since cumulative incidence of relapse, event free survival and overall survival rates are similar in both groups of patients. PMID:26473355

  10. The Genotype of the Donor for the (GT)n Polymorphism in the Promoter/Enhancer of FOXP3 Is Associated with the Development of Severe Acute GVHD but Does Not Affect the GVL Effect after Myeloablative HLA-Identical Allogeneic Stem Cell Transplantation.

    PubMed

    Noriega, Víctor; Martínez-Laperche, Carolina; Buces, Elena; Pion, Marjorie; Sánchez-Hernández, Noemí; Martín-Antonio, Beatriz; Guillem, Vicent; Bosch-Vizcaya, Anna; Bento, Leyre; González-Rivera, Milagros; Balsalobre, Pascual; Kwon, Mi; Serrano, David; Gayoso, Jorge; de la Cámara, Rafael; Brunet, Salut; Rojas-Contreras, Rafael; Nieto, José B; Martínez, Carmen; Gónzalez, Marcos; Espigado, Ildefonso; Vallejo, Juan C; Sampol, Antonia; Jiménez-Velasco, Antonio; Urbano-Ispizua, Alvaro; Solano, Carlos; Gallardo, David; Díez-Martín, José L; Buño, Ismael

    2015-01-01

    The FOXP3 gene encodes for a protein (Foxp3) involved in the development and functional activity of regulatory T cells (CD4+/CD25+/Foxp3+), which exert regulatory and suppressive roles over the immune system. After allogeneic stem cell transplantation, regulatory T cells are known to mitigate graft versus host disease while probably maintaining a graft versus leukemia effect. Short alleles (≤(GT)15) for the (GT)n polymorphism in the promoter/enhancer of FOXP3 are associated with a higher expression of FOXP3, and hypothetically with an increase of regulatory T cell activity. This polymorphism has been related to the development of auto- or alloimmune conditions including type 1 diabetes or graft rejection in renal transplant recipients. However, its impact in the allo-transplant setting has not been analyzed. In the present study, which includes 252 myeloablative HLA-identical allo-transplants, multivariate analysis revealed a lower incidence of grade III-IV acute graft versus host disease (GVHD) in patients transplanted from donors harboring short alleles (OR = 0.26, CI 0.08-0.82, p = 0.021); without affecting chronic GVHD or graft versus leukemia effect, since cumulative incidence of relapse, event free survival and overall survival rates are similar in both groups of patients.

  11. Common procedures in rabbits.

    PubMed

    Graham, Jennifer

    2006-05-01

    Rabbits are popular companion animals that present to veterinary clinics for routine and emergency care. Clinics equipped for treat-ing dogs and cats may be easily adapted to accommodate rabbits. This article reviews common procedures performed by the clinician specific to rabbits. Topics include handling and restraint, triage and patient assessment, sample collection, and supportive care techniques. Miscellaneous procedures, including anesthetic delivery, nasolacrimal duct flushing, and ear cleaning, are also discussed.

  12. [Complications of plateletpheresis procedures].

    PubMed

    García Gala, J M; Rodríguez-Vicente, P; Martínez Revuelta, E; Alonso García, A; Sanzo Lombardero, C; Alvarez Ferrando, A

    1998-10-01

    Thrombopheresis procedures have been recently expanded with the development or different programmes. Taking into account that this reasonably safe procedure is not devoid of complications, it would be desirable to select those individuals with lower risk of suffering adverse side effects as donors. The thrombopheresis procedures performed in our hospital between 1986 and 1997 were analysed in order to establish the useful guidelines for such selection. All the thrombopheresis procedures performed in the Asturias Central Hospital blood bank in the 1986-1987 period were analysed. The first procedure per donor, along with all data referred to adverse effects appearing during thrombopheresis, were collected. Sex, age, body, weight, blood cells count (before and after thrombopheresis) and serum calcium levels (before and after thrombopheresis) were taken as variables with predictive value for adverse effects. With regard to the procedure, the model of cell separator, the duration of the procedure, the amount and type of anticoagulant solution and the prophylactic use of calcium ions were assessed. A total number of 1,024 thrombophereses were analysed. Some types of adverse effect were seen in 259 instances (25.3%). Of these, 70.3%, were mild, 29.3% moderate and 0.4% severe. The commonest adverse effect was perioral paraesthesia. Of the different variables studied, female sex and low weight acquired predictive value with respect to the occurrence of adverse effects. Prophylactic administration of calcium did not prevent the appearance of complications. The thrombopheresis procedures may present adverse side effects in a high percentage of cases, which, although mostly mild, require specialised personnel for identification and management. Males weighing over 70 kg are less prone to suffer such effects. Oral administration of calcium before the apheresis does not prevent the adverse reactions.

  13. [The EXIT procedure].

    PubMed

    Lehmann, S; Blödow, A; Flügel, W; Renner-Lützkendorf, H; Isbruch, A; Siegling, F; Untch, M; Strauß, J; Bloching, M B

    2013-08-01

    The ex utero intrapartum treatment (EXIT) procedure is used for unborn fetuses in cases of predictable complications of postpartum airway obstruction. Indications for the EXIT procedure are fetal neck tumors, obstruction of the trachea, hiatus hernia of the diaphragm and congenital high airway obstruction syndrome (CHAOS). Large cervical tumors prevent normal delivery of a fetus due to reclination of the head with airway obstruction. Therefore, a primary caesarean section or the EXIT procedure has to be considered. The EXIT procedure has time limitations as the blood supply by the placenta only lasts for 30-60 min. Airway protection has to be ensured during parturition.This article reports the case of an unborn fetus with a large cervical teratoma where an obstruction of the cervical airway was detected and monitored by ultrasound and magnetic resonance imaging (MRI) during pregnancy. The EXIT procedure was therefore used and successfully accomplished. The features of the interdisciplinary aspects of the EXIT procedure are described with the special aspects of each medical discipline.

  14. Procedural sedation analgesia

    PubMed Central

    Sheta, Saad A

    2010-01-01

    The number of noninvasive and minimally invasive procedures performed outside of the operating room has grown exponentially over the last several decades.Sedation, analgesia, or both may be needed for many of these interventional or diagnostic procedures. Individualized care is important when determining if a patient requires procedural sedation analgesia (PSA). The patient might need an anti-anxiety drug, pain medicine, immobilization, simple reassurance, or a combination of these interventions. The goals of PSA in four different multidisciplinary practices namely; emergency, dentistry, radiology and gastrointestinal endoscopy are discussed in this review article. Some procedures are painful, others painless. Therefore, goals of PSA vary widely. Sedation management can range from minimal sedation, to the extent of minimal anesthesia. Procedural sedation in emergency department (ED) usually requires combinations of multiple agents to reach desired effects of analgesia plus anxiolysis. However, in dental practice, moderate sedation analgesia (known to the dentists as conscious sedation) is usually what is required. It is usually most effective with the combined use of local anesthesia. The mainstay of success for painless imaging is absolute immobility. Immobility can be achieved by deep sedation or minimal anesthesia. On the other hand, moderate sedation, deep sedation, minimal anesthesia and conventional general anesthesia can be all utilized for management of gastrointestinal endoscopy. PMID:20668560

  15. Procedural learning and dyslexia.

    PubMed

    Nicolson, R I; Fawcett, A J; Brookes, R L; Needle, J

    2010-08-01

    Three major 'neural systems', specialized for different types of information processing, are the sensory, declarative, and procedural systems. It has been proposed (Trends Neurosci., 30(4), 135-141) that dyslexia may be attributable to impaired function in the procedural system together with intact declarative function. We provide a brief overview of the increasing evidence relating to the hypothesis, noting that the framework involves two main claims: first that 'neural systems' provides a productive level of description avoiding the underspecificity of cognitive descriptions and the overspecificity of brain structural accounts; and second that a distinctive feature of procedural learning is its extended time course, covering from minutes to months. In this article, we focus on the second claim. Three studies-speeded single word reading, long-term response learning, and overnight skill consolidation-are reviewed which together provide clear evidence of difficulties in procedural learning for individuals with dyslexia, even when the tasks are outside the literacy domain. The educational implications of the results are then discussed, and in particular the potential difficulties that impaired overnight procedural consolidation would entail. It is proposed that response to intervention could be better predicted if diagnostic tests on the different forms of learning were first undertaken.

  16. Mobile Energy Laboratory Procedures

    SciTech Connect

    Armstrong, P.R.; Batishko, C.R.; Dittmer, A.L.; Hadley, D.L.; Stoops, J.L.

    1993-09-01

    Pacific Northwest Laboratory (PNL) has been tasked to plan and implement a framework for measuring and analyzing the efficiency of on-site energy conversion, distribution, and end-use application on federal facilities as part of its overall technical support to the US Department of Energy (DOE) Federal Energy Management Program (FEMP). The Mobile Energy Laboratory (MEL) Procedures establish guidelines for specific activities performed by PNL staff. PNL provided sophisticated energy monitoring, auditing, and analysis equipment for on-site evaluation of energy use efficiency. Specially trained engineers and technicians were provided to conduct tests in a safe and efficient manner with the assistance of host facility staff and contractors. Reports were produced to describe test procedures, results, and suggested courses of action. These reports may be used to justify changes in operating procedures, maintenance efforts, system designs, or energy-using equipment. The MEL capabilities can subsequently be used to assess the results of energy conservation projects. These procedures recognize the need for centralized NM administration, test procedure development, operator training, and technical oversight. This need is evidenced by increasing requests fbr MEL use and the economies available by having trained, full-time MEL operators and near continuous MEL operation. DOE will assign new equipment and upgrade existing equipment as new capabilities are developed. The equipment and trained technicians will be made available to federal agencies that provide funding for the direct costs associated with MEL use.

  17. Environmental Test Screening Procedure

    NASA Technical Reports Server (NTRS)

    Zeidler, Janet

    2000-01-01

    This procedure describes the methods to be used for environmental stress screening (ESS) of the Lightning Mapper Sensor (LMS) lens assembly. Unless otherwise specified, the procedures shall be completed in the order listed, prior to performance of the Acceptance Test Procedure (ATP). The first unit, S/N 001, will be subjected to the Qualification Vibration Levels, while the remainder will be tested at the Operational Level. Prior to ESS, all units will undergo Pre-ESS Functional Testing that includes measuring the on-axis and plus or minus 0.95 full field Modulation Transfer Function and Back Focal Length. Next, all units will undergo ESS testing, and then Acceptance testing per PR 460.

  18. Reasoning about procedural knowledge

    NASA Technical Reports Server (NTRS)

    Georgeff, M. P.

    1985-01-01

    A crucial aspect of automated reasoning about space operations is that knowledge of the problem domain is often procedural in nature - that is, the knowledge is often in the form of sequences of actions or procedures for achieving given goals or reacting to certain situations. In this paper a system is described that explicitly represents and reasons about procedural knowledge. The knowledge representation used is sufficiently rich to describe the effects of arbitrary sequences of tests and actions, and the inference mechanism provides a means for directly using this knowledge to reach desired operational goals. Furthermore, the representation has a declarative semantics that provides for incremental changes to the system, rich explanatory capabilities, and verifiability. The approach also provides a mechanism for reasoning about the use of this knowledge, thus enabling the system to choose effectively between alternative courses of action.

  19. Computerized operating procedures

    SciTech Connect

    Ness, E.; Teigen, J.

    1994-12-31

    A number of observed and potential problems in the nuclear industry are related to the quality of operating procedures. Many of the problems identified in operating procedure preparation, implementation, and maintenance have a technical nature, which can be directly addressed by developing computerized procedure handling tools. The Halden Reactor Project (HRP) of the Organization for Economic Cooperation and Development has since 1985 performed research work within this field. A product of this effort is the development of a second version of the computerized operation manuals (COPMA) system. This paper summarizes the most important characteristics of the COPMA-II system and discusses some of the experiences in using a system like COPMA-II.

  20. Procedure and Program Examples

    NASA Astrophysics Data System (ADS)

    Britz, Dieter

    Here some modules, procedures and whole programs are described, that may be useful to the reader, as they have been, to the author. They are all in Fortran 90/95 and start with a generally useful module, that will be used in most procedures and programs in the examples, and another module useful for programs using a Rosenbrock variant. The source texts (except for the two modules) are not reproduced here, but can be downloaded from the web site www.springerlink.com/openurl.asp?genre=issue &issn=1616-6361&volume=666 (the two lines form one contiguous URL!).

  1. Robotic benign esophageal procedures.

    PubMed

    Hanna, Jennifer M; Onaitis, Mark W

    2014-05-01

    Robotic master-slave devices can assist surgeons to perform minimally invasive esophageal operations with approaches that have already been demonstrated using laparoscopy and thoracoscopy. Robotic-assisted surgery for benign esophageal disease is described for the treatment of achalasia, epiphrenic diverticula, refractory reflux, paraesophageal hernias, duplication cysts, and benign esophageal masses, such as leiomyomas. Indications and contraindications for robotic surgery in benign esophageal disease should closely approximate the indications for laparoscopic and thoracoscopic procedures. Given the early application of the technology and paucity of clinical evidence, there are currently no procedures for which robotic esophageal surgery is the clinically proven preferred approach. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. Toddler test or procedure preparation

    MedlinePlus

    Preparing toddler for test/procedure; Test/procedure preparation - toddler; Preparing for a medical test or procedure - toddler ... Before the test, know that your child will probably cry. Even if you prepare, your child may feel some discomfort or ...

  3. Preschooler test or procedure preparation

    MedlinePlus

    Preparing preschoolers for test/procedure; Test/procedure preparation - preschooler ... Preparing children for medical tests can reduce their anxiety. It can also make them less likely to cry and resist the procedure. Research shows that ...

  4. Short duration, high dose, alternating chemotherapy in metastatic neuroblastoma. (ENSG 3C induction regimen). The European Neuroblastoma Study Group.

    PubMed Central

    Pinkerton, C. R.; Zucker, J. M.; Hartmann, O.; Pritchard, J.; Broadbent, V.; Morris-Jones, P.; Breatnach, F.; Craft, A. E.; Pearson, A. D.; Wallendszus, K. R.

    1990-01-01

    Fifty-one children, aged from 15 months to 13 years 5 months with metastatic neuroblastoma presenting sequentially at the participating institutions received four 3 to 4 weekly courses of high dose multiagent chemotherapy. High dose cisplatin (200 mg m-2) combined with etoposide (500 mg m-2), HIPE, was alternated with ifosfamide (9 g m-2), vincristine (1.5 mg m-2), and adriamycin (60 mg m-1), IVAd. Disease status was re-evaluated 3 to 4 weeks after the fourth course and the response classified according to the International Neuroblastoma Response Criteria (INRC). The overall response rate in evaluable patients was 55% and response rates by site were: bone marrow 67% (complete response 47%); bone scan 68%; primary tumour 61%, and urinary catecholamine metabolites (VMA/HVA) 95%. Serial 51Cr EDTA renal clearance studies showed a glomerular filtration rate (GFR) decline in 40% of patients but in only seven cases to below 50% of the pretreatment value. There was no instance of renal failure during induction, though two patients developed severe renal failure following 'megatherapy' given to consolidate remission. Serial audiometry showed a significant decline in hearing at frequencies above 2,000 Hz in 37% of children but at or below 2,000 Hz in only 17%. Neutropenia and thrombocytopenia were severe and intravenous antibiotics were required after 30% of courses. Each of two treatment-related deaths occurred during pancytopenia following courses of IVAd. Complete, or greater than 90%, removal of primary site tumour was possible in 70% of cases following this induction regimen and 75% of patients proceeded to elective megatherapy within a median time of 24 weeks after diagnosis. This short intensive induction programme is highly effective at achieving cytoreduction, enabling early surgery and early megatherapy procedures. It is, however, too early to draw firm conclusions about the impact of this approach to treatment on the cure rate. PMID:2386751

  5. Pediatric Procedural Pain

    ERIC Educational Resources Information Center

    Blount, Ronald L.; Piira, Tiina; Cohen, Lindsey L.; Cheng, Patricia S.

    2006-01-01

    This article reviews the various settings in which infants, children, and adolescents experience pain during acute medical procedures and issues related to referral of children to pain management teams. In addition, self-report, reports by others, physiological monitoring, and direct observation methods of assessment of pain and related constructs…

  6. Evaluation Perspectives and Procedures.

    ERIC Educational Resources Information Center

    Scriven, Michael

    This article on evaluation perspectives and procedures is divided into six sections. The first section briefly discusses qualitative and quantitative research and evaluation. In the second section there is an exploration of the utility and validity of a checklist that can be used to evaluate products, as an instrument for evaluating producers, for…

  7. Visual Screening: A Procedure.

    ERIC Educational Resources Information Center

    Williams, Robert T.

    Vision is a complex process involving three phases: physical (acuity), physiological (integrative), and psychological (perceptual). Although these phases cannot be considered discrete, they provide the basis for the visual screening procedure used by the Reading Services of Colorado State University and described in this document. Ten tests are…

  8. Procedures and Policies Manual

    ERIC Educational Resources Information Center

    Davis, Jane M.

    2006-01-01

    This document was developed by the Middle Tennessee State University James E. Walker Library Collection Management Department to provide policies and procedural guidelines for the cataloging and processing of bibliographic materials. This document includes policies for cataloging monographs, serials, government documents, machine-readable data…

  9. Simulating Laboratory Procedures.

    ERIC Educational Resources Information Center

    Baker, J. E.; And Others

    1986-01-01

    Describes the use of computer assisted instruction in a medical microbiology course. Presents examples of how computer assisted instruction can present case histories in which the laboratory procedures are simulated. Discusses an authoring system used to prepare computer simulations and provides one example of a case history dealing with fractured…

  10. Student Loan Collection Procedures.

    ERIC Educational Resources Information Center

    National Association of College and University Business Officers, Washington, DC.

    This manual on the collection of student loans is intended for the use of business officers and loan collection personnel of colleges and universities of all sizes. The introductory chapter is an overview of sound collection practices and procedures. It discusses the making of a loan, in-school servicing of the accounts, the exit interview, the…

  11. Educational Accounting Procedures.

    ERIC Educational Resources Information Center

    Tidwell, Sam B.

    This chapter of "Principles of School Business Management" reviews the functions, procedures, and reports with which school business officials must be familiar in order to interpret and make decisions regarding the school district's financial position. Among the accounting functions discussed are financial management, internal auditing,…

  12. Write Procedures That Work.

    ERIC Educational Resources Information Center

    Cubberley, Carol W.

    1991-01-01

    Discusses written procedures that explain library tasks and describes methods for writing them clearly and coherently. The use of appropriate terminology and vocabulary is discussed; the value of illustrations, typography, and format to enhance the visual effect is explained; the intended audience is considered; and examples are given. (seven…

  13. Numerical Boundary Condition Procedures

    NASA Technical Reports Server (NTRS)

    1981-01-01

    Topics include numerical procedures for treating inflow and outflow boundaries, steady and unsteady discontinuous surfaces, far field boundaries, and multiblock grids. In addition, the effects of numerical boundary approximations on stability, accuracy, and convergence rate of the numerical solution are discussed.

  14. Simulating Laboratory Procedures.

    ERIC Educational Resources Information Center

    Baker, J. E.; And Others

    1986-01-01

    Describes the use of computer assisted instruction in a medical microbiology course. Presents examples of how computer assisted instruction can present case histories in which the laboratory procedures are simulated. Discusses an authoring system used to prepare computer simulations and provides one example of a case history dealing with fractured…

  15. Parliamentary Procedure Made Easy.

    ERIC Educational Resources Information Center

    Hayden, Ellen T.

    Based on the newly revised "Robert's Rules of Order," these self-contained learning activities will help students successfully and actively participate in school, social, civic, political, or professional organizations. There are 13 lessons. Topics studied include the what, why, and history of parliamentary procedure; characteristics of the ideal…

  16. Special Education: Procedural Guide.

    ERIC Educational Resources Information Center

    Dependents Schools (DOD), Washington, DC.

    The guide is intended to provide information to administrators and regional and local case study committees on special education procedures within Department of Defense Dependents Schools (DoDDS). The manual addresses a step-by step approach from referral to the implementation of individualized education programs (IEP). The following topics are…

  17. Advanced intrarenal ureteroscopic procedures.

    PubMed

    Monga, Manoj; Beeman, William W

    2004-02-01

    The role of flexible ureteroscopy in the management of intrarenal pathology has undergone a dramatic evolution, powered by improvements in flexible ureteroscope design; deflection and image quality; diversification of small, disposable instrumentation; and the use of holmium laser lithotripsy. This article reviews the application of flexible ureteroscopy for advanced intrarenal procedures.

  18. Write Procedures That Work.

    ERIC Educational Resources Information Center

    Cubberley, Carol W.

    1991-01-01

    Discusses written procedures that explain library tasks and describes methods for writing them clearly and coherently. The use of appropriate terminology and vocabulary is discussed; the value of illustrations, typography, and format to enhance the visual effect is explained; the intended audience is considered; and examples are given. (seven…

  19. Subsea HIPPS design procedure

    SciTech Connect

    Aaroe, R.; Lund, B.F.; Onshus, T.

    1995-12-31

    The paper is based on a feasibility study investigating the possibilities of using a HIPPS (High Integrity Pressure Protection System) to protect a subsea pipeline that is not rated for full wellhead shut-in pressure. The study was called the Subsea OPPS Feasibility Study, and was performed by SINTEF, Norway. Here, OPPS is an acronym for Overpressure Pipeline Protection System. A design procedure for a subsea HIPPS is described, based on the experience and knowledge gained through the ``Subsea OPPS Feasibility Study``. Before a subsea HIPPS can be applied, its technical feasibility, reliability and profitability must be demonstrated. The subsea HIPPS design procedure will help to organize and plan the design activities both with respect to development and verification of a subsea HIPPS. The paper also gives examples of how some of the discussed design steps were performed in the Subsea OPPS Feasibility Study. Finally, further work required to apply a subsea HIPPS is discussed.

  20. CTO PCI Procedural Planning.

    PubMed

    Lembo, Nicholas J; Karmpaliotis, Dimitri; Kandzari, David E

    2012-07-01

    Chronic total occlusion percutaneous coronary intervention (CTO PCI) procedural planning involves much thought and deliberation before one actually attempts to cross the CTO lesion in the cardiac catheterization laboratory. Careful preprocedural angiographic assessment is a key to successful CTO PCI. CTO PCI represents the most complex PCI one can perform, and thus operator and staff training as well as the concept of CTO days are all essential for a successful CTO PCI program. Copyright © 2012. Published by Elsevier Inc.

  1. Musculoskeletal Aspiration Procedures

    PubMed Central

    Hansford, Barry Glenn; Stacy, Gregory Scott

    2012-01-01

    With advances in imaging technology, there has been a significant increase in the number and range of interventional musculoskeletal image-guided procedures. One of the most commonly performed image-guided musculoskeletal interventions is the diagnostic and therapeutic percutaneous aspiration and drainage of multiple types of intra-articular, juxta-articular, and intramuscular pathologic fluid collections. These procedures may be performed under fluoroscopic, ultrasound, computed tomography, or even magnetic resonance guidance depending on the location to be accessed, type of pathology, patient characteristics, and operator preference. Musculoskeletal image-guided aspiration and drainage procedures are minimally invasive and generally very safe while offering valuable diagnostic information as well as therapeutic benefit. This article focuses on the appropriate indications, contraindications, and general technique for accessing the major joints via imaging guidance. For each joint, we discuss pertinent anatomy, appropriate imaging modalities, and preferred approaches to gaining intra-articular access. Additionally, the article discusses some of the more frequently encountered juxta-articular and intramuscular fluid collections that can be accessed and aspirated via percutaneous intervention, with mention of the importance of recognizing extremity sarcomas that can mimic these benign collections. PMID:24293800

  2. Sedation for electrophysiological procedures.

    PubMed

    Thomas, Stuart P; Thakkar, Jay; Kovoor, Pramesh; Thiagalingam, Aravinda; Ross, David L

    2014-06-01

    Administration of intravenous sedation (IVS) has become an integral component of procedural cardiac electrophysiology. IVS is employed in diagnostic and ablation procedures for transcutaneous treatment of cardiac arrhythmias, electrical cardioversion of arrhythmias, and the insertion of implantable electronic devices including pacemakers, defibrillators, and loop recorders. Sedation is frequently performed by nursing staff under the supervision of the proceduralist and in the absence of specialist anesthesiologists. The sedation requirements vary depending on the nature of the procedure. A wide range of sedation techniques have been reported with sedation from the near fully conscious to levels approaching that of general anesthesia. This review examines the methods employed and outcomes associated with reported sedation techniques. There is a large experience with the combination of benzodiazepines and narcotics. These drugs have a broad therapeutic range and the advantage of readily available reversal agents. More recently, the use of propofol without serious adverse events has been reported. The results provide a guide regarding the expected outcomes of these approaches. The complication rate and need for emergency assistance is low in reported series where sedation is administered by nonspecialist anesthesiology staff. ©2014 Wiley Periodicals, Inc.

