Randomized Trial of prophylactic granulocyte colony-stimulating factor during rapid COJEC induction in pediatric patients with high-risk neuroblastoma: the European HR-NBL1/SIOPEN study.

Purpose To reduce the incidence of febrile neutropenia during rapid COJEC (cisplatin, vincristine, carboplatin, etoposide, and cyclophosphamide given in a rapid delivery schedule) induction. In the High-Risk Neuroblastoma-1 (HR-NBL1) trial, the International Society of Paediatric Oncology European Neuroblastoma Group (SIOPEN) randomly assigned patients to primary prophylactic (PP) versus symptom-triggered granulocyte colony-stimulating factor (GCSF; filgrastim). Patients and Methods From May 2002 to November 2005, 239 patients in 16 countries were randomly assigned to receive or not receive PPGCSF. There were 144 boys with a median age of 3.1 years (range, 1 to 17 years) of whom 217 had International Neuroblastoma Staging System (INSS) stage 4 and 22 had stage 2 or 3 MYCN-amplified disease. The prophylactic arm received a single daily dose of 5 μg/kg GCSF, starting after each of the eight COJEC chemotherapy cycles and stopping 24 hours before the next cycle. Chemotherapy was administered every 10 days regardless of hematologic recovery, provided that infection was controlled. Results The PPGCSF arm had significantly fewer febrile neutropenic episodes (P = .002), days with fever (P = .004), hospital days (P = .017), and antibiotic days (P = .001). Reported Common Toxicity Criteria (CTC) graded toxicity was also significantly reduced: infections per cycle (P = .002), fever (P < .001), severe leucopenia (P < .001), neutropenia (P < .001), mucositis (P = .002), nausea/vomiting (P = .045), and constipation (P = .008). Severe weight loss was reduced significantly by 50% (P = .013). Protocol compliance with the rapid induction schedule was also significantly better in the PPGCSF arm shown by shorter time to completion (P = .005). PPGCSF did not adversely affect response rates or success of peripheral-blood stem-cell harvest. Following these results, PPG-GSF was advised for all patients on rapid COJEC induction.

Identification of Conifer Trees in Iowa, September 22, 1998

This publication is designed to help identify the most common trees found in Iowa. It is based on vegetative characteristics including leaves, fruit, and bark. It is neither complete nor without possible oversights. Separate species are grouped by similar characteristics, mainly based on type and arrangement of leaves. These groups are; awl- or scale like needles; single needles, flattened with rounded tips; single needles, square in cross section, with pointed tips; and needles in bundles or fascicles of two or more. Remember, vegetative characteristics are quite variable; use more than one specimen for comparison.

Friday Facts, August 22, 2014, Vol. 223

Bureau of Nutrition and Health Promotion part of the Iowa Department of Public Health produces of weekly newsletter about the Iowa WIC Program for the State of Iowa citizen.

Iowa Privacy Task Force Final Report, January 22, 2002

In appointing the Iowa Privacy Task Force, Governor Vilsack sought to obtain the opinions of both average Iowa citizens and businesses and professionals that work with health and financial information. The Governor recognized that the free flow of information is essential to the vitality of the Iowa economy. At the same time, he also recognized the legitimate fears and concerns of Iowa citizens with the potential loss of privacy inherent in the vast new information flows in this new economy. In order to obtain broad and balanced input, the Governor appointed half the members of the Task Force to represent average Iowa citizens. The other half of the Task Force was appointed with representatives of the financial services industry, providers of health care and the health insurance industry. The Task Force was further balanced to represent the different geographic regions of the state and gender. A total of 32 members were appointed to the Task Force.

EPI Update, August 22, 2014

Weekly newsletter for Center For Acute Disease Epidemiology of Iowa Department of Public Health.

Iowa Crop Progress & Condition, September 22, 2014

Report produced by the The Department of Agriculture and Land Stewardship, Climatology Bureau. Weather report released by the USDA National Agricultural Statistical Service. The report is released weekly from April through October. Formally titled: Iowa Crop and Weather Report

Vancomycin exposure from active calcium sulfate bone filler

Objective: Bone cements and substitutes are commonly used in surgery to deliver antibiotics locally. The objective of this study was to assess the systemic absorption and disposition of vancomycin in patients treated with active calcium sulfate bone filler and to predict systemic concentrations under various conditions. Method: 277 blood samples were taken from 42 patients receiving vancomycin in bone cement during surgery. Blood samples were collected from 3h to 10 days after implantation. Vancomycin was measured by immunoenzymatic assay. Population pharmacokinetic (PK) analysis was performed using NONMEM to assess average estimates and variability of PK parameters. Based on the final model, simulations with various doses and renal function levels were performed. Results: The patients were 64 ± 20 years old, their body weight was 81 ± 22 kg and Cockcroft-Gault creatinine clearance (CLcr) 98 ± 55 mL/min. Vancomycin doses ranged from 200 mg to 6000 mg and implantation sites were hip (n=16), tibia (10) or others (16). Concentration profiles remained low and consistent with absorption rate-limited first-order release, while showing prominent variability. Mean clearance (CL) was 3.87 L/h (CV 35%), absorption rate constant (ka) 0.004 h-1 (66%) and volume of distribution (V) 9.5 L. Simulations with up to 8000 mg vancomycin implant showed systemic concentrations exceeding 20 mg/L for 3.5 days in 43% of the patients with CLcr 15 mL/min, whereas 7% of the patients with normal renal function had a concentration above 20 mg/L for 1.1 days. Subtherapeutic concentrations (0.4-4 mg/L) were predicted during a median of 22 days in patients with normal renal function and 4000 mg vancomycin implant, with limited influence of dose or renal function. Conclusion: Vancomycin-laden calcium sulfate implant does not raise toxicity concern. Selection of resistant bacteria, such as Enterococcus and Staphylococcus species, might however be a concern, as simulations show persistent subtherapeutic systemic concentrations during 3 to 4 weeks in these patients.

Iowa Agri-News, September 26, 2014, Vol. 14, no. 22

Crop and livestock summaries for the state of Iowa, produced by the Iowa Department of Agriculture. Previously Agri-News

Report on a review of selected general and application controls over the Iowa State University of Science and Technology student financial aid system for the period of April 22, 2013 through May 17, 2013

Report on a review of selected general and application controls over the Iowa State University of Science and Technology student financial aid system for the period of April 22, 2013 through May 17, 2013

Oeuvres complètes de J. Michelet. T.22, 6

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