Advanced statistics identification of participant and treatment predictors associated with severe adverse effects induced by fluoropyrimidine-based chemotherapy

PURPOSE

Adverse effects following fluoropyrimidine-based chemotherapy regimens are common. However, there are no current accepted diagnostic markers for prediction prior to treatment, and the underlying mechanisms remain unclear. This study aimed to determine genetic and non-genetic predictors of adverse effects.

METHODS

Genomic DNA was analyzed for 25 single nucleotide polymorphisms (SNPs). Demographics, comorbidities, cancer and fluoropyrimidine-based chemotherapy regimen types, and adverse effect data were obtained from clinical records for 155 Australian White participants. Associations were determined by bivariate analysis, logistic regression modeling and Bayesian network analysis.

RESULTS

Twelve different adverse effects were observed in the participants, the most common severe adverse effect was diarrhea (12.9%). Bivariate analysis revealed associations between all adverse effects except neutropenia, between genetic and non-genetic predictors, and between 8 genetic and 12 non-genetic predictors with more than 1 adverse effect. Logistic regression modeling of adverse effects revealed a greater/sole role for six genetic predictors in overall gastrointestinal toxicity, nausea and/or vomiting, constipation, and neutropenia, and for nine non-genetic predictors in diarrhea, mucositis, neuropathy, generalized pain, hand-foot syndrome, skin toxicity, cardiotoxicity and fatigue. The Bayesian network analysis revealed less directly associated predictors (one genetic and six non-genetic) with adverse effects and confirmed associations between six adverse effects, eight genetic predictors and nine non-genetic predictors.

CONCLUSION

This study is the first to link both genetic and non-genetic predictors with adverse effects following fluoropyrimidine-based chemotherapy. Collectively, we report a wealth of information that warrants further investigation to elucidate the clinical significance, especially associations with genetic predictors and adverse effects.

Development of the chemical exposure monitor with indoor positioning (CEMWIP) for workplace VOC surveys

The purpose of this article was to research and develop a direct-reading exposure assessment method that combined a real-time location system with a wireless direct-reading personal chemical sensor. The personal chemical sensor was a photoionization device for detecting volatile organic compounds. The combined system was calibrated and tested against the same four standard gas concentrations and calibrated at one standard location and tested at four locations that included the standard locations. Data were wirelessly collected from the chemical sensor every 1.4 sec, for volatile organic compounds concentration, location, temperature, humidity, and time. Regression analysis of the photo-ionization device voltage response against calibration gases showed the chemical sensor had a limit of detection of 0.2 ppm. The real-time location system was accurate to 13 cm ± 6 cm (standard deviation) in an open area and to 57 cm ± 31 cm in a closed room where the radio frequency has to penetrate drywall-finished walls. The streaming data were collected and graphically displayed as a three-dimensional hazard map for assessment of peak exposure with location. A real-time personal exposure assessment device with indoor positioning was practical and provided new knowledge on direct reading exposure assessment methods.

Evaluation of leakage from a metal machining center using tracer gas methods: a case study

To evaluate the efficacy of engineering controls in reducing worker exposure to metalworking fluids, an evaluation of an enclosure for a machining center during face milling was performed. The enclosure was built around a vertical metal machining center with an attached ventilation system consisting of a 25-cm diameter duct, a fan, and an air-cleaning filter. The evaluation method included using sulfur hexafluoride (SF6) tracer gas to determine the ventilation system's flow rate and capture efficiency, a respirable aerosol monitor (RAM) to identify aerosol leak locations around the enclosure, and smoke tubes and a velometer to evaluate air movement around the outside of the enclosure. Results of the tracer gas evaluation indicated that the control system was approximately 98% efficient at capturing tracer gas released near the spindle of the machining center. This result was not significantly different from 100% efficiency (p = 0.2). The measured SF6 concentration when released directly into the duct had a relative standard deviation of 2.2%; whereas, when releasing SF6 at the spindle, the concentration had a significantly higher relative standard deviation of 7.8% (p = 0.016). This increased variability could be due to a cyclic leakage at a small gap between the upper and lower portion of the enclosure or due to cyclic stagnation. Leakage also was observed with smoke tubes, a velometer, and an aerosol photometer. The tool and fluid motion combined to induce a periodic airflow in and out of the enclosure. These results suggest that tracer gas methods could be used to evaluate enclosure efficiency. However, smoke tubes and aerosol instrumentation such as optical particle counters or aerosol photometers also need to be used to locate leakage from enclosures.

Factory performance evaluations of engineering controls for asphalt paving equipment

This article describes a unique analytical tool to assist the development and implementation of engineering controls for the asphalt paving industry. Through an agreement with the U.S. Department of Transportation, the National Asphalt Pavement Association (NAPA) requested that the National Institute for Occupational Safety and Health (NIOSH) assist U.S. manufacturers of asphalt paving equipment with the development and evaluation of engineering controls. The intended function of the controls was to capture and remove asphalt emissions generated during the paving process. NIOSH engineers developed a protocol to evaluate prototype engineering controls using qualitative smoke and quantitative tracer gas methods. Video recordings documented each prototype's ability to capture theatrical smoke under "managed" indoor conditions. Sulfur hexafluoride (SF6), released as a tracer gas, enabled quantification of the capture efficiency and exhaust flow rate for each prototype. During indoor evaluations, individual prototypes' capture efficiencies averaged from 7 percent to 100 percent. Outdoor evaluations resulted in average capture efficiencies ranging from 81 percent down to 1 percent as wind gusts disrupted the ability of the controls to capture the SF6. The tracer gas testing protocol successfully revealed deficiencies in prototype designs which otherwise may have gone undetected. It also showed that the combination of a good enclosure and higher exhaust ventilation rate provided the highest capture efficiency. Some manufacturers used the stationary evaluation results to compare performances among multiple hood designs. All the manufacturers identified areas where their prototype designs were susceptible to cross-draft interferences. These stationary performance evaluations proved to be a valuable method to identify strengths and weaknesses in individual designs and subsequently optimize those designs prior to expensive analytical field studies.