  3. The calcaneo-stop procedure.

    PubMed

    Usuelli, F G; Montrasio, U Alfieri

    2012-06-01

    Flexible flatfoot is one of the most common deformities. Arthroereisis procedures are designed to correct this deformity. Among them, the calcaneo-stop is a procedure with both biomechanical and proprioceptive properties. It is designed for pediatric treatment. Results similar to endorthesis procedure are reported. Theoretically the procedure can be applied to adults if combined with other procedures to obtain a stable plantigrade foot, but medium-term follow up studies are missing.

  4. Pollutant Assessments Group Procedures Manual

    SciTech Connect

    Chavarria, D.E.; Davidson, J.R.; Espegren, M.L.; Kearl, P.M.; Knott, R.R.; Pierce, G.A.; Retolaza, C.D.; Smuin, D.R.; Wilson, M.J.; Witt, D.A. ); Conklin, N.G.; Egidi, P.V.; Ertel, D.B.; Foster, D.S.; Krall, B.J.; Meredith, R.L.; Rice, J.A.; Roemer, E.K. )

    1991-02-01

    This procedures manual combines the existing procedures for radiological and chemical assessment of hazardous wastes used by the Pollutant Assessments Group at the time of manuscript completion (October 1, 1990). These procedures will be revised in an ongoing process to incorporate new developments in hazardous waste assessment technology and changes in administrative policy and support procedures. Format inconsistencies will be corrected in subsequent revisions of individual procedures.

  5. Pipe Cleaning Operating Procedures

    SciTech Connect

    Clark, D.; Wu, J.; /Fermilab

    1991-01-24

    This cleaning procedure outlines the steps involved in cleaning the high purity argon lines associated with the DO calorimeters. The procedure is broken down into 7 cycles: system setup, initial flush, wash, first rinse, second rinse, final rinse and drying. The system setup involves preparing the pump cart, line to be cleaned, distilled water, and interconnecting hoses and fittings. The initial flush is an off-line flush of the pump cart and its plumbing in order to preclude contaminating the line. The wash cycle circulates the detergent solution (Micro) at 180 degrees Fahrenheit through the line to be cleaned. The first rinse is then intended to rid the line of the majority of detergent and only needs to run for 30 minutes and at ambient temperature. The second rinse (if necessary) should eliminate the remaining soap residue. The final rinse is then intended to be a check that there is no remaining soap or other foreign particles in the line, particularly metal 'chips.' The final rinse should be run at 180 degrees Fahrenheit for at least 90 minutes. The filters should be changed after each cycle, paying particular attention to the wash cycle and the final rinse cycle return filters. These filters, which should be bagged and labeled, prove that the pipeline is clean. Only distilled water should be used for all cycles, especially rinsing. The level in the tank need not be excessive, merely enough to cover the heater float switch. The final rinse, however, may require a full 50 gallons. Note that most of the details of the procedure are included in the initial flush description. This section should be referred to if problems arise in the wash or rinse cycles.

  6. Interventional radiology neck procedures.

    PubMed

    Zabala Landa, R M; Korta Gómez, I; Del Cura Rodríguez, J L

    2016-05-01

    Ultrasonography has become extremely useful in the evaluation of masses in the head and neck. It enables us to determine the anatomic location of the masses as well as the characteristics of the tissues that compose them, thus making it possible to orient the differential diagnosis toward inflammatory, neoplastic, congenital, traumatic, or vascular lesions, although it is necessary to use computed tomography or magnetic resonance imaging to determine the complete extension of certain lesions. The growing range of interventional procedures, mostly guided by ultrasonography, now includes biopsies, drainages, infiltrations, sclerosing treatments, and tumor ablation.

  7. Radiometric correction procedure study

    NASA Technical Reports Server (NTRS)

    Colby, C.; Sands, R.; Murphrey, S.

    1978-01-01

    A comparison of MSS radiometric processing techniques identified as a preferred radiometric processing technique a procedure which equalizes the mean and standard deviation of detector-specific histograms of uncalibrated scene data. Evaluation of MSS calibration data demonstrated that the relationship between detector responses is essentially linear over the range of intensities typically observed in MSS data, and that the calibration wedge data possess a high degree of temporal stability. An analysis of the preferred radiometric processing technique showed that it could be incorporated into the MDP-MSS system without a major redesign of the system, and with minimal impact on system throughput.

  8. Clarification Procedure for Gels

    NASA Technical Reports Server (NTRS)

    Barber, Patrick G.; Simpson, Norman R.

    1987-01-01

    Procedure developed to obtain transparent gels with consistencies suitable for crystal growth, by replacing sodium ions in silicate solution with potassium ions. Clarification process uses cation-exchange resin to replace sodium ions in stock solution with potassium ions, placed in 1M solution of soluble potassium salt. Slurry stirred for several hours to allow potassium ions to replace all other cations on resin. Supernatant solution decanted through filter, and beads rinsed with distilled water. Rinsing removes excess salt but leaves cation-exchange beads fully charged with potassium ions.

  9. [Physical restraint and procedure].

    PubMed

    Van de Vyvere, A; Dumont, C

    2013-09-01

    The widespread practice of physical restraint of the elderly has used in most case in order to protect elders against injuries after falls or to manage behaviour agitation during delirium for example. However, "protect" isn't correct because of the adverse effects have been reported as falls increase, pressures sores, depression, aggression and death. In fact, efficacy of restraints for safeguarding patients from injury has not been demonstrated clinically. This paper reviews the current medico-legal knowledge regarding physical restraint use in this frail population and suggests some considerations about ethical practice and procedure evaluation.

  10. Surface cleanliness measurement procedure

    DOEpatents

    Schroder, Mark Stewart; Woodmansee, Donald Ernest; Beadie, Douglas Frank

    2002-01-01

    A procedure and tools for quantifying surface cleanliness are described. Cleanliness of a target surface is quantified by wiping a prescribed area of the surface with a flexible, bright white cloth swatch, preferably mounted on a special tool. The cloth picks up a substantial amount of any particulate surface contamination. The amount of contamination is determined by measuring the reflectivity loss of the cloth before and after wiping on the contaminated system and comparing that loss to a previous calibration with similar contamination. In the alternative, a visual comparison of the contaminated cloth to a contamination key provides an indication of the surface cleanliness.

  11. Regulations and Procedures Manual

    SciTech Connect

    Young, Lydia J.

    2011-07-25

    The purpose of the Regulations and Procedures Manual (RPM) is to provide LBNL personnel with a reference to University and Lawrence Berkeley National Laboratory (LBNL or Laboratory) policies and regulations by outlining normal practices and answering most policy questions that arise in the day-to-day operations of Laboratory organizations. Much of the information in this manual has been condensed from detail provided in LBNL procedure manuals, Department of Energy (DOE) directives, and Contract DE-AC02-05CH11231. This manual is not intended, however, to replace any of those documents. RPM sections on personnel apply only to employees who are not represented by unions. Personnel policies pertaining to employees represented by unions may be found in their labor agreements. Questions concerning policy interpretation should be directed to the LBNL organization responsible for the particular policy. A link to the Managers Responsible for RPM Sections is available on the RPM home page. If it is not clear which organization is responsible for a policy, please contact Requirements Manager Lydia Young or the RPM Editor.

  12. Regulations and Procedures Manual

    SciTech Connect

    Young, Lydia

    2010-09-30

    The purpose of the Regulations and Procedures Manual (RPM) is to provide Laboratory personnel with a reference to University and Lawrence Berkeley National Laboratory policies and regulations by outlining the normal practices and answering most policy questions that arise in the day-to-day operations of Laboratory departments. Much of the information in this manual has been condensed from detail provided in Laboratory procedure manuals, Department of Energy (DOE) directives, and Contract DE-AC02-05CH11231. This manual is not intended, however, to replace any of those documents. The sections on personnel apply only to employees who are not represented by unions. Personnel policies pertaining to employees represented by unions may be found in their labor agreements. Questions concerning policy interpretation should be directed to the department responsible for the particular policy. A link to the Managers Responsible for RPM Sections is available on the RPM home page. If it is not clear which department should be called, please contact the Associate Laboratory Director of Operations.

  13. Designing Flight Deck Procedures

    NASA Technical Reports Server (NTRS)

    Degani, Asaf; Wiener, Earl

    2005-01-01

    Three reports address the design of flight-deck procedures and various aspects of human interaction with cockpit systems that have direct impact on flight safety. One report, On the Typography of Flight- Deck Documentation, discusses basic research about typography and the kind of information needed by designers of flight deck documentation. Flight crews reading poorly designed documentation may easily overlook a crucial item on the checklist. The report surveys and summarizes the available literature regarding the design and typographical aspects of printed material. It focuses on typographical factors such as proper typefaces, character height, use of lower- and upper-case characters, line length, and spacing. Graphical aspects such as layout, color coding, fonts, and character contrast are discussed; and several cockpit conditions such as lighting levels and glare are addressed, as well as usage factors such as angular alignment, paper quality, and colors. Most of the insights and recommendations discussed in this report are transferable to paperless cockpit systems of the future and computer-based procedure displays (e.g., "electronic flight bag") in aerospace systems and similar systems that are used in other industries such as medical, nuclear systems, maritime operations, and military systems.

  14. Advanced crew procedures development techniques: Procedures and performance program description

    NASA Technical Reports Server (NTRS)

    Arbet, J. D.; Mangiaracina, A. A.

    1975-01-01

    The Procedures and Performance Program (PPP) for operation in conjunction with the Shuttle Procedures Simulator (SPS) is described. The PPP user interface, the SPS/PPP interface, and the PPP applications software are discussed.

  15. A single apheresis procedure in the donor may be enough to complete an allograft using the “Mexican Method” of non-ablative allografting

    PubMed Central

    Ruiz-Delgado, Guillermo J.; Gutiérrez-Riveroll, Karla I.; Gutiérrez-Aguirre, César H.; Gómez-Almaguer, David; Eyzaguirre-Zapata, Renee; Priesca-Marin, Manuel; González-Carrillo, Martha L.; Ruiz-Argüelles, Guillermo J.

    2009-01-01

    Background Since 1999, in Mexico we have been using a regimen to conduct allografts that involves non-myeloablative conditioning and peripheral blood stem cells (PBSC) and have introduced some changes with the main goal of decreasing the cost of the procedure. Materials and methods We analysed the salient apheresis features of a group of 175 allogeneic peripheral blood stem cell transplants conducted in two institutions in a 7-year period. The grafts were conducted using the “Mexican” non-myelo ablative conditioning regimen employing oral busulphan, i.v. cyclophosphamide and i.v. fludarabine. In all instances, the apheresis machine employed was the Baxter CS3000 Plus and donors were mobilised with filgrastim. The apheresis procedures were performed on days 0, +1 and +2, the end-point of collection being 5,000 mL of blood/m2 in each procedure. Three apheresis sessions were planned but the number was adjusted according to the cell yield. Results The final number of allografted CD34 cells ranged between 0.5 and 25.4 × 106/Kg of the recipient’s body weight (median, 5.2 × 106/Kg). One to three apheresis procedures were needed to obtain a product containing more than 0.5 × 106 CD34 cells/Kg of the recipient, the median being two procedures; in 72 cases (41%) a single apheresis procedure was sufficient to obtain the target number of CD34 cells. The volumes of apheresis ranged between 50 and 600 mL (median, 400 mL). Conclusions Since the median cost of each apheresis procedure is 900 USD, the fact that two apheresis procedures was spared in 72 cases and one apheresis was spared in another 65 cases, led to a total saving of approximately 188,100 USD. It can be concluded that, in many cases, allogeneic transplants can be completed with a single apheresis session and that there are considerable financial benefits from this practice. PMID:19503634

  16. Mechanization of Cataloging Procedures *

    PubMed Central

    Kilgour, Frederick G.

    1965-01-01

    The Columbia-Harvard-Yale Medical Libraries Computerization Project has put into operation its mechanized procedure for the production of catalog cards. Cards produced are in final form ready to be filed into a card catalog. Catalogers prepare copy on a worksheet from which punched cards are punched. An IBM 1401 computer processes the decklets of punched cards on magnetic tape to produce the expanded decklets of punched cards needed to print the various packs of catalog cards required to go into different catalogs. Next, the computer punches the expanded decklets of cards to operate an 870 Document Writer, which types out the catalog cards in final form. Cost of cards ready to file is 12.5 cents per card. Images PMID:14271110

  17. [Capillaroscopy. Procedure and nomenclature].

    PubMed

    Sander, O; Sunderkötter, C; Kötter, I; Wagner, I; Becker, M; Herrgott, I; Schwarting, A; Ostendorf, B; Iking-Konert, C; Genth, E

    2010-05-01

    Capillaroscopy has high diagnostic and prognostic value in autoimmune connective tissue diseases, in particular systemic sclerosis (SSc). Our working group has developed a consensus on nomenclature, technical equipment, procedure, and diagnostic interpretation of results. The following are required: binocular microscopes with at least 20-/50- and 160-/200-fold magnification and digital archiving. Documentation of defined findings is mandatory. The simultaneous occurrence of, e.g. caliber variations, ectasia, ramifications, elongation (length > 350 microm), torsion (at least two crossing segments per capillary loop), sludge, hemorrhage, and edema is of pathological significance. The isolated occurrence of bushy capillaries (multiple ramifications), thrombosis, giant capillary (capillary lumen > 50 microm), and avascular areas also indicates disease. The latter two findings are highly specific for SSc. Other findings are consistent with connective tissue diseases. These standardized definitions increase quality and comparability of nailfold capillaroscopy in Germany.

  18. MECHANIZATION OF CATALOGING PROCEDURES.

    PubMed

    KILGOUR, F G

    1965-04-01

    The Columbia-Harvard-Yale Medical Libraries Computerization Project has put into operation its mechanized procedure for the production of catalog cards. Cards produced are in final form ready to be filed into a card catalog. Catalogers prepare copy on a worksheet from which punched cards are punched. An IBM 1401 computer processes the decklets of punched cards on magnetic tape to produce the expanded decklets of punched cards needed to print the various packs of catalog cards required to go into different catalogs. Next, the computer punches the expanded decklets of cards to operate an 870 Document Writer, which types out the catalog cards in final form. Cost of cards ready to file is 12.5 cents per card.

  19. Grant Competition Dispute Resolution Procedures

    EPA Pesticide Factsheets

    Notice of the availability of a Class Deviation from EPA’s assistance agreement dispute procedures and alsosets forth the procedures that will apply to the resolution of competition-related disputes and disagreements that may arise.

  20. Group Syntality and Parliamentary Procedure.

    ERIC Educational Resources Information Center

    Winn, Larry James; Kell, Carl L.

    The group syntality concept of Raymond B. Cattell furnishes a useful framework for teaching parliamentary procedure. Although there are contrasts between the histories, subject matters, and perspectives of the areas of parliamentary procedure and group dynamics, teachers and students of parliamentary procedure might profitably draw from some of…

  1. Group Syntality and Parliamentary Procedure.

    ERIC Educational Resources Information Center

    Winn, Larry James; Kell, Carl L.

    The group syntality concept of Raymond B. Cattell furnishes a useful framework for teaching parliamentary procedure. Although there are contrasts between the histories, subject matters, and perspectives of the areas of parliamentary procedure and group dynamics, teachers and students of parliamentary procedure might profitably draw from some of…

  2. Policy and Procedures Manual. Revised.

    ERIC Educational Resources Information Center

    Mississippi State Board for Community and Junior Colleges, Jackson.

    The Mississippi State Board for Community and Junior College Policy and Procedures Manual has been established by the State Board to govern its actions and activities and those of the staff. It describes polices and procedures regarding board operations, staff employment, staff workplace, employee performance/grievance procedure, staff positions,…

  3. Advanced crew procedures development techniques

    NASA Technical Reports Server (NTRS)

    Arbet, J. D.; Benbow, R. L.; Mangiaracina, A. A.; Mcgavern, J. L.; Spangler, M. C.; Tatum, I. C.

    1975-01-01

    The development of an operational computer program, the Procedures and Performance Program (PPP), is reported which provides a procedures recording and crew/vehicle performance monitoring capability. The PPP provides real time CRT displays and postrun hardcopy of procedures, difference procedures, performance, performance evaluation, and training script/training status data. During post-run, the program is designed to support evaluation through the reconstruction of displays to any point in time. A permanent record of the simulation exercise can be obtained via hardcopy output of the display data, and via magnetic tape transfer to the Generalized Documentation Processor (GDP). Reference procedures data may be transferred from the GDP to the PPP.

  4. Impact of in vivo T cell depletion in HLA-identical allogeneic stem cell transplantation for acute myeloid leukemia in first complete remission conditioned with a fludarabine iv-busulfan myeloablative regimen: a report from the EBMT Acute Leukemia Working Party.

    PubMed

    Rubio, Marie Thérèse; D'Aveni-Piney, Maud; Labopin, Myriam; Hamladji, Rose-Marie; Sanz, Miguel A; Blaise, Didier; Ozdogu, Hakan; Daguindeau, Etienne; Richard, Carlos; Santarone, Stella; Irrera, Giuseppe; Yakoub-Agha, Ibrahim; Yeshurun, Moshe; Diez-Martin, Jose L; Mohty, Mohamad; Savani, Bipin N; Nagler, Arnon

    2017-01-24

    The impact of the use of anti-thymocyte globulin (ATG) in allogeneic stem cell transplantation performed with HLA-identical sibling donors following fludarabine and 4 days intravenous busulfan myeloablative conditioning regimen has been poorly explored. We retrospectively analyzed 566 patients who underwent a first HLA-identical allogeneic stem cell transplantation with this conditioning regimen for acute myeloid leukemia in first complete remission between 2006 and 2013 and compared the outcomes of 145 (25.6%) patients who received ATG (ATG group) to 421 (74.4%) who did not (no-ATG group). The Kaplan-Meier estimator, the cumulative incidence function, and Cox proportional hazards regression models were used where appropriate. Patients in the ATG group were older, received more frequently peripheral blood stem cell grafts from older donors, and were transplanted more recently. With a median follow-up of 19 months, patients in the ATG group had reduced 2-year cumulative incidence of chronic graft-versus-host disease (GVHD) (31 vs. 52%, p = 0.0002) and of its extensive form (8 vs. 26%, p < 0.0001) but similar relapse incidence (22 vs. 27%, p = 0.23) leading to improved GVHD and relapse-free survival (GRFS) (60 vs. 40%, p = 0.0001). In multivariate analyses, the addition of ATG was independently associated with lower chronic GVHD (HR = 0.46, p = 0.0001), improved leukemia-free survival (HR = 0.67, p = 0.027), overall survival (HR = 0.65, p = 0.027), and GRFS (HR = 0.51, p = 4 × 10(-5)). Recipient age above 50 years was the only other factor associated with worse survivals. These results suggest that the use of ATG with fludarabine and 4 days intravenous busulfan followed by HLA-identical sibling donor allogeneic stem cell transplantation for acute myeloid leukemia improves overall transplant outcomes due to reduced incidence of chronic GVHD without increased relapse risk.

  5. [Costing nuclear medicine diagnostic procedures].

    PubMed

    Markou, Pavlos

    2005-01-01

    To the Editor: Referring to a recent special report about the cost analysis of twenty-nine nuclear medicine procedures, I would like to clarify some basic aspects for determining costs of nuclear medicine procedure with various costing methodologies. Activity Based Costing (ABC) method, is a new approach in imaging services costing that can provide the most accurate cost data, but is difficult to perform in nuclear medicine diagnostic procedures. That is because ABC requires determining and analyzing all direct and indirect costs of each procedure, according all its activities. Traditional costing methods, like those for estimating incomes and expenses per procedure or fixed and variable costs per procedure, which are widely used in break-even point analysis and the method of ratio-of-costs-to-charges per procedure may be easily performed in nuclear medicine departments, to evaluate the variability and differences between costs and reimbursement - charges.

  6. Development of preventive maintenance procedures.

    PubMed

    Ben-Zvi, S

    1984-01-01

    A large number of in-house preventive maintenance (PM) programs, which call for varying degrees of thoroughness in the checkout of patient care instrumentation, are currently in existence throughout the country. This paper discusses the types of preventive maintenance, or PM procedures, which can be used by a clinical engineering department; the rationale for drafting different types of PM procedures in-house; and some long-term considerations affecting hospital-based inspection programs. Three types of PM procedures are described and compared: general checks; generic procedures; and, specific procedures. An outline is provided for writing a PM procedure; and, a call is made for a national guideline for writing preventive maintenance procedures.

  7. The procedure safety system

    NASA Technical Reports Server (NTRS)

    Obrien, Maureen E.

    1990-01-01

    Telerobotic operations, whether under autonomous or teleoperated control, require a much more sophisticated safety system than that needed for most industrial applications. Industrial robots generally perform very repetitive tasks in a controlled, static environment. The safety system in that case can be as simple as shutting down the robot if a human enters the work area, or even simply building a cage around the work space. Telerobotic operations, however, will take place in a dynamic, sometimes unpredictable environment, and will involve complicated and perhaps unrehearsed manipulations. This creates a much greater potential for damage to the robot or objects in its vicinity. The Procedural Safety System (PSS) collects data from external sensors and the robot, then processes it through an expert system shell to determine whether an unsafe condition or potential unsafe condition exists. Unsafe conditions could include exceeding velocity, acceleration, torque, or joint limits, imminent collision, exceeding temperature limits, and robot or sensor component failure. If a threat to safety exists, the operator is warned. If the threat is serious enough, the robot is halted. The PSS, therefore, uses expert system technology to enhance safety thus reducing operator work load, allowing him/her to focus on performing the task at hand without the distraction of worrying about violating safety criteria.

  8. NASA trend analysis procedures

    NASA Technical Reports Server (NTRS)

    1993-01-01

    This publication is primarily intended for use by NASA personnel engaged in managing or implementing trend analysis programs. 'Trend analysis' refers to the observation of current activity in the context of the past in order to infer the expected level of future activity. NASA trend analysis was divided into 5 categories: problem, performance, supportability, programmatic, and reliability. Problem trend analysis uncovers multiple occurrences of historical hardware or software problems or failures in order to focus future corrective action. Performance trend analysis observes changing levels of real-time or historical flight vehicle performance parameters such as temperatures, pressures, and flow rates as compared to specification or 'safe' limits. Supportability trend analysis assesses the adequacy of the spaceflight logistics system; example indicators are repair-turn-around time and parts stockage levels. Programmatic trend analysis uses quantitative indicators to evaluate the 'health' of NASA programs of all types. Finally, reliability trend analysis attempts to evaluate the growth of system reliability based on a decreasing rate of occurrence of hardware problems over time. Procedures for conducting all five types of trend analysis are provided in this publication, prepared through the joint efforts of the NASA Trend Analysis Working Group.

  9. Combined procedures in laparoscopic surgery.

    PubMed

    Wadhwa, Atul; Chowbey, Pradeep K; Sharma, Anil; Khullar, Rajesh; Soni, Vandana; Baijal, Manish

    2003-12-01

    With advancements in minimal access surgery, combined laparoscopic procedures are now being performed for treating coexisting abdominal pathologies at the same surgery. In our center, we performed 145 combined surgical procedures from January 1999 to December 2002. Of the 145 procedures, 130 were combined laparoscopic/endoscopic procedures and 15 were open procedures combined with endoscopic procedures. The combination included laparoscopic cholecystectomy, various hernia repairs, and gynecological procedures like hysterectomy, salpingectomy, ovarian cystectomy, tubal ligation, urological procedures, fundoplication, splenectomy, hemicolectomy, and cystogastrostomy. In the same period, 40 patients who had undergone laparoscopic cholecystectomy and 40 patients who had undergone ventral hernia repair were randomly selected for comparison of intraoperative outcomes with a combined procedure group. All the combined surgical procedures were performed successfully. The most common procedure was laparoscopic cholecystectomy with another endoscopic procedure in 129 patients. The mean operative time was 100 minutes (range 30-280 minutes). The longest time was taken for the patient who had undergone laparoscopic splenectomy with renal transplant (280 minutes). The mean hospital stay was 3.2 days (range 1-21 days). The pain experienced in the postoperative period measured on the visual analogue scale ranged from 2 to 5 with a mean of 3.1. Of 145 patients who underwent combined surgical procedures, 5 patients developed fever in the immediate postoperative period, 7 patients had port site hematoma, 5 patients developed wound sepsis, and 10 patients had urinary retention. As long as the basic surgical principles and indications for combined procedures are adhered to, more patients with concomitant pathologies can enjoy the benefit of minimal access surgery. Minimal access surgery is feasible and appears to have several advantages in simultaneous management of two different

  10. MUSE optical alignment procedure

    NASA Astrophysics Data System (ADS)

    Laurent, Florence; Renault, Edgard; Loupias, Magali; Kosmalski, Johan; Anwand, Heiko; Bacon, Roland; Boudon, Didier; Caillier, Patrick; Daguisé, Eric; Dubois, Jean-Pierre; Dupuy, Christophe; Kelz, Andreas; Lizon, Jean-Louis; Nicklas, Harald; Parès, Laurent; Remillieux, Alban; Seifert, Walter; Valentin, Hervé; Xu, Wenli

    2012-09-01

    MUSE (Multi Unit Spectroscopic Explorer) is a second generation VLT integral field spectrograph (1x1arcmin² Field of View) developed for the European Southern Observatory (ESO), operating in the visible wavelength range (0.465-0.93 μm). A consortium of seven institutes is currently assembling and testing MUSE in the Integration Hall of the Observatoire de Lyon for the Preliminary Acceptance in Europe, scheduled for 2013. MUSE is composed of several subsystems which are under the responsibility of each institute. The Fore Optics derotates and anamorphoses the image at the focal plane. A Splitting and Relay Optics feed the 24 identical Integral Field Units (IFU), that are mounted within a large monolithic instrument mechanical structure. Each IFU incorporates an image slicer, a fully refractive spectrograph with VPH-grating and a detector system connected to a global vacuum and cryogenic system. During 2011, all MUSE subsystems were integrated, aligned and tested independently in each institute. After validations, the systems were shipped to the P.I. institute at Lyon and were assembled in the Integration Hall This paper describes the end-to-end optical alignment procedure of the MUSE instrument. The design strategy, mixing an optical alignment by manufacturing (plug and play approach) and few adjustments on key components, is presented. We depict the alignment method for identifying the optical axis using several references located in pupil and image planes. All tools required to perform the global alignment between each subsystem are described. The success of this alignment approach is demonstrated by the good results for the MUSE image quality. MUSE commissioning at the VLT (Very Large Telescope) is planned for 2013.

