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Petiot, Geneviève, and Sandrine Reboul-Touré. "Le hidjab. Un emprunt autour duquel on glose." Mots, no. 82 (November 1, 2006): 49–64. http://dx.doi.org/10.4000/mots.781.
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Koussens, David. "Le port de signes religieux dans les écoles québécoises et françaises. Accomodements (dé)raisonnables ou interdiction (dé)raisonnée?" Globe 11, no. 1 (February 7, 2011): 115–31. http://dx.doi.org/10.7202/1000494ar.
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Les débats portant sur le port de signes religieux dans les écoles ont trait à la question fondamentale de l’intégration des religions minoritaires dans l’espace public et soulèvent la question de la mise en oeuvre de la neutralité par l’État dans la sphère publique. Le port de signes religieux dans les écoles suscite des débats pour la première fois en France en 1989 et au Québec, en 1994. Sur des fondements différents, mais tout en refusant d’interpréter le signe religieux, ces deux sociétés adoptent alors des positions similaires en autorisant notamment le port du hidjab dans les écoles publiques. Cette situation n’est plus d’actualité. Refusant la visibilité de la diversité religieuse dans l’enceinte de l’institution républicaine qu’est l’école et réaffirmant le rôle de cette institution comme lieu de transmission de valeurs partagées par les citoyens, la France a explicitement interprété le signe religieux pour l’interdire dans les écoles publiques par une loi édictée le 15 mars 2004. Ce faisant, elle confirme son attachement à un modèle d’intégration républicain et s’éloigne ainsi du Canada, où la Cour suprême, en imposant désormais des accommodements raisonnables aux institutions scolaires, promeut l’idée que l’école est un espace de redéfinition des valeurs partagées par les citoyens.
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Dhina, A. "Hidjaba." Encyclopédie berbère, no. 22 (January 1, 2000): 3460–61. http://dx.doi.org/10.4000/encyclopedieberbere.1731.
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Sanjaya, Ari Susandy, and Ari Nofendy. "Prediksi Pembentukan Hidrat Gas dengan Pengaruh Joule-Thomson Effect yang Diakibatkan oleh Choke Performance." Jurnal Chemurgy 1, no. 1 (April 24, 2018): 1. http://dx.doi.org/10.30872/cmg.v1i1.1132.
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Hidrat gas merupakan air bebas dan gas alam yang membentuk padatan, yang dapat mengakibatkan saluran gas akan membuntu, terutama di flow line serta akan menimbulkan beberapa permasalahan lainnya. Penelitian ini bertujuan untuk memprediksi pembentukan hidrat gas dengan pengaruh Joule-Thomson Effect yang diakibatkan oleh choke performance.Di gunakan metode Katz untuk memprediksi gas hidrat dengan kisaran tekanan antara 100-1000 Psia.Didapatkan temperatur pembentukan hidrat gas pada tekanan 100 Psia sebesar 0.7005 ˚C,sedangkan pada tekanan 1000 Psia sebesar 17.4766 ˚C. Dari hasil nilai koefisien Joule-Thomson didapatkan 0.003972 K/Kpa. Dari hasil nilai temperatur pada flowline terdapat beberapa temperatur yang berada diatas kurva temperatur pembentuk hidrat gas sehingga berpotensi terjadi hidrat gas pada flowline. Sehingga dapat disimpulkan bahwa beberapa kondisi pada flowline berpotensi terjadinya hidrat gas dan harus dilakukan pencegahan.Kata Kunci: hidrat gas, efek Joule-Thomson, metode Katz, flow line.
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Nandari, Wibiana Wulan, Imam Prasetyo, and Moh Fahrurrozi. "Optimasi Rasio Air dan Karbon Berpori untuk Proses Pembentukan Metana Hidrat." Eksergi 13, no. 1 (June 1, 2016): 17. http://dx.doi.org/10.31315/e.v13i1.1437.
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Metana merupakan sumber energi alternatif yang sangat potensial dan melimpah serta menghasilkan emisi CO2 yang lebih rendah ketika digunakan sebagai bahan bakar karena kandungan C dalam molekul metana jauh lebih kecil dari kandungan H nya. Selain ada dalam bentuk gas, metana di alam juga bisa berada dalam bentuk metana hidrat. Setiap volume metana hidrat mengandung sebanyak 164 volume gas metana dalam keadaan standar (STP). Proses terbentuknya metana hidrat di alam dapat diadopsi sebagai metode penyimpanan gas metana. Pada penelitian ini akan dilakukan percobaan pembentukan metana hidrat pada karbon mesopori dengan jumlah air yang bervariasi untuk mengetahui kandungan air optimum untuk membentuk metana hidrat secara efektif. Penelitian dilakukan dengan mengadsorpsi gas metana pada karbon berpori yang basah dengan metode static volumetric. Untuk mengetahui rasio yang optimum terhadap proses terbentuknya metana hidrat, maka pada penelitian ini dilakukan percobaan dengan rasio berat air dibandingkan karbon berpori 0,5 ; 1 ; 1,5 ; 2. Sistem adsorpsi dikondisikan pada suhu 275 K dengan maksud untuk menghindari terbentuknya es (sistem dikondisikan diatas titik beku air). Hasil percobaan menunjukkan bahwa rasio air : karbon mesopori yang memberikan jumlah metana hidrat yang paling besar adalah pada R = 1
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Mayasari, Vanniastuti, Okto Ivansyah, and Yulinar Firdaus. "Identifikasi Keberadaan Gas Hidrat Menggunakan Bottom Simulating Reflector pada Penampang Seismic 2D di Cekungan Aru, Papua Barat." POSITRON 9, no. 2 (December 2, 2019): 61. http://dx.doi.org/10.26418/positron.v9i2.33303.
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Gas hidrat merupakan senyawa dengan molekul gas terperangkap di dalam sel-sel kristal yang terbentuk dari molekul air dan dipertahankan dalam bentuk hidrat oleh ikatan hidrogen. Gas hidrat diharapkan dapat menjadi sumber energi alternatif. Penelitian ini dilakukan di Cekungan Aru, Papua Barat. Cekungan Aru memiliki kondisi terisi oleh sedimen berupa fraksi halus setelah proses deformasi pada masa pliosen hingga resen yang diidentifikasi sebagai sedimen terigenus atau pelagik karena terdiri dari sisa-sisa cangkang mikroorganisme sehingga memungkinkan terbentuknya zona stabilitas gas hidrat. Penelitian ini bertujuan untuk mengidentifikasi keberadaan gas hidrat menggunakan bottom simulating reflector (BSR) pada penampang seismik 2D. Kenampakan BSR menjadi indikator utama keberadaan gas hidrat pada saat proses interpretasi. Penelitian ini menggunakan tiga lintasan seismik hasil brute stack, yaitu L01.6, L26, dan L27. Berdasarkan hasil penelitian yang diperoleh, BSR terindikasi pada L01.6 dengan rentang CDP 8321 hingga CDP 8481 pada TWT 4000 ms hingga TWT 5500 ms, kemudian CDP 16300 hingga CDP 23600 pada TWT 4500 ms hingga TWT 7900 ms dan L27 dengan rentang CDP 1281 hingga CDP 4641 pada TWT 5250 ms hingga TWT 6500 ms. Kenampakan BSR pada penampang seismik menyerupai garis putus-putus, memotong stratigrafi, sejajar dengan lapisan sedimen, dan ada yang membentuk lensa-lensa. Karakteristik BSR juga didukung dengan anomali interval velocity pada semblance saat proses analisis kecepatan.
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Dewi, Rismala, and Andina Judith. "Penggunaan Kloral Hidrat Oral Dibandingkan Ketamin Intramuskular sebagai Agen Sedasi Pratindakan Invasif pada Anak." Sari Pediatri 22, no. 1 (June 24, 2020): 49. http://dx.doi.org/10.14238/sp22.1.2020.49-56.
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Latar belakang. Sedasi pratindakan merupakan salah satu faktor penentu keberhasilan tindakan invasif pada anak. Sebelum tindakan, pasien idealnya diberikan sedasi melalui jalur intravena. Jalur intravena ini seringkali sulit didapat, bahkan menjadi indikasi pemasangan akses sentral. Sedasi rutin diluar intravena yang umum digunakan adalah ketamin intramuskular, namun pemberian ini tidak nyaman dan seringkali dibutuhkan pemberian berulang sehingga menyakitkan bagi anak. Salah satu sedasi yang dapat dipertimbangkan sebagai alternatif adalah pemberian kloral hidrat oral.Tujuan. Mengetahui efektivitas kloral hidrat oral dibandingkan dengan ketamin intramuskular pada pasien anak yang memerlukan tindakan invasif dalam kondisi akses vaskular sulit.Metode. Penelusuran pustaka database elektronik menggunakan Pubmed®, Cochrane® serta penelusuran manual.Hasil. Studi oleh Campbell dkk, menunjukkan bahwa rerata waktu induksi dengan menggunakan kloral hidrat lebih lama dibandingkan ketamin intramuskular (43,8 menit vs 16,6 dan 15,2 menit, p<0,001) dengan rerata waktu sedasi yang hampir sama pada kedua kelompok. Studi lain oleh Min dkk, menunjukkan hasil serupa dalam waktu induksi (kloral hidrat 34,97±24.07 menit, ketamin 14,97±8.77 menit, p≤0,001), tetapi tidak berbeda bermakna dalam durasi sedasi (kloral hidrat 72,49±51,75 menit, ketamin 56,09 ±32,31 menit p=0,102).Kesimpulan. Pemberian kloral hidrat sebagai sedasi pratindakan invasif memiliki efektivitas yang sama dengan ketamin intramuskular, meskipun memerlukan waktu lebih lama untuk induksi sedasi.
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Capizzi, R. L., R. Davis, B. Powell, J. Cuttner, R. R. Ellison, M. R. Cooper, R. Dillman, W. B. Major, E. Dupre, and O. R. McIntyre. "Synergy between high-dose cytarabine and asparaginase in the treatment of adults with refractory and relapsed acute myelogenous leukemia--a Cancer and Leukemia Group B Study." Journal of Clinical Oncology 6, no. 3 (March 1988): 499–508. http://dx.doi.org/10.1200/jco.1988.6.3.499.
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One hundred ninety-five adult patients with refractory or first relapse acute myelogenous leukemia (AML) were randomly assigned to receive high-dose cytarabine (HiDAC), 3 g/m2 as a three-hour intravenous (IV) infusion every 12 hours for four doses, followed by 6,000 IU/m2 asparaginase (ASNase) administered at hour 42, or HiDAC without ASNase. Treatment was repeated on day 8. The median patient age was 52 years. There was an overall superior complete remission (CR) rate for HiDAC/ASNase (40%) v HiDAC (24%), P = .02. Subset analysis according to prior response and age showed the following CR rates: 54% from HiDAC/ASNase treatment of refractory AML in patients less than 60 years, and 31% in patients greater than 60 years; CR from HiDAC in the same refractory groups were 18% (less than 60) and 0% (greater than 60); 37% from HiDAC/ASNase treatment of relapsed AML in patients less than 60 years, and 43% in patients greater than 60 years; CRs from HiDAC in the same relapsed groups were 33% (less than 60) and 21% (greater than 60). Toxicity in the two treatment arms was comparable and consisted primarily of leukopenia, thrombocytopenia, mild hepatic dysfunction, diarrhea, conjunctivitis and serositis, and hyperglycemia. There was only one case of transient cerebellar toxicity and no cutaneous toxicity. Median time to full hematologic recovery was 5 weeks. There was an overall survival benefit for patients treated with HiDAC/ASNase (19.6 weeks) compared with HiDAC (15.9 weeks), P = .046, primarily attributable to effects in refractory patients. Median time to failure for refractory patients who achieved CR was 38.5 weeks with HiDAC/ASNase, and 13.3 weeks for those treated with HiDAC. For relapsed patients in CR from HiDAC/ASNase the median time to failure was 17.7 weeks and 18.3 weeks for HiDAC. The overall 42% CR rate from HiDAC/ASNase v 12% from HiDAC in patients with refractory AML indicates that HiDAC/ASNase is not cross-resistant with standard-dose cytarabine (SDAC) and anthracyclines. We conclude that HiDAC/ASNase has substantial activity in poor-prognosis AML and that this combination warrants further trials in earlier stage disease.
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Ucok, Ucok Sugeng. "A Perancangan Pompa Hidram Pada Tabung Udara Dengan Metode VDI 2221." TEKNOSAINS : Jurnal Sains, Teknologi dan Informatika 7, no. 1 (January 28, 2020): 36–42. http://dx.doi.org/10.37373/tekno.v7i1.7.
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Saat ini teknologi untuk menyuplai air masih kebanyakan menggunakan pompa dengan penggerak motor listrik sebagian besar pompa tersebut memiliki ketergantungan akan energi listrik atau bahan bakar minyak sebagai energi penggerak pompa . Salah satu teknologi yang mulai dikembangkan adalah pompa hydraulic ram . Pompa hidram bekerja berdasarkan prinsip palu air. Ketika aliran fluida dihentikan secara tiba-tiba maka perubahan momentum massa fluida tersebut akan meningkatkan tekanan secara tiba-tiba. Peningkatan tekanan ini digunakan untuk mengangkat sebagian air ke tempat yang lebih tinggi. Maka dirancanglah pompa hidram yang menggunakan energi potensial air sebagai penggeraknya.Dalam perancangan pompa hidram yang penulis lakukan, menggunakan variasi tinggi tabung udara dengan tinggi 0,55 m dengan diameter 3 inch dan variasi panjang pipa pemasukan dengan panjang 1,64 m,Tinggi saluran suplai 0,3 m dan tinggi saluran output 1,55 m dapat kapasitas pompa maksimum sebesar 0,00041 Efesiensi maksimum pompa hidram 5,9 % .
