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Sample records for monitoring clinical variables

  1. Microcomputer-assisted monitoring system for measuring and processing cardiorespiratory variables: preliminary results of clinical trials.

    PubMed

    Hankeln, K B; Michelsen, H; Schipulle, M; Engel, H J; Beez, M; Szreter, T; Boehmert, F

    1985-05-01

    A microcomputer-assisted monitoring system was developed for the continuous measuring and processing of cardiorespiratory variables, including: systemic and pulmonary arterial pressures, CVP, minute ventilation, inspired and expired O2 and CO2 concentrations, temperature, and heart rate. The primary data were converted to digital form, processed, displayed on a CRT monitor, and also stored for later evaluation. This system automatically calculated and displayed on-line and in real-time both primary measurements and derived cardiorespiratory variables, including: oxygen consumption, CO2 production, left and right ventricular stroke work, pulmonary venous admixture, and systemic and pulmonary vascular resistances. Printouts of the variables and trend graphs could be obtained for any desired time period. During its development, we tested this monitoring system in 30 critically ill patients, finding that the real-time calculation of cardiorespiratory variables was a great advantage during monitoring and treatment. PMID:3987322

  2. Variability in opioid prescription monitoring and evidence of aberrant medication taking behaviors in urban safety-net clinics.

    PubMed

    Lange, Allison; Lasser, Karen E; Xuan, Ziming; Khalid, Laila; Beers, Donna; Heymann, Orlaith D; Shanahan, Christopher W; Crosson, Julie; Liebschutz, Jane M

    2015-02-01

    Little is known about variability in primary care providers' (PCPs) adherence to opioid-monitoring guidelines for patients. We examined variability of adherence to monitoring guidelines among PCPs and ascertained the relationship between PCP adherence and opioid misuse by their patients. We included primary care patients receiving long-term opioids (≥3 prescriptions within 6 months) for chronic noncancer pain and PCPs with ≥4 eligible patients. We examined guideline adherence using: (1) electronic health record documentation of opioid treatment agreement, (2) past-year urine drug screen (UDS), and (3) evidence of misuse through early refills (≥2 opioid prescriptions written 7-25 days after the previous prescription). Covariates included morphine equivalent daily opioid medication dose (MED, >50 mg/d vs ≤50mg/d). Multilevel regression models assessed variability among PCPs, and odds ratios examined associations among patient-level binary outcomes. Sixty-seven PCPs prescribed opioids to 1546 patients. Significant variability was found between PCPs in use of agreement (variance = 1.27, P < 0.001), UDS (variance = 1.75, P < 0.001), and early refills (variance = 0.29, P = 0.002). Primary care providers had a mean of 48% of patients with agreement (range, 9%-84%), 56% with ≥1 UDS (range, 7%-91%) and 36% with early refills (range, 19%-60%). High MED among patients was associated with increased odds of agreement (1.93, confidence interval [CI], 1.53-2.44), UDS (2.65, CI: 2.06-3.41), and early refill (2.92, CI: 2.30-3.70). Primary care providers varied significantly in adherence to opioid prescription guidelines. Increased patient risk was associated with increased monitoring and with greater misuse. Future work should study system-level interventions to enable clinical monitoring and support opioid guideline adherence. PMID:25599455

  3. Glycemic variability: Clinical implications

    PubMed Central

    Satya Krishna, Surabhi Venkata; Kota, Sunil K.; Modi, Kirtikumar D.

    2013-01-01

    Glycemic control and its benefits in preventing microvascular diabetic complications are convincingly proved by various prospective trials. Diabetes control and complications trial (DCCT) had reported variable glycated hemoglobin (HbA1C) as a cause of increased microvascular complications in conventional glycemic control group versus intensive one. However, in spite of several indirect evidences, its link with cardiovascular events or macrovascular complications is still not proved. Glycemic variability (GV) is one more tool to explain relation between hyperglycemia and increased cardiovascular risk in diabetic patients. In fact GV along with fasting blood sugar, postprandial blood sugar, HbA1C, and quality of life has been proposed to form glycemic pentad, which needs to be considered in diabetes management. Postprandial spikes in blood glucose as well as hypoglycemic events, both are blamed for increased cardiovascular events in Type 2 diabetics. GV includes both these events and hence minimizing GV can prevent future cardiovascular events. Modern diabetes management modalities including improved sulfonylureas, glucagon like peptide-1 (GLP-1)-based therapy, newer basal insulins, and modern insulin pumps address the issue of GV effectively. This article highlights mechanism, clinical implications, and measures to control GV in clinical practice. PMID:23961476

  4. Monitoring Physiological Variables with Membrane Probes

    NASA Technical Reports Server (NTRS)

    Janle, Elsa M.

    1997-01-01

    This project has demonstrated the possibility of using membrane probes in rodents to monitor physiological variables for extended periods of time. The utility of these probes in physiological studies of microgravity has been demonstrated. The feasibility of developing on-line sensors has also been demonstrated and allows for the possibility of developing real-time automated monitoring systems which can be used in ground-base physiological research as well as in research and medical monitoring in space. In addition to space applications these techniques can be extended to medical monitoring in critical care situations on earth as well as facilitating research in many human and animal diseases.