  11. Safeguards management inspection procedures

    SciTech Connect

    Barth, M.J.; Dunn, D.R.

    1984-08-01

    The objective of this inspection module is to independently assess the contributions of licensee management to overall safeguards systems performance. The inspector accomplishes this objective by comparing the licensee's safeguards management to both the 10 CFR, parts 70 and 73, requirements and to generally accepted management practices. The vehicle by which this comparison is to be made consists of assessment questions and key issues which point the inspector to areas of primary concern to the NRC and which raise additional issues for the purpose of exposing management ineffectiveness. Further insight into management effectiveness is obtained through those assessment questions specifically directed toward the licensee's safeguards system performance. If the quality of the safeguards is poor, then the inspector should strongly suspect that management's role is ineffective and should attempt to determine management's influence (or lack thereof) on the underlying safeguards deficiencies. (The converse is not necessarily true, however.) The assessment questions in essence provide an opportunity for the inspector to identify, to single out, and to probe further, questionable management practices. Specific issues, circumstances, and concerns which point to questionable or inappropriate practices should be explicitly identified and referenced against the CFR and the assessment questions. The inspection report should also explain why the inspector feels certain management practices are poor, counter to the CFR, and/or point to ineffecive management. Concurrent with documenting the inspection results, the inspector should provide recommendations for alleviating observed management practices that are detrimental to effective safeguards. The recommendations could include: specific changes in the practices of the licensee, followup procedures on the part of NRC, and proposed license changes.

  12. Documenting Laboratory Procedures with Video.

    PubMed

    Wyttenbach, Robert A

    2015-01-01

    Demonstrating laboratory procedures in person during class time can be time-consuming. When procedures are done under a microscope, live demonstration is also impractical because of the limited number of students who can view the demonstration at once. Creating videos beforehand, which students can watch before class and review during lab sessions, solves both of these problems. This article suggests ways to make and distribute high quality video of microscopic procedures.

  13. Documenting Laboratory Procedures with Video

    PubMed Central

    Wyttenbach, Robert A.

    2015-01-01

    Demonstrating laboratory procedures in person during class time can be time-consuming. When procedures are done under a microscope, live demonstration is also impractical because of the limited number of students who can view the demonstration at once. Creating videos beforehand, which students can watch before class and review during lab sessions, solves both of these problems. This article suggests ways to make and distribute high quality video of microscopic procedures. PMID:26240520

  14. Arthroscopically Assisted Modified Jones Procedure.

    PubMed

    Lui, Tun Hing

    2016-12-01

    The modified Jones procedure is the classic operative treatment of symptomatic clawed hallux. It is composed of transfer of the extensor hallucis longus tendon to the first metatarsal neck and fusion of the hallux interphalangeal joint. The purpose of this technical note is to report the technique of an arthroscopically assisted modified Jones procedure. This can be combined with other minimally invasive bone and soft-tissue procedures to correct all aspects of the complex cavus foot deformity.

  15. Training for advanced endoscopic procedures.

    PubMed

    Feurer, Matthew E; Draganov, Peter V

    2016-06-01

    Advanced endoscopy has evolved from diagnostic ERCP to an ever-increasing array of therapeutic procedures including EUS with FNA, ablative therapies, deep enteroscopy, luminal stenting, endoscopic suturing and endoscopic mucosal resection among others. As these procedures have become increasingly more complex, the risk of potential complications has also risen. Training in advanced endoscopy involves more than obtaining a minimum number of therapeutic procedures. The means of assessing a trainee's competence level and ability to practice independently continues to be a matter of debate. The use of quality indicators to measure performance levels may be beneficial as more advanced techniques and procedures become available.

  16. Coding for urologic office procedures.

    PubMed

    Dowling, Robert A; Painter, Mark

    2013-11-01

    This article summarizes current best practices for documenting, coding, and billing common office-based urologic procedures. Topics covered include general principles, basic and advanced urologic coding, creation of medical records that support compliant coding practices, bundled codes and unbundling, global periods, modifiers for procedure codes, when to bill for evaluation and management services during the same visit, coding for supplies, and laboratory and radiology procedures pertinent to urology practice. Detailed information is included for the most common urology office procedures, and suggested resources and references are provided. This information is of value to physicians, office managers, and their coding staff.

  17. Electronic Procedures for Medical Operations

    NASA Technical Reports Server (NTRS)

    2015-01-01

    Electronic procedures are replacing text-based documents for recording the steps in performing medical operations aboard the International Space Station. S&K Aerospace, LLC, has developed a content-based electronic system-based on the Extensible Markup Language (XML) standard-that separates text from formatting standards and tags items contained in procedures so they can be recognized by other electronic systems. For example, to change a standard format, electronic procedures are changed in a single batch process, and the entire body of procedures will have the new format. Procedures can be quickly searched to determine which are affected by software and hardware changes. Similarly, procedures are easily shared with other electronic systems. The system also enables real-time data capture and automatic bookmarking of current procedure steps. In Phase II of the project, S&K Aerospace developed a Procedure Representation Language (PRL) and tools to support the creation and maintenance of electronic procedures for medical operations. The goal is to develop these tools in such a way that new advances can be inserted easily, leading to an eventual medical decision support system.

  18. Myeloablative Umbilical Cord Blood Transplantation in Hematological Diseases

    ClinicalTrials.gov

    2017-10-04

    Acute Myeloid Leukemia; Acute Lymphocytic Leukemia; Chronic Myelogenous Leukemia; Myelofibrosis; MDS; Refractory Anemia; Chronic Lymphocytic Leukemia; Prolymphocytic Leukemia; Non-Hodgkin's Lymphoma; Leukemia; Lymphoma; Multiple Myeloma; Myelodysplastic Syndromes

  19. UCB Transplant for Hematological Diseases Using a Non Myeloablative Prep

    ClinicalTrials.gov

    2016-12-07

    Acute Leukemia; Acute Myeloid Leukemia; Acute Lymphoblastic Leukemia/Lymphoma; Burkitt's Lymphoma; Natural Killer Cell Malignancies; Chronic Myelogenous Leukemia; Myelodysplastic Syndrome; Large-cell Lymphoma; Hodgkin Lymphoma; Multiple Myeloma; Chronic Lymphocytic Leukemia; Small Lymphocytic Lymphoma; Marginal Zone B-cell Lymphoma; Follicular Lymphoma; Lymphoplasmacytic Lymphoma; Mantle-cell Lymphoma; Prolymphocytic Leukemia; Bone Marrow Failure Syndromes; Myeloproliferative Syndromes

  20. Research Commentary: Reconceptualizing Procedural Knowledge

    ERIC Educational Resources Information Center

    Star, Jon R.

    2005-01-01

    In this article, I argue for a renewed focus in mathematics education research on procedural knowledge. I make three main points: (1) The development of students' procedural knowledge has not received a great deal of attention in recent research; (2) one possible explanation for this deficiency is that current characterizations of conceptual and…

  1. Intranasal ethmoidectomy and concurrent procedures.

    PubMed

    Taylor, J S; Crocker, P V; Keebler, J S

    1982-07-01

    In this review of 526 intranasal ethmoidectomy procedures, there was a complication rate of 2.5% with no blindness, meningitis, or deaths. The rationale for associated concurrent procedures is presented. The use of an absorbable hemostatic sinus sponge and an easily removable Telfa nasal packing made possible just a two-night hospital stay in over 90% of these patients.

  2. Painful Ophthalmoplegia Following Dental Procedure

    PubMed Central

    Simsek, Ilke Bahceci; Kiziloglu, Ozge Yabas; Ziylan, Sule

    2013-01-01

    Abstract This case report is about a 26-year-old patient complaining of painful diplopia shortly after a dental procedure. Magnetic resonance imaging demonstrated a mass lesion in the cavernous sinus that responded well to oral corticosteroids. The possible side effect of the intraoral local anaesthetic injection used during the dental procedure was questioned. PMID:28167982

  3. Accounting Procedures for Student Organizations.

    ERIC Educational Resources Information Center

    California State Dept. of Education, Sacramento.

    This two-part handbook presents information on accounting procedures for student organizations, with a focus on the laws, policies, and procedures that affect student body organizations. Part 1 contains information about: (1) legal status of a school's student body organization; (2) principles governing student body finance; (3) administration of…

  4. Research Commentary: Reconceptualizing Procedural Knowledge

    ERIC Educational Resources Information Center

    Star, Jon R.

    2005-01-01

    In this article, I argue for a renewed focus in mathematics education research on procedural knowledge. I make three main points: (1) The development of students' procedural knowledge has not received a great deal of attention in recent research; (2) one possible explanation for this deficiency is that current characterizations of conceptual and…

  5. Laboratory Procedures for Medical Assistants.

    ERIC Educational Resources Information Center

    Johnson, Pauline

    The purpose of the manual is to provide the medical assisting student a text which presents the common laboratory procedures in use today in physician's offices. The procedures for performing a complete urinalysis are outlined, along with those for carrying out various hematological tests. Information is also presented to help the student learn to…

  6. Accounting Procedures for Student Organizations.

    ERIC Educational Resources Information Center

    California State Dept. of Education, Sacramento.

    This two-part handbook presents information on accounting procedures for student organizations, with a focus on the laws, policies, and procedures that affect student body organizations. Part 1 contains information about: (1) legal status of a school's student body organization; (2) principles governing student body finance; (3) administration of…

  7. 22 CFR 217.61 - Procedures.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Procedures § 217.61 Procedures. The procedural provisons applicable to title VI of the Civil Rights Act of 1964 apply to this part. These procedures are found...

  8. 45 CFR 84.61 - Procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Procedures § 84.61 Procedures. The procedural provisions applicable to title VI of the Civil Rights Act of 1964 apply to this part. These procedures...

  9. HF Interference, Procedures and Tools (Interferences HF, procedures et outils)

    DTIC Science & Technology

    2007-06-01

    models for these transmission systems. Therefore methods have been investigated to find procedures, models and tools applicable for being able to...pour trouver des procédures, modèles et outils applicables , permettant de déterminer l’influence des communications PLT et xDSL sur la réception des...because of missing models for these transmission systems. Therefore methods have been investigated to find procedures, models and tools applicable for

  10. Specified assurance level sampling procedure

    SciTech Connect

    Willner, O.

    1980-11-01

    In the nuclear industry design specifications for certain quality characteristics require that the final product be inspected by a sampling plan which can demonstrate product conformance to stated assurance levels. The Specified Assurance Level (SAL) Sampling Procedure has been developed to permit the direct selection of attribute sampling plans which can meet commonly used assurance levels. The SAL procedure contains sampling plans which yield the minimum sample size at stated assurance levels. The SAL procedure also provides sampling plans with acceptance numbers ranging from 0 to 10, thus, making available to the user a wide choice of plans all designed to comply with a stated assurance level.

  11. Surface Environmental Surveillance Procedures Manual

    SciTech Connect

    Hanf, RW; Dirkes, RL

    1990-02-01

    This manual establishes the procedures for the collection of environmental samples and the performance of radiation surveys and other field measurements. Responsibilities are defined for those personnel directly involved in the collection of samples and the performance of field measurements.

  12. Infant test/procedure preparation

    MedlinePlus

    ... treatment rooms where procedures are done. Imitate the behavior you or your provider need the infant to do, such as opening the mouth. Many children's hospitals have child life specialists who are specially ...

  13. Interventional procedures in the chest.

    PubMed

    Vollmer Torrubiano, I; Sánchez González, M

    2016-05-01

    Many thoracic conditions will require an interventional procedure for diagnosis and/or treatment. For this reason, radiologists need to know the indications and the technique for each procedure. In this article, we review the various interventional procedures that radiologists should know and the indications for each procedure. We place special emphasis on the potential differences in the diagnostic results and complications between fine-needle aspiration and biopsy. We also discuss the indications for radiofrequency ablation of lung tumors and review the concepts related to the drainage of pulmonary abscesses. We devote special attention to the management of pleural effusion, covering the indications for thoracocentesis and when to use imaging guidance, and to the protocol for pleural drainage. We also discuss the indications for percutaneous treatment of pericardial effusion and the possible complications of this treatment. Finally, we discuss the interventional management of mediastinal lesions and provide practical advice about how to approach these lesions to avoid serious complications.

  14. Polarization of perceived Procedural Justice.

    PubMed

    Flint, Douglas H; Hernandez-Marrero, Pablo; Wielemaker, Martin

    2006-02-01

    This study examined polarization of perceptions of Procedural Justice. Two polarization mechanisms are examined, Persuasive Arguments and Social Comparisons. Participants were students enrolled in a first-year introductory business class. There were 216 participants in the Persuasive Arguments study, 429 in the Social Comparisons study. The average age of all participants was 22.3 yr. (SD = 2.1); 56% were women. Fields of study represented were business, engineering, information technology, and sports. Analysis showed under conditions of low Procedural Justice, polarization effects were only found with the Persuasive Arguments mechanism. Under conditions of high Procedural Justice, polarization effects were only found with Social Comparisons. Implications for group polarization and Procedural Justice theories are considered.

  15. Quarantine document system indexing procedure

    NASA Technical Reports Server (NTRS)

    1972-01-01

    The Quarantine Document System (QDS) is described including the indexing procedures and thesaurus of indexing terms. The QDS consists of these functional elements: acquisition, cataloging, indexing, storage, and retrieval. A complete listing of the collection, and the thesaurus are included.

  16. Loop Electrosurgical Excision Procedure (LEEP)

    MedlinePlus

    ... that acts like a scalpel (surgical knife). An electric current is passed through the loop, which cuts away ... A procedure in which an instrument works with electric current to destroy tissue. Local Anesthesia: The use of ...

  17. Loop Electrosurgical Excision Procedure (LEEP)

    MedlinePlus

    ... that acts like a scalpel (surgical knife). An electric current is passed through the loop, which cuts away ... A procedure in which an instrument works with electric current to destroy tissue. Local Anesthesia: The use of ...

  18. Effective waveform recorder evaluation procedures

    NASA Astrophysics Data System (ADS)

    Green, Philip J.

    The evaluation of waveform recorders is a subject attracting considerable attention as waveform recorders continue to increase in capabilities without dramatic increase in costs. However, caution is required when developing evaluation procedures because of the potential of any evaluation procedure to overestimate the performance of a device. A system is described which is controlled by a Microvax II with instrumentation control through the IEEE-488 bus. Evaluation procedures are described with attention given to the pathological cases which can lead to significant misestimates of a digitizer's performance. These evaluation procedures are aimed at being consistent with the new Trial Waveform Digitizer Standard generated by the Waveform Measurements and Analysis committee appointed by the Instrumentation and Measurement Society of IEEE. This standard was recently accepted by the IEEE as a trial use standard through July 1991 and is available from the IEEE Service Center as IEEE Std. 1057.

  19. Adolescent test or procedure preparation

    MedlinePlus

    ... someone else) during the procedure Playing hand-held video games Using guided imagery Trying other distractions, such as ... about any appearance changes or other possible side effects the test ... from videos that show adolescents of the same age explaining ...

  20. Establishment of new asylum procedures.

    PubMed

    1988-01-01

    As of May 1988, the Austrian Government instituted new accelerated asylum procedures which enable applicants to know within a short time whether they are granted refugee status. Those who are not granted such status are refused further government assistance and asked to leave the country. This change in procedures was undertaken in part because of the increased number of applicants resulting from the abolishment of the visa requirement for citizens of Hungary and Poland travelling to Austria.

  1. [Euthanasia: medications and medical procedures].

    PubMed

    Lossignol, D

    2008-09-01

    The Belgian law relative to euthanasia has been published in 2002. A physician is allowed to help a patient with intractable suffering (physical or psychological). Legal conditions are clear. However, nothing is said about medical procedures or medications to be used. The present paper will present specific clinical situations at the end of life, practical procedures and medications. A special focus is made on psychological impact of euthanasia.

  2. Consent procedures in pediatric biobanks.

    PubMed

    Giesbertz, Noor Aa; Bredenoord, Annelien L; van Delden, Johannes Jm

    2015-09-01

    The inclusion of children's samples in biobanks brings forward specific ethical issues. Guidelines indicate that children should be involved in the consent procedure. It is, however, unclear how to allocate an appropriate role for children. Knowledge of current practice will be helpful in addressing this issue. Therefore, we conducted an international multiple-case study on the child's role in consent procedures in pediatric biobanks. Four biobanks were included: (1) LifeLines, (2) Prevention and Incidence of Asthma and Mite Allergy (PIAMA), (3) Young-HUNT3 and (4) the Oxford Radcliffe Biobank contribution to the Children's Cancer and Leukaemia Group tissue bank (ORB/CCLG). Four themes linked to the child's role in the consent procedure emerged from the multiple-case study: (1) motives to involve the child, (2) informing the child, (3) the role of dissent, assent and consent and (4) voluntariness of children to participate. We conclude that biobank characteristics influence the biobank's motives to include children in the consent procedure. Moreover, the motives to include children influence how the children are involved in the consent procedure, and the extent to which children are able to make voluntary decisions as part of the consent procedure. This insight is valuable when designing pediatric biobank governance.

  3. Certification procedure of building thermographers

    NASA Astrophysics Data System (ADS)

    Kauppinen, Timo T.; Paloniitty, Sauli; Krankka, Juha

    2005-03-01

    Thermography has been used in Finland in building survey from the late 70s. The service has been provided by consultants, whose background is varied. When technology and devices have improved and the prices have increased, more and more doers have come into the market. At the same time, building developers and contractors have begun to use thermography for quality control in new building. Thermography has also been used in renovation planning. The problem is, that there are no procedures for building thermography, no guidelines to order the thermography services, no instructions how to scan, how to report and most important -- how to interpret the results. That fact has caused a lot of problems and also damaged the reputation and reliability of the method. In this year 2004 the various organizations in building trade launched a pilot project to certificate building thermographers. The procedure is divided into two parts: Part 1 is Level I (the basis of thermography) and Part II (divided into two periods) thermography applications of buildings, including also information on building physics, heat and mass transfer and structures. Both parts will take a week, two weeks in total with the examinations. The procedure follows moisture measurement procedure -- certification of building moisture measurements started a couple of years ago. In the paper the procedure, problems and the future plans are introduced. The following big issue is to develop and improve the interpretation procedure for reporting the results of thermography.

  4. Collected radiochemical and geochemical procedures

    SciTech Connect

    Kleinberg, J

    1990-05-01

    This revision of LA-1721, 4th Ed., Collected Radiochemical Procedures, reflects the activities of two groups in the Isotope and Nuclear Chemistry Division of the Los Alamos National Laboratory: INC-11, Nuclear and radiochemistry; and INC-7, Isotope Geochemistry. The procedures fall into five categories: I. Separation of Radionuclides from Uranium, Fission-Product Solutions, and Nuclear Debris; II. Separation of Products from Irradiated Targets; III. Preparation of Samples for Mass Spectrometric Analysis; IV. Dissolution Procedures; and V. Geochemical Procedures. With one exception, the first category of procedures is ordered by the positions of the elements in the Periodic Table, with separate parts on the Representative Elements (the A groups); the d-Transition Elements (the B groups and the Transition Triads); and the Lanthanides (Rare Earths) and Actinides (the 4f- and 5f-Transition Elements). The members of Group IIIB-- scandium, yttrium, and lanthanum--are included with the lanthanides, elements they resemble closely in chemistry and with which they occur in nature. The procedures dealing with the isolation of products from irradiated targets are arranged by target element.

  5. Consent procedures in pediatric biobanks

    PubMed Central

    Giesbertz, Noor AA; Bredenoord, Annelien L; van Delden, Johannes JM

    2015-01-01

    The inclusion of children's samples in biobanks brings forward specific ethical issues. Guidelines indicate that children should be involved in the consent procedure. It is, however, unclear how to allocate an appropriate role for children. Knowledge of current practice will be helpful in addressing this issue. Therefore, we conducted an international multiple-case study on the child's role in consent procedures in pediatric biobanks. Four biobanks were included: (1) LifeLines, (2) Prevention and Incidence of Asthma and Mite Allergy (PIAMA), (3) Young-HUNT3 and (4) the Oxford Radcliffe Biobank contribution to the Children's Cancer and Leukaemia Group tissue bank (ORB/CCLG). Four themes linked to the child's role in the consent procedure emerged from the multiple-case study: (1) motives to involve the child, (2) informing the child, (3) the role of dissent, assent and consent and (4) voluntariness of children to participate. We conclude that biobank characteristics influence the biobank's motives to include children in the consent procedure. Moreover, the motives to include children influence how the children are involved in the consent procedure, and the extent to which children are able to make voluntary decisions as part of the consent procedure. This insight is valuable when designing pediatric biobank governance. PMID:25537361

  6. Reporting Child Language Sampling Procedures

    PubMed Central

    Finestack, Lizbeth H.; Payesteh, Bita; Disher, Jill Rentmeester; Julien, Hannah M.

    2015-01-01

    Purpose Despite the long history of language sampling use in the study of child language development and disorders, there are no set guidelines specifying the reporting of language sampling procedures. The authors propose reporting standards for use by investigators who employ language samples in their research. Method The authors conducted a literature search of child-focused studies published in journals of the American Speech-Language-Hearing Association between January 2000 and December 2011 that included language sampling procedures to help characterize child participants or to derive measures to serve as dependent variables. Following this search, they reviewed each study and documented the language sampling procedures reported. Results The authors’ synthesis revealed that approximately 25% of all child-focused studies use language samples to help characterize participants and/or derive dependent variables. They found remarkable inconsistencies in the reporting of language sampling procedures. Conclusion To maximize the conclusions drawn from research using language samples, the authors strongly encourage investigators of child language to consistently report language sampling procedures using the proposed reporting checklist. PMID:25399013

  7. Designing Flightdeck Procedures: Literature Resources

    NASA Technical Reports Server (NTRS)

    Feldman, Jolene; Barshi, Immanuel; Degani, Asaf; Loukopoulou, Loukia; Mauro, Robert

    2017-01-01

    This technical publication contains the titles, abstracts, summaries, descriptions, and/or annotations of available literature sources on procedure design and development, requirements, and guidance. It is designed to provide users with an easy access to available resources on the topic of procedure design, and with a sense of the contents of these sources. This repository of information is organized into the following publication sources: Research (e.g., journal articles, conference proceedings), Manufacturers' (e.g., operation manuals, newsletters), and Regulatory and/or Government (e.g., advisory circulars, reports). An additional section contains synopses of Accident/Incident Reports involving procedures. This work directly supports a comprehensive memorandum by Barshi, Mauro, Degani, & Loukopoulou (2016) that summarizes the results of a multi-year project, partially funded by the FAA, to develop technical reference materials that support guidance on the process of developing cockpit procedures (see "Designing Flightdeck Procedures" https://ntrs.nasa.gov/archive/nasa/casi.ntrs.nasa.gov/20160013263.pdf). An extensive treatment of this topic is presented in a forthcoming book by the same authors.

  8. 21 CFR 1270.31 - Written procedures.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Written procedures. 1270.31 Section 1270.31 Food... FOR TRANSPLANTATION Procedures and Records § 1270.31 Written procedures. (a) There shall be written... the procedures are performed unless impractical. Any deviation from the written procedures shall be...