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BOUZIANI, YAMNA, H. Degaichia, and M. Benmoussa. "Effect of cadmium on the germinative parameters of bread wheat." Revista Mexicana de Ciencias Agrícolas 10, no. 2 (March 22, 2019): 301–9. http://dx.doi.org/10.29312/remexca.v10i2.1476.
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The wheat is being a plant largely cultivated for its seeds and its straw wherefore the research of tolerant varieties to this dangerous element for the plant or the human health is necessary. Its concentrations increase day after day in the ground considering the development of the farming which involves the intensive contributions of this polling metal element. Objectives of this study is to test the effect of a range of cadmium concentration from 0 to 200 mg L-1 Cd+2on the parameters of germination of two varieties of bread wheat Anza and Hiddab. The results show that the phytotoxicity increases, according to the increase in the Cd amount on the rate of germination, root and shoot length, root and shoot dry weight and tolerant index compared with the control for both varieties studied, nevertheless, Hiddab variety shows more sensitivity when compared to Anza variety. The inhibiting effect of cadmium on the germination stage can be continued in the advanced stages of plant cycle and disturb its physiological aspects.
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Wibowo, Budi Santoso. "PENGARUH VARIASI DIAMETER PIPA INPUT DAN PIPA OUTPUT TERHADAP KINERJA POMPA HIDRAM." Machine : Jurnal Teknik Mesin 5, no. 2 (October 2, 2019): 41–44. http://dx.doi.org/10.33019/jm.v5i2.1366.
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Provinsi Bangka Belitung merupakan salah satu provinsi yang memiliki potensi lahan pertanian yang sangat luas, dengan potensi sumber daya air melimpah disuatu daerah seringkali berlawanan dengan kondisi yang ada dimana sebagian wilayah masih terjadi kekurangan air. Seringkali adanya sumber air berada di bawah lokasi pemukiman ataupun lahan pertanian, sehingga kesulitan dalam memanfaatkannya. Penggunaan pompa listrik/diesel mempunyai konsekuensi biaya yang tidak sedikit, seperti yang dilakukan beberapa petani dengan menggunakan pompa diesel untuk mengairi ladang pertaniannya dari sungai yang ada di dekat lokasi. Salah satu teknologi yang sederhana dan murah untuk dimanfaatkan adalah dengan pemanfaatan pompa hidram. Metodelogi dalam penelitian ini adalah penggerak pompa hidram berasal dari hantaman air yang masuk kedalam pompa melalui pipa yang bergantung kepada debit aliran yang masuk kedalam pompa. Penelitian ini membahas tentang kinerja pompa hidram pada variasi diameter pipa Input dan pipa Output. Hasil dari penelitian bahwa efisiensi terbesar pompa hidram untuk debit 8 LPM adalah pada variasi diameter pipa Input 1 inchi dan pipa Output 1½ inchi yaitu 9,5%, sedangkan efisiensi terendah pada variasi diameter pipa Input 1½ inchi dan pipa Output 1½ inchi yaitu 6,2%. Dari hasil penelitian yang didapatkan bahwa semakin besardiameter pipa Input dan semakin kecil diameter pipa Output maka efisiensi yang dihasilkan pada pompa hidram semakin besar.
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Rifandi, Ahmad, and Zayyin Kamil Billiman. "Pengaruh “Drive Head” terhadap Efisiensi dan Kemampuan “Delivery Head” Maksimum pada Pompa Hidram." FLUIDA 12, no. 1 (May 31, 2019): 21–28. http://dx.doi.org/10.35313/fluida.v12i1.1619.
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Tujuan dari penelitian ini adalah untuk mempelajari pengaruh ketinggian sumber air (drive head) terhadap efisiensi dan kemampuan maksimum memompa air (delivery head) pada pompa jenis hidram. Pompa hidram yang dibuat terdiri dari ukuran ½, ¾, dan 1 in. Dalam penelitian ini, air dialirkan dari tangki penampung sebagai sumber air melalui “drive pipe”, selanjutnya pompa hidram memompakan air tersebut ke tempat yang lebih tinggi melalui “delivery pipe”. Hasil penelitian menunjukkan bahwa tinggi sumber air umpan (drive head) dan tinggi tangki air penampung (delivery head) berpengaruh terhadap efisiensi pompa. Semakin besar drive head (h) dan delivery head (H), untuk semua ukuran pompa, efisiensi pompa semakin menurun. Efisiensi tertinggi pompa yaitu pada pompa hidram ukuran 1 in dimana drive head (h) pompa tersebut setinggi 0,55 m dan delivery head (H) setinggi 3 m dengan efisiensi sebesar 56,73 %. Tinggi sumber air umpan (drive head) berpengaruh terhadap delivery head maksimum (Hmax), semakin besar drive head (h) semakin besar delivery head maksimumnya (Hmax).
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Triarso, Eko, and Rainer Arief Troa. "INDIKASI KEBERADAAN GAS HIDRAT PADA CEKUNGAN BUSUR MUKA SIMEULUE DAN POTENSINYA SEBAGAI SUMBER ENERGI MASA DEPAN." Jurnal Kelautan Nasional 11, no. 3 (October 14, 2016): 127. http://dx.doi.org/10.15578/jkn.v11i3.6114.
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Gas hidrat merupakan gas metana (CH4) yang bersenyawa dengan air membentuk padatan kristal es pada temperatur dan tekanan tertentu sehingga pada kristal es ini mengandung molekul CH4 di dalam rongga molekul air (H2O). Keberadaan gas hidrat diharapkan dapat menjadi sumber energi baru masa depan. Cekungan Busur Muka (Cekungan) Simeulue memiliki kondisi tektonik dengan akumulasi sedimen laut dalam yang tebal sertadiindikasikan memiliki temperatur dan tekanan yang memungkinkan bagi terbentuknya zona stabilitas gas hidrat (Gas Hydrate Stability Zone-GHSZ).Tujuan penelitian adalah melakukan identifikasi keberadaan gas hidrat melalui interpretasi pada penampang seismik Cekungan Simeulue. Metodologi yang digunakan adalah melakukan pengolahan data seismik (seismic data processing) untuk menghasilkan penampang bawah permukaan dasar laut yang dapat memberikan gambaran struktur geologi dan perlapisan sedimen dengan cukup detail dan akurat. Karakteristik bottom simulating reflector(BSR) pada penampang seismik merupakan indikasi utama keberadaan gashidrat di dalam lapisan sedimen dasar laut. Data primer yang digunakan adalah hasil survei akuisisi seismik multichannel 2-Dpada 3 lintasan di Cekungan Simeulue. Survei seismik ini merupakan hasil kerjasama riset kelautan Indonesia-Jerman SEACAUSE II pada tahun 2006 di perairan barat Sumatera yang berhasil mendapatkan data pada 43 lintasan seismik. Berdasarkan hasil penelitian ini, BSR sebagai indikasi keberadaaan gas hidrat ditemukan pada 3 lintasan seismik pada Cekungan Simeulue yaitu lintasan BGR06-136, BGR06-137, dan BGR06-139 dengan karakteristik membentuk lensa, sejajar ataupun memotong horison perlapisan sedimen.
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Benderradji, Laid, Faiçal Brini, Kamel Kellou, Nadia Ykhlef, Abdelhamid Djekoun, Khaled Masmoudi, and Hamenna Bouzerzour. "Callus Induction, Proliferation, and Plantlets Regeneration of Two Bread Wheat (Triticum aestivum L.) Genotypes under Saline and Heat Stress Conditions." ISRN Agronomy 2012 (December 15, 2012): 1–8. http://dx.doi.org/10.5402/2012/367851.
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Response of two genotypes of bread wheat (Triticum aestivum), Mahon-Demias (MD) and Hidhab (HD1220), to mature embryo culture, callus production, and in vitro salt and heat tolerance was evaluated. For assessment of genotypes to salt and heat tolerance, growing morphogenic calli were exposed to different concentrations of NaCl (0, 5, 10, and 15 g·L−1) and under different thermal stress intensities (25, 30, 35, and 40°C). Comparison of the two genotypes was reported for callus induction efficiency from mature embryo. While, for salt and heat tolerance, the proliferation efficiency, embryonic efficiency, and regeneration efficiency were used. The results show significant medium and genotype effects for the embryogenesis capacity of calluses induction and plantlets regeneration under saline and thermal stresses. Mahon-Demias showed good callus induction and ability to proliferate and regenerate seedling under heat and salt stress conditions compared to Hidhab. No sizeable differences were observed between the two genotypes at higher salt stress rates. This study will serve as a base line for in vitro screening of several elite wheat cultivars for their ability to induce callus and regenerate plants from mature embryos, and to start selection for tolerance to salinity.
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Schwarer, Anthony P., Joel Wight, Kathryn Jackson, Ashanka Mahilal Beligaswatte, Jason P. Butler, Glen Kennedy, Louisa Martin, et al. "High-Dose Cytarabine (HiDAC) Improves the Cure Rate of Patients with Newly Diagnosed Acute Myeloid Leukemia (AML): Is It Better to be Given As Induction Therapy or As Consolidation Therapy?" Blood 128, no. 22 (December 2, 2016): 3989. http://dx.doi.org/10.1182/blood.v128.22.3989.3989.
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Abstract Introduction: The optimal treatment approach for newly diagnosed patients with AML remains uncertain. HiDAC is widely considered to increase the proportion of patients cured compared to standard-dose cytarabine. However, it remains uncertain whether HiDAC is best given during induction or consolidation, and how many cycles of HiDAC are optimal. Many centres in Australia treat younger patients (age ≤60 yrs) with newly diagnosed AML with one of two approaches: either 7+3 induction followed by HiDAC-2 consolidation for 2 cycles; or a single course of HiDAC-3±7 induction followed by 2 cycles of lower dose cytarabine-based therapy (eg 5+2±5). Our retrospective study compared the outcomes of these 2 approaches in a large cohort of Australian patients treated at 5 centres. Methods: Consecutive patients aged ≤60 yrs with a new diagnosis of AML (de novo or secondary) were included in the study if they were planned for treatment with either: 1) cytarabine 100 mg/m2 for 7 days plus idarubicin 12 mg/m2 for 3 days (7+3) induction followed by 2 cycles of HiDAC 3 g/m2 days 1,3,5,7 plus idarubicin 12 mg/m2 for 2 days (HiDAC consolidation cohort); or 2) HiDAC 3 g/m2 days 1,3,5,7 plus idarubicin 9-12 mg/m2 for 3 days ± etoposide 75-100 mg/m2 for 7 days as induction followed mostly by cytarabine 100 mg/m2 for 5 days plus idarubicin 9-12 mg/m2 for 2 days ± etoposide 75-100 mg/m2 for 5 days as consolidation (HiDAC induction cohort). Patients were diagnosed from 1999 to June 2013, and were followed for at least 12 months with data cut off June 2014. Results: 486 patients were included: HiDAC consolidation cohort n=251; HiDAC induction cohort n=235. The HiDAC consolidation cohort had a greater median age (49 vs 47 yrs, p=0.02) and more patients with good risk cytogenetics (16% vs 8%, p=<0.005). Other baseline demographics were well matched. For the HiDAC consolidation cohort and the HiDAC induction cohort, respectively, CR1 rate was 80% vs 91% (p=0.001); TRM 8% vs 5% (p=0.14); OS (5 yrs) 49% vs 50% (p=0.7); DFS (5 yrs) 47% vs 41% (p=0.24) and the cumulative incidence of relapse (CIR) 41% vs 50% (p=0.1). The CIR was greater in the HiDAC induction cohort despite a higher allogeneic hematopoietic stem cell transplantation (alloHSCT) in CR1 rate (18% vs 29%, p=0.002) in this cohort. For the 301 patients who achieved CR1 and did not undergoing alloHSCT in CR1, CIR was greater in the HiDAC induction cohort (49% vs 60%, p=0.059) leading to a reduced DFS (58% vs 46%, p=0.058), and OS (59% vs 49%, p=0.13) in that subset of patients. Excluding patients with good risk cytogenetics from the analyses did not change the results significantly. Conclusions: OS and PFS using HiDAC as induction or consolidation therapy were similar, and compared favourably to published data. Interestingly, the better CR rate and a greater use of alloHSCT in CR1 in the HiDAC induction cohort did not lead to a better PFS or OS - because of a greater relapse rate in this cohort - primarily seen in those patients not undergoing alloHSCT in CR1. In the absence of mutational prognostic information, these data may suggest that HiDAC as induction therapy can achieve CR in patients with biologically higher risk disease who have a higher relapse rate, and that including 2 cycles of HiDAC in consolidation in the absence of alloHSCT in CR1 is a more effective therapy than a single cycle of HiDAC administered during induction therapy. Disclosures Mollee: Celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen: Membership on an entity's Board of Directors or advisory committees, Research Funding; Amgen: Membership on an entity's Board of Directors or advisory committees; Bristol-Myers Squibb: Membership on an entity's Board of Directors or advisory committees; Nilelse: Research Funding.
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Wirandoko, Hendry, Dirga Wahyuzar, and Boi Haris H. Siahaan. "Indikasi Potensi Gas Hidrat Sebagai Sumber Energi Nonkonvensional di Wilayah Maritim Indonesia." Indonesian Journal of Earth Sciences 1, no. 1 (June 20, 2021): 36–48. http://dx.doi.org/10.52562/injoes.v1i1.90.
