Hunterdon Prevention Resources

This article is a summary of a half-day continuing education course jointly sponsored by the Society for Toxicologic Pathology (STP) and the Health and Environmental Sciences Institute (HESI) at the annual meeting of the STP in Baltimore, MD, held June 16-19, 2024. Presenters discussed pathology, toxicology, immunotoxicology, and regulatory implications of findings in the immune system in context of development of immunomodulatory therapeutics. Interpretation of pathology findings requires knowledge of immune system morphology and function including species-specific differences and spontaneous findings in animal model systems. A weight of evidence (WoE) approach is required to integrate pathology findings and immunotoxicology assay results to assess translatability to humans. Communication and collaboration among scientists of various disciplines can be instrumental in optimal generation and interpretation of appropriate data for development of immunomodulatory therapeutics.

Background: Venous thromboembolism (VTE) is a significant healthcare burden, but is a preventable and treatable condition. The new oral anticoagulants (NOACs), apixaban, rivaroxaban, dabigatran, and edoxaban have all been shown in phase III trials to be noninferior in efficacy to standard therapies for acute VTE treatment, although there may be some differences in the bleeding rates among the NOACs. This study evaluated the net clinical benefits (NCB) of NOACs vs. standard therapies based on the AMPLIFY, EINSTEIN-Pooled analysis, RECOVER-1, RE-COVER II, and Hokusai-VTE trial results. Methods: Event rates of the primary efficacy and safety outcomes, as defined in each original trial, among VTE patients during trial periods were obtained from the published clinical trial data. Data from RECOVER-I and -II trials were combined to represent the findings for dabigatran since the two trials were of similar design. EINSTEIN-pooled (DVT and PE combined) data were used to represent findings for rivaroxaban. The combinations of rates for the primary efficacy endpoint, representing recurrent VTE or death and major bleedings (MB) were evaluated and defined as the NCB of each NOAC. Additionally, the number of VTE patients needed to treat (NNT) to avoid one event (e.g. VTE or MB) with each NOAC was also determined. Results: For patients treated in the VTE clinical trials, the differences in event rates of recurrent VTE or death for apixaban, rivaroxaban, dabigatran, and edoxaban vs. standard therapy were -0.43%, -0.23%, 0.20%, and -0.34%, respectively. The differences in event rates of MB for apixaban, rivaroxaban, dabigatran, and edoxaban vs. standard therapy were -1.26%, -0.78%, -0.43%, and -0.24%, respectively. The NCB improved for all NOAC treated patients, with those treated with apixaban (-1.69%) vs. standard therapy having the greatest NCB, followed by those treated with rivaroxaban (-1.01%), edoxaban (-0.58%), and dabigatran ( -0.23%) (Table 1). Conclusions: All NOACs were shown to be non-inferior to standard VTE treatments in clinical trials; however, apixaban may provide the optimal NCB with the lowest NNT. How these results translate into real-world outcomes or medical cost reductions will require further evaluation.

Objective: The purpose of this study was to provide an initial assessment of the effectiveness of the high nutrient density (HND) diet on glycemic control and cardiovascular risk factors in participants with type 2 diabetes. Design: This was a retrospective case series study. Participants were 13 adult type 2 diabetic U.S. women and men between the ages of 30 - 80 years old. Glycosylated hemoglobin (HbA1C), lipid profile, blood pressure, BMI, and medication requirements before and after commencement of the HND diet were compared. Results: After a median length on the HND diet of 7 months, the mean HbA1C dropped from 8.2% to 5.8% (p = 0.002), with sixty-two percent of participants reaching normoglycemic levels (HbA1C p = 0.0004 for systolic blood pressure, p = 0.01 for diastolic blood pressure). Triglycerides significantly decreased from a mean of 171 mg/dl to a mean of 103 mg/dl (p = 0.02). The HDL increased significantly from 48.3 mg/dl to 54.6 mg/dl (p = 0.03). The mean number of medications dropped from 4 to 1 (p = 0.0006). Conclusions: The HND diet was very effective in controlling glycemic levels and cardiovascular risk factors in 13 participants with type 2 diabetes. Therefore, there is a well-justified need for further study with the HND diet.