  9. 40 CFR 1033.315 - Test procedures.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 33 2014-07-01 2014-07-01 false Test procedures. 1033.315 Section 1033... Programs § 1033.315 Test procedures. (a) Test procedures. Use the test procedures described in subpart F of this part, except as specified in this section. (1) You may ask to use other test procedures. We...

  10. 40 CFR 1033.315 - Test procedures.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 34 2012-07-01 2012-07-01 false Test procedures. 1033.315 Section 1033... Programs § 1033.315 Test procedures. (a) Test procedures. Use the test procedures described in subpart F of this part, except as specified in this section. (1) You may ask to use other test procedures. We...

  11. 40 CFR 1033.315 - Test procedures.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 33 2011-07-01 2011-07-01 false Test procedures. 1033.315 Section 1033... Programs § 1033.315 Test procedures. (a) Test procedures. Use the test procedures described in subpart F of this part, except as specified in this section. (1) You may ask to use other test procedures. We...

  12. 31 CFR 547.801 - Procedures.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Procedures. 547.801 Section 547.801 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN... Procedures § 547.801 Procedures. For license application procedures and procedures relating to amendments...

  13. Fluorometric procedures for dye tracing

    USGS Publications Warehouse

    Wilson, James F.

    1968-01-01

    This manual describes the current fluorometric procedures used by the U.S. Geological Survey in dye tracer studies such as time of travel, dispersion, reaeration, and dilution-type discharge measurements. The advantages of dye tracing are (1) low detection and measurement limits and (2) simplicity and accuracy in measuring dye tracer concentrations using fluorometric techniques. The manual contains necessary background information about fluorescence, dyes, and fluorometers and a description of fluorometric operation and calibration procedures as a guide for laboratory and field use. The background information should be useful to anyone wishing to experiment with dyes, fluorometer components, or procedures different from those described. In addition, a brief section on aerial photography is included because of its possible use to supplement ground-level fluorometry.

  14. Fluorometric procedures for dye tracing

    USGS Publications Warehouse

    Wilson, James E.; Cobb, E.D.; Kilpatrick, F.A.

    1984-01-01

    This manual describes the current fluorometric procedures used by the U.S. Geological Survey in dye tracer studies such as time of travel, dispersion, reaeration, and dilution-type discharge measurements. The outstanding characteristics of dye tracing are: (1) the low detection and measurement limits, and (2) the simplicity and accuracy of measuring dye tracer concentrations using fluorometric techniques. The manual contains necessary background information about fluorescence, dyes, and fluorometers and a description of fluorometric operation and calibration procedures as a general guide for laboratory and field use. The background information should be useful to anyone wishing to experiment with dyes, fluorometer components, or procedures different from those described. In addition, a brief section is included on aerial photography because of its possible use to supplement ground-level fluorometry. (USGS)

  15. Fluorometric procedures for dye tracing

    USGS Publications Warehouse

    Wilson, James F.; Cobb, Ernest D.; Kilpatrick, F.A.

    1986-01-01

    This manual describes the current fluorometric procedures used by the U.S. Geological Survey in dye tracer studies such as time of travel, dispersion, reaeration, and dilution-type discharge measurements. The advantages of dye tracing are (1) low detection and measurement limits and (2) simplicity and accuracy in measuring dye tracer concentrations using fluorometric techniques. The manual contains necessary background information about fluorescence, dyes, and fluorometers and a description of fluorometric operation and calibration procedures as a guide for laboratory and field use. The background information should be useful to anyone wishing to experiment with dyes, fluorometer components, or procedures different from those described. In addition, a brief section on aerial photography is included because of its possible use to supplement ground-level fluorometry.

  16. Fluorometric procedures for dye tracing

    USGS Publications Warehouse

    Wilson, James E.; Cobb, Ernest D.; Kilpatrick, Frederick A.

    1984-01-01

    This manual describes the current fluorometric procedures used by the U.S. Geological Survey in dye tracer studies such as time of travel, dispersion, reaeration, and dilution-type discharge measurements. The outstanding characteristics of dye tracing are: (1) the low detection and measurement limits, and (2) the simplicity and accuracy of measuring dye tracer concentrations using fluorometric techniques. The manual contains necessary background information about fluorescence, dyes, and fluorometers and a description of fluorometric operation and calibration procedures as a general guide for laboratory and field use. The background information should be useful to anyone wishing to experiment with dyes, fluorometer components, or procedures different from those described. In addition, a brief section is included on aerial photography because of its possible use to supplement ground-level fluorometry.

  17. Ultrasound-Guided Knee Procedures.

    PubMed

    Lueders, Daniel R; Smith, Jay; Sellon, Jacob L

    2016-08-01

    Most knee structures can be accurately targeted using ultrasound guidance. These structures are usually superficial, and the overlying soft tissues are mobile and compressible, facilitating excellent visualization with a high-frequency linear array transducer. The circumferential accessibility to the knee affords flexibility and often multiple procedural approach options. In most cases, an in-plane approach is easily achieved. Studies of ultrasonography-guided knee procedures have consistently shown high accuracy, and its use is particularly beneficial for obese patients, diagnostic injection specificity, safety, and precise targeting of pathology. More studies are needed to assess the clinical efficacy and cost-effectiveness of ultrasonography-guided knee procedures. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Designing Flight-Deck Procedures

    NASA Technical Reports Server (NTRS)

    Degani, Asaf; Wiener, L.; Shafto, Mike (Technical Monitor)

    1995-01-01

    A complex human-machine system consists of more than merely one or more human operators and a collection of hardware components. In order to operate a complex system successfully, the human-machine system must be supported by an organizational infrastructure of operating concepts, rules, guidelines, and documents. The coherency of such operating concepts, in terms of consistency and logic, is vitally important for the efficiency and safety of any complex system. In high-risk endeavors such as aircraft operations, space flight, nuclear power production, manufacturing process control, and military operations, it is essential that such support be flawless, as the price of operational error can be high. When operating rules are not adhered to, or the rules are inadequate for the task at hand, not only will the system's goals be thwarted, but there may also be tragic human and material consequences. To ensure safe and predictable operations, support to the operators, in this case flight crews, often comes in the form of standard operating procedures. These provide the crew with step-by-step guidance for carrying out their operations. Standard procedures do indeed promote uniformity, but they do so at the risk of reducing the role of human operators to a lower level. Management, however, must recognize the danger of over-procedurization, which fails to exploit one of the most valuable assets in the system, the intelligent operator who is "on the scene." The alert system designer and operations manager recognize that there cannot be a procedure for everything, and the time will come in which the operators of a complex system will face a situation for which there is no written procedure. Procedures, whether executed by humans or machines, have their place, but so does human cognition.

  19. Procedures of endoscopic periradicular surgery.

    PubMed

    Yura, Shinya; Ooi, Kazuhiro; Izumiyama, Yuri

    2010-01-01

    When a tooth with an apical lesion is identified, an apicoectomy is frequently performed when nonsurgical treatment is considered unfeasible or has previously failed. However, the treatment is usually difficult in molars. This article describes a minimally invasive procedure for removing a gutta-percha point under the maxillary sinus mucosa using an ultrathin arthroscope and a visualization approach in apicoectomy using an intranasal endoscope. These surgical techniques using endoscopes are minimally invasive and reliable procedures that provide limited incision and bone removal and respect the integrity of the maxillary sinus.

  20. Falsification Procedures for Behavioral Research in Communication.

    ERIC Educational Resources Information Center

    Frentz, Thomas S.

    1983-01-01

    Argues that reliance upon verification procedures has inhibited theory building in communication. Advances four falsification procedures and presents examples from communication studies. Offers several implications these procedures have for empirical research in communication. (PD)

  1. 13 CFR 113.605 - Enforcement procedures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Procedures § 113.605 Enforcement procedures. The investigative, compliance, and enforcement procedural provisions of Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d) (“Title VI”) are hereby adopted...

  2. Grievance Procedures. SPEC Kit 23.

    ERIC Educational Resources Information Center

    Association of Research Libraries, Washington, DC. Office of Management Studies.

    This collection of grievance procedures from member libraries of the Association of Research Libraries (ARL) contains: (1) documents on committee approaches to grievances from University of British Columbia, Center for Research Libraries, University of Connecticut, Harvard University, Michigan State University, and University of Nebraska; (2)…

  3. Grievance Procedures. SPEC Kit 23.

    ERIC Educational Resources Information Center

    Association of Research Libraries, Washington, DC. Office of Management Studies.

    This collection of grievance procedures from member libraries of the Association of Research Libraries (ARL) contains: (1) documents on committee approaches to grievances from University of British Columbia, Center for Research Libraries, University of Connecticut, Harvard University, Michigan State University, and University of Nebraska; (2)…

  4. Procedural Error and Task Interruption

    DTIC Science & Technology

    2016-09-30

    performance, and pilot data suggest that the task can distinguish between cognitive processes that are impaired by sleep deprivation and those that are...TERMS procedural error, task interruption, individual differences, fluid intelligence, sleep deprivation 16. SECURITY CLASSIFICATION OF: 17...0247 Background Accomplishments Validation studies Modeling Other publications Table of Contents Pilot study: Effects of sleep deprivation

  5. Grievance Procedures: A Working Paper.

    ERIC Educational Resources Information Center

    Furniss, W. Todd

    Campus grievance procedures, now mandated for most institutions by the Title IX regulations, ordinarily include informal measures to resolve a grievance, provision for a formal written complaint for the grievant, a grievance committee with a number of roles, a hearing committee for cases involving major policy issues and major sanctions, and a set…

  6. Promotion: Responsibilities, Policies and Procedures.

    ERIC Educational Resources Information Center

    Menendez, Miguel; And Others

    Designed by librarians and administrators of the Florida International University in compliance with the requirements of the Florida Board of Regents, this document contains a list of responsibilities, policies, and procedures for the promotion process in library administration. It is noted that the promotion decision is one of the most important…

  7. Procedure for dispersing fiber bundles

    NASA Technical Reports Server (NTRS)

    Padilla, D.

    1974-01-01

    Fiber bundles are dispersed and fibers are cleaned within enclosed container; therefore, safety clothing, masks, and eye protection are not required. Procedure also could be used wherever materials, such as fiberglass or insulation, require dispersion, fluffing, or cleaning. Process could be automated into continuous operation for handling large quantities of fiber.

  8. The Maryland Refutation Proof Procedure.

    ERIC Educational Resources Information Center

    Minker, Jack; And Others

    The Maryland Refutation Proof Procedure System (MRPPS) is an interactive experimental system intended for studying deductive search methods. Although the work is oriented towards question-answering, MRPPS provides a general problem solving capability. There are three major components within MRPPS. These are: (1) an inference system, (2) a search…

  9. Network-Based Management Procedures.

    ERIC Educational Resources Information Center

    Buckner, Allen L.

    Network-based management procedures serve as valuable aids in organizational management, achievement of objectives, problem solving, and decisionmaking. Network techniques especially applicable to educational management systems are the program evaluation and review technique (PERT) and the critical path method (CPM). Other network charting…

  10. Environmental Impact Assessment: A Procedure.

    ERIC Educational Resources Information Center

    Stover, Lloyd V.

    Prepared by a firm of consulting engineers, this booklet outlines the procedural "whys and hows" of assessing environmental impact, particularly for the construction industry. Section I explores the need for environmental assessment and evaluation to determine environmental impact. It utilizes a review of the National Environmental Policy Act and…

  11. Lipogranuloma after facial cosmetic procedures.

    PubMed

    Zhang, Fangfei; Chen, Yan

    2017-04-01

    Lipogranuloma is a rare inflammatory reactive process in the dermis and subcutis. We present a summary of the 6 cases of lipogranuloma after facial cosmetic procedures. We performed a retrospective review including patient demographic data, clinical symptoms, appearance on computed tomography, treatment, pathology results, and history of facial cosmetic procedures. In most cases, the nodules were painless and showed no significant growth. Computed tomography revealed ill-defined swellings in the buccal fat pad with heterogeneous density. Histopathological examinations revealed numerous variable-sized empty microcysts surrounded by abundant lymphocytes and foamy macrophages, the characteristic features of lipogranuloma. On further questioning, all of the patients revealed that they had undergone some form of facial cosmetic procedure in the preceding months to years. Among the 6 cases, facial autologous fat injection may have been the main cause of lipogranuloma. Lipogranulomas can develop months to years after facial cosmetic procedures distant from the injection sites. A thorough understanding of the patient's medical history and the clinical and histopathologic characteristics of lipogranuloma are necessary to make a definite diagnosis and allow appropriate treatment. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Procedural learning during declarative control.

    PubMed

    Crossley, Matthew J; Ashby, F Gregory

    2015-09-01

    There is now abundant evidence that human learning and memory are governed by multiple systems. As a result, research is now turning to the next question of how these putative systems interact. For instance, how is overall control of behavior coordinated, and does learning occur independently within systems regardless of what system is in control? Behavioral, neuroimaging, and neuroscience data are somewhat mixed with respect to these questions. Human neuroimaging and animal lesion studies suggest independent learning and are mostly agnostic with respect to control. Human behavioral studies suggest active inhibition of behavioral output but have little to say regarding learning. The results of two perceptual category-learning experiments are described that strongly suggest that procedural learning does occur while the explicit system is in control of behavior and that this learning might be just as good as if the procedural system was controlling the response. These results are consistent with the idea that declarative memory systems inhibit the ability of the procedural system to access motor output systems but do not prevent procedural learning.

  13. Pascal Statistical Procedures Package (PSPP).

    DTIC Science & Technology

    1983-12-01

    microcomputer center and as a research tool for users to do a ’ball-park’ analysis of a data base. Included in the package are procedures to handle data base...Issue. . . . . . . . . . . . . . Research Question . . . . a . . . . . . . . . 1 Objectives of the Research . . . . . . . . . . 2 Specific Objectives... Research . . . . . . . 12 Appendix A: (User’s Guide) .............. 14 Introduction . . . . . 17 Data Manipulation Module. . . . . . . . . . . 21

  14. Software Verification and Validation Procedure

    SciTech Connect

    Olund, Thomas S.

    2008-09-15

    This Software Verification and Validation procedure provides the action steps for the Tank Waste Information Network System (TWINS) testing process. The primary objective of the testing process is to provide assurance that the software functions as intended, and meets the requirements specified by the client. Verification and validation establish the primary basis for TWINS software product acceptance.

  15. Rules of Procedure for Investigation.

    ERIC Educational Resources Information Center

    National Education Association, Washington, DC. Commission on Professional Rights and Responsibilities.

    Among the functions of the Commission on Professional Rights and Responsibilities of the NEA is the investigation of cases of alleged unethical conduct by members of the teaching profession. The rules of procedure for investigations presented in this document are intended to assure all parties in a conflict of their individual rights of procedural…

  16. 78 FR 22546 - Hearing Procedures

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-16

    ... explanation of the basis of the proposed determination. 12 U.S.C. 5323(e)(1) and 12 C.F.R. 1310.21(b). However... comments were submitted.\\3\\ \\1\\ 12 U.S.C. 5321, 5323, 5463, and 5469. \\2\\ Hearing Procedures; Notice of... institution engaged in a payment, clearing, or settlement activity that requests a hearing. \\4\\ 12......

  17. Concepts & Procedures. [SITE 2001 Section].

    ERIC Educational Resources Information Center

    Bauder, Deborah Y., Ed.; Mullick, Rosemary, Ed.; Sarner, Ronald, Ed.

    This document contains the following papers on concepts and procedures from the SITE (Society for Information Technology & Teacher Education) 2001 conference: "Using School District Standards To Develop Thematic Lessons for Electronic Portfolios" (Cindy L. Anderson and others); "Using Adobe Acrobat for Electronic Portfolio…

  18. Off-Campus Registration Procedures.

    ERIC Educational Resources Information Center

    Maas, Michael L.

    Registration is one of the more critical functions that a college staff encounters each semester. To have a smooth, efficient, college-wide registration, it is essential that all segments of the college be aware of registration procedures as well as data control operations. This packet was designed to acquaint interested parties with the…

  19. Manual of General Searching Procedures.

    ERIC Educational Resources Information Center

    Cornell Univ., Ithaca, NY. Univ. Libraries

    A training and reference tool for searchers in the Preorder Section of Cornell's Olin Library Acquisitions Department, this manual establishes the rationale for searching operations and includes illustrations as well as detailed explanations of searching procedures and problems. The information given applies only to the searching of monographs,…

  20. Arkansas' Office Procedures Curriculum Guide.

    ERIC Educational Resources Information Center

    Clayton, Dean

    This curriculum guide provides teachers of office procedures classes with unit lesson plans and information about resource materials that can be examined, selected, and integrated into the instructional program. Contents are mainly established for the following two types of secondary-level programs: cooperative office education and intensive…

  1. Illustration of a Learning Procedure.

    ERIC Educational Resources Information Center

    Borghouts-van Erp, J. W. M.

    The paper describes evolution of an approach to teaching mathematically disabled and slow learning students through a Piagetian framework. It is explained that a step-by-step procedure is used to internalize material actions into mental actions via perception and verbalization. Formulae are introduced early, and emphasis is placed on promoting…

  2. Expanded civil judicial referral procedures

    SciTech Connect

    Not Available

    1986-08-28

    The directive provides guidance on procedures for civil judicial referrals to the Department of Justice. The memorandum expands the current direct referral program, indicates that Headquarters should not establish mandatory requirements for pre-referral negotiations, mandates use of hold action cases only for strategic or tactical reasons and offers guidance on the preparation of bankruptcy cases.

  3. Environmental Impact Assessment: A Procedure.

    ERIC Educational Resources Information Center

    Stover, Lloyd V.

    Prepared by a firm of consulting engineers, this booklet outlines the procedural "whys and hows" of assessing environmental impact, particularly for the construction industry. Section I explores the need for environmental assessment and evaluation to determine environmental impact. It utilizes a review of the National Environmental Policy Act and…

  4. Budgetary Control Procedures for Institutions.

    ERIC Educational Resources Information Center

    Powell, Ray M.

    Budgetary control procedures for not-for-profit institutions are presented in this compilation of budgetary materials and ideas gathered at the Program for Institutional Administrators at the University of Notre Dame. Budgetary reporting and control are suggested as the most effective tools for coordinating and controlling the acquisition and use…

  5. International Studies Program Procedures Manual.

    ERIC Educational Resources Information Center

    Finkelston, Theodore

    This eleven-part procedures manual provides information on the operations of the International Studies Program (ISP) at St. Louis Community College. After introductory material on the program, which provides off-campus credit courses involving travel and field study of life and the cultures in foreign countries, Section I presents the philosophy…

  6. 77 FR 34186 - Appeal Procedures

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-11

    ...The Natural Resources Conservation Service (NRCS), United States Department of Agriculture (USDA) issues this final rule amending NRCS' informal appeal procedures as required by Title II of the Federal Crop Insurance Reform and Department of Agriculture Reorganization Act of 1994 (the 1994 Act). This final rule amends regulations promulgated by the interim final rule published on May 16, 2006,......

  7. Concepts & Procedures. [SITE 2002 Section].

    ERIC Educational Resources Information Center

    Sarner, Ronald, Ed.; Mullick, Rosemary J., Ed.; Bauder, Deborah Y., Ed.

    This document contains the following full and short papers on concepts and procedures from the SITE (Society for Information Technology & Teacher Education) 2002 conference: "Exploring Minds Network" (Marino C. Alvarez and others); "Learning Communities: A Kaleidoscope of Ecological Designs" (Alain Breuleux and others);…

  8. Scapular dyskinesis after Latarjet procedure.

    PubMed

    Carbone, Stefano; Moroder, Philipp; Runer, Armin; Resch, Herbert; Gumina, Stefano; Hertel, Ralph

    2016-03-01

    Because of detachment of the pectoralis minor and variation of the vector of the conjoint tendons, we hypothesized that the Latarjet procedure may alter scapular position and motion. The purpose of this study was to evaluate scapular position and motion in patients who underwent a Latarjet or a modified iliac crest bone graft transfer (ICBGT) procedure (J-bone graft). Forty-six consecutive patients treated for recurrent anterior shoulder dislocation between 2010 and 2012 were retrospectively enrolled. Twenty-three were treated with a Latarjet and 23 with an ICBGT procedure. Twenty Latarjet and 20 ICBGT patients were available at a mean follow-up of 20 months (min, 12; max, 60). We recorded the Western Ontario Instability Index, the Rowe Score, and the Subjective Shoulder Value. Scapulothoracic position was studied according to the dyskinesis yes/no method. Intraobserver and interobserver reliability of the dyskinesis assessment was assessed. Intraobserver and interobserver reliability of scapula dyskinesis assessment was high (Latarjet: intratester, κ = 0.84; intertester, κ = 0.75; ICBGT: intratester, κ = 0.78; intertester, κ = 0.71). Scapular dyskinesis was observed after 5 of 20 Latarjet and after 0 of 20 ICBGT procedures (P = .047). Patients with dyskinesis had lower scores (Western Ontario Instability Index, P = .043; Rowe, P = .047; Subjective Shoulder Value, P = .046), but no statistically significant difference was found between the Latarjet and ICBGT groups. Two of the 5 scapular dyskinesis patients reached the SICK (Scapular malposition, Inferior medial scapular winging, Coracoid tenderness, and scapular dysKinesis) scapula syndrome definition. Scapular dyskinesis was found in 5 of 20 patients who underwent a Latarjet procedure. Dyskinesis may be related to the detachment of the pectoralis minor, and variation of the vector and the working length of the coracobrachialis and the short head of the biceps. Copyright © 2016 Journal of Shoulder and Elbow

  9. Laparoscopic reversal of Hartmann's procedure.

    PubMed

    Fiscon, Valentino; Portale, Giuseppe; Mazzeo, Antonio; Migliorini, Giovanni; Frigo, Flavio

    2014-12-01

    Reestablishing continuity after a Hartmann's procedure is considered a major surgical procedure with high morbidity/mortality. The aim of this study was to assess the short-/long-term outcome of laparoscopic restoration of bowel continuity after HP. A prospectively collected database of colorectal laparoscopic procedures (>800) performed between June 2005 and June 2013 was used to identify 20 consecutive patients who had undergone laparoscopic reversal of Hartmann's procedure (LHR). Median age was 65.4. Ten patients (50 %) had undergone surgery for perforated diverticulitis, 3 (15 %) for cancer, and 7 (35 %) for other reasons (volvulus, posttraumatic perforation, and sigmoid perforation from foreign body). Previous HP had been performed laparoscopically in only 3 patients. Median operative time was 162.5 min. All the procedures were completed laparoscopically. Intraoperative complication rate was nil. Post-operative mortality and morbidity were respectively 0 and 10 % (1 pneumonia, 1 bowel obstruction from post-anastomotic stenosis which required resection and redo of the anastomosis). Median time to first flatus was 3 days, to normal diet 5 days. Median hospital stay was 9 days without readmissions. We followed up the patients for a median of 44 months: when asked, all 20 (100 %) said they would undergo the operation (LHR) again; 3 (15 %) had been re-operated of laparoscopic mesh repair for incisional hernia. When performed by experienced surgeons, LHR is a feasible, safe, reproducible operation, which allows early return of bowel function, early discharge and fast return to work for the patient. It has a low morbidity rate.

  10. Radiation exposure during endovascular procedures.

    PubMed

    Lekovic, Gregory P; Kim, Louis J; Gonzalez, L Fernando; Bice, Alden; Albuquerque, Felipe C; McDougall, Cameron G

    2008-07-01

    The duration of fluoroscopy exposure is routinely recorded as part of endovascular procedures. However, to better relate the duration of exposure to actual doses of surface and intracranial radiation, we compared surface doses during endovascular procedures with intracranial doses in a cadaver model exposed to lateral fluoroscopy. Optically stimulated luminescence dosimeter chips (Landauer, Glenwood, IL) were used to measure the cranial surface dose of three consecutive patients undergoing endovascular procedures. Bitemporal craniotomies were performed on a cadaver. Dosimeter chips were placed on both the ipsilateral and contralateral skin and meningeal surfaces, and the cadaver was exposed to lateral fluoroscopy. Finally, to assess mean fluoroscopy times in patients undergoing embolization procedures, the operative notes of 100 consecutive patients were reviewed. Three patients undergoing endovascular treatment received peak doses of 0.24, 0.31, and 1.38 Gy, respectively. In the cadaver, the peak surface dose recorded after 120 minutes of exposure was 1.71 Gy. The cranium and scalp absorbed or reflected 29% of the surface dose. Time in minutes of fluoroscopy was found to correlate with surface dose (R2 = 0.925). Our data show that radiation exposure during endovascular treatment can reach clinically significant levels. The surface doses recorded during this study were comparable to the mean dose of 1.5 Gy estimated by others to increase the relative risk of inducing meningiomas, gliomas, and nerve sheath tumors. Pending long-term follow-up of patients exposed to endovascular procedures, consent for possible long-term sequelae of radiation may be warranted.

  11. Orbital operations study. Appendix B: Operational procedures

    NASA Technical Reports Server (NTRS)

    Galvin, D. M.; Mattson, H. L.; True, D. M.; Anderson, N. R.; Mehrbach, E.; Gianformaggio, A.; Steinwachs, W. L.; Turkel, S. H.