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Abstrak: Gas hidrat merupakan sumber energi nonkonvesional yang kuantitasnya hampir dua kali lebih banyak apabila dibandingkan dengan energi yang bersumber dari fosil. Oleh karena itu, penulis memiliki tujuan untuk mengembangkan potensi gas hidrat tersebut dan mengindikasikan potensi persebaran serta pembentukannya di Indonesia. Metode penelitian yang digunakan yaitu studi pustaka yang bersumber dari literatur seperti jurnal, artikel, dan buku. Berdasarkan penelitian ini, potensi cadangan gas hidrat di Indonesia dapat ditemukan di wilayah perairan Indonesia terutama perairan laut dalam seperti di Cekungan Busur Muka Simeulue, Sumatera dan Selat Makassar. Selain itu, potensi tersebut juga didukung oleh adanya kegiatan tektonik yang terjadi Indonesia. Metode geofisika seismik, BSR (Bottom Stimulating Reflector) dan analisa AVO merupakan beberapa metode yang digunakan untuk mengindikasikan adanya keberadaan potensi gas hidrat di suatu daerah. Gas hidrat dapat menjadi substitusi bagi bahan bakar fosil dan berpotensi masuk tahap eksplorasi dan eksploitasi, sehingga dibutuhkan studi lanjutan agar dapat diproduksi secara komersial. Kata Kunci: bottom stimulating reflector (BSR), gas hidrat, Indonesia, laut dalam, seismik Abstract: Gas hydrate is a non-conventional energy source, which is almost twice as large as fossil energy sources. Therefore, the authors want to develop gas hydrate potential and indicate the potential for its distribution and formation in Indonesia. The research method used is literature study sourced from literature such as journals, articles and books. Based on this research, the potential gas hydrate reserves in Indonesia is found in Indonesian territorial waters, especially deep sea waters such as the Simeulue Forearc Basin, Sumatra and the Makassar Strait. In addition, this potential is supported by tectonic activity occurs in Indonesia. Seismic geophysical methods, BSR (Bottom Stimulating Reflector) and AVO analysis are some of the methods used to indicate presence gas hydrate potential in area. Gas hydrate can be substitute fossil fuels and has the potential enter the exploration and exploitation stage, so further studies needed so that it can be produced commercially. Keywords: bottom stimulating reflector (BSR), deep sea, gas hydrate, Indonesia, seismic
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Габибов, Ибрагим. "МЕТОДИКА ДИАГНОСТИКИ СОСТОЯНИЯ МАГИСТРАЛЬНОГО ГАЗОПРОВОДА." ETM Equipment, Technologies, Materials 04, no. 02 (October 15, 2020): 11–16. http://dx.doi.org/10.36962/etm0402202011.
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Maqistral qazkəmərlərinə qaz axınının hidravlik müqavimət əmsalı artmasına ən çox təsir edən faktorlar sırasıda hidrat tıxacları və kondensatın əmələ gəlməsi, borunun diametrinin istismar prosesində dəyişməsi və son olaraq kəmərinin tıxanmasına səbəb olan qum amili səbəb olur. Məqalədə qəzaları aşkar etmək üçün onların ardıcıl əmələgəlmə metodlardan istifadə edərək magistral qaz kəmərinin vəziyyətinin öyrənilməsinə həsr edilmişdir. Açar sözlər: magistral boru kəmərləri, hidravlik müqavimət əmsalı, hidrat tıxacları, stasionar rejim, imtinalar.
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Bhalla, K., C. Tang, AM Ibrado, S. Grant, E. Tourkina, C. Holladay, M. Hughes, ME Mahoney, and Y. Huang. "Granulocyte-macrophage colony-stimulating factor/interleukin-3 fusion protein (pIXY 321) enhances high-dose Ara-C-induced programmed cell death or apoptosis in human myeloid leukemia cells." Blood 80, no. 11 (December 1, 1992): 2883–90. http://dx.doi.org/10.1182/blood.v80.11.2883.2883.
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Abstract High dose Ara-C (HIDAC) induces programmed cell death (PCD) or apoptosis in vitro in human myeloid leukemia cells, which correlates with the inhibition of their clonogenic survival. Hematopoietic growth factors (HGFs) granulocyte-macrophage colony-stimulating factor (GM- CSF) and interleukin-3 (IL-3) have been demonstrated to enhance the metabolism and cytotoxic effects of HIDAC against leukemic progenitor cells. We examined the effect of pIXY 321 (a GM-CSF/IL-3 fusion protein) on HIDAC-induced PCD and related gene expressions as well as HIDAC-mediated colony growth inhibition of human myeloid leukemia cells. Unlike the previously described effects of HGFs on normal bone marrow progenitor cells, exposure to pIXY 321 alone for up to 24 hours did not suppress PCD in HL-60 or KG-1 cells. However, exposure to pIXY 321 for 20 hours followed by a combined treatment with Ara-C plus pIXY 321 for 4 or 24 hours versus treatment with Ara-C alone significantly enhanced the oligonucleosomal DNA fragmentation characteristic of PCD. This was temporally associated with a marked induction of c-jun expression and a significant decrease in BCL-2. In addition, the treatment with pIXY 321 plus HIDAC versus HIDAC alone produced a significantly greater inhibition of HL-60 colony growth. These findings highlight an additional mechanism of HIDAC-induced leukemic cell death that is augmented by cotreatment with pIXY 321 and may contribute toward an improved antileukemic activity of HIDAC.
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Bhalla, K., C. Tang, AM Ibrado, S. Grant, E. Tourkina, C. Holladay, M. Hughes, ME Mahoney, and Y. Huang. "Granulocyte-macrophage colony-stimulating factor/interleukin-3 fusion protein (pIXY 321) enhances high-dose Ara-C-induced programmed cell death or apoptosis in human myeloid leukemia cells." Blood 80, no. 11 (December 1, 1992): 2883–90. http://dx.doi.org/10.1182/blood.v80.11.2883.bloodjournal80112883.
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High dose Ara-C (HIDAC) induces programmed cell death (PCD) or apoptosis in vitro in human myeloid leukemia cells, which correlates with the inhibition of their clonogenic survival. Hematopoietic growth factors (HGFs) granulocyte-macrophage colony-stimulating factor (GM- CSF) and interleukin-3 (IL-3) have been demonstrated to enhance the metabolism and cytotoxic effects of HIDAC against leukemic progenitor cells. We examined the effect of pIXY 321 (a GM-CSF/IL-3 fusion protein) on HIDAC-induced PCD and related gene expressions as well as HIDAC-mediated colony growth inhibition of human myeloid leukemia cells. Unlike the previously described effects of HGFs on normal bone marrow progenitor cells, exposure to pIXY 321 alone for up to 24 hours did not suppress PCD in HL-60 or KG-1 cells. However, exposure to pIXY 321 for 20 hours followed by a combined treatment with Ara-C plus pIXY 321 for 4 or 24 hours versus treatment with Ara-C alone significantly enhanced the oligonucleosomal DNA fragmentation characteristic of PCD. This was temporally associated with a marked induction of c-jun expression and a significant decrease in BCL-2. In addition, the treatment with pIXY 321 plus HIDAC versus HIDAC alone produced a significantly greater inhibition of HL-60 colony growth. These findings highlight an additional mechanism of HIDAC-induced leukemic cell death that is augmented by cotreatment with pIXY 321 and may contribute toward an improved antileukemic activity of HIDAC.
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Advani, Anjali S., Holly Gundacker, Nolyn Nyatanga, Paul Elson, Peter J. Rosen, Jennifer Bates, Mikkael A. Sekeres, et al. "Response to High Dose Cytarabine (HIDAC) As First Salvage for Relapsed Acute Lymphocytic Leukemia in Patients Receiving HIDAC As Initial Therapy." Blood 118, no. 21 (November 18, 2011): 2594. http://dx.doi.org/10.1182/blood.v118.21.2594.2594.
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Abstract Abstract 2594 The treatment of adult acute lymphocytic leukemia (ALL) is challenging. Traditional induction regimens have incorporated vincristine, anthracycline, asparaginase, and steroids that result in high rates of complete remission (CR). However, less than half of pts in CR will be cured. To improve results, high dose cytarabine (HIDAC) has been increasingly incorporated into post-remission therapy. Since HIDAC is often used to treat relapsed ALL, we hypothesized that the prior use of HIDAC would reduce the CR rate when it is applied to pts at the time of their first relapse. Methods: Consecutive pts with ALL in first relapse treated with HIDAC-containing regimens either at the Cleveland Clinic (CC) between the years 1993–2010 or at any institution participating in SWOG trial S9030 (HIDAC 3000 mg/m2 Days 1–5, mitoxantrone 80 mg/m2 Day 1) (1992–1993) were included. HIDAC was defined as a cycle of at least 3000 mg/m2 × 5 days. Remission was defined according to standard criteria. The outcome analysis [CR and overall survival (OS)] was adjusted for the following factors: age, WBC at diagnosis, cytogenetic (CG) risk, immunophenotype, transplant, and prior HIDAC exposure. Results: Sixty-six pts were included (39 treated at CC, and 27 as part of SWOG protocol S9030). All pts received a vincristine/prednisone/anthracycline/steroid-based induction regimen (S8417, CALGB 19802, CALGB 8811) except for 1 pt who was treated with hyperCVAD. Seventeen pts treated at CC had HIDAC incorporated into their initial treatment (1: hyperCVAD; 16: CALGB 19802), but none of the SWOG pts did. The median age was 35 yrs (range 17 to 73). The median WBC at the time of diagnosis for CC pts was 21.4 K/uL (range 0.5–260.0) and median WBC at the time of study registration for SWOG patients was 17.6 K/uL (range 0.4–198.4). Three pts (5%) had a mixed (B/T) lineage leukemia. Three patients had lymphoblastic lymphoma (1 B-cell; 2 T-cell) at the time of initial diagnosis, and had ALL at the time of relapse. For the 39 CC pts, the median time from diagnosis to relapse was 12 mos (range 1–55 mos). CG risk was ascribed by CALGB criteria. Of the 50 pts with evaluable pre-study CG, 20 pts (40%) had normal CG, 18 (36%) miscellaneous, and 12 (24%) poor risk CG. Twenty pts (30%) received HIDAC alone, and 46 (70%) received HIDAC in combination with other drugs for relapsed ALL. The CR rate for all relapsed pts was 32% (CC 36% and SWOG 26%) and was not affected by the addition of other drugs to HIDAC. Twenty-nine patients (44%) were able to proceed to HSCT; and the median OS was 5.4 mos (95% CI: 4.8–6.0 mos). After adjusting for all baseline and demographic factors, the CR rate and OS between pts receiving or not receiving HIDAC during initial treatment was not significantly different. Five of 17 (29%: 95% CI 10%-56%) pts with prior exposure to HIDAC achieved CR while 16 of 49 (33%: 95% CI 20%-48%) pts without prior HIDAC exposure achieved a CR (p=0.80). The 1 year OS (from salvage) for pts treated with HIDAC for relapse who also were treated with prior HIDAC was 12% (95% CI: 0%-27%) and for pts not treated with prior HIDAC was 33% (95% CI: 20%-46%)(p=0.17). Since additional information was available on the CC pts, additional analyses were performed on this subgroup of pts. With the exception of lymphoblastic lymphoma at the time of diagnosis, no other factors correlated with achievement of CR. Achievement of CR was the only factor associated with proceeding to HSCT (79% vs. 36%, p=0.01). Variables associated with improved OS included: lymphoblastic lymphoma at the time of diagnosis (p=0.04; 2 of the 3 pts are still being followed at 80+ and 96+ mos), achievement of CR (p=0.0001), longer remission (> 30 mos, p=0.005), and transplantation (p=0.0001). Conclusion: The outcome of relapsed ALL with HIDAC salvage therapy is dismal, regardless of prior HIDAC exposure; and novel treatments are needed. There was a suggestion that the OS of pts with prior HIDAC exposure may be lower, but further study of 1 year OS with larger pt numbers will be needed to evaluate this. An interesting finding in this study was the favorable outcome of pts with lymphoblastic lymphoma at diagnosis, who subsequently relapsed in the leukemic phase and were treated with HIDAC. However, few pts carried this diagnosis and a larger number of pts are required before drawing firm conclusions. Disclosures: No relevant conflicts of interest to declare.
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hidayat, rian. "PENGUATAN KELEMBAGAAN PENGELOLAAN HIDRAN UMUM : Kasus; Pengelolaan Hidran Umum di Kota Padang." economica 5, no. 1 (October 16, 2016): 15–26. http://dx.doi.org/10.22202/economica.2016.v5.i1.1070.
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Vale, Colin, Dimitrios Farmakiotis, Pamela C. Egan, Randall Ingham, and John L. Reagan. "Outcomes Associated with Antimicrobial Use during High Dose Cytarabine Consolidation in Acute Myeloid Leukemia." Blood 132, Supplement 1 (November 29, 2018): 1402. http://dx.doi.org/10.1182/blood-2018-99-110175.