Purpose: To assess the incidence and time course of symptomatic venous thromboembolism (VTE) events in patients during and following hospitalization for major orthopedic or abdominal surgery. Methods: Data were extracted from the Thomson Reuters MarketScan® Inpatient Drug Link File for surgical patients admitted between January 2005 and December 2008. The analysis included 8989 abdominal surgery patients and 4220 orthopedic surgery patients. The cumulative risks of VTE and VTE hazard were assessed over a 180-day evaluation period after the hospital admission date, using Kaplan–Meier analysis and LOESS regression, respectively. Results: In total, 305 (2.3%) patients experienced a symptomatic VTE event. These were most frequent during days 1–9 (78 events) and 10–19 (72 events). In all, 64% of events occurred after discharge. Venous thromboembolism hazard peaked at approximately 1.3 per 1000 person-days (day 8) following orthopedic surgery and at approximately 0.52 per 1000 person-days (day 11) following abdominal surgery. In-hospital pharmacologic prophylaxis was received by 88.3% and 30.2% of orthopedic and abdominal surgery patients, respectively, whereas pharmacologic prophylaxis following hospitalization was received by 41.3% and 3.0% of patients, respectively. Conclusions: The time course of VTE in major surgery patients suggests that VTE risk is highest during the first 19 days after admission and that considerable VTE risk extends into the period after discharge.

ABSTRACT Stencil printing fine powder solder paste on wafers and reflowing leverages the flexibility and productivity of standard SMT assembly equipment. As with any process, a vast number of variables need to be considered before launching successfully. Design of a proper stencil template is critical to print consistently formed individual solder paste deposits of correct dimensions. Stencil foil thickness and aperture size selection not only determines the capacity available for formation of the solder paste deposits, but also affects the ability of solder paste within the aperture to be conveyed to the wafer. Compliance to area ratio rules will result in high paste transfer efficiency and predictable bump size. Maintaining a sensible spacing between adjacent apertures will minimize defects. With the demand for finer pitch escalating, conventional design rules are being stretched to their limit. This study investigated the influence of five different squeegee designs on bump size and distribution using several aperture designs intended to challenge fineness of spacing. Metal trailing edge squeegees deposited the largest average paste volume. The experiment also produced excellent yield at tighter than recommended aperture spacing attributed to technology advancements in tools and materials.

Fireside slagging, fouling, and corrosion due to impurities in steam-raising fuels has been under investigation for over a hundred years. From the very beginning impurities in steam-raising fuels has been responsible for costly maintenance problems, a reduction in heat transfer, derating, costly alterations or the use of more expensive fuels. For the first eighty years scientists and engineers have taken an empirical approach to understanding and dealing with these problems. Although complex models have been proposed for various phases or steps in the deposition process, it was not until the development of sophisticated analytical techniques for characterizing fuels and the expanded use of the computer in the late seventies and early eighties that comprehensive modeling was attempted. Consequently a large data base critically outlining the various steps in the complex process of deposition already existed awaiting development of more comprehensive economic models. Fouling and slagging are very complex phenomena which depend upon the release of inorganic constituents in fuels during combustion and their transformation into troublesome compounds during the post-combustion heating and cooling process. Fouling, slagging, and corrosion also depends upon the juxtaposition of individual inorganic ash-forming species during comminution, combustion, and quenching while recovering heat; the chemical reactions between gas, liquid, and solid phases in motion and at rest; the kinetics of transformation of minerals and fly ash; the existence of nonequilibrium conditions frequently associated with super-cooling; and the attachment of impurities to surfaces and the detachment or re-entrainment of deposited solids (1). Figure 1 is a flow diagram illustrating these changes prior to deposition or emission from the steam generator. The complexity of fouling and slagging is compounded by the fact that fireside problems cannot be simply represented by a single rate of deposition on a target by ash characterized by a single elemental analysis. The inorganic components—minerals and organically associated cations—in coal and the fly ash it generates are heterogeneous with