    1972-01-01

    Operational procedures for each alternate approach for each interfacing activity of the orbital operations study are presented. The applicability of the procedures to interfacing element pairs is identified.

  12. 21 CFR 1270.31 - Written procedures.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... procedures prepared and followed for all significant steps in the infectious disease testing process under... procedures prepared, validated, and followed for prevention of infectious disease contamination or cross...

  13. 21 CFR 1270.31 - Written procedures.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... procedures prepared and followed for all significant steps in the infectious disease testing process under... procedures prepared, validated, and followed for prevention of infectious disease contamination or cross...

  14. 21 CFR 1270.31 - Written procedures.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... procedures prepared and followed for all significant steps in the infectious disease testing process under... procedures prepared, validated, and followed for prevention of infectious disease contamination or cross...

  15. 21 CFR 1270.31 - Written procedures.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... procedures prepared and followed for all significant steps in the infectious disease testing process under... procedures prepared, validated, and followed for prevention of infectious disease contamination or cross...

  16. 14 CFR 217.8 - Reporting procedures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... REGULATIONS REPORTING TRAFFIC STATISTICS BY FOREIGN AIR CARRIERS IN CIVILIAN SCHEDULED, CHARTER, AND NONSCHEDULED SERVICES § 217.8 Reporting procedures. Reporting guidelines and procedures for Schedule...

  17. Bonding procedure for Teflon seals

    NASA Technical Reports Server (NTRS)

    Barringer, S. R.; Ezell, T. E., Jr.; Stacey, A. B., Jr.; Wright, D. B., Jr.

    1982-01-01

    Material and bonding procedures designed for use as seals at the National Transonic Facility at the NASA Langley Research Center are presented. Teflon TFE was chosen for its ability to withstand pressures of up to 130 psi and temperatures ranging from -320 to 150 F, in addition to tolerances of 0.074 in. and having a movement allowance of 0.75 in. during transient cycles. Since some of the seals are 14 in. in diameter, Teflon sheets had to be sliced and bonded together after machining to size, resulting in seals with circular, oval, straight, and rectangular cross sections. Step-by-step preparation procedures are provided, and it is noted that the scarf joints performed as predicted during tests.

  18. Structured programming: Principles, notation, procedure

    NASA Technical Reports Server (NTRS)

    JOST

    1978-01-01

    Structured programs are best represented using a notation which gives a clear representation of the block encapsulation. In this report, a set of symbols which can be used until binding directives are republished is suggested. Structured programming also allows a new method of procedure for design and testing. Programs can be designed top down, that is, they can start at the highest program plane and can penetrate to the lowest plane by step-wise refinements. The testing methodology also is adapted to this procedure. First, the highest program plane is tested, and the programs which are not yet finished in the next lower plane are represented by so-called dummies. They are gradually replaced by the real programs.

  19. Regenerative Endodontic Procedures: Clinical Outcomes.

    PubMed

    Diogenes, Anibal; Ruparel, Nikita B

    2017-01-01

    Immature teeth are at risk for pulp necrosis, resulting in arrested root development and poor long-term prognosis. There is growing evidence that regenerative endodontic procedures promote desirable clinical outcomes. Despite significant advances in the field of regenerative endodontics and acceptable clinical outcomes, current evidence suggests that the tissues formed following currently used procedures do not completely recapitulate the former pulp-dentin complex. Further research is needed to identify prognostic factors and predictors of successful outcomes and to develop different treatment strategies to better predictably achieve all identified clinical outcomes, while favoring tissue formation that more closely resembles the pulp-dentin complex. Copyright © 2016. Published by Elsevier Inc.

  20. Surface Environmental Surveillance Procedures Manual

    SciTech Connect

    RW Hanf; TM Poston

    2000-09-20

    Environmental surveillance data are used in assessing the impact of current and past site operations on human health and the environment, demonstrating compliance with applicable local, state, and federal environmental regulations, and verifying the adequacy of containment and effluent controls. SESP sampling schedules are reviewed, revised, and published each calendar year in the Hanford Site Environmental Surveillance Master Sampling Schedule. Environmental samples are collected by SESP staff in accordance with the approved sample collection procedures documented in this manual.

  1. Aesthetic Surgical Crown Lengthening Procedure

    PubMed Central

    de Oliveira, Pablo Santos; Chiarelli, Fabio; Rodrigues, José A.; Shibli, Jamil A.; Zizzari, Vincenzo Luca; Piattelli, Adriano; Iezzi, Giovanna; Perrotti, Vittoria

    2015-01-01

    The aim of this case report was to describe the surgical sequence of crown lengthening to apically reposition the dentogingival complex, in addition to an esthetic restorative procedure. Many different causes can be responsible for short clinical crown. In these cases, the correct execution of a restorative or prosthetic rehabilitation requires an increasing of the crown length. According to the 2003 American Academy of Periodontology (Practice Profile Survey), crown lengthening is the most habitual surgical periodontal treatment. PMID:26609452

  2. Feline onychectomy and elective procedures.

    PubMed

    Young, William Phillip

    2002-05-01

    The development of the carbon dioxide (CO2) surgical laser has given veterinarians a new perspective in the field of surgery. Recently developed techniques and improvisations of established procedures have opened the field of surgery to infinite applications never before dreamed of as little as 10 years ago. Today's CO2 surgical laser is an adaptable, indispensable tool for the everyday veterinary practitioner. Its use is becoming a common occurrence in offices of veterinarians around the world.

  3. Cost analysis for procedure comparisons.

    PubMed

    Trowers, E A; Batra, S C; Buessler, J; Anderson, L K

    1995-01-01

    Using the methodology of activity-based costing as a conceptual framework, the authors present the potential cost reduction of a new office routine and a medical procedure. The costs of a new instrument for colorectal cancer screening and a new surveying and follow-up of at-risk patients show that time and relevant costs in the G.I Clinic and G.I Endoscopy Lab were significantly reduced.

  4. The transfer of analytical procedures.

    PubMed

    Ermer, J; Limberger, M; Lis, K; Wätzig, H

    2013-11-01

    Analytical method transfers are certainly among the most discussed topics in the GMP regulated sector. However, they are surprisingly little regulated in detail. General information is provided by USP, WHO, and ISPE in particular. Most recently, the EU emphasized the importance of analytical transfer by including it in their draft of the revised GMP Guideline. In this article, an overview and comparison of these guidelines is provided. The key to success for method transfers is the excellent communication between sending and receiving unit. In order to facilitate this communication, procedures, flow charts and checklists for responsibilities, success factors, transfer categories, the transfer plan and report, strategies in case of failed transfers, tables with acceptance limits are provided here, together with a comprehensive glossary. Potential pitfalls are described such that they can be avoided. In order to assure an efficient and sustainable transfer of analytical procedures, a practically relevant and scientifically sound evaluation with corresponding acceptance criteria is crucial. Various strategies and statistical tools such as significance tests, absolute acceptance criteria, and equivalence tests are thoroughly descibed and compared in detail giving examples. Significance tests should be avoided. The success criterion is not statistical significance, but rather analytical relevance. Depending on a risk assessment of the analytical procedure in question, statistical equivalence tests are recommended, because they include both, a practically relevant acceptance limit and a direct control of the statistical risks. However, for lower risk procedures, a simple comparison of the transfer performance parameters to absolute limits is also regarded as sufficient. Copyright © 2013 Elsevier B.V. All rights reserved.

  5. Cosmetic procedures in orthognathic surgery.

    PubMed

    Nocini, Pier Francesco; Chiarini, Luigi; Bertossi, Dario

    2011-03-01

    Orthognathic surgery produces cosmetic and functional effects, and patients should be evaluated for additional cosmetic improvements beyond those possible with orthognathic surgery. Soft tissue procedures can be performed on an outpatient basis in an office environment and can be combined with orthognathics and delayed in a second stage. Systematic accurate facial evaluation is necessary to focus on cosmetic soft tissue problems. Features that make the patient look unattractive, old, tired, out of shape, weak, or sad must be identified by accurate clinical analysis and 3-dimensional planning. Then it will be possible to select the treatment plan according to the patient's input, prioritizing the additional cosmetic improvements that can be added to primary surgery. It is particularly important to review the results and the patient's satisfaction by clinical examination, a questionnaire, and with 3-dimensional pictures, and to understand if the treatment options have been accurately chosen and their lasting effect on follow-up. The treatment sequence is analyzed, and if there are residual defects, a secondary cosmetic procedure can be planned to complete the result. The surgeon's goal must be the simultaneous treatment of malocclusions and facial esthetic disharmonies, and orthognathic surgical procedures and facial cosmetics must be performed simultaneously, if possible. Residual defects must be treated after at least 6 to 12 months. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  6. Radiation injuries after fluoroscopic procedures.

    PubMed

    Mettler, Fred A; Koenig, Titus R; Wagner, Louis K; Kelsey, Charles A

    2002-10-01

    Fluoroscopically guided diagnostic and interventional procedures have become much more commonplace over the last decade. Current fluoroscopes are easily capable of producing dose rates in the range of 0.2 Gy (20 rads) per minute. The dose rate often changes dramatically with patient positioning and size. Most machines currently in use have no method to display approximate patient dose other than the rough surrogate of total fluoroscopy time. This does not include patient dose incurred during fluorography (serial imaging or cine runs), which can be considerably greater than dose during fluoroscopy. There have been over 100 cases of documented radiation skin and underlying tissue injury, a large portion of which resulted in dermal necrosis. The true number of injuries is undoubtedly much higher. The highest dose procedures are complex interventions such as those involving percutaneous angioplasties, stent placements, embolizations, and TIPS. In some cases skin doses have been in excess of 60 Gy (6000 rads). In many instances the procedures have been performed by physicians with little training in radiation effects, little appreciation of the radiation injuries that are possible or the strategies that could have been used to reduce both patient and staff doses. Almost all of the severe injuries that have occurred were avoidable.

  7. 40 CFR 154.34 - Expedited procedures.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 24 2011-07-01 2011-07-01 false Expedited procedures. 154.34 Section 154.34 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) PESTICIDE PROGRAMS SPECIAL REVIEW PROCEDURES Procedures § 154.34 Expedited procedures. (a) The Agency may elect to issue...

  8. 40 CFR 90.508 - Test procedures.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 20 2014-07-01 2013-07-01 true Test procedures. 90.508 Section 90.508....508 Test procedures. (a) For nonroad engines subject to the provisions of this subpart, the prescribed test procedures are the appropriate small SI engine test procedures as described in subpart E of...

  9. 10 CFR 431.154 - Test procedures.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 3 2011-01-01 2011-01-01 false Test procedures. 431.154 Section 431.154 Energy DEPARTMENT... EQUIPMENT Commercial Clothers Washers Test Procedures § 431.154 Test procedures. The test procedures for residential clothes washers in Appendix J1 to subpart B of part 430 of this title shall be used to...

  10. 40 CFR 89.508 - Test procedures.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 21 2013-07-01 2013-07-01 false Test procedures. 89.508 Section 89.508... Test procedures. (a)(1) For nonroad engines subject to the provisions of this subpart, the prescribed test procedures are the nonroad engine 8-mode test procedure as described in subpart E of this...

  11. 10 CFR 2.1304 - Hearing procedures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Hearing procedures. 2.1304 Section 2.1304 Energy NUCLEAR REGULATORY COMMISSION RULES OF PRACTICE FOR DOMESTIC LICENSING PROCEEDINGS AND ISSUANCE OF ORDERS Procedures for Hearings on License Transfer Applications § 2.1304 Hearing procedures. The procedures in this...

  12. 28 CFR 42.530 - Procedures.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 1 2013-07-01 2013-07-01 false Procedures. 42.530 Section 42.530 Judicial Administration DEPARTMENT OF JUSTICE NONDISCRIMINATION; EQUAL EMPLOYMENT OPPORTUNITY; POLICIES AND... Section 504 of the Rehabilitation Act of 1973 Procedures § 42.530 Procedures. (a) The procedural...

  13. 22 CFR 142.70 - Procedures.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Relations DEPARTMENT OF STATE CIVIL RIGHTS NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Procedures § 142.70 Procedures. The procedural provisions applicable to title VI of the Civil Rights Act of 1964 apply to this part. These procedures are found in...

  14. 29 CFR 2200.120 - Settlement procedure.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... procedure, such procedure shall not be imposed. (2) Length of voluntary settlement procedures. The settlement procedures under this section shall be for a period not to exceed 45 days. (b) Mandatory... aggregate amount of the penalties sought by the Secretary is $100,000 or greater. (2) Proceedings under...

  15. 29 CFR 2200.120 - Settlement procedure.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... procedure, such procedure shall not be imposed. (2) Length of voluntary settlement procedures. The settlement procedures under this section shall be for a period not to exceed 45 days. (b) Mandatory... aggregate amount of the penalties sought by the Secretary is $100,000 or greater. (2) Proceedings under...

  16. 29 CFR 2200.120 - Settlement procedure.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... procedure, such procedure shall not be imposed. (2) Length of voluntary settlement procedures. The settlement procedures under this section shall be for a period not to exceed 45 days. (b) Mandatory... aggregate amount of the penalties sought by the Secretary is $100,000 or greater. (2) Proceedings under...

  17. 29 CFR 2200.120 - Settlement procedure.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... procedure, such procedure shall not be imposed. (2) Length of voluntary settlement procedures. The settlement procedures under this section shall be for a period not to exceed 45 days. (b) Mandatory... aggregate amount of the penalties sought by the Secretary is $100,000 or greater. (2) Proceedings under...

  18. 29 CFR 2200.120 - Settlement procedure.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... procedure, such procedure shall not be imposed. (2) Length of voluntary settlement procedures. The settlement procedures under this section shall be for a period not to exceed 45 days. (b) Mandatory... aggregate amount of the penalties sought by the Secretary is $100,000 or greater. (2) Proceedings under...

  19. 10 CFR 766.105 - Payment procedures.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 4 2013-01-01 2013-01-01 false Payment procedures. 766.105 Section 766.105 Energy DEPARTMENT OF ENERGY URANIUM ENRICHMENT DECONTAMINATION AND DECOMMISSIONING FUND; PROCEDURES FOR SPECIAL ASSESSMENT OF DOMESTIC UTILITIES Procedures for Special Assessment § 766.105 Payment procedures. DOE shall...

  20. 10 CFR 766.105 - Payment procedures.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 4 2014-01-01 2014-01-01 false Payment procedures. 766.105 Section 766.105 Energy DEPARTMENT OF ENERGY URANIUM ENRICHMENT DECONTAMINATION AND DECOMMISSIONING FUND; PROCEDURES FOR SPECIAL ASSESSMENT OF DOMESTIC UTILITIES Procedures for Special Assessment § 766.105 Payment procedures. DOE shall...

  1. 10 CFR 766.105 - Payment procedures.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 4 2011-01-01 2011-01-01 false Payment procedures. 766.105 Section 766.105 Energy DEPARTMENT OF ENERGY URANIUM ENRICHMENT DECONTAMINATION AND DECOMMISSIONING FUND; PROCEDURES FOR SPECIAL ASSESSMENT OF DOMESTIC UTILITIES Procedures for Special Assessment § 766.105 Payment procedures. DOE shall...

  2. 10 CFR 766.105 - Payment procedures.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 4 2012-01-01 2012-01-01 false Payment procedures. 766.105 Section 766.105 Energy DEPARTMENT OF ENERGY URANIUM ENRICHMENT DECONTAMINATION AND DECOMMISSIONING FUND; PROCEDURES FOR SPECIAL ASSESSMENT OF DOMESTIC UTILITIES Procedures for Special Assessment § 766.105 Payment procedures. DOE shall...

  3. 10 CFR 766.105 - Payment procedures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Payment procedures. 766.105 Section 766.105 Energy DEPARTMENT OF ENERGY URANIUM ENRICHMENT DECONTAMINATION AND DECOMMISSIONING FUND; PROCEDURES FOR SPECIAL ASSESSMENT OF DOMESTIC UTILITIES Procedures for Special Assessment § 766.105 Payment procedures. DOE shall...

  4. 12 CFR 303.121 - Filing procedures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Filing procedures. 303.121 Section 303.121 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION PROCEDURE AND RULES OF PRACTICE FILING PROCEDURES Activities of Insured State Banks § 303.121 Filing procedures. (a) Where to file. A notice...

  5. 12 CFR 303.201 - Filing procedures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Filing procedures. 303.201 Section 303.201 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION PROCEDURE AND RULES OF PRACTICE FILING PROCEDURES Prompt Corrective Action § 303.201 Filing procedures. Applications shall be filed with...

  6. 40 CFR 154.34 - Expedited procedures.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 23 2010-07-01 2010-07-01 false Expedited procedures. 154.34 Section 154.34 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) PESTICIDE PROGRAMS SPECIAL REVIEW PROCEDURES Procedures § 154.34 Expedited procedures. (a) The Agency may elect to issue...

  7. 47 CFR 1.1121 - Billing procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 47 Telecommunication 1 2010-10-01 2010-10-01 false Billing procedures. 1.1121 Section 1.1121 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL PRACTICE AND PROCEDURE Schedule of Statutory Charges and Procedures for Payment § 1.1121 Billing procedures. (a) The fees required for the...

  8. 47 CFR 1.1121 - Billing procedures.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 47 Telecommunication 1 2011-10-01 2011-10-01 false Billing procedures. 1.1121 Section 1.1121 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL PRACTICE AND PROCEDURE Schedule of Statutory Charges and Procedures for Payment § 1.1121 Billing procedures. (a) The fees required for the...

  9. 7 CFR 15a.71 - Interim procedures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... FEDERAL FINANCIAL ASSISTANCE Procedures (Interim) § 15a.71 Interim procedures. For the purposes of... a consolidated procedural regulation applicable to title IX and other civil rights authorities administered by the Department, the procedural provisions applicable to title VI of the Civil Rights Act of...

  10. 16 CFR 1.20 - Alternative procedures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Alternative procedures. 1.20 Section 1.20 Commercial Practices FEDERAL TRADE COMMISSION ORGANIZATION, PROCEDURES AND RULES OF PRACTICE GENERAL PROCEDURES Rules and Rulemaking Under Section 18(a)(1)(B) of the FTC Act § 1.20 Alternative procedures. If...

  11. 44 CFR 78.14 - Alternative procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Alternative procedures. 78.14... ASSISTANCE § 78.14 Alternative procedures. For the purposes of this part, alternative procedures are... alternative procedures are available in the following circumstances. Native American tribes or authorized...

  12. Series expansion of the modified Einstein Procedure

    Treesearch

    Seema Chandrakant Shah-Fairbank

    2009-01-01

    This study examines calculating total sediment discharge based on the Modified Einstein Procedure (MEP). A new procedure based on the Series Expansion of the Modified Einstein Procedure (SEMEP) has been developed. This procedure contains four main modifications to MEP. First, SEMEP solves the Einstein integrals quickly and accurately based on a series expansion. Next,...

  13. A systematic approach to upgrading operating procedures

    SciTech Connect

    Solne, B.J. III; Richardson, C.E. ); Corson, J.A. )

    1993-01-01

    Some utilities emphasize Operations Department procedure content details without an overall philosophy of operation. A methodology has been formulated to produce high-quality operating procedures by establishing a logical, hierarchical structure of procedure types and identifying procedure interfaces and development and implementation sequences and schedules.

  14. 32 CFR 32.44 - Procurement procedures.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 1 2011-07-01 2011-07-01 false Procurement procedures. 32.44 Section 32.44..., HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Procurement Standards § 32.44 Procurement procedures. (a) All recipients shall establish written procurement procedures. These procedures...

  15. 10 CFR 600.144 - Procurement procedures.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 4 2011-01-01 2011-01-01 false Procurement procedures. 600.144 Section 600.144 Energy... Nonprofit Organizations Post-Award Requirements § 600.144 Procurement procedures. (a) All recipients shall establish written procurement procedures. These procedures shall provide for, at a minimum, that paragraphs...

  16. 40 CFR 30.44 - Procurement procedures.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 1 2011-07-01 2011-07-01 false Procurement procedures. 30.44 Section..., HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Procurement Standards § 30.44 Procurement procedures. (a) All recipients shall establish written procurement procedures. These procedures...

  17. 45 CFR 2543.44 - Procurement procedures.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 4 2011-10-01 2011-10-01 false Procurement procedures. 2543.44 Section 2543.44... ORGANIZATIONS Post-Award Requirements Property Standards § 2543.44 Procurement procedures. (a) All recipients shall establish written procurement procedures. These procedures shall provide for, at a minimum, that...

  18. 22 CFR 226.44 - Procurement procedures.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Procurement procedures. 226.44 Section 226.44...-GOVERNMENTAL ORGANIZATIONS Post-award Requirements Procurement Standards § 226.44 Procurement procedures. (a) All recipients shall establish written procurement procedures. These procedures shall provide, at a...

  19. 22 CFR 518.44 - Procurement procedures.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 2 2011-04-01 2009-04-01 true Procurement procedures. 518.44 Section 518.44... Requirements Procurement Standards § 518.44 Procurement procedures. (a) All recipients shall establish written procurement procedures. These procedures shall provide for, at a minimum, that the conditions in paragraphs (a...

  20. Compound estimation procedures in reliability

    NASA Technical Reports Server (NTRS)

    Barnes, Ron

    1990-01-01

    At NASA, components and subsystems of components in the Space Shuttle and Space Station generally go through a number of redesign stages. While data on failures for various design stages are sometimes available, the classical procedures for evaluating reliability only utilize the failure data on the present design stage of the component or subsystem. Often, few or no failures have been recorded on the present design stage. Previously, Bayesian estimators for the reliability of a single component, conditioned on the failure data for the present design, were developed. These new estimators permit NASA to evaluate the reliability, even when few or no failures have been recorded. Point estimates for the latter evaluation were not possible with the classical procedures. Since different design stages of a component (or subsystem) generally have a good deal in common, the development of new statistical procedures for evaluating the reliability, which consider the entire failure record for all design stages, has great intuitive appeal. A typical subsystem consists of a number of different components and each component has evolved through a number of redesign stages. The present investigations considered compound estimation procedures and related models. Such models permit the statistical consideration of all design stages of each component and thus incorporate all the available failure data to obtain estimates for the reliability of the present version of the component (or subsystem). A number of models were considered to estimate the reliability of a component conditioned on its total failure history from two design stages. It was determined that reliability estimators for the present design stage, conditioned on the complete failure history for two design stages have lower risk than the corresponding estimators conditioned only on the most recent design failure data. Several models were explored and preliminary models involving bivariate Poisson distribution and the

  1. Midazolam for sedation before procedures.

    PubMed

    Conway, Aaron; Rolley, John; Sutherland, Joanna R

    2016-05-20

    Midazolam is used for sedation before diagnostic and therapeutic medical procedures. It is an imidazole benzodiazepine that has depressant effects on the central nervous system (CNS) with rapid onset of action and few adverse effects. The drug can be administered by several routes including oral, intravenous, intranasal and intramuscular. To determine the evidence on the effectiveness of midazolam for sedation when administered before a procedure (diagnostic or therapeutic). We searched the Cochrane Central Register of Controlled Trials (CENTRAL to January 2016), MEDLINE in Ovid (1966 to January 2016) and Ovid EMBASE (1980 to January 2016). We imposed no language restrictions. Randomized controlled trials in which midazolam, administered to participants of any age, by any route, at any dose or any time before any procedure (apart from dental procedures), was compared with placebo or other medications including sedatives and analgesics. Two authors extracted data and assessed risk of bias for each included study. We performed a separate analysis for each different drug comparison. We included 30 trials (2319 participants) of midazolam for gastrointestinal endoscopy (16 trials), bronchoscopy (3), diagnostic imaging (5), cardioversion (1), minor plastic surgery (1), lumbar puncture (1), suturing (2) and Kirschner wire removal (1). Comparisons were: intravenous diazepam (14), placebo (5) etomidate (1) fentanyl (1), flunitrazepam (1) and propofol (1); oral chloral hydrate (4), diazepam (2), diazepam and clonidine (1); ketamine (1) and placebo (3); and intranasal placebo (2). There was a high risk of bias due to inadequate reporting about randomization (75% of trials). Effect estimates were imprecise due to small sample sizes. None of the trials reported on allergic or anaphylactoid reactions. Intravenous midazolam versus diazepam (14 trials; 1069 participants)There was no difference in anxiety (risk ratio (RR) 0.80, 95% confidence interval (CI) 0.39 to 1.62; 175

  2. National Ignition Facility (NIF) operations procedures plan

    SciTech Connect

    Mantrom, D.

    1998-05-06

    The purpose of this Operations Procedures Plan is to establish a standard procedure which outlines how NIF Operations procedures will be developed (i.e , written, edited, reviewed, approved, published, revised) and accessed by the NIF Operations staff who must use procedures in order to accomplish their tasks. In addition, this Plan is designed to provide a guide to the NIF Project staff to assist them in planning and writing procedures. Also, resource and scheduling information is provided.