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Abstract Introduction: Patients with acute myeloid leukemia (AML) undergoing consolidation chemotherapy with high dose cytarabine (HiDAC) are often placed on prophylactic antimicrobials. This practice is largely based on the defined benefit of antimicrobial prophylaxis for AML patients during induction chemotherapy. Recent concerns regarding antimicrobial prophylaxis include increased risk of Clostridium difficile colitis, antimicrobial toxicities, and the potential for fostering multidrug-resistant pathogens. These emerging concerns coupled with the relatively shorter duration of neutropenia for AML patients with consolidative chemotherapy raised the question of whether antimicrobial prophylaxis in this setting is necessary. Therefore we examined the role of antimicrobial prophylaxis in HiDAC consolidation within our institution. Methods: This retrospective review included all adult patients who received HiDAC consolidation chemotherapy between January 2007 and March 2018. HiDAC was defined as a dose of 1g/m2 or greater. In patients receiving more than one cycle of HiDAC, data from each cycle was included. Patients prescribed antibiotics, antiviral medications, or antifungal medications at the time of discharge following HiDAC were considered to have received prophylactic antimicrobials. Several baseline patient characteristics were documented including age, sex, Charlson Comorbidity Index, and ECOG PS. The primary endpoint was incidence of febrile neutropenia (FN), while secondary endpoints consisted of hospitalizations for any cause as well as incidence of bacteremia, invasive fungal infection, Clostridium difficile colitis, and death from infection. Patients admitted within one month following HiDAC consolidation were considered to have been hospitalized following therapy. Data was then analyzed based on whether or not patients received antibiotic and antimicrobial prophylaxis. Patients less than 60 and 60 years of age an older where also analyzed separately regarding the use of prophylactic antibiotics to determine if older patients benefited from antibiotic prophylaxis. Results: One hundred twenty patients met inclusion criteria, and data from two hundred thirty-three cycles of HiDAC was analyzed. No significant demographic differences were detected amongst patients who did and did not receive antimicrobial prophylaxis (Table 1). There was no difference in incidence of FN or the number of hospitalizations for each cycle of HiDAC consolidation amongst the prophylaxis and no prophylaxis cohorts. The only statistically significant difference between groups was that in cycle 2 the mean length of hospital stay following HiDAC consolidation was less (p=0.02) in patients prescribed prophylactic antimicrobials. The rates of bacteremia and Clostridium difficile colitis were also similar across both groups in all three cycles of HiDAC consolidation (Table 1). In the setting of HiDAC consolidation, only one patient was found to have an invasive fungal infection and zero patients died as a result of infection. When only antibiotic prophylaxis was analyzed there was likewise no difference in the rates of FN across all 3 cycles of HiDAC nor was there a difference in incidence of FN for patients < 60 and patients ≥ 60 (Figure 1). Furthermore, there was no difference in demographics or other outcomes amongst the antibiotic prophylaxis and no prophylaxis cohorts (data not shown). Discussion: Neither antibiotic nor antimicrobial prophylaxis during consolidation chemotherapy with HiDAC reduced the incidence of FN or frequency of hospitalizations. Additionally, there was no difference in the rates of bacteremia, Clostridium difficile colitis, or invasive fungal infections between the two groups. Importantly, no patients in either cohort died from infectious complications following HiDAC consolidation. In patients with acute myeloid leukemia undergoing HiDAC consolidation, the role of prophylactic antimicrobials remains unclear. Prophylactic antimicrobials may not be necessary for all patients consolidated with HiDAC due to a potentially shorter course of neutropenia when compared to patients with AML undergoing induction chemotherapy, especially amongst younger AML patients. The use of antimicrobial prophylaxis should take into context patient and institutional factors. Disclosures Reagan: Pfizer: Research Funding; Takeda Oncology: Research Funding; Alexion: Honoraria.
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Hsu, Hui-Chi, Jyh-Pyng Gau, Hsiouh-Hsiang Chern, Wing-Keung Chau, Cheng-Hwai Tzeng, and Chao-Hung Ho. "Cost Effectiveness of Post-Remission Intensive Therapy in Patients with Acute Leukemia." Blood 108, no. 11 (November 16, 2006): 5522. http://dx.doi.org/10.1182/blood.v108.11.5522.5522.
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Abstract Background: We assessed the cost-effectiveness of high dose arabinoside (HiDAC)-based and allogeneic stem cell transplantation (alloSCT)-based therapy in patients with acute leukemia. Patients and Methods: We analyzed the outcome, cost and cost-effectiveness of 106 patients treated between 01/94 and 01/02 (94 AML/12 ALL). Forty-two young patients at either intermediate or unknown cytogenetic risk received post-remission intensive therapy (24 HiDAC-based / 18 alloSCT-based therapy). Results: After a median follow-up of 50 months, the estimated 7 year overall survival for the HiDAC-based group showed a tendency to be higher than the alloSCT-based group (48% versus 28%; p=0.1452). HiDAC-base group spent a significantly lower total cost (USD 51,857 versus 75,474; p=0.004) than the alloSCT-based group. Cost-effectiveness analysis showed that the mean cost per year of life saved for the HiDAC-based group is considerably less expensive than the alloSCT-based group (USD 11,224 versus 21,564). The reduced total cost for the HiDAC-based group originated from lower cost in room fees, medication, laboratory and procedure, but not in blood transfusion and professional man-power fees. Conclusion: HiDAC therapy as initial post-remission intensive therapy is a cost-effective approach in AML patients at either intermediate or unknown cytogenetic risk, which deserves further prospective clinical study to address this issue.
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Jafari, Leila, Jubair Hussain, Ravi Krishnadasan, Keri R. Maher, Faiz Anwer, Emad Elquza, Christopher Campen, et al. "Implementation of Outpatient High-Dose Cytarabine (HiDAC) for AML: Evaluation of the Impact of Transitioned Outpatient Chemotherapy in an Oncology Care Model Setting." Blood 134, Supplement_1 (November 13, 2019): 2153. http://dx.doi.org/10.1182/blood-2019-132121.
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Background: Patients with acute myeloid leukemia (AML) who achieve complete remission with induction therapy require consolidation therapy. The standard of care consolidation is HiDAC based on age and risk stratification. Consolidation therapy has historically been administered in the inpatient setting. The rising cost of inpatient care, alternative payment model implementation and patient preference has prompted institutions to consider shifting therapy to the outpatient setting. However, the safety and feasibility of outpatient high dose Cytarabine (HiDAC) consolidation therapy is not well established. The University of Arizona Cancer Center developed an Outpatient Program (OP) to facilitate administration of hematologic chemotherapy regimens in the outpatient setting. We hypothesized that OP administration of HiDAC consolidation therapy would be safe and efficacious and have large cost-savings implications under alternative payment model pilots, such as the oncology care model. Methods: We conducted a retrospective chart review on high-risk MDS/AML patients who were 18 years or older and received HiDAC consolidation therapy at UACC following induction therapy from November 1st 2013 to June 1st 2019. Interim data collection included age, risk stratification, treatment history, clinic visits, number of cycles received in the OP versus inpatient setting, supportive care, hospitalizations, and chemotherapy related adverse events. Our Outpatient HiDAC protocol consisted of a one-hour infusion for all cytarabine doses administered at 7:30am and 4:00pm, with neurologic checks prior to each dose. Growth factor support, if required was administered on the same day as the last dose of cytarabine Results: We evaluated 19 patients at our cancer center who received 52 total cycles of HiDAC consolidation therapy. The median patient age was 49.6 yrs with 21.1 % being over the age of 60. Thirty-three cycles were administered in the outpatient setting, with 19 cycles being administered inpatient. None of the patients who were administered HiDAC in either the IP or OP setting had reported clinically significant neurotoxicity (≥ grade III). Nine patients receive all of their cycles in the outpatient setting. 57.9% of our patients developed febrile neutropenia, with 47.4% of the patients requiring hospitalization for neutropenic fever. The average inpatient HiDAC length of stay was 6 days. Transitioning HiDAC to the outpatient setting led to a savings of 198 hospital days, with a corresponding cost reduction to our healthcare system of $529,650. Transitioning HiDAC to the outpatient setting also improved patient satisfaction. Conclusion: Outpatient administration of HiDAC consolidation therapy for AML patients is a safe and effective treatment option. In addition, transitioning HiDAC to the outpatient setting led to a reduced overall cost of care for AML treatment , under an OCM based practice model. Utilization of outpatient HiDAC for the outpatient setting provides a unique opportunity for select patients. Disclosures Maher: Agios: Consultancy. Anwer:Seattle Genetics: Membership on an entity's Board of Directors or advisory committees; In-Cyte: Speakers Bureau. Campen:Coherus: Speakers Bureau; Teva: Speakers Bureau; Amgen: Consultancy. McBride:teva: Consultancy; Sandoz: Consultancy; Sanofi Genzyme: Consultancy.
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Wulan Wangi and Wisnu Kuncoro. "Sosialisasi Penggunaan Pompa Hidram dalam Mengoptimalisasi Pengairan Lahan di Atas Permukaan Sungai." JURPIKAT (Jurnal Pengabdian Kepada Masyarakat) 2, no. 1 (April 20, 2021): 77–87. http://dx.doi.org/10.37339/jurpikat.v2i1.482.
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Persoalan irigasi lahan merupakan persoalan kompleks yang sering dimiliki oleh pemilik lahan yang memiliki lahan di atas aliran sungai. Dampak dari irigasi lahan yang tidak lancar akan mengakibatkan permasalahan serius terhadap tanaman dan hasil panen. Adapun tujuan dari kegiatan pengabdian masyarakat ini adalah untuk mengatasi permasalahan irigasi lahan yang memiliki letak geografis di atas permukaan sungai melalui teknologi tepat guna berupa pompa hidram. Metode kegiatan ini terdiri dari beberapa langkah yaitu 1) Persiapan Materi dan Alat, 2) Sosialisasi, 3) Demonstrasi, dan 4) Evaluasi. Kegiatan pengabdian masyarakat ini diharapkan menjadi solusi yang efektif dalam menanggulangi permasalahan irigasi pada lahan pertanian mereka. Hasil kegiatan pengabdian masyarakat ini menunjukkan bahwa pompa hidram merupakan solusi yang sesuai atas permasalahan irigasi yang terjadi pada pemilik lahan di dataran tinggi di daerah Gaplek, Banyuwangi. Melalui penggunaan pompa hidram ini, para petani dan pemilik lahan diharapkan bisa mengoptimalisasi irigasi lahan di sekitar kawasan dataran tinggi Gaplek, Banyuwangi.
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Fagundes, Evandro M., Vanderson Rocha, Ana Beatriz F. Glória, Nelma Cristina D. Clementino, José S. Quintão, Joao Paulo O. Guimaraes, Enio Roberto P. Pedroso, and Marcos B. Viana. "]Socioeconomic Factors May Select Adults Younger Than 60 Years of Age with “De Novo” Acute Myeloid Leukemia To Receive Intensive Treatment outside a Clinical Trial in Developing Countries. Experience of a Brazilian University Center." Blood 104, no. 11 (November 16, 2004): 4517. http://dx.doi.org/10.1182/blood.v104.11.4517.4517.
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Abstract Socioeconomic status (SES) is associated with treatment outcomes of ALL childhood. Whether this factor is associated with outcomes in adults AML in a developing country is not known. We have studied the impact of the human development index (HDI) of the United Nations as a SES factor for treatment outcomes of adults with “de novo” AML. Among 124 consecutive patients retrospectively analyzed, 46 (37 %) died during induction, 66 reached complete remission (53%) and 46 (37%) received high dose Ara-C (Hidac) consolidation. Five years-overall survival (OS) and leukemia free survival (LFS) were 17%±3% and 26%±6% respectively for all patients and 36%±7% and 30%±7% respectively for those receiving Hidac. In multivariate analysis, the HDI lower than 0.660 was associated with lower probability to receive Hidac (p=0.001), a trend for higher mortality in remission induction (p=0.062) and a decreased LFS (p<0.0001), however it was not associated with outcomes for patients receiving Hidac. In conclusion, survival for patients who received Hidac consolidation is similar to those reported in developed countries, but results of overall outcomes are inferior, probably due to the influence of socio-economic factors before Hidac consolidation. Poor SES may be a factor associated with patient selection for intensive treatment and survival.
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Kahar, Kahar. "Pengaruh Jumlah Katup Hisap dan Katup Buang Terhadap Kinerja Pompa Hidram." Jurnal Pertanian Terpadu 5, no. 2 (December 20, 2017): 92–103. http://dx.doi.org/10.36084/jpt..v5i2.130.
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Penelitian ini bertujuan mengetahui pengaruh pengujian variasi jumlah katup terhadap kinerja pompa hidram, mengetahui debit air yang dihasilkan pada pompa hidram. Penelitian ini dilaksanakan pada bulan April sampai Juni 2016. Data-data yang diperoleh melalui pengujian alat akan dianalisis dengan menggunakan rumus-rumus empiris yang mendukung proses pengolahan data. Hasil penelitian menunjukkan bahwa efisiensi pompa hidram pada jumlah katup 1 buah sebesar 6,0000725%, jumlah katup 2 buah 10,20 %, dan jumlah katup 3 buah 16,0003525 %. Kapasitas pemompaan pada jumlah katup 1 buah 9,2083.10-6 m3/s, jumlah katup 2 buah 1,25833.10-5m3/s, dan jumlah katup 3 buah 2,35416.10-5 m3/s. Kapasitas limbah pada jumlah katup 1 buah 7,25.10-5 m3/s, jumlah katup 2 buah 9,41667.10-5m3/s, dan jumlah katup 3 buah 1,175.10-4m3/s. Kapasitas total pada jumlah katup 1 buah 9,09166.10-5m3/s, jumlah katup 2 buah 1,319167.104 m3/s, dan jumlah katup 3 buah 2,116665.10-4 m3/s.
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Canaani, Jonathan, Marlise R. Luskin, Alison Loren, Colleen Timlin, James Mangan, Elizabeth O. Hexner, Noelle V. Frey, David L. Porter, Edward A. Stadtmauer, and Selina Luger. "Outcome of Patients with Acute Myeloid Leukemia Treated with Salvage High-Dose Cytarabine Monotherapy." Blood 126, no. 23 (December 3, 2015): 2543. http://dx.doi.org/10.1182/blood.v126.23.2543.2543.
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Abstract Introduction Cytarabine in high doses (> 1 g/m2) is commonly combined with other cytotoxic chemotherapy agents to treat acute myeloid leukemia (AML) in the initial and salvage settings. Single-agent high dose cytarabine (HiDAC) is traditionally reserved for consolidation therapy for patients in remission. At our institution we also use single agent HiDAC to treat patients with active disease. We reviewed our experience to assess the outcomes. Methods We identified patients (pts) with AML diagnosed from 2009-2014 and treated at the Hospital of The University of Pennsylvania with anthracycline plus infusional cytarabine induction (7+3) who received subsequent single agent HiDAC for active disease. Pts included were those with evidence of residual leukemia on nadir biopsy after one cycle of therapy or those with refractory disease (positive nadir after 2 cycles of therapy or disease at the time of or within 30 days of count recovery). Comparisons of categorical covariates by subgroup were evaluated using the Fisher's exact test. Patients In total, 44 pts with median age of 54 (range 23-69) years were identified. Twenty-five (56%) pts had de novo AML, and 19 (43%) had AML secondary to prior myelodysplasia (MDS) or a myeloproliferative neoplasm (MPN). Twenty-two pts (50%) had unfavorable cytogenetics, 8 (18%) were FLT3 -ITD positive, and 4 (9%) were NPM1 mutant (Table 1). Indications for HiDAC salvage included positive nadir marrow or frankly progressive disease at day 14 of 1 (n=28) or refractory disease (n=16) Outcome Six pts (14%) died during index hospital admission for HiDAC therapy (5 from sepsis, 1 from multi-organ failure). Twelve (27%) pts achieved CR following HiDAC salvage and 4 (9%) achieved CRp. Pts with de novo AML were more likely to achieve a CR/CRp (11/24; 46%) compared to those with secondary AML (antecedent myeloid disorder or prior chemotherapy/radiation therapy) (5/20, 25%; p=0.037). CR/CRp rates were higher for pts with a white blood cell (WBC) count ≤10K/µL at initial diagnosis (50% vs. 20%; p=0.039). Pts treated for residual disease at first nadir were more likely to respond to HiDAC (n=13/28, 46%) than pts treated for refractory disease (3/16, 19%; p=0.104). Cytogenetic risk, age, presence of extramedullary disease, and FLT3 -ITD/NPM1 mutation status were not associated with response in this small sample (Table 2). No features predicted early mortality. Conclusion Our data suggest that pts with AML who received HiDAC therapy for active disease after 1-2 cycles of anthracycline plus infusional cytarabine induction have CR rates of 36% with single agent HiDAC with a 14% rate of early mortality. De-novo disease, initial WBC count < 10K/µL and treatment for residual disease at first nadir predict for a better response. Pts presenting with refractory disease are less likely to respond to this approach, consistent with previously published data with HiDAC combination regimens. HiDAC monotherapy for persistent AML following initial induction is a reasonable therapeutic option. Figure 1. Patient Characteristics Figure 1. Patient Characteristics Figure 2. Response to HiDAC monotherapy Figure 2. Response to HiDAC monotherapy Disclosures Loren: Merck: Research Funding. Mangan:Incyte Corporation: Membership on an entity's Board of Directors or advisory committees. Frey:Novartis: Research Funding. Porter:Novartis: Patents & Royalties, Research Funding.
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Miyawaki, Shuichi, Shigeki Ohtake, Shin Fujisawa, Hitoshi Kiyoi, Katsuji Shinagawa, Noriko Usui, Toru Sakura, et al. "A randomized comparison of 4 courses of standard-dose multiagent chemotherapy versus 3 courses of high-dose cytarabine alone in postremission therapy for acute myeloid leukemia in adults: the JALSG AML201 Study." Blood 117, no. 8 (February 24, 2011): 2366–72. http://dx.doi.org/10.1182/blood-2010-07-295279.
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Abstract We conducted a prospective randomized study to assess the optimal postremission therapy for adult acute myeloid leukemia in patients younger than 65 years in the first complete remission. A total of 781 patients in complete remission were randomly assigned to receive consolidation chemotherapy of either 3 courses of high-dose cytarabine (HiDAC, 2 g/m2 twice daily for 5 days) alone or 4 courses of conventional standard-dose multiagent chemotherapy (CT) established in the previous JALSG AML97 study. Five-year disease-free survival was 43% for the HiDAC group and 39% for the multiagent CT group (P = .724), and 5-year overall survival was 58% and 56%, respectively (P = .954). Among the favorable cytogenetic risk group (n = 218), 5-year disease-free survival was 57% for HiDAC and 39% for multiagent CT (P = .050), and 5-year overall survival was 75% and 66%, respectively (P = .174). In the HiDAC group, the nadir of leukocyte counts was lower, and the duration of leukocyte less than 1.0 × 109/L longer, and the frequency of documented infections higher. The present study demonstrated that the multiagent CT regimen is as effective as our HiDAC regimen for consolidation. Our HiDAC regimen resulted in a beneficial effect on disease-free survival only in the favorable cytogenetic leukemia group. This trial was registered at www.umin.ac.jp/ctr/ as #C000000157.
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Kolla, Bhaskar, Nurul Aidah Abdul Halim, Zohar Sachs, Erica D. Warlick, Daniel J. Weisdorf, Fiona He, and Lao Zhentang. "High Risk of Relapse with Intermediate Dose Cytarabine for Consolidation in Young Favorable Risk AML Patients Following Induction with 7+3." Blood 134, Supplement_1 (November 13, 2019): 3432. http://dx.doi.org/10.1182/blood-2019-123306.
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Introduction CALGB study in 1994 reported improved leukemia free survival (LFS) with sequential courses of high dose cytarabine (HIDAC- 3 gm/m2, q12h on days 1, 3 and 5) compared to lower doses of 100 mg/m2 and 400 mg/m2 per day. Following this study, HIDAC has been commonly used for chemotherapy consolidation in AML patients 60 years or younger. More recently, several groups investigated the role of intermediate dose cytarabine (IDAC-1.5 gm/m2 q12h D 1, 3 and 5 or D 1-3) in this population and reported equivalent outcomes for IDAC compared to HIDAC (Table 1). ELN guidelines published in January 2017 recommend IDAC for consolidation therapy in young (<60 years) favorable risk AML patients. Following these studies and ELN publication, consolidation protocols for AML patients 60 years or younger were changed from HIDAC to IDAC at Singapore General Hospital (SGH) in 2011 and at University of Minnesota Medical Center (UMMC) in February 2017. NCCN continues to recommend HIDAC as category 1 recommendation for consolidation of patients in this setting. We performed a combined analysis of outcomes in young favorable risk AML patients to assess impact of this change in practice on outcomes at our institutions as a quality initiative. Methods Patients 60 years or younger with ELN favorable risk AML between 2004 and 2015 at SGH and between September 2015 and March 2018 at UMMC, who underwent induction therapy with 7+3 regimen (idarubicin 12 mg/m2 D1-3 or daunorubicin 60 - 90 mg/m2 and cytarabine 100 mg/m2 continuous infusion from D1-7) and consolidation with cytarabine monotherapy were identified. These dates were chosen to allow reasonably equal time distribution before and after change in our practice. We extracted relevant outcomes data using chart review. We used Chi-square testing and applied Kaplan-Meier survival analysis to detect differences in relapse and survival outcomes. Results Of 67 ELN favorable risk patients 60 years or younger, 42 received HIDAC and 25 received IDAC. Median age was 39 years (range 16-59). 64 patients received 1 induction cycle and 3 patients received 2 induction cycles to achieve complete remission. Median LFS and overall survival (OS) with HIDAC vs IDAC were not-reached (NR, median time for follow up = 6.9 years) vs 1.35 years (p=0.004) and NR vs 2.27 years (p=0.001) respectively (Figure 1). Cumulative incidence of relapse at 2 years was 23.8% for HIDAC and 60% for IDAC groups (p=0.003). 3-year LFS and OS for HIDAC vs IDAC groups were 71% vs 36% (p=0.06) and 90% vs 48% (p=0.002). Discussion Historical data suggests chemotherapy consolidation with 3-4 cycles of HIDAC achieves long-term LFS of 60 - 70 % in young favorable risk AML patients. While the outcomes in HIDAC group in this study are comparable to historical data with good outcomes, a significantly larger proportion of patients in the IDAC group had early relapse (60%) and death. A major difference between the patients in this study and the other studies which showed similar outcomes with HIDAC and IDAC is the mode of induction. Data from large randomized studies in AML (Table 1) that suggest similar efficacy of IDAC compared to HIDAC used higher intensity induction regimens (frequently double induction therapy) compared to 7+3 and/or used other agents in combination with Ara-C for consolidation. These data are not broadly applicable in patients who receive a single cycle of 7+3 for induction, when selecting dose of Ara-C as monotherapy for consolidation. Furthermore, studies that used 7+3 for induction therapy showed benefit for HIDAC compared with multi-agent chemotherapy that included IDAC (Table 1). Conclusion Using single agent IDAC for post remission therapy is associated with higher rates of relapse and poor overall survival compared to HIDAC among young, ELN favorable risk AML patients who achieve complete remission following 7+3. The large randomized studies that suggested equivalency of IDAC to HIDAC for post remission therapy in AML patients, either used more than one cycle of intensive induction regimen and/or used cytarabine in combination with an anthracycline for consolidation. Hence, ELN guidelines should be cautiously interpreted given the above limitations in generalizability. Our study suggests that HIDAC, rather than IDAC, is the preferred chemotherapy consolidation regimen in young, favorable risk AML patients following standard 7+3 induction. Foot note: BK & NAAH contributed equally. FH & ZL contributed equally. Disclosures Kolla: Amgen: Equity Ownership. Weisdorf:Pharmacyclics: Consultancy; Incyte: Research Funding; Fate Therapeutics: Consultancy.
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Siebenaller, Caitlin, Tomas Radivoyevitch, Connie Cheng, Hetty Carraway, Sudipto Mukherjee, Anjali S. Advani, Aaron Thomas Gerds, et al. "Hospital readmission rate for febrile neutropenia (FN) following high dose cytarabine (HiDAC) consolidation chemotherapy for acute myeloid leukemia (AML)." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): e18513-e18513. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.e18513.
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e18513 Background: FN is an anticipated complication of consolidation with HiDAC for AML, though precise descriptions of incidence, type, and severity of infection leading to FN are lacking. Since AML patients (pts) with FN after HiDAC are routinely readmitted to the hospital, there is a likely impact on measures of quality and value in this population. Methods: Our primary aim was to define the rate of FN inpatient readmissions among all HiDAC cycles. Secondary aims included: estimating rates of all-cause readmissions, clinical (e.g., probable pneumonia per imaging) and microbiologically-documented infections, and identify pts-specific risk factors associated with readmission. Readmission per patient were modeled using Poisson regression, with means proportional to total cycles exposed, and logistic regression for the probability of FN per treatment cycle. Results: We identified 150 AML pts ≥ 18 years of age, who received at least one cycle of HiDAC consolidation (1000-3000 mg/m2 for six doses) in 2009-2016. The median age was 50 (range 19-69); 55% were female and 45% were male. For 417 HiDAC cycles analyzed (87% at 3000 mg/m2), all pts received flouroquinalone prophylaxis and the overall readmission rate was 49% (203/417), of which 86% (174/203) were for FN. Median time to FN hospital admission was 18 days (range 10-22) from the start of HiDAC. Of the 174 FN readmissions, 60% had documented infections. Of these infections, 35% were bacteremia, 29% other bacterial, 24% fungal, 6% sepsis, and 6% viral. Females had higher FN readmission rates (RR 1.7 (1.3, 2.4) p = 0.007), as did pts with higher BMI (RR 1.06 (1.01, 1.09) p = 0.005), while age and HiDAC dose were not associated with readmission. Only 34% of all readmissions were in the absence of a documented infection. Conclusions: The majority of FN readmissions were associated with clinical or microbiologically documented infections and are not avoidable. Females and pts with higher BMI were more likely to be readmitted. Readmission of AML pts following HiDAC is expected, and therefore, should be excluded from measures of value and quality.
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Escobar, Christina, Sukanthini Subbiah, Maxim Norkin, Helen Leather, Ashley Richards, Randy A. Brown, W. Stratford May, John R. Wingard, Jack W. Hsu, and Christopher R. Cogle. "Reinduction Chemotherapy for AML: Comparison Between CECA, High Dose Cytarabine and CLAG-M." Blood 118, no. 21 (November 18, 2011): 4301. http://dx.doi.org/10.1182/blood.v118.21.4301.4301.
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Abstract Abstract 4301 Background: Currently, there is no standard reinduction regimen for relapsed and refractory (RR) AML. In order to evaluate responses to reinduction regimens we present a retrospective side-by-side comparison frequently used AML salvage regimens at our institution: CECA, HiDAC and CLAG-M. Method: From April 2007 to May 2011, 74 consecutive patients with RR AML received CECA (n=44), HiDAC (n=18) or CLAG-M (n=12). The primary outcome was complete remission (CR) rates and secondary outcomes were overall survival (OS) and relapse free survival (RFS). Additional variables such as toxicity and transplant data were also examined. Result: Baseline characteristics among the three groups were similar except for relapse status, with a greater proportion of AML patients receiving CECA after first relapse and HiDAC and CLAG-M after multiple relapses (Table 1). The mean age was 55.6 (range, 24–70), 53.8 (range, 25–71) and 49.5 (range, 23–68) years for CECA, HiDAC and CLAG-M respectively (P=0.38). For CECA, HiDAC and CLAG-M, respectively, 29.5%, 27.7% and 50% of patients were classified with therapy-related AML (P=0.85) and 11.4%, 11.1% and 16.7% of patients were classified with AML transformed from MDS (P=0.62). There was no difference in cytogenetic risk groups between the cohorts with the majority of the patients classified as intermediate risk. The mean blast percentage at the start of treatment was equivalent between the three groups at 39.8%, 27.4% and 26.7% for CECA, HiDAC and CLAG-M respectively (P=0.25). Median follow-up for all patients was 3.5 months. CR rates for CECA, HiDAC and CLAG-M were similar (20.5%, 16.7%, 41.7%; P=0.44). Median OS was 5 months for patients receiving CECA, 5 months for HiDAC and 3.5 months for CLAG-M (P=0.91) (Figure 1A). RFS was also similar among the three groups (p=0.91) (Fig. 1B). Of patients treated with CECA, HiDAC and CLAG-M, 27.2%, 38.8% and 41.6% proceeded to allogeneic hematopoietic cell transplant (P=0.71). Of the 8 patients who achieved CR with CECA but did not proceed to transplant, 5 patients had a CR of less then 3 months, 1 refused further care, 1 was lost to follow up and 1 received further consolidation therapy then relapsed. The mean length of stay in the hospital was 33.6±3.4, 99.7±60.3 and 45.4 ±35.7 days respectively for CECA, HiDAC and CLAG-M (P=0.19). The 30-day treatment related mortality rate was 2.3%, 16.7% and 16.7% respectively (P=0.13). Patients who received CECA had a higher number of total adverse events than patients who received HiDAC and CLAG-M (Table 1), with higher rates of pulmonary edema, sepsis, fungal pneumonia and C. difficle colitis. However, due to the small number of patients per cohort, only descriptive statistics are reported. Conclusion: CECA, HiDAC and CLAG-M are equivalent AML salvage regimens in terms of CR, OS, and RFS. Although each resulted in different adverse event profiles. These data provide a basis for designing prospective clinical studies and sample size estimates to formally compare three common reinduction regimens in RR AML. Disclosures: No relevant conflicts of interest to declare.