  3. Revised Unfilling Procedure for Solid Lithium Lenses

    SciTech Connect

    Leveling, A.; /Fermilab

    2003-06-03

    A procedure for unfilling used lithium lenses to has been described in Pbar Note 664. To date, the procedure has been used to disassemble lenses 20, 21, 17, 18, and 16. As a result of this work, some parts of the original procedure were found to be time consuming and ineffective. Modifications to the original procedure have been made to streamline the process and are discussed in this note. The revised procedure is included in this note.

  4. Efficiency of performing pulmonary procedures in a shared endoscopy unit: procedure time, turnaround time, delays, and procedure waiting time.

    PubMed

    Verma, Akash; Lee, Mui Yok; Wang, Chunhong; Hussein, Nurmalah B M; Selvi, Kalai; Tee, Augustine

    2014-04-01

    The purpose of this study was to assess the efficiency of performing pulmonary procedures in the endoscopy unit in a large teaching hospital. A prospective study from May 20 to July 19, 2013, was designed. The main outcome measures were procedure delays and their reasons, duration of procedural steps starting from patient's arrival to endoscopy unit, turnaround time, total case durations, and procedure wait time. A total of 65 procedures were observed. The most common procedure was BAL (61%) followed by TBLB (31%). Overall procedures for 35 (53.8%) of 65 patients were delayed by ≥ 30 minutes, 21/35 (60%) because of "spillover" of the gastrointestinal and surgical cases into the time block of pulmonary procedure. Time elapsed between end of pulmonary procedure and start of the next procedure was ≥ 30 minutes in 8/51 (16%) of cases. In 18/51 (35%) patients there was no next case in the room after completion of the pulmonary procedure. The average idle time of the room after the end of pulmonary procedure and start of next case or end of shift at 5:00 PM if no next case was 58 ± 53 minutes. In 17/51 (33%) patients the room's idle time was >60 minutes. A total of 52.3% of patients had the wait time >2 days and 11% had it ≥ 6 days, reason in 15/21 (71%) being unavailability of the slot. Most pulmonary procedures were delayed due to spillover of the gastrointestinal and surgical cases into the block time allocated to pulmonary procedures. The most common reason for difficulty encountered in scheduling the pulmonary procedure was slot unavailability. This caused increased procedure waiting time. The strategies to reduce procedure delays and turnaround times, along with improved scheduling methods, may have a favorable impact on the volume of procedures performed in the unit thereby optimizing the existing resources.

  5. Instrument Calibration and Certification Procedure

    SciTech Connect

    Davis, R. Wesley

    2016-05-31

    The Amptec 640SL-2 is a 4-wire Kelvin failsafe resistance meter, designed to reliably use very low-test currents for its resistance measurements. The 640SL-1 is a 2-wire version, designed to support customers using the Reynolds Industries type 311 connector. For both versions, a passive (analog) dual function DC Milliameter/Voltmeter allows the user to verify the actual 640SL output current level and the open circuit voltage on the test leads. This procedure includes tests of essential performance parameters. Any malfunction noticed during calibration, whether specifically tested for or not, shall be corrected before calibration continues or is completed.

  6. Ultrasound-Guided Elbow Procedures.

    PubMed

    Sussman, Walter I; Williams, Christopher J; Mautner, Ken

    2016-08-01

    High-resolution ultrasonography can help clinicians visualize key anatomic structures of the elbow and guide periarticular and intra-articular injections. Historically, most procedures done around the elbow have been done using landmark guidance, and few studies have reported the accuracy of ultrasonography-guided injections in the elbow region. This article reviews common musculoskeletal disorders about the elbow that can be evaluated with ultrasonography, reviews the literature on ultrasonography-guided injections of the elbow region, and describes the senior author's preferred approach for the most commonly performed elbow region injections.

  7. Procedures for precap visual inspection

    NASA Technical Reports Server (NTRS)

    1984-01-01

    Screening procedures for the final precap visual inspection of microcircuits used in electronic system components are described as an aid in training personnel unfamiliar with microcircuits. Processing techniques used in industry for the manufacture of monolithic and hybrid components are presented and imperfections that may be encountered during this inspection are discussed. Problem areas such as scratches, voids, adhesions, and wire bonding are illustrated by photomicrographs. This guide can serve as an effective tool in training personnel to perform precap visual inspections efficiently and reliably.

  8. Inspection system performance test procedure

    SciTech Connect

    Jensen, C.E.

    1995-01-17

    This procedure establishes requirements to administer a performance demonstration test. The test is to demonstrate that the double-shell tank inspection system (DSTIS) supplied by the contractor performs in accordance with the WHC-S-4108, Double-Shell Tank Ultrasonic Inspection Performance Specification, Rev. 2-A, January, 1995. The inspection system is intended to provide ultrasonic (UT) and visual data to determine integrity of the Westinghouse Hanford Company (WHC) site underground waste tanks. The robotic inspection system consists of the following major sub-systems (modules) and components: Mobile control center; Deployment module; Cable management assembly; Robot mechanism; Ultrasonic testing system; Visual testing system; Pneumatic system; Electrical system; and Control system.

  9. Entangled entanglement: A construction procedure

    NASA Astrophysics Data System (ADS)

    Uchida, Gabriele; Bertlmann, Reinhold A.; Hiesmayr, Beatrix C.

    2015-10-01

    The familiar Greenberger-Horne-Zeilinger (GHZ) states can be rewritten by entangling the Bell states for two qubits with a third qubit state, which is dubbed entangled entanglement. We show that in a constructive way we obtain all eight independent GHZ states that form the simplex of entangled entanglement, the magic simplex. The construction procedure allows a generalization to higher dimensions both, in the degrees of freedom (considering qudits) as well as in the number of particles (considering n-partite states). Such bases of GHZ-type states exhibit a cyclic geometry, a Merry Go Round, that is relevant for experimental and quantum information theoretic applications.

  10. [Procedural learning disorder: neuropsychological characteristics].

    PubMed

    Crespo-Eguílaz, N; Narbona, J

    This research aims at neurocognitive delineation of the core features of procedural learning disorder (PLD), otherwise labeled as motor coordination disorder or non-verbal learning disorder. A sample of 209 correlative outpatients (73% males), aged 6-12 years, all of them having QI ranging from 81 to 120, was clustered into the following neurobehavioural groups: PLD (n = 16), PLD plus attention deficit hyperactivity disorder (ADHD) (n = 37), ADHD combined type (n = 47), ADHD predominantly inattentive type (n = 23), specific language impairment (n = 68), and semantic-pragmatic language impairment (n = 18). Two additional groups of patients were included for some comparisons: children with periventricular leukomalacia (PVL) without learning disability (n = 8) or associating PLD (n = 17). A set of behavioural scales and neurocognitive tests was used to evaluate verbal and non-verbal IQ, attention, impulsivity control, visuo-motor coordination, declarative memory, procedural memory and learning, formal and functional dimensions of language, peer relationships and academic achievement. Parametric analysis were used to test the differences and similarities of neurobehavioural variables between groups. Our results allow us to conclude that PLD implies a difficult acquisition of automatized motor, cognitive and communicative abilities required in school work and peer social relationships. PLD is different from autistic spectrum disorders. It is frequently associated to inattentive ADHD. Operational criteria for diagnosis of PLD are proposed, according to our results. A bilateral posterior parietal dysfunction is a plausible explanation of its physiopathology. Preserved general intelligence and formal linguistic abilities are the clues for intervention designs.

  11. Design procedures for compressor blades

    NASA Technical Reports Server (NTRS)

    Starken, H.

    1983-01-01

    The conventional methods for the design of the blades in the case of axial turbomachines are considered, taking into account difficulties concerning the determination of optimal blade profiles. These difficulties have been partly overcome as a consequence of the introduction of new numerical methods during the last few years. It is pointed out that, in the case of the subsonic range, a new procedure is now available for the determination of the form of blade profile on the basis of a given velocity distribution on the profile surface. The search for a profile form with favorable characteristics is consequently transformed into a search for a favorable velocity or pressure distribution on the blade. The distribution of velocities depends to a large degree on the characteristics of the profile boundary layers. The considered concept is not new. However, its practical implementation has only recently become possible. The employment of the new design procedure is illustrated with the aid of an example involving a concrete design problem.

  12. Procedures for computing site seismicity

    NASA Astrophysics Data System (ADS)

    Ferritto, John

    1994-02-01

    This report was prepared as part of the Navy's Seismic Hazard Mitigation Program. The Navy has numerous bases located in seismically active regions throughout the world. Safe effective design of waterfront structures requires determining expected earthquake ground motion. The Navy's problem is further complicated by the presence of soft saturated marginal soils that can significantly amplify the levels of seismic shaking as evidenced in the 1989 Loma Prieta earthquake. The Naval Facilities Engineering Command's seismic design manual, NAVFAC P355.l, requires a probabilistic assessment of ground motion for design of essential structures. This report presents the basis for the Navy's Seismic Hazard Analysis procedure that was developed and is intended to be used with the Seismic Hazard Analysis computer program and user's manual. This report also presents data on geology and seismology to establish the background for the seismic hazard model developed. The procedure uses the historical epicenter data base and available geologic data, together with source models, recurrence models, and attenuation relationships to compute the probability distribution of site acceleration and an appropriate spectra. This report discusses the developed stochastic model for seismic hazard evaluation and the associated research.

  13. Neuromonitoring after major neurosurgical procedures.

    PubMed

    Messerer, M; Daniel, R T; Oddo, M

    2012-07-01

    Postoperative care of major neurosurgical procedures is aimed at the prevention, detection and treatment of secondary brain injury. This consists of a series of pathological events (i.e. brain edema and intracranial hypertension, cerebral hypoxia/ischemia, brain energy dysfunction, non-convulsive seizures) that occur early after the initial insult and surgical intervention and may add further burden to primary brain injury and thus impact functional recovery. Management of secondary brain injury requires specialized neuroscience intensive care units (ICU) and continuous advanced monitoring of brain physiology. Monitoring of intracranial pressure (ICP) is a mainstay of care and is recommended by international guidelines. However, ICP monitoring alone may be insufficient to detect all episodes of secondary brain insults. Additional invasive (i.e. brain tissue PO2, cerebral microdialysis, regional cerebral blood flow) and non-invasive (i.e. transcranial doppler, near-infrared spectroscopy, EEG) brain monitoring devices might complement ICP monitoring and help clinicians to target therapeutic interventions (e.g. management of cerebral perfusion pressure, blood transfusion, glucose control) to patient-specific pathophysiology. Several independent studies demonstrate such multimodal approach may optimize patient care after major neurosurgical procedures. The aim of this review is to evaluate some of the available monitoring systems and summarize recent important data showing the clinical utility of multimodal neuromonitoring for the management of main acute neurosurgical conditions, including traumatic brain injury, subarachnoid hemorrhage and stroke.

  14. Esophageal Carcinoma Following Bariatric Procedures

    PubMed Central

    Leeman, Matthew F.; Richardson, J. David

    2004-01-01

    Background: The long-term success of bariatric operations for weight reduction has been well documented, but their potential effects on the risk of esophageal cancer have not been evaluated. Methods: We performed operations on 3 patients for esophageal cancer following bariatric operations: 2 had Roux-en-Y gastric bypass, and 1 underwent vertical banded gastroplasty. All of these patients had adenocarcinoma at the gastroesophageal junction; 1 involved the entire intrathoracic esophagus. Results: The intervals between the weight-loss operations and cancer diagnoses were 21, 16, and 14 years. All 3 patients had symptoms of reflux for many years before dysphagia developed and cancer was diagnosed. We performed a limited esophagogastrectomy, a classic IvorLewis procedure, and a total esophagectomy with jejunal free-tissue transfer from stomach to cervical esophagus. Two patients had positive lymph nodes. One patient is alive at 6 years; 2 died at 13 and 15 months after undergoing operation for recurrent cancer. Conclusion: The effect of bariatric operations on gastroesophageal reflux is not known, although gastric bypass has been advocated as the “ultimate antireflux procedure.” The presence of esophageal cancer in these 3 patients years after the weight loss operation is worrisome. We believe that patients who develop new symptoms should have endoscopic evaluation and that epidemiologic studies on the incidence of esophageal cancer occurring years after bariatric operation should be performed. PMID:15554284

  15. Cardiovascular procedures/diagnostic techniques and therapeutic procedures

    SciTech Connect

    Tilkian, A.G.; Daily, E.K.

    1986-01-01

    This book covers the technical and therapeutic aspects of cardiovascular procedures in immense detail. There are large and appropriate diagrams and tables. The topics of the chapters are tools for catheterization, venous access, arterial access, hemodynamic monitoring, cardiac catheterization and coronary arteriography, ergonovine provocation testing for coronary artery spasm, pulmonary angiography, endomyocredial biopsy, electrophysiologic studies, pericardiocentesis and drainage, intraaortic balloon pumping, direct current cardioversion and defibrilaltion, pacemaker implantation of the automatic implantable cardioverter/defibrillator, coronary angioplasty, thrombolytic therapy, transluminal catheter extraction and resolution of intracardiac catheter knots, cardiopulmonary resuscitation, contrast media toxicity and allergic reactions, radiation hazards, and medicolegal concerns. An appendix and index follow these chapters. In general, each chapter covers historical aspects, indications, complications, techniques, and preoperative and postoperative care.

  16. 40 CFR 91.119 - Certification procedure-use of special test procedures.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Standards and Certification Provisions § 91.119 Certification procedure—use of special test procedures. (a) Use of special test procedures by EPA. The Administrator may establish special test procedures for any... test procedures set forth in subpart E of this part. (b) Use of alternative test procedures by an...

  17. 40 CFR 90.120 - Certification procedure-use of special test procedures.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... test procedures. (a) Use of special test procedures by EPA. The Administrator may establish special... testing under the specified test procedures set forth in subpart E of this part. (b)(1) Use of alternate test procedures by an engine manufacturer. A manufacturer may elect to use an alternate test procedure...

  18. Physiotherapy following elective orthopaedic procedures.

    PubMed

    De Kleijn, P; Blamey, G; Zourikian, N; Dalzell, R; Lobet, S

    2006-07-01

    As haemophilic arthropathy and chronic synovitis are still the most important clinical features in people with haemophilia, different kinds of invasive and orthopaedic procedures have become more common during the last decades. The availability of clotting factor has made arthroplasty of one, or even multiple joints possible. This article highlights the role of physiotherapy before and after such procedures. Synovectomies are sometimes advocated in people with haemophilia to stop repetitive cycles of intra-articular bleeds and/or chronic synovitis. The synovectomy itself, however, does not solve the muscle atrophy, loss of range of motion (ROM), instability and poor propriocepsis, often developed during many years. The key is in taking advantage of the subsequent, relatively safe, bleed-free period to address these important issues. Although the preoperative ROM is the most important variable influencing the postoperative ROM after total knee arthroplasty, there are a few key points that should be considered to improve the outcome. Early mobilization, either manual or by means of a continuous passive mobilization machine, can be an optimal solution during the very first postoperative days. Muscle isometric contractions and light open kinetic chain exercises should also be started in order to restore the quadriceps control. Partial weight bearing can be started shortly after, because of quadriceps inhibition and to avoid excessive swelling. The use of continuous clotting factor replacement permits earlier and intensive rehabilitation during the postoperative period. During the rehabilitation of shoulder arthroplasty restoring the function of the rotator cuff is of utmost importance. Often the rotator cuff muscles are inhibited in the presence of pain and loss of ROM. Physiotherapy also assists in improving pain and maintaining ROM and strength. Functional weight-bearing tasks, such as using the upper limbs to sit and stand, are often discouraged during the first 6

  19. Nitrogenase Assembly: Strategies and Procedures.

    PubMed

    Sickerman, Nathaniel S; Hu, Yilin; Ribbe, Markus W

    2017-01-01

    Nitrogenase is a metalloenzyme system that plays a critical role in biological nitrogen fixation, and the study of how its metallocenters are assembled into functional entities to facilitate the catalytic reduction of dinitrogen to ammonia is an active area of interest. The diazotroph Azotobacter vinelandii is especially amenable to culturing and genetic manipulation, and this organism has provided the basis for many insights into the assembly of nitrogenase proteins and their respective metallocofactors. This chapter will cover the basic procedures necessary for growing A. vinelandii cultures and subsequent recombinant transformation and protein expression techniques. Furthermore, protocols for nitrogenase protein purification and substrate reduction activity assays are described. These methods provide a solid framework for the assessment of nitrogenase assembly and catalysis. © 2017 Elsevier Inc. All rights reserved.

  20. Glaucoma and Corneal Transplant Procedures

    PubMed Central

    Al-Mahmood, Ammar M.; Al-Swailem, Samar A.; Edward, Deepak P.

    2012-01-01

    Glaucoma after corneal transplantation is a leading cause of ocular morbidity after penetrating keratoplasty. The incidence reported is highly variable and a number of etiologic factors have been identified. A number of treatment options are available; surgical intervention for IOP control is associated with a high incidence of graft failure. IOP elevation is less frequently seen following deep anterior lamellar keratoplasty. Descemet's striping-automated endothelial keratoplasty is also associated with postprocedure intraocular pressure elevation and secondary glaucoma and presents unique surgical challenges in patients with preexisting glaucoma surgeries. Glaucoma exists in up to three-quarters of patients who undergo keratoprosthesis surgery and the management if often challenging. The aim of this paper is to highlight the incidence, etiology, and management of glaucoma following different corneal transplant procedures. It also focuses on the challenges in the diagnosis of glaucoma and intraocular pressure monitoring in this group of patients. PMID:22315661

  1. Design procedure for effervescent atomizers

    NASA Astrophysics Data System (ADS)

    Chin, J. S.; Lefebvre, A. H.

    1995-04-01

    A methodology for the design of effervescent atomizers is described. The objective is to achieve sprays of minimum mean drop size for any stipulated values of liquid flow rate, air supply pressure, and air/liquid ratio. Application of the method leads to optimum values for all the key atomizer dimensions, including the number and size of the air injection holes, and the diameters of the mixing chamber and discharge orifice. It also enables optimum dimensions to be determined for a convergent-divergent nozzle should such a device be fitted to the nozzle exit to improve atomization performance. Examples are provided to demonstrate the application of the recommended design procedure and to illustrate the relative importance of various flow and geometric parameters in regard to their effects on atomization quality.

  2. Pattern recognition systems and procedures

    NASA Technical Reports Server (NTRS)

    Nelson, G. D.; Serreyn, D. V.

    1972-01-01

    The objectives of the pattern recognition tasks are to develop (1) a man-machine interactive data processing system; and (2) procedures to determine effective features as a function of time for crops and soils. The signal analysis and dissemination equipment, SADE, is being developed as a man-machine interactive data processing system. SADE will provide imagery and multi-channel analog tape inputs for digitation and a color display of the data. SADE is an essential tool to aid in the investigation to determine useful features as a function of time for crops and soils. Four related studies are: (1) reliability of the multivariate Gaussian assumption; (2) usefulness of transforming features with regard to the classifier probability of error; (3) advantage of selecting quantizer parameters to minimize the classifier probability of error; and (4) advantage of using contextual data. The study of transformation of variables (features), especially those experimental studies which can be completed with the SADE system, will be done.

  3. 48 CFR 8.705 - Procedures.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 1 2013-10-01 2013-10-01 false Procedures. 8.705 Section 8.705 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION ACQUISITION PLANNING... Blind or Severely Disabled 8.705 Procedures. ...

  4. 48 CFR 8.705 - Procedures.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 1 2014-10-01 2014-10-01 false Procedures. 8.705 Section 8.705 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION ACQUISITION PLANNING... Blind or Severely Disabled 8.705 Procedures. ...

  5. Procedures For Microbial-Ecology Laboratory

    NASA Technical Reports Server (NTRS)

    Huff, Timothy L.

    1993-01-01

    Microbial Ecology Laboratory Procedures Manual provides concise and well-defined instructions on routine technical procedures to be followed in microbiological laboratory to ensure safety, analytical control, and validity of results.

  6. Conformal Antennas and Integrated Design Procedures

    DTIC Science & Technology

    2006-10-01

    Conformal Antennas and Integrated Design Procedures Mauro Bandinelli, Aldo Citriniti , Antonio Guidoni IDS Ingegneria Dei Sistemi SpA Via Livornese...UNCLASSIFIED/UNLIMITED Bandinelli, M.; Citriniti , A.; Guidoni, A. (2006) Conformal Antennas and Integrated Design Procedures. In Multifunctional

  7. 23 CFR 650.313 - Inspection procedures.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION ENGINEERING AND TRAFFIC OPERATIONS BRIDGES, STRUCTURES, AND HYDRAULICS National Bridge Inspection Standards § 650.313 Inspection procedures. (a) Inspect each bridge in accordance with the inspection procedures in the AASHTO Manual (incorporated by...

  8. 23 CFR 650.313 - Inspection procedures.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION ENGINEERING AND TRAFFIC OPERATIONS BRIDGES, STRUCTURES, AND HYDRAULICS National Bridge Inspection Standards § 650.313 Inspection procedures. (a) Inspect each bridge in accordance with the inspection procedures in the AASHTO Manual (incorporated by...

  9. 10 CFR 2.1304 - Hearing procedures.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... for Hearings on License Transfer Applications § 2.1304 Hearing procedures. The procedures in this subpart will constitute the exclusive basis for hearings on license transfer applications for all...

  10. 10 CFR 2.1304 - Hearing procedures.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... for Hearings on License Transfer Applications § 2.1304 Hearing procedures. The procedures in this subpart will constitute the exclusive basis for hearings on license transfer applications for all...

  11. 40 CFR 92.515 - Hearing procedures.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...) CONTROL OF AIR POLLUTION FROM LOCOMOTIVES AND LOCOMOTIVE ENGINES Manufacturer and Remanufacturer Production Line Testing and Audit Programs § 92.515 Hearing procedures. The procedures provided in § 86.1014...

  12. 40 CFR 92.515 - Hearing procedures.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...) CONTROL OF AIR POLLUTION FROM LOCOMOTIVES AND LOCOMOTIVE ENGINES Manufacturer and Remanufacturer Production Line Testing and Audit Programs § 92.515 Hearing procedures. The procedures provided in § 86.1014...

  13. 16 CFR 1610.6 - Test procedure.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... FLAMMABILITY OF CLOTHING TEXTILES The Standard § 1610.6 Test procedure. The test procedure is divided into two... (k) and (l). There are some fabrics that require extra attention when preparing test...

  14. 16 CFR 1610.6 - Test procedure.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... FLAMMABILITY OF CLOTHING TEXTILES The Standard § 1610.6 Test procedure. The test procedure is divided into two... (k) and (l). There are some fabrics that require extra attention when preparing test...

  15. 47 CFR 15.313 - Measurement procedures.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL RADIO FREQUENCY DEVICES Unlicensed Personal Communications Service Devices § 15.313 Measurement procedures. Measurements must be made in accordance with... measurement procedure must be in accordance with good engineering practice. ...

  16. 28 CFR 902.5 - Hearing procedures.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... PROCEDURES § 902.5 Hearing procedures. (a) The hearing shall be open to the public pursuant to Article VI (d... shall be based upon a majority vote of Council members or their proxies present (as per Compact Article...

  17. 28 CFR 902.5 - Hearing procedures.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... PROCEDURES § 902.5 Hearing procedures. (a) The hearing shall be open to the public pursuant to Article VI (d... shall be based upon a majority vote of Council members or their proxies present (as per Compact Article...

  18. 28 CFR 902.5 - Hearing procedures.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... PROCEDURES § 902.5 Hearing procedures. (a) The hearing shall be open to the public pursuant to Article VI (d... shall be based upon a majority vote of Council members or their proxies present (as per Compact Article...

  19. 28 CFR 902.5 - Hearing procedures.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... PROCEDURES § 902.5 Hearing procedures. (a) The hearing shall be open to the public pursuant to Article VI (d... shall be based upon a majority vote of Council members or their proxies present (as per Compact Article...

  20. Study of Medicare beneficiary complaint procedures.

    PubMed

    Harrington, C; Hanawi, N; Ramirez, T; Parker, M; Giammona, M; Tantaros, M; Newman, J

    2001-01-01

    New procedures for reviewing a sample of Medicare beneficiary complaints about quality of care are compared with traditional procedures at a peer review organization (PRO) for 1998-1999. These new procedures included: (1) expanded communications with complainants and providers, (2) changed data collection methods, (3) integrated concurrent review findings from other agencies, (4) expedited review procedures, and (5) changed the medical review procedures. The findings showed improved beneficiary satisfaction with the new procedures over the traditional procedures and shorter time periods for processing the reviews. Even with the new procedures, beneficiaries continued to be concerned that the review time frames were too lengthy, the reviews generally failed to confirm their complaints, and the PROs generally did not disclose the findings to the beneficiaries.