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Benitez, Lydia, Anthony J. Perissinotti, Caitlin R. Rausch, Jeff Klaus, Stephen Michael Clark, Michael Filtz, Kelley L. Ratermann, et al. "Multi-Center Retrospective Evaluation of High-Dose Cytarabine Based Induction Versus CPX-351 Induction in Patients with Secondary AML." Blood 134, Supplement_1 (November 13, 2019): 2639. http://dx.doi.org/10.1182/blood-2019-122189.
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BACKGROUND Secondary AML (sAML) that develops after an antecedent hematologic disorder or exposure to genotoxic therapy is associated with a poor prognosis and historical long-term survival rates of 5-10% (Granfeldt Østgård et al. 2015). Liposomal daunorubicin and cytarabine (CPX-351) was recently FDA approved for the treatment of sAML, based on a randomized phase III trial that found a higher complete remission (CR) rate, event-free survival (EFS), and overall survival (OS) with CPX-351 compared to 7+3 chemotherapy (Lancet et al. 2018). Retrospective studies conducted in this patient population suggest that high-dose cytarabine (HIDAC)-based regimens may also be safe and effective in sAML (Vulaj et al. 2018, Talati et al. 2018). With an average wholesale price of up to $150,000 for induction, CPX-351 represents a large financial burden when compared to HIDAC-based regimens. Because HIDAC-based regimens employ older, generic medications, and sAML is a relatively rare diagnosis, it is unlikely these two induction strategies will be compared prospectively. This real-world, multicenter study retrospectively compared clinical outcomes in patients with sAML receiving CPX-351 and HIDAC-based regimens. METHODS Adult patients with newly diagnosed sAML treated between January 2013 and January 2019 from 7 academic medical centers (University of Michigan n=73, MD Anderson Cancer Center n=27, Barnes Jewish Hospital n=22, University of North Carolina n=21, Huntsman Cancer Institute n=9, University of Rochester n=9, Indiana University n=8) were divided into 2 cohorts based on induction regimen: HIDAC-based or CPX-351. Demographics, disease characteristics, and outcomes were collected in accordance with the institutional review board approved protocol. The primary endpoint of composite complete response/complete response with incomplete count recovery (CR/CRi) as well as secondary efficacy endpoints were defined using 2003 International Working Group Criteria. For the primary endpoint, a sample of 96 patients was established a priori as necessary to demonstrate non-inferiority of HIDAC-based regimens using a non-inferiority margin of 7.5% and historical CR/CRi rates or 65% and 47.7% for HIDAC-based and CPX-351 respectively. Chi-square or Fisher's exact tests were utilized to evaluate dichotomous variables. Continuous variables were analyzed via Student's t-test or Mann-Whitney U test. Kaplan-Meier analysis with log-rank test was performed to estimate progression-free survival (PFS) and overall survival (OS). RESULTS A total of 169 patients were included (HIDAC-based: n=75; CPX-351: n=94). HIDAC-based regimen distribution was as follows: fludarabine/cytarabine ± G-CSF (n=73) and clofarabine/cytarabine ± G-CSF (n=2). Baseline characteristics were well balanced (table 1) with the exception of a higher Charlson Comorbidity Index in patients who received HIDAC-based therapy. The median age of all patients was 67 years and the majority of patients had sAML due to an antecedent hematologic disorder. CR/CRi rate was numerically higher and non-inferior with HIDAC-based therapy (62.7%) compared with CPX-351 (47.9%) (p=0.002 [one-sided for non-inferiority]). Median OS was 10.06 vs 10.59 months and median EFS was 5.56 vs 4.11 months with HIDAC-based regimens compared with CPX-351, respectively. Thirty-day mortality (1.3 vs 8.5%; p=0.039) and confirmed infection in induction (56% vs 74.5%; p=0.012) were significantly higher with CPX-351. Additionally, the time to absolute neutrophil count (ANC) and platelet count (PLT) recovery in CR/CRi were significantly longer with CPX (ANC: 18 vs 35.5 days; p<0.001; PLT: 23 vs 37.5 days; p<0.001). CONCLUSIONS HIDAC-based regimens yield CR/CRi rates that are non-inferior to CPX-351 in patients with sAML with similar EFS and OS. In a primarily elderly population, HIDAC-based therapy demonstrates greater tolerability with lower induction mortality, infection rates, and a more favorable duration of cytopenias. With non-inferior efficacy, better tolerability, and significantly lower cost, HIDAC-based regimens may be preferred to CPX-351 in patients with sAML. Disclosures Klaus: Jazz Pharmaceuticals: Other: Advisory Board, Speakers Bureau. Clark:Elliott Benson Research: Consultancy. Pettit:Samus Therapeutics: Research Funding.
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Li, Wenhui, Katherine Simondsen, Jamie Lee, Maher Elharake, and Timothy Edward Kubal. "Safety and feasibility of outpatient high-dose cytarabine (HIDAC) and intermediate-dose cytarabine (IDAC) for consolidation therapy in acute myeloid leukemia (AML)." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e18509-e18509. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e18509.
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e18509 Background: Patients with acute myeloid leukemia (AML) who achieve complete remission with induction therapy require consolidation therapy. The standard of care consolidation is HIDAC or IDAC depending on age and risk stratification. Consolidation therapy has historically been administered in the inpatient setting. The rising cost of AML care has prompted institutions to consider shifting therapy to the outpatient setting. However, the safety and feasibility of outpatient HIDAC/IDAC consolidation therapy has not been established. Moffitt Cancer Center (MCC) developed an Inpatient/Outpatient (IPOP) program to facilitate administration of complicated regimens in the outpatient setting. We hypothesized that IPOP administration of HIDAC/IDAC consolidation therapy is safe and may have cost-savings implications. Methods: We conducted a retrospective chart review on AML patients who were 18 years or older and received HIDAC/IDAC consolidation therapy at MCC following induction therapy from January 1, 2015 to November 1, 2018. Data collected included age, risk stratification, treatment history, clinic visits, number of cycles received in the IPOP versus inpatient setting, supportive care, hospitalizations, and chemotherapy related adverse events. Results: 258 of 270 cycles of HIDAC/IDAC were delivered outpatient over the reviewed time period to 122 patients. 45 patients (37%) required hospitalization during consolidation with the primary reason being neutropenic fever (72%), consistent with historical data (50 to 90%). No patients receiving outpatient consolidation required hospitalization during chemotherapy. Specific details regarding administration of HIDAC/IDAC in IPOP, including infusion times, frequency of visits, laboratory frequency, supportive medications, and home antimicrobials will be reported. 1,290 hospital days were saved through IPOP administration. Financial assessment of cost-savings is being determined and will be reported. Conclusions: Outpatient administration of HIDAC/IDAC consolidation therapy for AML is a safe option for AML patients undergoing consolidation.
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Fu, Samuel H., Alexander H. Flannery, and Melissa L. Thompson Bastin. "Acute Hepatotoxicity After High-Dose Cytarabine for the Treatment of Relapsed Acute Myeloid Leukemia: A Case Report." Hospital Pharmacy 54, no. 3 (June 1, 2018): 160–64. http://dx.doi.org/10.1177/0018578718779763.
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Purpose: Cytarabine is considered the standard of care for induction therapy in patients with acute myeloid leukemia (AML) who are preparing for bone marrow transplant. Summary: We report a case of a 72-year-old female presenting to the intensive care unit with hepatic failure after high-dose cytarabine (HiDAC) for the treatment of relapsed AML. The patient’s liver function tests (LFTs) were elevated acutely, with a mildly elevated bilirubin and a normal alkaline phosphatase. HiDAC was discontinued but her LFTs remained high for 9 days post discontinuation, and the patient eventually expired due to sepsis and multiple organ failure. We estimated the probability of the hepatotoxicity observed with HiDAC as probable based on a score of 5 on the Naranjo scale. Conclusion: Clinicians should be aware of the potential hepatotoxicity associated with HiDAC for patients with AML, specifically in the elderly population.
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Wetzstein, Gene A., Jeffrey E. Lancet, Jennifer E. Kallner, Jeffrey M. Sivik, Viet Q. Ho, Timothy J. George, Sheetal Desai, Shanel Fisher, Michael D. Newton, and Alan F. List. "Safety, Feasibility, and Cost-Effectiveness with Outpatient Administration of High-Dose Cytarabine Consolidation in Acute Myeloid Leukemia." Blood 112, no. 11 (November 16, 2008): 2405. http://dx.doi.org/10.1182/blood.v112.11.2405.2405.
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Abstract Introduction: High-dose cytarabine (HiDAC) consolidation chemotherapy is frequently used in acute myeloid leukemia (AML) patients less than 60 years of age. Traditionally, the potential risk for neurotoxicity, which has been reported to occur in 8–26% of patients, has limited its administration to the inpatient setting with a median length of stay of 5 days. Institutional retrospective data revealed the incidence to be much lower than previously reported with grade III/IV neurotoxicity in only 0.7% of cycles (N=267). As a result, we developed a comprehensive outpatient (OP) approach for the administration of HiDAC utilizing a pre-printed order and monitoring forms, pre-defined eligibility criteria/risk factors, administration/screening checklist, standard ancillary medications, designated scheduling, patient counseling, and written instructions for follow up. The benefits of OP administration may include improved patient satisfaction and decreased institutional costs and constraints on inpatient resources. However, there does not appear to be any published literature to date describing the OP administration of HiDAC. We report herein on the safety, feasibility, and outcomes of 43 patients receiving HiDAC consolidation therapy (n=88 cycles) between September 2006 and July 2008. Methods: Patients < 60 yo received 3 g/m2 over 1 hour every 12 hours on days 1, 3, and 5 and the dose was reduced to 1.5 g/m2 for pts ≥ 60 yo. All cycles of HiDAC were dosed based on age, renal, and hepatic function. There were no empiric dosage adjustments based on renal function alone. Post-treatment, patients received antibiotic prophylaxis and growth-factor support. Patients returned twice weekly for blood work until neutrophil and count recovery. Results: Forty-three patients received 88 cycles of HiDAC as an OP. The median patient age was 49 yrs (23–74) with 16% being over 60. Patient baseline characteristics of the OP group were similar to the inpatient group from our institutional review with respect to age, body surface area, gender, and race. Diagnosis, history of CNS radiation/disease, intrathecal chemotherapy, alcohol abuse, cumulative cytarabine dosage, and concurrent medications were also similar between the two groups. Only 1 patient was ineligible to receive OP therapy which was the result of both renal (estCL < 60mL/min) and hepatic (alk phos > 3X ULN) risk factors. Two patients with moderate renal insufficiency (est CL 30–60 mL/min) received full dose HiDAC without adverse event. All 43 patients successfully completed their full course of therapy. During the 88 cycles, there were no cases of clinically significant neurotoxicity (≥ grade III). There were 3 instances of grade I nystagmus. In all cases, therapy was completed without interruption. Rates of admission to the hospital post HiDAC OP consolidation for neutropenic fever (NF) was comparable to the inpatient group from our institutional review, occurring in 26% and 37% (p=0.07), respectively. All admissions post HiDAC OP was secondary to NF with the exception of one patient who was admitted for mucosal bleeding. Conclusions: In the present analysis, we confirm the safety and feasibility of OP-based HiDAC chemotherapy for the management of AML patients in remission. If patients are dosed and monitored properly, HiDAC can be successfully transitioned to the OP setting. With the implementation of this approach, we have improved patient convenience and satisfaction, decreased pressure on inpatient resources (nearly 450 days of hospital bed use), while maintaining similar rates of hospital re-admission. With proper patient selection, dosing, and education of both providers and patients, HiDAC can be safely administered in the OP setting and has become our standard of care.
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Stuart, R. K., K. Stockerl-Goldstein, M. Cooper, M. Devetten, R. Herzig, B. Medeiros, G. Schiller, A. Wei, G. Acton, and D. Rizzieri. "Randomized phase II trial of the nucleolin targeting aptamer AS1411 combined with high-dose cytarabine in relapsed/refractory acute myeloid leukemia (AML)." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): 7019. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.7019.
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7019 Background: Aptamers are small synthetic oligonucleotides that form stable nuclease-resistant 3D structures and bind target proteins with specificity and affinity similar to antibodies. These “chemical antibodies” represent a new class of therapeutics. The AS1411 aptamer binds nucleolin on the surface of cancer cells and induces apoptosis. AS1411 has synergistic effects in combination with cytarabine on AML cell lines in vitro and in vivo. A phase I trial of AS1411 monotherapy in 30 patients with advanced cancer showed objective responses without serious toxicities. Methods: This open-label randomized phase II trial compared AS1411 plus high-dose cytarabine (HiDAC) with HiDAC alone in patients with primary refractory or relapsed AML who had received up to 3 previous lines of chemotherapy. Patients in cohort I were randomized 2:1 to receive AS1411 10 mg/kg/day as continuous IVI on days 1–7 + HiDAC 1.5 g/m2/ twice daily on days 4–7 or HiDAC alone for 4 days. Following safety assessment, a second cohort was randomized in a similar manner, with AS1411 escalated to 40 mg/kg/day. Objectives were comparison of response rates (CR+CRp), safety and tolerability between treatment groups. Results: Accrual has been completed, with 71 patients randomized: 22 to AS1411 10 mg/kg/day + HiDAC (AS1411–10), 26 to AS1411 40 mg/kg/day + HiDAC (AS1411–40) and 23 to HiDAC alone (control). Safety findings are currently available for 44 patients (AS1411–10, 21; AS1411–40, 9; control, 14). The main grade 3/4 toxicities were hematologic, notably febrile neutropenia, neutropenia, and thrombocytopenia; and infections. Safety findings were similar across groups, except that grade 3 hypokalemia was more frequent with AS1411–40. Deaths within 28 days of treatment were: AS1411–10, 1/21; AS1411–40, 1/9; and control, 2/14. Response data are currently available for 39 patients; response rates were: AS1411–10, 16% (3/19); AS1411–40, 14% (1/7); and control, 0% (0/13). Conclusions: Data from this first phase II trial of an aptamer in oncology are encouraging. The combination of AS1411 at 10 or 40 mg/kg/day with HiDAC appears well tolerated and shows promising signs of activity in patients with relapsed/refractory AML. [Table: see text]
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Bishop, JF, JP Matthews, GA Young, J. Szer, A. Gillett, D. Joshua, K. Bradstock, A. Enno, MM Wolf, and R. Fox. "A randomized study of high-dose cytarabine in induction in acute myeloid leukemia [see comments]." Blood 87, no. 5 (March 1, 1996): 1710–17. http://dx.doi.org/10.1182/blood.v87.5.1710.1710.
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Abstract High-dose cytarabine (ara-c) may overcome cytarabine resistance in leukemic blasts. It has been used as a successful salvage and in postremission therapy but not as initial induction treatment. Patients aged 15 to 60 years, presenting with newly diagnosed acute myeloid leukemia (AML) were randomized to receive either high-dose cytarabine, 3 g/m2 12 hourly on days 1, 3, 5, and 7 for 8 doses, daunorubicin 50 mg/m2 days 1 to 3, etoposide 75 mg/m2 days 1 to 7, (HIDAC-3–7) or standard dose cytarabine 100 mg/m2 continuous intravenous infusion for 7 days with daunorubicin and etoposide at the same dose and schedule as above (7–3–7). Patients could receive a second or third induction course if complete remission (CR) was not achieved. All patients received the same postinduction consolidation therapy (5–2–5) for 2 courses. Eligible patients had no prior chemotherapy or myelodysplastic disease. Patients have been followed for a median of 4.5 years. Of 301 patients treated, complete response (CR) was achieved in 71% with HIDAC- 3–7 and 74% with 7–3–7. For patients in CR, the estimated median remission duration was 45 months with HIDAC-3–7 and 12 months with 7–3– 7 (P = .0005 univariate analysis, P = .0004 multivariate analysis). The estimated percentage of patients relapse free 5 years after achieving a CR was 49% on HIDAC-3–7 and 24% on 7–3–7. Patients in CR tended to survive longer with HIDAC-3–7 but there were no overall survival differences between the two arms. HIDAC-3–7 was associated with significantly more toxicity in induction with more leukopenia, thrombocytopenia, nausea, and vomiting and eye toxicity (all P < .001) but a similar incidence of severe central nervous system and cerebellar toxicity compared to 7–3–7. The consolidation treatment was the same in both arms but caused significantly more leukopenia and thrombocytopenia in patients previously treated with HIDAC-3–7 induction (P < .0001). We conclude that a dose-effect exists for cytarabine in AML and that HIDAC- 3–7 prolongs remission duration and disease-free survival and is tolerable when used as initial induction therapy in patients with de novo AML.
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Bishop, JF, JP Matthews, GA Young, J. Szer, A. Gillett, D. Joshua, K. Bradstock, A. Enno, MM Wolf, and R. Fox. "A randomized study of high-dose cytarabine in induction in acute myeloid leukemia [see comments]." Blood 87, no. 5 (March 1, 1996): 1710–17. http://dx.doi.org/10.1182/blood.v87.5.1710.bloodjournal8751710.
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High-dose cytarabine (ara-c) may overcome cytarabine resistance in leukemic blasts. It has been used as a successful salvage and in postremission therapy but not as initial induction treatment. Patients aged 15 to 60 years, presenting with newly diagnosed acute myeloid leukemia (AML) were randomized to receive either high-dose cytarabine, 3 g/m2 12 hourly on days 1, 3, 5, and 7 for 8 doses, daunorubicin 50 mg/m2 days 1 to 3, etoposide 75 mg/m2 days 1 to 7, (HIDAC-3–7) or standard dose cytarabine 100 mg/m2 continuous intravenous infusion for 7 days with daunorubicin and etoposide at the same dose and schedule as above (7–3–7). Patients could receive a second or third induction course if complete remission (CR) was not achieved. All patients received the same postinduction consolidation therapy (5–2–5) for 2 courses. Eligible patients had no prior chemotherapy or myelodysplastic disease. Patients have been followed for a median of 4.5 years. Of 301 patients treated, complete response (CR) was achieved in 71% with HIDAC- 3–7 and 74% with 7–3–7. For patients in CR, the estimated median remission duration was 45 months with HIDAC-3–7 and 12 months with 7–3– 7 (P = .0005 univariate analysis, P = .0004 multivariate analysis). The estimated percentage of patients relapse free 5 years after achieving a CR was 49% on HIDAC-3–7 and 24% on 7–3–7. Patients in CR tended to survive longer with HIDAC-3–7 but there were no overall survival differences between the two arms. HIDAC-3–7 was associated with significantly more toxicity in induction with more leukopenia, thrombocytopenia, nausea, and vomiting and eye toxicity (all P < .001) but a similar incidence of severe central nervous system and cerebellar toxicity compared to 7–3–7. The consolidation treatment was the same in both arms but caused significantly more leukopenia and thrombocytopenia in patients previously treated with HIDAC-3–7 induction (P < .0001). We conclude that a dose-effect exists for cytarabine in AML and that HIDAC- 3–7 prolongs remission duration and disease-free survival and is tolerable when used as initial induction therapy in patients with de novo AML.
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Žust, Lojze, Anja Fettich, Matej Kristan, and Matjaž Ličer. "HIDRA 1.0: deep-learning-based ensemble sea level forecasting in the northern Adriatic." Geoscientific Model Development 14, no. 4 (April 21, 2021): 2057–74. http://dx.doi.org/10.5194/gmd-14-2057-2021.
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Abstract. Interactions between atmospheric forcing, topographic constraints to air and water flow, and resonant character of the basin make sea level modelling in the Adriatic a challenging problem. In this study we present an ensemble deep-neural-network-based sea level forecasting method HIDRA, which outperforms our set-up of the general ocean circulation model ensemble (NEMO v3.6) for all forecast lead times and at a minuscule fraction of the numerical cost (order of 2×10-6). HIDRA exhibits larger bias but lower RMSE than our set-up of NEMO over most of the residual sea level bins. It introduces a trainable atmospheric spatial encoder and employs fusion of atmospheric and sea level features into a self-contained network which enables discriminative feature learning. HIDRA architecture building blocks are experimentally analysed in detail and compared to alternative approaches. Results show the importance of sea level input for forecast lead times below 24 h and the importance of atmospheric input for longer lead times. The best performance is achieved by considering the input as the total sea level, split into disjoint sets of tidal and residual signals. This enables HIDRA to optimize the prediction fidelity with respect to atmospheric forcing while compensating for the errors in the tidal model. HIDRA is trained and analysed on a 10-year (2006–2016) time series of atmospheric surface fields from a single member of ECMWF atmospheric ensemble. In the testing phase, both HIDRA and NEMO ensemble systems are forced by the ECMWF atmospheric ensemble. Their performance is evaluated on a 1-year (2019) hourly time series from a tide gauge in Koper (Slovenia). Spectral and continuous wavelet analysis of the forecasts at the semi-diurnal frequency (12 h)−1 and at the ground-state basin seiche frequency (21.5 h)−1 is performed. The energy at the basin seiche in the HIDRA forecast is close to that observed, while our set-up of NEMO underestimates it. Analyses of the January 2015 and November 2019 storm surges indicate that HIDRA has learned to mimic the timing and amplitude of basin seiches.
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Szittner, Antal. "Budapesti Duna-hidak." Építés - Építészettudomány 29, no. 3-4 (November 2001): 219–44. http://dx.doi.org/10.1556/eptud.29.2001.3-4.2.
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Castro, Rute Andrade. "Hidra nos trópicos." História Revista 25, no. 3 (December 28, 2020): 290–311. http://dx.doi.org/10.5216/hr.v25i3.66093.
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No século XIX os britânicos se espalharam por várias partes do mundo, e o fizeram por motivos variados. Entretanto, tal movimento emigratório foi personificado na historiografia por grandes comerciantes e investidores, ignorando-se por vezes os trabalhadores e, mais ainda, os bêbados e baderneiros. Desse modo, o objetivo deste artigo é mostrar episódios da participação de britânicos destituídos nos mundos do trabalho do Brasil no final do século XIX, quando a Grã Bretanha exercia grande influência no país. Para tanto, os documentos selecionados abarcam um escopo que não se limita aos centros urbanos, casas comerciais ou indústrias, muito pelo contrário. Eles estavam nas ruas das cidades, nas áreas rurais do país, nas praias, nos bares ou em qualquer lugar onde desejassem estar. Para chegar até estes trabalhadores, foram utilizados documentos consulares e relatos de viagem britânicos – para compreender como eles mesmos viam seus conterrâneos em situação precária num país desconhecido –, além de jornais brasileiros.
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El-Emam, Omyma, Syed Ziauddin A. Zaidi, Bassim Albeirouti, Abdul-Aziz Al-Humaidi, and Ali Al-Shanqeeti. "Improved Outcome of Acute Leukemia Patients Followed up In out-Patient Setting After High Dose Ara-C (HDAC) Consolidation with Infection Prophylaxis Strategies." Blood 116, no. 21 (November 19, 2010): 4363. http://dx.doi.org/10.1182/blood.v116.21.4363.4363.
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Abstract Abstract 4363 Background: Outpatient care of patients with malignancies has become increasingly common and is driven by health care costs, increased demand for existing inpatient resources, improved supportive care and patient wishes to spend the least amount of time in the inpatient setting. High dose Ara-C/cytosine arabinoside (HIDAC) consolidation is frequently used for most acute leukemias. Typically HIDAC consists of 12 hourly IV administrations of 3 grams/m2 dose of Ara-C every other day for a total of 6 doses. One of the authors (AS) had earlier pioneered the idea of giving HIDAC and discharging the patients for out-patient follow up. Prince Sultan Hematology Oncology Centre (PSHOC), Riyadh adopted “post-HIDAC early discharge” policy in late 2006 and later found that it is safe and has resulted in huge hospital-days saving in comparison to our contemporary policy of keeping the patients in hospital till they recover counts after going through nadir. Lately we have also added G-CSF along with antimicrobial prophylaxis during neutropenia for preventing/reducing the period of febrile neutropenia (FN) after HIDAC chemotherapy. Here we present the results of our practice improvement strategy analysis to evaluate the effectiveness of these new measures. Method: Sixty five patients receiving 96 cycles of HIDAC between October 2004 and March 2009 were divided in three groups: First cohort of 23 patients (group I) were discharged without any kind of prophylaxis after HIDAC (35 cycles); and 30 patients in later cohort (group II) received prophylactic ciprofloxacin, fluconazole and acyclovir once absolute neutrophil count (ANC) dropped to <1.0 × 109/L, and GCSF 300 mcg S/C daily once ANC was <0.5 × 109/L until ANC recovered (>1.0 × 109/L) after HIDAC (44 cycles), and the last cohort (group III) consisted of 12 patients who stayed in the hospital after HIDAC (17 cycles) till count recovery. Discharged patients stayed in the vicinity of Riyadh city and were followed-up in outpatient treatment unit (OTU) every other day. All patients were given detailed instructions and a medical alert card to provide them fast access to emergency care. Any patient who had neutropenic fever or judged as septic was admitted. Data on number of total hospital inpatient days for each HIDAC cycle, type of infection developed, and any mortality & serious morbidity requiring ICU care were recorded. Result: In group I, all of the 23 patients who received 35 cycles of HIDAC were re-admitted in all cycles for febrile neutropenia (33/35) and/or severe thrombocytopenia (2/35) until they recovered. The median of their inpatient hospital days was 15 (range 9–23). There was one septic shock that required 4 days of ICU stay. In group II, 30 patients received 44 cycles of HIDAC along with the prophylaxis and 21/44 (47.7%) cycles were without febrile neutropenia. In 23/44 cycles (52.2 %) febrile neutropenia required shorter admission for a median of 12 days (range 7–23). However 8/10 positive blood cultures in group II revealed ciprofloxacin resistant E. coli, and one each revealed K. pneumonia, and S. viridians. One patient was admitted with non documented fever noted at home, one with dental abscess, and HSV PCR was positive from mouth wash in one patient. In group III comprising of 10 of our historic patients, who received 17 cycles of HIDAC, 11 cycles (64.7%) were associated with FN. Conclusion: The currently reported policy of post-HIDAC early discharge with infection prophylaxis is feasible, safe, and may be more cost effective as it resulted in saving more hospital days: compared to a median of 26 days in group III and a median of 15 days in group I, patients in group II with infection prophylaxis required only a median of 12 days of hospitalization. GCSF and antimicrobial prophylaxis have important value in decreasing the incidence of febrile neutropenia but increase in ciprofloxacin resistant E. coli bacteremia is worrisome and may need change in type of prophylactic antibiotic (e.g. to levofloxacin). Disclosures: No relevant conflicts of interest to declare.