  1. 40 CFR 96.308 - Appeal procedures.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Ozone Season Trading Program General Provisions § 96.308 Appeal procedures. The appeal procedures for decisions of the Administrator under the CAIR NOX Ozone Season Trading Program are set forth in part 78...

  2. 40 CFR 96.308 - Appeal procedures.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Ozone Season Trading Program General Provisions § 96.308 Appeal procedures. The appeal procedures for decisions of the Administrator under the CAIR NOX Ozone Season Trading Program are set forth in part 78...

  3. 40 CFR 96.308 - Appeal procedures.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Ozone Season Trading Program General Provisions § 96.308 Appeal procedures. The appeal procedures for decisions of the Administrator under the CAIR NOX Ozone Season Trading Program are set forth in part 78...

  4. 40 CFR 96.308 - Appeal procedures.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Ozone Season Trading Program General Provisions § 96.308 Appeal procedures. The appeal procedures for decisions of the Administrator under the CAIR NOX Ozone Season Trading Program are set forth in part 78...

  5. 40 CFR 96.308 - Appeal procedures.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Ozone Season Trading Program General Provisions § 96.308 Appeal procedures. The appeal procedures for decisions of the Administrator under the CAIR NOX Ozone Season Trading Program are set forth in part 78...

  6. 48 CFR 225.7502 - Procedures.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... OF DEFENSE SOCIOECONOMIC PROGRAMS FOREIGN ACQUISITION Balance of Payments Program 225.7502 Procedures. If the Balance of Payments Program applies to the acquisition, follow the procedures at PGI 225.7502....

  7. 48 CFR 225.7502 - Procedures.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... OF DEFENSE SOCIOECONOMIC PROGRAMS FOREIGN ACQUISITION Balance of Payments Program 225.7502 Procedures. If the Balance of Payments Program applies to the acquisition, follow the procedures at PGI 225.7502....

  8. 48 CFR 225.7502 - Procedures.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... OF DEFENSE SOCIOECONOMIC PROGRAMS FOREIGN ACQUISITION Balance of Payments Program 225.7502 Procedures. If the Balance of Payments Program applies to the acquisition, follow the procedures at PGI 225.7502....

  9. 48 CFR 225.7502 - Procedures.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... OF DEFENSE SOCIOECONOMIC PROGRAMS FOREIGN ACQUISITION Balance of Payments Program 225.7502 Procedures. If the Balance of Payments Program applies to the acquisition, follow the procedures at PGI 225.7502....

  10. 48 CFR 225.7502 - Procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... OF DEFENSE SOCIOECONOMIC PROGRAMS FOREIGN ACQUISITION Balance of Payments Program 225.7502 Procedures. If the Balance of Payments Program applies to the acquisition, follow the procedures at PGI 225.7502....

  11. 48 CFR 704.7004 - Procedures.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 5 2012-10-01 2012-10-01 false Procedures. 704.7004 Section 704.7004 Federal Acquisition Regulations System AGENCY FOR INTERNATIONAL DEVELOPMENT GENERAL ADMINISTRATIVE MATTERS Partner Vetting 704.7004 Procedures. ...

  12. 48 CFR 704.7004 - Procedures.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 5 2013-10-01 2013-10-01 false Procedures. 704.7004 Section 704.7004 Federal Acquisition Regulations System AGENCY FOR INTERNATIONAL DEVELOPMENT GENERAL ADMINISTRATIVE MATTERS Partner Vetting 704.7004 Procedures. ...

  13. 48 CFR 704.7004 - Procedures.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 5 2014-10-01 2014-10-01 false Procedures. 704.7004 Section 704.7004 Federal Acquisition Regulations System AGENCY FOR INTERNATIONAL DEVELOPMENT GENERAL ADMINISTRATIVE MATTERS Partner Vetting 704.7004 Procedures. ...

  14. 40 CFR 89.508 - Test procedures.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... procedure as adopted in the California Regulations for New 1996 and Later Heavy-Duty Off-Road Diesel Cycle... exhaust emission standard (or applicable FEL) for oxides of nitrogen. If alternate procedures were used...

  15. 40 CFR 89.508 - Test procedures.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... procedure as adopted in the California Regulations for New 1996 and Later Heavy-Duty Off-Road Diesel Cycle... exhaust emission standard (or applicable FEL) for oxides of nitrogen. If alternate procedures were used...

  16. 40 CFR 89.508 - Test procedures.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... procedure as adopted in the California Regulations for New 1996 and Later Heavy-Duty Off-Road Diesel Cycle... exhaust emission standard (or applicable FEL) for oxides of nitrogen. If alternate procedures were used...

  17. 49 CFR 1180.20 - Procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... railroads under a plan of reorganization are governed by the following procedures: (1) If the buyer or...) If the buyer or operator is a carrier, either: (i) The application procedures in subpart A of...

  18. 40 CFR 307.31 - Filing procedures.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ....31 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY... LIABILITY ACT (CERCLA) CLAIMS PROCEDURES Procedures for Filing and Processing Response Claims § 307.31... under section 107 of CERCLA....

  19. 40 CFR 307.31 - Filing procedures.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ....31 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY... LIABILITY ACT (CERCLA) CLAIMS PROCEDURES Procedures for Filing and Processing Response Claims § 307.31... under section 107 of CERCLA....

  20. 40 CFR 307.31 - Filing procedures.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ....31 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY... LIABILITY ACT (CERCLA) CLAIMS PROCEDURES Procedures for Filing and Processing Response Claims § 307.31... under section 107 of CERCLA....

  1. 40 CFR 307.31 - Filing procedures.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ....31 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY... LIABILITY ACT (CERCLA) CLAIMS PROCEDURES Procedures for Filing and Processing Response Claims § 307.31... under section 107 of CERCLA....

  2. 40 CFR 307.31 - Filing procedures.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ....31 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY... LIABILITY ACT (CERCLA) CLAIMS PROCEDURES Procedures for Filing and Processing Response Claims § 307.31... under section 107 of CERCLA....

  3. 19 CFR 122.173 - Application procedures.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... TREASURY AIR COMMERCE REGULATIONS Air Carrier Smuggling Prevention Program § 122.173 Application procedures... minimum, procedures are in place which: (1) Assure positive security background checks are performed on...

  4. 29 CFR 15.42 - Claim procedures.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Arising Out of the Operation of the Job Corps § 15.42 Claim procedures. (a) Claim. A claim under this... this subpart shall be available pursuant to the procedures and limitations set forth in § 15.29. ...

  5. 37 CFR 42.400 - Procedure; pendency

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... OF COMMERCE TRIAL PRACTICE BEFORE THE PATENT TRIAL AND APPEAL BOARD Derivation § 42.400 Procedure; pendency (a) A derivation proceeding is a trial subject to the procedures set forth in subpart A of this...

  6. 37 CFR 42.100 - Procedure; pendency.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... OF COMMERCE TRIAL PRACTICE BEFORE THE PATENT TRIAL AND APPEAL BOARD Inter Partes Review General § 42.100 Procedure; pendency. (a) An inter partes review is a trial subject to the procedures set forth in...

  7. 37 CFR 42.400 - Procedure; pendency

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... OF COMMERCE TRIAL PRACTICE BEFORE THE PATENT TRIAL AND APPEAL BOARD Derivation § 42.400 Procedure; pendency (a) A derivation proceeding is a trial subject to the procedures set forth in subpart A of this...

  8. 48 CFR 919.805-2 - Procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... BUSINESS PROGRAMS Contracting With the Small Business Administration (The 8(a) Program) 919.805-2 Procedures. Acquisitions involving section 8(a) competition must comply with source selection procedures...

  9. 12 CFR 303.221 - Filing procedures.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... PROCEDURES Section 19 of the FDI Act (Consent to Service of Persons Convicted of Certain Criminal Offenses) § 303.221 Filing procedures. (a) Where to file. An application under section 19 of the FDI Act shall...

  10. 12 CFR 303.221 - Filing procedures.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... PROCEDURES Section 19 of the FDI Act (Consent to Service of Persons Convicted of Certain Criminal Offenses) § 303.221 Filing procedures. (a) Where to file. An application under section 19 of the FDI Act shall...

  11. 12 CFR 303.221 - Filing procedures.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... PROCEDURES Section 19 of the FDI Act (Consent to Service of Persons Convicted of Certain Criminal Offenses) § 303.221 Filing procedures. (a) Where to file. An application under section 19 of the FDI Act shall...

  12. 12 CFR 303.221 - Filing procedures.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... PROCEDURES Section 19 of the FDI Act (Consent to Service of Persons Convicted of Certain Criminal Offenses) § 303.221 Filing procedures. (a) Where to file. An application under section 19 of the FDI Act shall...

  13. Sandia Satellite Program summary of operational procedures

    SciTech Connect

    Not Available

    1989-08-01

    Operational procedures for the Space Systems Department and Space Sensors Department are described. Departmental policies and procedures from design of systems for space applications through qualification for spaceflight are summarized. 1 fig.

  14. Radiation Exposure from Medical Exams and Procedures

    MedlinePlus

    ... Measurements (NCRP) states that exposure to the U.S. population from medical procedures has in- creased since the 1980s (NCRP 2009). These findings can be attrib- uted to the growth in the use of medical im- aging procedures, ...

  15. 40 CFR 140.5 - Analytical procedures.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...) MARINE SANITATION DEVICE STANDARD § 140.5 Analytical procedures. In determining the composition and quality of effluent discharge from marine sanitation devices, the procedures contained in 40 CFR part...

  16. 40 CFR 140.5 - Analytical procedures.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...) MARINE SANITATION DEVICE STANDARD § 140.5 Analytical procedures. In determining the composition and quality of effluent discharge from marine sanitation devices, the procedures contained in 40 CFR part...

  17. 40 CFR 140.5 - Analytical procedures.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...) MARINE SANITATION DEVICE STANDARD § 140.5 Analytical procedures. In determining the composition and quality of effluent discharge from marine sanitation devices, the procedures contained in 40 CFR part...

  18. 40 CFR 140.5 - Analytical procedures.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...) MARINE SANITATION DEVICE STANDARD § 140.5 Analytical procedures. In determining the composition and quality of effluent discharge from marine sanitation devices, the procedures contained in 40 CFR part...

  19. 40 CFR 140.5 - Analytical procedures.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...) MARINE SANITATION DEVICE STANDARD § 140.5 Analytical procedures. In determining the composition and quality of effluent discharge from marine sanitation devices, the procedures contained in 40 CFR part...

  20. Headache following intracranial neuroendovascular procedures.

    PubMed

    Baron, Eric P; Moskowitz, Shaye I; Tepper, Stewart J; Gupta, Rishi; Novak, Eric; Hussain, Muhammad Shazam; Stillman, Mark J

    2012-05-01

    Predicting who will develop post-procedure headache (PPH) following intracranial endovascular procedures (IEPs) would be clinically useful and potentially could assist in reducing the excessive diagnostic testing so often obtained in these patients. Although limited safety data exist, the use of triptans or dihydroergotamine (DHE) often raise concern when used with pre/post-coiled aneurysms. We sought to determine risk factors for PPH following IEP, to evaluate the utility of diagnostic testing in patients with post-coil acute headache (HA), and to record whether triptans and DHE have been used safely in this clinical setting. We conducted a retrospective chart review of adult patients undergoing IEPs. Bivariate analyses were conducted to compare patients who did and did not develop PPH. We reviewed records pertaining to 372 patients, of whom 263 underwent intracranial coil embolizations, 21 acrylic glue embolizations, and 88 stent placements. PPH occurred in 72% of coil patients, 33% of glue patients, and 14% of stent patients. Significant risk factors for post-coil HA were female gender, any pre-coil HA history, smoking, and anxiety/depression. A pre-stent history of HA exceeding 1 year's duration, and smoking were risk factors for post-stent HA. A pre-glue history of HA exceeding 1 year was the only risk factor for post-glue HA. In the small subgroup available for study, treatment with triptans or DHE was not associated with adverse events in pre/post-coiled aneurysms. Diagnostic testing was low yield. Occurrence of PPH was common after IEPs and especially so with coiling and in women, smokers, and those with anxiety/depression, and was often of longer duration than allowed by current International Classification of Headache Disorders-II criteria. The yield of diagnostic testing was low, and in a small subgroup treatment with triptans or DHE did not cause adverse events in pre/post-coiled aneurysms. Prospective studies are needed to confirm these findings.

  1. Automated Product Test Wafer Procedure

    NASA Astrophysics Data System (ADS)

    Brown, Andrew; Minvielle, Anna; Salugsugan, Anita

    1987-04-01

    An automated test wafer procedure has been developed using the KLA 2020 wafer inspector to measure registration and critical dimensions on production wafers. The procedure reduces operator interactions to loading the wafer and entering information for wafer identification. The analysis of the registration data is performed on a PC using the methods established by Perloff to determine both intrafield and grid errors. These results are then used to correct the stepper. CD data is also analyzed by the program and corrections to the exposure time are calculated. It was found that the KLA 2020 is as much as 10 times faster and 4 times more precise in obtaining registration data then an operator reading optical verniers on a microscope. Due to the high precision of the reading, the analysis does not need a large number of readings to obtain precise and accurate stepper corrections. Further, significant improvements can be obtained by adding registration targets to measure the intrafield errors. Using the KLA 2020 and computer analysis we have demonstrated an ability to reduce the errors for a manually aligned run to a one sigma distribution of 0.09 um for x and y translation, 0.4 PPM for scaling and orthogonality, and 2.3 PPM for rotation from the first test wafer for a GCA 6100. Nearly all of this variation is due to operator misalignment or the inability of the stepper to correct the errors. The corrections with this technique measuring the same wafer are precise to + 0.01 um in translation and + 0.5 PPM for rotation, scaling, and orthogonality. It has also been shown that a simple linear equation can be used to correct exposure time, even when a process is not tightly controlled.

  2. Advances in Procedural Techniques - Antegrade

    PubMed Central

    Wilson, William; Spratt, James C.

    2014-01-01

    There have been many technological advances in antegrade CTO PCI, but perhaps most importantly has been the evolution of the “hybrid’ approach where ideally there exists a seamless interplay of antegrade wiring, antegrade dissection re-entry and retrograde approaches as dictated by procedural factors. Antegrade wire escalation with intimal tracking remains the preferred initial strategy in short CTOs without proximal cap ambiguity. More complex CTOs, however, usually require either a retrograde or an antegrade dissection re-entry approach, or both. Antegrade dissection re-entry is well suited to long occlusions where there is a healthy distal vessel and limited “interventional” collaterals. Early use of a dissection re-entry strategy will increase success rates, reduce complications, and minimise radiation exposure, contrast use as well as procedural times. Antegrade dissection can be achieved with a knuckle wire technique or the CrossBoss catheter whilst re-entry will be achieved in the most reproducible and reliable fashion by the Stingray balloon/wire. It should be avoided where there is potential for loss of large side branches. It remains to be seen whether use of newer dissection re-entry strategies will be associated with lower restenosis rates compared with the more uncontrolled subintimal tracking strategies such as STAR and whether stent insertion in the subintimal space is associated with higher rates of late stent malapposition and stent thrombosis. It is to be hoped that the algorithms, which have been developed to guide CTO operators, allow for a better transfer of knowledge and skills to increase uptake and acceptance of CTO PCI as a whole. PMID:24694104

  3. XML syntax for clinical laboratory procedure manuals.

    PubMed

    Saadawi, Gilan; Harrison, James H

    2003-01-01

    We have developed a document type description (DTD) in Extensable Markup Language (XML) for clinical laboratory procedures. Our XML syntax can adequately structure a variety of procedure types across different laboratories and is compatible with current procedure standards. The combination of this format with an XML content management system and appropriate style sheets will allow efficient procedure maintenance, distributed access, customized display and effective searching across a large body of test information.

  4. XML Syntax for Clinical Laboratory Procedure Manuals

    PubMed Central

    Saadawi, Gilan; Harrison, James H.

    2003-01-01

    We have developed a document type description (DTD) in Extensable Markup Language (XML)1 for clinical laboratory procedures. Our XML syntax can adequately structure a variety of procedure types across different laboratories and is compatible with current procedure standards. The combination of this format with an XML content management system and appropriate style sheets will allow efficient procedure maintenance, distributed access, customized display and effective searching across a large body of test information. PMID:14728496

  5. 40 CFR 231.7 - Emergency procedure.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Emergency procedure. 231.7 Section 231.7 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) OCEAN DUMPING SECTION 404(c) PROCEDURES § 231.7 Emergency procedure. Where a permit has already been issued, and the Administrator...

  6. 4 CFR 28.9 - Procedures; general.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 4 Accounts 1 2010-01-01 2010-01-01 false Procedures; general. 28.9 Section 28.9 Accounts GOVERNMENT ACCOUNTABILITY OFFICE GENERAL PROCEDURES GOVERNMENT ACCOUNTABILITY OFFICE PERSONNEL APPEALS BOARD; PROCEDURES APPLICABLE TO CLAIMS CONCERNING EMPLOYMENT PRACTICES AT THE GOVERNMENT ACCOUNTABILITY...

  7. 18 CFR 401.23 - Procedure.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 18 Conservation of Power and Water Resources 2 2011-04-01 2011-04-01 false Procedure. 401.23 Section 401.23 Conservation of Power and Water Resources DELAWARE RIVER BASIN COMMISSION ADMINISTRATIVE MANUAL RULES OF PRACTICE AND PROCEDURE Water Resources Program § 401.23 Procedure. Each project included...

  8. 40 CFR 205.54 - Test procedures.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Test procedures. 205.54 Section 205.54 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) NOISE ABATEMENT PROGRAMS TRANSPORTATION EQUIPMENT NOISE EMISSION CONTROLS Medium and Heavy Trucks § 205.54 Test procedures. The procedures described...

  9. TMACS Test Procedure TP007: System administration

    SciTech Connect

    Scanlan, P.; Washburn, S.; Seghers, R.

    1994-05-24

    The TMACS Software Project Test Procedures translate the project`s acceptance criteria into test steps. Software releases are certified when the affected Test Procedures are successfully performed and the customers authorize installation of these changes. This Test Procedure tests the TMACS System Administration functions.

  10. Developing Flexible Procedural Knowledge in Undergraduate Calculus

    ERIC Educational Resources Information Center

    Maciejewski, Wes; Star, Jon R.

    2016-01-01

    Mathematics experts often choose appropriate procedures to produce an efficient or elegant solution to a mathematical task. This "flexible procedural knowledge" distinguishes novice and expert procedural performances. This article reports on an intervention intended to aid the development of undergraduate calculus students' flexible use…

  11. 18 CFR 401.23 - Procedure.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 18 Conservation of Power and Water Resources 2 2013-04-01 2012-04-01 true Procedure. 401.23 Section 401.23 Conservation of Power and Water Resources DELAWARE RIVER BASIN COMMISSION ADMINISTRATIVE MANUAL RULES OF PRACTICE AND PROCEDURE Water Resources Program § 401.23 Procedure. Each project...

  12. 18 CFR 401.23 - Procedure.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 18 Conservation of Power and Water Resources 2 2014-04-01 2014-04-01 false Procedure. 401.23 Section 401.23 Conservation of Power and Water Resources DELAWARE RIVER BASIN COMMISSION ADMINISTRATIVE MANUAL RULES OF PRACTICE AND PROCEDURE Water Resources Program § 401.23 Procedure. Each project...

  13. 18 CFR 401.23 - Procedure.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 18 Conservation of Power and Water Resources 2 2012-04-01 2012-04-01 false Procedure. 401.23 Section 401.23 Conservation of Power and Water Resources DELAWARE RIVER BASIN COMMISSION ADMINISTRATIVE MANUAL RULES OF PRACTICE AND PROCEDURE Water Resources Program § 401.23 Procedure. Each project...

  14. Medical Service Clinical Laboratory Procedures--Bacteriology.

    ERIC Educational Resources Information Center

    Department of the Army, Washington, DC.

    This manual presents laboratory procedures for the differentiation and identification of disease agents from clinical materials. Included are procedures for the collection of specimens, preparation of culture media, pure culture methods, cultivation of the microorganisms in natural and simulated natural environments, and procedures in…

  15. 40 CFR 231.7 - Emergency procedure.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 25 2014-07-01 2014-07-01 false Emergency procedure. 231.7 Section 231.7 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) OCEAN DUMPING SECTION 404(c) PROCEDURES § 231.7 Emergency procedure. Where a permit has already been issued, and the Administrator has...

  16. 32 CFR 57.6 - Procedures.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 1 2010-07-01 2010-07-01 false Procedures. 57.6 Section 57.6 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE PERSONNEL, MILITARY AND CIVILIAN PROVISION OF EARLY INTERVENTION AND SPECIAL EDUCATION SERVICES TO ELIGIBLE DOD DEPENDENTS § 57.6 Procedures. (a) The procedures...

  17. 32 CFR 57.6 - Procedures.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... INTERVENTION AND SPECIAL EDUCATION SERVICES TO ELIGIBLE DOD DEPENDENTS § 57.6 Procedures. (a) The procedures..., ages 3 through 21 years, inclusive, on IEPs are prescribed in appendix B of this part. (c) The..., inclusive, are prescribed in appendix C of this part (d) Procedural safeguards and parent and student rights...

  18. 34 CFR 110.35 - Compliance procedure.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 34 Education 1 2010-07-01 2010-07-01 false Compliance procedure. 110.35 Section 110.35 Education..., Conciliation, and Enforcement Procedures § 110.35 Compliance procedure. (a) ED may enforce the Act and these regulations under § 110.35(a) (1) or (2) through— (1) Termination of, or refusal to grant or continue, a...

  19. 39 CFR 954.16 - Procedure.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 39 Postal Service 1 2014-07-01 2014-07-01 false Procedure. 954.16 Section 954.16 Postal Service UNITED STATES POSTAL SERVICE PROCEDURES RULES OF PRACTICE IN PROCEEDINGS RELATIVE TO THE DENIAL, SUSPENSION, OR REVOCATION OF PERIODICALS MAIL PRIVILEGES § 954.16 Procedure. (a) Evidence. The general rules...

  20. 39 CFR 954.16 - Procedure.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 39 Postal Service 1 2010-07-01 2010-07-01 false Procedure. 954.16 Section 954.16 Postal Service UNITED STATES POSTAL SERVICE PROCEDURES RULES OF PRACTICE IN PROCEEDINGS RELATIVE TO THE DENIAL, SUSPENSION, OR REVOCATION OF PERIODICALS MAIL PRIVILEGES § 954.16 Procedure. (a) Evidence. The general rules...

  1. 10 CFR 835.104 - Written procedures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Written procedures. 835.104 Section 835.104 Energy DEPARTMENT OF ENERGY OCCUPATIONAL RADIATION PROTECTION Management and Administrative Requirements § 835.104 Written procedures. Written procedures shall be developed and implemented as necessary to ensure...

  2. 49 CFR 581.7 - Test procedures.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 7 2012-10-01 2012-10-01 false Test procedures. 581.7 Section 581.7 Transportation Other Regulations Relating to Transportation (Continued) NATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) BUMPER STANDARD § 581.7 Test procedures. (a) Longitudinal impact test procedures. (1) Impact the...

  3. 40 CFR 1066.10 - Other procedures.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 34 2012-07-01 2012-07-01 false Other procedures. 1066.10 Section 1066.10 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR POLLUTION CONTROLS VEHICLE-TESTING PROCEDURES Applicability and General Provisions § 1066.10 Other procedures. (a)...

  4. 40 CFR 1066.10 - Other procedures.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 34 2013-07-01 2013-07-01 false Other procedures. 1066.10 Section 1066.10 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR POLLUTION CONTROLS VEHICLE-TESTING PROCEDURES Applicability and General Provisions § 1066.10 Other procedures. (a)...

  5. 40 CFR 1066.10 - Other procedures.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 33 2014-07-01 2014-07-01 false Other procedures. 1066.10 Section 1066.10 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR POLLUTION CONTROLS VEHICLE-TESTING PROCEDURES Applicability and General Provisions § 1066.10 Other procedures. (a)...

  6. 18 CFR 401.23 - Procedure.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 18 Conservation of Power and Water Resources 2 2010-04-01 2010-04-01 false Procedure. 401.23 Section 401.23 Conservation of Power and Water Resources DELAWARE RIVER BASIN COMMISSION ADMINISTRATIVE MANUAL RULES OF PRACTICE AND PROCEDURE Water Resources Program § 401.23 Procedure. Each project included...

  7. Administrative Procedures for Small Institutions. Second Edition.

    ERIC Educational Resources Information Center

    Mathews, Keith W., Ed.

    This guide offers sample administrative procedures and policies that can be used by small colleges and universities to prepare or revise administrative procedures manuals. The sample procedures and policies offered here have been compiled from a review of many manuals from many different institutions, and vary from the general to the specific.…

  8. The Cloze Procedure: Latest Research and Uses.

    ERIC Educational Resources Information Center

    Myers, Phyllis C.