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Đurović, Miloš. "Hidžab kao fenomen konstruisanja i osporavanja identiteta: primjer savremenog Novog Pazara." Issues in Ethnology and Anthropology 10, no. 4 (March 4, 2016): 821. http://dx.doi.org/10.21301/eap.v10i4.2.
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This paper represents a consideration and an analysis of the relationship between the hijab as an article of clothing and the female body which can be understood as a field of social relations and struggles. The covered body of Muslim women and the meanings it carries can be understood and represented through a number of aspects. The paper explains the phenomenon of the hijab as a place of constructing and contesting identity using the example of contemporary Novi Pazar. The issue of the ban on wearing the hijab, as well as other coverings worn by Muslim women – the niqab and the burka, has for years been a burning issue in many (officially) secular democratic societies. Even though this issue has not been as prevalent in the Republic of Serbia as it has been in many Western European countries, I think that an anthropological analysis of the use of the hijab in Novi Pazar – which had since the 1990s become a visible and significant element of the Sandžak cultural milieu – has both theoretical and social significance. Through the analysis of embodiment and bodily practices of young Muslim women who wear a hijab, and the consideration of the female experience and the personal relationship of the women themselves to the body, “covering” and their identities, we are given an insight into a more personal and more intimate, but also a more open and versatile perspective.
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Powell, Bayard L., James Lovato, Claire Kimbrough, Susan Lyerly, Sonya Galloway-Daniels, Cathy Motley, Robin Harrelson, et al. "Limited Phase I Trial of Sequential High Dose Cytarabine and Clofarabine (HiDAC→CLOF) in Relapsed or Refractory Acute Myeloid Leukemia." Blood 108, no. 11 (November 16, 2006): 4565. http://dx.doi.org/10.1182/blood.v108.11.4565.4565.
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Abstract High dose cytarabine (HiDAC) is the most effective single agent for the treatment of acute myeloid leukemia (AML); clofarabine (CLOF) is also an active agent in AML. Preclinical data suggest synergy between cytarabine and clofarabine. We conducted a two step limited phase I trial of sequential HiDAC (2g/m2 over 3 hours) followed by CLOF (30 or 40 mg/m2 infused over 2 hours), each given daily for 5 days, in adults with AML in first or second relapse or refractory to initial induction chemotherapy. Patients with persistent leukemia on day 12–14 received a second course of HiDAC→CLOF; phase I toxicity evaluation was based on cycle 1 data only. Nine patients (6 men and 3 women) were treated. The median age was 55.5 years (range 29.2 – 68.1). All had relapsed AML; two had prior autologous stem cell transplant. The initial cohort of 3 patients received clofarabine 30 mg/m2 with one dose limiting toxicity (DLT); an additional 3 patients were treated in cohort 1. The second cohort was treated with CLOF 40 mg/m2, the target dose for a planned phase II trial of HiDAC→CLOF. Hematologic toxicities and infections were not considered DLT. In the first cohort (30 mg/m2; n = 6) there was 1 DLT - grade 4 skin rash in a patient who subsequently died on day 17 with sepsis-related multi-organ failure; 3 patients had reversible grade 3 elevations in AST/ALT, 1 had grade 3 skin toxicity. In cohort 2 (40 mg/m2 ; n = 3) there was no DLT; 1 patient had grade 3 AST/ALT; 2 had grade 3 skin. Three of nine patients received a second course of induction HiDACCLOF. Two of six patients in cohort 1 achieved complete remission (CR), 1/3 patients in cohort 2 achieved CRi(CRp). Two of three CR/CRi patients received one course and one received two courses of HiDAC→CLOF induction. Conclusion: HiDAC→CLOF was associated with transient elevation in AST/ALT (4/9) and skin rash (3/9; primarily extensive palmar/plantar); skin toxicity appeared especially prominent in patients with palmar/plantar toxicity during prior therapy with HiDAC. Toxicities (other than skin) were comparable to other salvage regimens for relapsed and refractory AML. This combination is active in relapsed AML with 3/9 CR/CRp. A phase II trial of HiDAC→CLOF is underway; prophylactic intravenous hydrocortisone has been incorporated in an attempt to decrease skin toxicity.
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Rubin, E. H., J. W. Andersen, D. T. Berg, C. A. Schiffer, R. J. Mayer, and R. M. Stone. "Risk factors for high-dose cytarabine neurotoxicity: an analysis of a cancer and leukemia group B trial in patients with acute myeloid leukemia." Journal of Clinical Oncology 10, no. 6 (June 1992): 948–53. http://dx.doi.org/10.1200/jco.1992.10.6.948.
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PURPOSE We analyzed pretreatment characteristics of patients with postremission acute myeloid leukemia (AML) treated with high-dose cytarabine (HIDAC) during a recent Cancer and Leukemia Group B (CALGB) trial to determine risk factors associated with HIDAC neurotoxicity. PATIENTS AND METHODS One hundred seventy-six patients received at least one course of HIDAC as part of a CALGB protocol designed to determine the optimal dose of cytarabine (ara-C) for postremission treatment of AML. HIDAC consisted of 3 g/m2 ara-C infused over 3 hours at 12-hour intervals on days 1, 3, and 5. The pretreatment characteristics of 170 patients were available for risk analyses. RESULTS Eighteen patients (10%) experienced neurotoxicity. Univariate analyses demonstrated associations between the occurrence of neurotoxicity and elevated serum creatinine, age, and alkaline phosphatase (AP). Multivariate analysis showed that these variables were independent risk factors. These findings were used to construct a risk model with the following parameters: creatinine greater than or equal to 1.2 mg/dL, age greater than or equal to 40 years, and AP greater than or equal to 3 x normal. Seventeen of 46 (37%) patients with two or more of these criteria developed neurotoxicity compared with one of 124 (1%) patients with one or none. The sensitivity and specificity of this model were 94% and 81%, respectively. CONCLUSION We conclude that patients with two or more of the following parameters may be at increased risk for HIDAC neurotoxicity: (creatinine greater than or equal to 1.2 mg/dL, age greater than or equal to 40, and AP greater than or equal to 3 x normal). However, this model should be confirmed by analysis of additional groups of patients treated with HIDAC.
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Arlin, Z. A., T. Ahmed, A. Mittelman, E. Feldman, R. Mehta, P. Weinstein, E. Rieber, P. Sullivan, and P. Baskind. "A new regimen of amsacrine with high-dose cytarabine is safe and effective therapy for acute leukemia." Journal of Clinical Oncology 5, no. 3 (March 1987): 371–75. http://dx.doi.org/10.1200/jco.1987.5.3.371.
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Amsacrine and high-dose cytarabine (HiDAc), when administered as single agents, are effective treatment of acute leukemia. When used in combination, a high remission rate is also possible. We treated 47 patients with acute myelogenous leukemia (AML), acute lymphoblastic leukemia (ALL), and blastic phase of chronic myelogenous leukemia (CML) with a combination of amsacrine and HiDAc. The patients received amsacrine 200 mg/m2 daily for three days and, concurrently, HiDAc 3 g/m2 over three hours once daily for five days. Of 20 evaluable patients with AML in relapse, there were 12 remissions; of seven additional patients with primary refractory AML, there were two remissions, and of 12 patients with ALL in relapse, there were eight remissions. The three patients with blastic phase CML and the three patients with biphenotypic leukemia did not respond. Nausea, vomiting, stomatitis, hepatic dysfunction, and diarrhea were common, but cutaneous, conjunctival, and significant cerebellar and cerebral side effects were absent. We conclude that this regimen is highly effective therapy for AML and ALL and is also safe, eliminating the major toxicities encountered with HiDAc.
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Pertiwi, Rahmi Nanda, Trevi Jayanti Puspasari, Elistia Liza Namigo, and Dwi Pujiastuti. "Identifikasi Gas Hidrat pada Cekungan Simeuleu di Lintasan BGR-135 Menggunakan Analisis AVO (Amplitude Versus Offset)." Jurnal Fisika Unand 7, no. 4 (October 1, 2018): 305–11. http://dx.doi.org/10.25077/jfu.7.4.305-311.2018.
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Pengolahan data seismik laut 2D menghasilkan indikasi adanya gas hidrat pada lintasan BGR-135 yang kemudian divalidasi dengan analisis Amplitude Versus Offset (AVO). Daerah penelitian berlokasi di Cekungan Simeuleu yang terdapat di pantai barat Sumatera. Software ProMax digunakan untuk pengolahan data seismik dan Software HRS (Humpson Russel) untuk analisis AVO. Pengolahan data seismik dimulai dari input raw data serta dilakukan proses prosesing (filtering, editing, dekonvolusi, analisis kecepatan, stacking, migrasi) hingga didapatkan output berupa data pre stack dan post stack. Data post stack kemudian diinterpretasi untuk menentukan zona fokus yang mengindikasikan keberadaan gas hidrat yang ditandai dengan kenampakan Buttom Simulating Reflector (BSR). Dari hasil interpretasi, indikasi kehadiran BSR terdapat pada CDP 26318 sampai 26354 dan TWT 1590 ms sampai 1660 ms. Data seismik pre stack yang telah ditentukan batasan CDP dan kedalaman dari zona fokus, dijadikan input untuk analisis AVO. Analisis AVO dilakukan pada rentang daerah target di lapisan terindikasi BSR dengan menentukan nilai gradient dan crossplot. Dari analisis diperoleh nilai gradient positif dan crossplot berada pada kuadran AVO kelas III. Gradient positif menandakan adanya anomali amplitudo pada zona fokus sedangkan AVO kelas III menandakan adanya indikasi hidrokarbon pada zona fokus.Kata kunci : Analisis Versus Offset (AVO) , Gas hidrat, Bottom Simulating Reflector (BSR), Cekungan Simeuleu
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Aldridge, Patrick, Rachel Parish, Heather Castle, Emma Russell, Raj Rout, and Roohi Singh. "Head home: implementation during COVID-19 pandemic." Emergency Medicine Journal 38, no. 9 (July 21, 2021): 692–93. http://dx.doi.org/10.1136/emermed-2020-211007.
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BackgroundRecent research suggests that between 20% and 50% of paediatric head injuries attending our emergency department (ED) could be safely discharged soon after triage, without the need for medical review, using a ‘Head Injury Discharge At Triage’ tool (HIDAT). We sought to implement this into clinical practice.MethodsPaediatric ED triage staff underwent competency-based assessments for HIDAT with all head injury presentations 1 May to 31 October 2020 included in analysis. We determined which patients were discharged using the tool, which underwent CT of the brain and whether there was a clinically important traumatic brain injury or representation to the ED.ResultsOf the 1429 patients screened; 610 (43%) screened negative with 250 (18%) discharged by nursing staff. Of the entire cohort, 32 CTs were performed for head injury concerns (6 abnormal) with 1 CT performed in the HIDAT negative group (normal). Of those discharged using HIDAT, four reattended, two with vomiting (no imaging or admission) and two with minor scalp wound infections. Two patients who screened negative declined discharge under the policy with later medical discharge (no imaging or admission). Paediatric ED attendances were 29% lower than in 2018.ConclusionWe have successfully implemented HIDAT into local clinical practice. The number discharged (18%) is lower than originally described; this is likely multifactorial. The relationship between COVID-19 and paediatric ED attendances is unclear but decreased attendances suggest those for whom the tool was originally designed are not attending ED and may be accessing other medical/non-medical resources
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Irawan, Aditiya, and Giri Prasetyaji. "KONSEP PENGANGKATAN AIR MENGGUNAKAN POMPA HIDRAM." SPEKTRA : Jurnal Kajian Pendidikan Sains 3, no. 2 (September 1, 2017): 160. http://dx.doi.org/10.32699/spektra.v3i2.34.
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Tujuan dari penelitian ini adalah untuk 1) menunjukkan bahwa air dapat mengalir dari tempat yang rendah ke tempat yang tinggi, 2) mengetahui perbedaan besarnya usaha pada massa jenis air tawar dan massa jenis air garam, 3) membuktikan teorema usaha dan energi.
Metode yang digunakan dalam penelitian ini adalah metode eksperimen, dimana hidram yang menggunakan pompa diganti dengan Menggunakan Katup untuk menaikkan air dari bawah ke atas dengan menggunakan pipa dan selang untuk mengalirkan air.Dari konsep tersebut, dapat dicari besarnya volume yang dihasilkan dalam waktu 30 sekon.Percobaan dilakukan sebanyak tiga kali setiap satu variasi yang dibuat. Setelah itu menganalisis perbedaan besarnya usaha pada massa jenis air dan massa jenis air garam pada ketingian pipa serta membuktikan adanya teorema W = ??k. Volume pada ketinggian pipa dicari untuk menemukan besarnya usaha baik yang menggunakan air tawar maupun massa jenis garam. Setelah itu menganalisis adanya perbedaan usaha pada massa jenis air tawar dengan massa jenis air garam menggunakan analisis komparatif independen dengan dua sampel serta pembuktian teorema W = ??k.
Berdasarkan percobaan didapatkan variasi ketinggian pipa berpengaruh terhadap besarnya usaha pada massa jenis air tawar dan massa jenis air garam serta variasi dimeter pipa terhadap teorema usaha dan energi pada mekanika fluida dengan model hidram ini. Semakin tinggi pipa maka volume yang dihasilkan semakin sedikit dan usahanya semakin rendah hal ini berlaku pada massa jenis air tawar dan massa jenis air garam, tetapi volume yang dihasilkan pada massa jenis garam lebih sedikit daripada massa jenis air tawar. Namun, besarnya usaha yang diperlukan hampir sama karena massa jenis air garam lebih besar, hal ini sesuai dengan hasil analisis data, dengan dk = 2 dan taraf signifikansi 0,1 % diperoleh hasil X^(2 )hitung = 0,014118