    The purpose of this paper is to summarize the development of the cloze procedure, to introduce the most recent work done, and to project the implications for further research in the cloze procedure. The cloze procedure was derived from the Gestalt theory of closure whereby a subject has a tendency to fill in the gaps of an uncompleted visual or…

  9. 20 CFR 422.130 - Claim procedure.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Employees' Benefits SOCIAL SECURITY ADMINISTRATION ORGANIZATION AND PROCEDURES General Procedures § 422.130 Claim procedure. (a) General. The Social Security Administration provides facilities for the public to... station of the Social Security Administration, from the Division of Foreign Claims, Post Office Box 1756...

  10. 49 CFR 581.7 - Test procedures.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 7 2011-10-01 2011-10-01 false Test procedures. 581.7 Section 581.7... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) BUMPER STANDARD § 581.7 Test procedures. (a) Longitudinal impact test procedures. (1) Impact the vehicle's front surface and its rear surface two times...

  11. 49 CFR 581.7 - Test procedures.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 7 2013-10-01 2013-10-01 false Test procedures. 581.7 Section 581.7... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) BUMPER STANDARD § 581.7 Test procedures. (a) Longitudinal impact test procedures. (1) Impact the vehicle's front surface and its rear surface two times...

  12. 40 CFR 90.707 - Test procedures.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 20 2014-07-01 2013-07-01 true Test procedures. 90.707 Section 90.707... Program § 90.707 Test procedures. (a)(1) For small SI engines subject to the provisions of this subpart, the prescribed test procedures are specified in subpart E of this part. (2) The Administrator may,...

  13. Medical Service Clinical Laboratory Procedures--Bacteriology.

    ERIC Educational Resources Information Center

    Department of the Army, Washington, DC.

    This manual presents laboratory procedures for the differentiation and identification of disease agents from clinical materials. Included are procedures for the collection of specimens, preparation of culture media, pure culture methods, cultivation of the microorganisms in natural and simulated natural environments, and procedures in…

  14. 5 CFR 2423.21 - Motions procedure.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 3 2011-01-01 2011-01-01 false Motions procedure. 2423.21 Section 2423... Procedures § 2423.21 Motions procedure. (a) General requirements. All motions, except those made during a prehearing conference or hearing, shall be in writing. Motions for an extension of time, postponement of a...

  15. 22 CFR 911.3 - Procedure.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 22 Foreign Relations 2 2012-04-01 2009-04-01 true Procedure. 911.3 Section 911.3 Foreign Relations FOREIGN SERVICE GRIEVANCE BOARD IMPLEMENTATION DISPUTES § 911.3 Procedure. Implementation disputes shall be handled by the Board in accordance with the procedures set forth in parts 901-910 of this chapter. ...

  16. 22 CFR 911.3 - Procedure.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 22 Foreign Relations 2 2013-04-01 2009-04-01 true Procedure. 911.3 Section 911.3 Foreign Relations FOREIGN SERVICE GRIEVANCE BOARD IMPLEMENTATION DISPUTES § 911.3 Procedure. Implementation disputes shall be handled by the Board in accordance with the procedures set forth in parts 901-910 of this chapter. ...

  17. 22 CFR 911.3 - Procedure.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Procedure. 911.3 Section 911.3 Foreign Relations FOREIGN SERVICE GRIEVANCE BOARD IMPLEMENTATION DISPUTES § 911.3 Procedure. Implementation disputes shall be handled by the Board in accordance with the procedures set forth in parts 901-910 of this chapter. ...

  18. 22 CFR 911.3 - Procedure.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 2 2011-04-01 2009-04-01 true Procedure. 911.3 Section 911.3 Foreign Relations FOREIGN SERVICE GRIEVANCE BOARD IMPLEMENTATION DISPUTES § 911.3 Procedure. Implementation disputes shall be handled by the Board in accordance with the procedures set forth in parts 901-910 of this chapter. ...

  19. 22 CFR 911.3 - Procedure.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 2 2014-04-01 2014-04-01 false Procedure. 911.3 Section 911.3 Foreign Relations FOREIGN SERVICE GRIEVANCE BOARD IMPLEMENTATION DISPUTES § 911.3 Procedure. Implementation disputes shall be handled by the Board in accordance with the procedures set forth in parts 901-910 of this...

  20. 31 CFR 549.801 - Procedures.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Procedures. 549.801 Section 549.801 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY LEBANON SANCTIONS REGULATIONS Procedures § 549.801 Procedures...

  1. 10 CFR 5.605 - Enforcement procedures.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 1 2011-01-01 2011-01-01 false Enforcement procedures. 5.605 Section 5.605 Energy NUCLEAR REGULATORY COMMISSION NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Procedures § 5.605 Enforcement procedures. The investigative, compliance,...

  2. 10 CFR 5.605 - Enforcement procedures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Enforcement procedures. 5.605 Section 5.605 Energy NUCLEAR REGULATORY COMMISSION NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Procedures § 5.605 Enforcement procedures. The investigative, compliance,...

  3. 10 CFR 5.605 - Enforcement procedures.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 1 2013-01-01 2013-01-01 false Enforcement procedures. 5.605 Section 5.605 Energy NUCLEAR REGULATORY COMMISSION NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Procedures § 5.605 Enforcement procedures. The investigative, compliance,...

  4. 10 CFR 5.605 - Enforcement procedures.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 1 2014-01-01 2014-01-01 false Enforcement procedures. 5.605 Section 5.605 Energy NUCLEAR REGULATORY COMMISSION NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Procedures § 5.605 Enforcement procedures. The investigative, compliance,...

  5. 10 CFR 5.605 - Enforcement procedures.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 1 2012-01-01 2012-01-01 false Enforcement procedures. 5.605 Section 5.605 Energy NUCLEAR REGULATORY COMMISSION NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Procedures § 5.605 Enforcement procedures. The investigative, compliance,...

  6. 29 CFR 530.410 - Special procedures.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Special procedures. 530.410 Section 530.410 Labor... OF HOMEWORKERS IN CERTAIN INDUSTRIES Administrative Procedures § 530.410 Special procedures. In a revocation proceeding pursuant to § 530.205(d) of subpart C of this part arising as a result of a certificate...

  7. 40 CFR 1065.10 - Other procedures.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Other procedures. 1065.10 Section 1065.10 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR POLLUTION CONTROLS ENGINE-TESTING PROCEDURES Applicability and General Provisions § 1065.10 Other procedures. (a)...

  8. 49 CFR 195.214 - Welding procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 3 2010-10-01 2010-10-01 false Welding procedures. 195.214 Section 195.214... PIPELINE Construction § 195.214 Welding procedures. (a) Welding must be performed by a qualified welder in accordance with welding procedures qualified under Section 5 of API 1104 or Section IX of the ASME Boiler...

  9. 46 CFR 154.665 - Welding procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 5 2010-10-01 2010-10-01 false Welding procedures. 154.665 Section 154.665 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CERTAIN BULK DANGEROUS CARGOES SAFETY STANDARDS... Construction § 154.665 Welding procedures. Welding procedure tests for cargo tanks for a design...

  10. 10 CFR 26.127 - Procedures.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 1 2011-01-01 2011-01-01 false Procedures. 26.127 Section 26.127 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Licensee Testing Facilities § 26.127 Procedures. (a) Licensee testing facilities shall develop, implement, and maintain clear and well-documented procedures for...

  11. 10 CFR 26.127 - Procedures.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 1 2012-01-01 2012-01-01 false Procedures. 26.127 Section 26.127 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Licensee Testing Facilities § 26.127 Procedures. (a) Licensee testing facilities shall develop, implement, and maintain clear and well-documented procedures for...

  12. 10 CFR 26.127 - Procedures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Procedures. 26.127 Section 26.127 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Licensee Testing Facilities § 26.127 Procedures. (a) Licensee testing facilities shall develop, implement, and maintain clear and well-documented procedures for...

  13. 10 CFR 26.127 - Procedures.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 1 2013-01-01 2013-01-01 false Procedures. 26.127 Section 26.127 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Licensee Testing Facilities § 26.127 Procedures. (a) Licensee testing facilities shall develop, implement, and maintain clear and well-documented procedures for...

  14. 10 CFR 26.127 - Procedures.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 1 2014-01-01 2014-01-01 false Procedures. 26.127 Section 26.127 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Licensee Testing Facilities § 26.127 Procedures. (a) Licensee testing facilities shall develop, implement, and maintain clear and well-documented procedures for...

  15. 21 CFR 16.60 - Hearing procedure.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 1 2011-04-01 2011-04-01 false Hearing procedure. 16.60 Section 16.60 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL REGULATORY HEARING BEFORE THE FOOD AND DRUG ADMINISTRATION Procedures for Regulatory Hearing § 16.60 Hearing procedure....

  16. 21 CFR 16.60 - Hearing procedure.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 1 2014-04-01 2014-04-01 false Hearing procedure. 16.60 Section 16.60 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL REGULATORY HEARING BEFORE THE FOOD AND DRUG ADMINISTRATION Procedures for Regulatory Hearing § 16.60 Hearing procedure....

  17. TMACS Test Procedure TP002: Trending

    SciTech Connect

    Scanlan, P.K.

    1994-08-29

    The TMACS Software Project Test Procedures translate the project`s acceptance criteria into test steps. Software releases are certified when the affected Test Procedures are successfully performed and the customers authorize installation of these changes. This Test Procedure tests the TMACS Trending functions.

  18. 8 CFR 1101.4 - Registration procedure.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 8 Aliens and Nationality 1 2011-01-01 2011-01-01 false Registration procedure. 1101.4 Section 1101.4 Aliens and Nationality EXECUTIVE OFFICE FOR IMMIGRATION REVIEW, DEPARTMENT OF JUSTICE IMMIGRATION REGULATIONS PRESUMPTION OF LAWFUL ADMISSION § 1101.4 Registration procedure. The procedure for an...

  19. 8 CFR 1101.4 - Registration procedure.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 8 Aliens and Nationality 1 2014-01-01 2014-01-01 false Registration procedure. 1101.4 Section 1101.4 Aliens and Nationality EXECUTIVE OFFICE FOR IMMIGRATION REVIEW, DEPARTMENT OF JUSTICE IMMIGRATION REGULATIONS PRESUMPTION OF LAWFUL ADMISSION § 1101.4 Registration procedure. The procedure for an...

  20. 8 CFR 101.4 - Registration procedure.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 8 Aliens and Nationality 1 2011-01-01 2011-01-01 false Registration procedure. 101.4 Section 101.4 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS PRESUMPTION OF LAWFUL ADMISSION § 101.4 Registration procedure. The procedure for an application for creation of a record...

  1. 8 CFR 101.4 - Registration procedure.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Registration procedure. 101.4 Section 101.4 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS PRESUMPTION OF LAWFUL ADMISSION § 101.4 Registration procedure. The procedure for an application for creation of a record...

  2. 8 CFR 1101.4 - Registration procedure.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 8 Aliens and Nationality 1 2013-01-01 2013-01-01 false Registration procedure. 1101.4 Section 1101.4 Aliens and Nationality EXECUTIVE OFFICE FOR IMMIGRATION REVIEW, DEPARTMENT OF JUSTICE IMMIGRATION REGULATIONS PRESUMPTION OF LAWFUL ADMISSION § 1101.4 Registration procedure. The procedure for an...

  3. 8 CFR 101.4 - Registration procedure.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 8 Aliens and Nationality 1 2012-01-01 2012-01-01 false Registration procedure. 101.4 Section 101.4 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS PRESUMPTION OF LAWFUL ADMISSION § 101.4 Registration procedure. The procedure for an application for creation of a record...

  4. 8 CFR 101.4 - Registration procedure.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 8 Aliens and Nationality 1 2013-01-01 2013-01-01 false Registration procedure. 101.4 Section 101.4 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS PRESUMPTION OF LAWFUL ADMISSION § 101.4 Registration procedure. The procedure for an application for creation of a record...

  5. 8 CFR 101.4 - Registration procedure.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 8 Aliens and Nationality 1 2014-01-01 2014-01-01 false Registration procedure. 101.4 Section 101.4 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS PRESUMPTION OF LAWFUL ADMISSION § 101.4 Registration procedure. The procedure for an application for creation of a record...

  6. 8 CFR 1101.4 - Registration procedure.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 8 Aliens and Nationality 1 2012-01-01 2012-01-01 false Registration procedure. 1101.4 Section 1101.4 Aliens and Nationality EXECUTIVE OFFICE FOR IMMIGRATION REVIEW, DEPARTMENT OF JUSTICE IMMIGRATION REGULATIONS PRESUMPTION OF LAWFUL ADMISSION § 1101.4 Registration procedure. The procedure for an...

  7. 12 CFR 303.21 - Filing procedures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Filing procedures. 303.21 Section 303.21 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION PROCEDURE AND RULES OF PRACTICE FILING PROCEDURES... solely as a vehicle to accomplish a merger transaction. (c) A request for continuation of...

  8. 12 CFR 303.63 - Filing procedures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Filing procedures. 303.63 Section 303.63 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION PROCEDURE AND RULES OF PRACTICE FILING PROCEDURES... the merger transaction and any other information requested by the FDIC. (c) Interim...

  9. 7 CFR 1250.508 - Procedure.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 10 2014-01-01 2014-01-01 false Procedure. 1250.508 Section 1250.508 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS... Regulations General § 1250.508 Procedure. The organization of the Egg Board and the procedure for...

  10. 7 CFR 1250.508 - Procedure.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 10 2012-01-01 2012-01-01 false Procedure. 1250.508 Section 1250.508 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS... Regulations General § 1250.508 Procedure. The organization of the Egg Board and the procedure for...

  11. 48 CFR 45.202 - Evaluation procedures.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 1 2011-10-01 2011-10-01 false Evaluation procedures. 45... MANAGEMENT GOVERNMENT PROPERTY Solicitation and Evaluation Procedures 45.202 Evaluation procedures. (a) The... evaluation purposes only, a rental equivalent evaluation factor. (b) The contracting officer shall ensure the...

  12. 34 CFR 76.674 - Hearing procedures.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 34 Education 1 2011-07-01 2011-07-01 false Hearing procedures. 76.674 Section 76.674 Education Office of the Secretary, Department of Education STATE-ADMINISTERED PROGRAMS What Conditions Must Be Met by the State and Its Subgrantees? Procedures for Bypass § 76.674 Hearing procedures. (a)...

  13. 34 CFR 76.674 - Hearing procedures.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 34 Education 1 2010-07-01 2010-07-01 false Hearing procedures. 76.674 Section 76.674 Education Office of the Secretary, Department of Education STATE-ADMINISTERED PROGRAMS What Conditions Must Be Met by the State and Its Subgrantees? Procedures for Bypass § 76.674 Hearing procedures. (a)...

  14. 28 CFR 902.5 - Hearing procedures.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Hearing procedures. 902.5 Section 902.5 Judicial Administration NATIONAL CRIME PREVENTION AND PRIVACY COMPACT COUNCIL DISPUTE ADJUDICATION PROCEDURES § 902.5 Hearing procedures. (a) The hearing shall be open to the public pursuant to Article VI...

  15. 36 CFR 14.77 - Procedures. [Reserved

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 36 Parks, Forests, and Public Property 1 2010-07-01 2010-07-01 false Procedures. 14.77 Section 14.77 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR RIGHTS-OF-WAY Principles and Procedures, Power Transmission Lines § 14.77 Procedures....

  16. 22 CFR 305.5 - Procedures.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Procedures. 305.5 Section 305.5 Foreign Relations PEACE CORPS ELIGIBILITY AND STANDARDS FOR PEACE CORPS VOLUNTEER SERVICE § 305.5 Procedures. Procedures for filing, investigating, and determining allegations of discrimination on the basis of race...

  17. 22 CFR 305.5 - Procedures.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 2 2011-04-01 2009-04-01 true Procedures. 305.5 Section 305.5 Foreign Relations PEACE CORPS ELIGIBILITY AND STANDARDS FOR PEACE CORPS VOLUNTEER SERVICE § 305.5 Procedures. Procedures for filing, investigating, and determining allegations of discrimination on the basis of race...

  18. 22 CFR 305.5 - Procedures.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 2 2014-04-01 2014-04-01 false Procedures. 305.5 Section 305.5 Foreign Relations PEACE CORPS ELIGIBILITY AND STANDARDS FOR PEACE CORPS VOLUNTEER SERVICE § 305.5 Procedures. Procedures for filing, investigating, and determining allegations of discrimination on the basis of race...

  19. 22 CFR 305.5 - Procedures.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 22 Foreign Relations 2 2013-04-01 2009-04-01 true Procedures. 305.5 Section 305.5 Foreign Relations PEACE CORPS ELIGIBILITY AND STANDARDS FOR PEACE CORPS VOLUNTEER SERVICE § 305.5 Procedures. Procedures for filing, investigating, and determining allegations of discrimination on the basis of race...

  20. 48 CFR 45.202 - Evaluation procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Evaluation procedures. 45... MANAGEMENT GOVERNMENT PROPERTY Solicitation and Evaluation Procedures 45.202 Evaluation procedures. (a) The... evaluation purposes only, a rental equivalent evaluation factor. (b) The contracting officer shall ensure the...

  1. 45 CFR 1623.4 - Suspension procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Suspension procedures. 1623.4 Section 1623.4 Public Welfare Regulations Relating to Public Welfare (Continued) LEGAL SERVICES CORPORATION SUSPENSION PROCEDURES § 1623.4 Suspension procedures. (a) When the Corporation has made a proposed determination,...

  2. 39 CFR 776.9 - Review procedures.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 39 Postal Service 1 2010-07-01 2010-07-01 false Review procedures. 776.9 Section 776.9 Postal Service UNITED STATES POSTAL SERVICE ENVIRONMENTAL REGULATIONS FLOODPLAIN AND WETLAND PROCEDURES Wetlands Protection § 776.9 Review procedures. (a) Early public notice. If a facility action at the contending...

  3. 39 CFR 776.9 - Review procedures.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 39 Postal Service 1 2013-07-01 2013-07-01 false Review procedures. 776.9 Section 776.9 Postal Service UNITED STATES POSTAL SERVICE ENVIRONMENTAL REGULATIONS FLOODPLAIN AND WETLAND PROCEDURES Wetlands Protection § 776.9 Review procedures. (a) Early public notice. If a facility action at the contending...

  4. 39 CFR 776.9 - Review procedures.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 39 Postal Service 1 2014-07-01 2014-07-01 false Review procedures. 776.9 Section 776.9 Postal Service UNITED STATES POSTAL SERVICE ENVIRONMENTAL REGULATIONS FLOODPLAIN AND WETLAND PROCEDURES Wetlands Protection § 776.9 Review procedures. (a) Early public notice. If a facility action at the contending...

  5. 39 CFR 776.9 - Review procedures.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 39 Postal Service 1 2012-07-01 2012-07-01 false Review procedures. 776.9 Section 776.9 Postal Service UNITED STATES POSTAL SERVICE ENVIRONMENTAL REGULATIONS FLOODPLAIN AND WETLAND PROCEDURES Wetlands Protection § 776.9 Review procedures. (a) Early public notice. If a facility action at the contending...

  6. 39 CFR 776.9 - Review procedures.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 39 Postal Service 1 2011-07-01 2011-07-01 false Review procedures. 776.9 Section 776.9 Postal Service UNITED STATES POSTAL SERVICE ENVIRONMENTAL REGULATIONS FLOODPLAIN AND WETLAND PROCEDURES Wetlands Protection § 776.9 Review procedures. (a) Early public notice. If a facility action at the contending...

  7. 46 CFR 272.14 - Survey procedures.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 8 2011-10-01 2011-10-01 false Survey procedures. 272.14 Section 272.14 Shipping... OPERATORS REQUIREMENTS AND PROCEDURES FOR CONDUCTING CONDITION SURVEYS AND ADMINISTERING MAINTENANCE AND... Survey procedures. (a) Prior to survey. Unless otherwise directed by MARAD, the Operator of a...

  8. 46 CFR 272.14 - Survey procedures.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 8 2013-10-01 2013-10-01 false Survey procedures. 272.14 Section 272.14 Shipping... OPERATORS REQUIREMENTS AND PROCEDURES FOR CONDUCTING CONDITION SURVEYS AND ADMINISTERING MAINTENANCE AND... Survey procedures. (a) Prior to survey. Unless otherwise directed by MARAD, the Operator of a...

  9. 46 CFR 272.14 - Survey procedures.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 8 2012-10-01 2012-10-01 false Survey procedures. 272.14 Section 272.14 Shipping... OPERATORS REQUIREMENTS AND PROCEDURES FOR CONDUCTING CONDITION SURVEYS AND ADMINISTERING MAINTENANCE AND... Survey procedures. (a) Prior to survey. Unless otherwise directed by MARAD, the Operator of a...

  10. 46 CFR 272.14 - Survey procedures.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 8 2014-10-01 2014-10-01 false Survey procedures. 272.14 Section 272.14 Shipping... OPERATORS REQUIREMENTS AND PROCEDURES FOR CONDUCTING CONDITION SURVEYS AND ADMINISTERING MAINTENANCE AND... Survey procedures. (a) Prior to survey. Unless otherwise directed by MARAD, the Operator of a...

  11. 46 CFR 272.14 - Survey procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 8 2010-10-01 2010-10-01 false Survey procedures. 272.14 Section 272.14 Shipping... OPERATORS REQUIREMENTS AND PROCEDURES FOR CONDUCTING CONDITION SURVEYS AND ADMINISTERING MAINTENANCE AND... Survey procedures. (a) Prior to survey. Unless otherwise directed by MARAD, the Operator of a...

  12. 22 CFR 305.5 - Procedures.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 22 Foreign Relations 2 2012-04-01 2009-04-01 true Procedures. 305.5 Section 305.5 Foreign Relations PEACE CORPS ELIGIBILITY AND STANDARDS FOR PEACE CORPS VOLUNTEER SERVICE § 305.5 Procedures. Procedures for filing, investigating, and determining allegations of discrimination on the basis of...

  13. Procedural Learning and Individual Differences in Language

    ERIC Educational Resources Information Center

    Lee, Joanna C.; Tomblin, J. Bruce

    2015-01-01

    The aim of the current study was to examine different aspects of procedural memory in young adults who varied with regard to their language abilities. We selected a sample of procedural memory tasks, each of which represented a unique type of procedural learning, and has been linked, at least partially, to the functionality of the corticostriatal…

  14. 8 CFR 1101.4 - Registration procedure.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Registration procedure. 1101.4 Section 1101... REGULATIONS PRESUMPTION OF LAWFUL ADMISSION § 1101.4 Registration procedure. The procedure for an application... a person eligible for presumption of lawful admission for permanent residence under § 1101.1...

  15. 7 CFR 356.8 - Return procedure.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 5 2012-01-01 2012-01-01 false Return procedure. 356.8 Section 356.8 Agriculture Regulations of the Department of Agriculture (Continued) ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE FORFEITURE PROCEDURES § 356.8 Return procedure. If, at the conclusion...

  16. 10 CFR 603.400 - Competitive procedures.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 4 2014-01-01 2014-01-01 false Competitive procedures. 603.400 Section 603.400 Energy DEPARTMENT OF ENERGY (CONTINUED) ASSISTANCE REGULATIONS TECHNOLOGY INVESTMENT AGREEMENTS Competition Phase § 603.400 Competitive procedures. DOE policy is to award a TIA using competitive procedures and a merit...

  17. 10 CFR 603.400 - Competitive procedures.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 4 2012-01-01 2012-01-01 false Competitive procedures. 603.400 Section 603.400 Energy DEPARTMENT OF ENERGY (CONTINUED) ASSISTANCE REGULATIONS TECHNOLOGY INVESTMENT AGREEMENTS Competition Phase § 603.400 Competitive procedures. DOE policy is to award a TIA using competitive procedures and a merit...

  18. 10 CFR 603.400 - Competitive procedures.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 4 2011-01-01 2011-01-01 false Competitive procedures. 603.400 Section 603.400 Energy DEPARTMENT OF ENERGY (CONTINUED) ASSISTANCE REGULATIONS TECHNOLOGY INVESTMENT AGREEMENTS Competition Phase § 603.400 Competitive procedures. DOE policy is to award a TIA using competitive procedures and a merit...

  19. 25 CFR 11.313 - Trial procedure.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 25 Indians 1 2012-04-01 2011-04-01 true Trial procedure. 11.313 Section 11.313 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAW AND ORDER COURTS OF INDIAN OFFENSES AND LAW AND ORDER CODE Criminal Procedure § 11.313 Trial procedure. (a) The time and place of court sessions, and all other...

  20. 25 CFR 11.313 - Trial procedure.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 25 Indians 1 2011-04-01 2011-04-01 false Trial procedure. 11.313 Section 11.313 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAW AND ORDER COURTS OF INDIAN OFFENSES AND LAW AND ORDER CODE Criminal Procedure § 11.313 Trial procedure. (a) The time and place of court sessions, and all other...