  5. Variability in continuous traffic monitoring data

    SciTech Connect

    Wright, T.; Hu, P.S.; Young, J.

    1996-07-01

    Each state in the United States can be viewed as a universe of road segments. For each road segment in each state, it is desired to know various traffic characteristics based on count data, classification count data, and weigh-in-motion data. These data are absolutely essential for highway design, maintenance, safety, and planning. Given no cost constraints, each road segment would be continuously monitored every day of the year. However, in practice, a few road segments are monitored continuously every day of the year to produce annual characteristics of traffic flow. The remaining road segments are monitored for one or two days each year, and this resulting data are `adjusted` (using factors based on data collected from the continuously monitored road segments) to produce estimates of annual characteristics. With this general approach, each state strives to provide estimates of annual characteristics for each road segment within its jurisdiction. In 1985, the Federal Highway Administration (FHWA) published the Traffic Monitoring Guide to assist states in achieving this end. As with almost any data collection effort, the monitoring data suffers from errors from many sources. In this paper, we report some empirical findings in a research project sponsored by the FHWA. This research project studied the variability in the traffic data from the continuously monitored road segments from state(s) and, the extent to which this variability is transferred to and affects the precision of the data produced from the road segments which are monitored only one or two days each year. The ultimate hope is that states will eventually be able to not only publish an estimate of a characteristic such as Average Annual Daily Traffic (AADT) for each road segment, but also that each estimate will be accompanied by a statement expressing how good the estimate is in terms of its estimated variability or precision, which will likely be expressed as a coefficient of variation.

  6. Monitoring software development through dynamic variables

    NASA Technical Reports Server (NTRS)

    Doerflinger, Carl W.; Basili, Victor R.

    1983-01-01

    Research conducted by the Software Engineering Laboratory (SEL) on the use of dynamic variables as a tool to monitor software development is described. Project independent measures which may be used in a management tool for monitoring software development are identified. Several FORTRAN projects with similar profiles are examined. The staff was experienced in developing these types of projects. The projects developed serve similar functions. Because these projects are similar some underlying relationships exist that are invariant between projects. These relationships, once well defined, may be used to compare the development of different projects to determine whether they are evolving the same way previous projects in this environment evolved.

  7. Monitoring software development through dynamic variables

    NASA Technical Reports Server (NTRS)

    Doerflinger, C. W.; Basili, V. R.

    1985-01-01

    Research conducted by the Software Engineering Laboratory (SEL) on the use of dynamic variables as a tool to monitor software development is described. Project independent measures which may be used in a management tool for monitoring software development are identified. Several FORTRAN projects with similar profiles are examined. The staff was experienced in developing these types of projects. The projects developed serve similar functions. Because these projects are similar some underlying relationships exist that are invariant between the projects. These relationships, once well defined, may be used to compare the development of different projects to determine whether they are evolving the same way previous projects in this environment evolved.

  8. Monitoring software development through dynamic variables

    NASA Technical Reports Server (NTRS)

    Doerflinger, C. W.; Basili, V. R.

    1983-01-01

    Research conducted by the Software Engineering Laboratory (SEL) on the use of dynamic variables as a tool to monitor software development is described. Project independent measures which may be used in a management tool for monitoring software development are identified. Several FORTRAN projects with similar profiles are examined. The staff was experienced in developing these types of projects. The projects developed serve similar functions. Because these projects are similar some underlying relationships exist that are invariant between the projects. These relationships, once well defined, may be used to compare the development of different projects to determine whether they are evolving the same way previous projects in this environment evolved.

  9. Time Monitoring Variability of Classical Be Stars

    NASA Astrophysics Data System (ADS)

    Kuhn, Benjamin; Eisner, Joshua A.; Stone, Jordan

    2016-01-01

    Classical Be stars are B type stars that show hydrogen emission in their spectra, and exhibit variability across the electromagnetic spectrum, including visible and infrared wavelengths. While spectroscopic variability in the optical range has been studied previously, the near infrared region has not been investigated as thoroughly. We present multiple epochs of near infrared spectroscopy for a sample of eight Classical Be stars. Our observations were taken using the FSPEC instrument on the 90-inch Bok reflector telescope at Kitt Peak during the months of May and June of 2010 and 2011. We targeted the Brackett Gamma emission line of hydrogen with a resolution of ≈3500. Using Python we developed tools to analyze the reduced and calibrated spectra, as well as compute equivalent widths. Time-series spectra indicate that a majority of the systems exhibit spectroscopic variability. By monitoring the strengths of the emission feature over time we aim to constrain the physical properties of these systems.

  10. What variables can influence clinical reasoning?

    PubMed Central

    Ashoorion, Vahid; Liaghatdar, Mohammad Javad; Adibi, Peyman

    2012-01-01

    Background: Clinical reasoning is one of the most important competencies that a physician should achieve. Many medical schools and licensing bodies try to predict it based on some general measures such as critical thinking, personality, and emotional intelligence. This study aimed at providing a model to design the relationship between the constructs. Materials and Methods: Sixty-nine medical students participated in this study. A battery test devised that consist four parts: Clinical reasoning measures, personality NEO inventory, Bar-On EQ inventory, and California critical thinking questionnaire. All participants completed the tests. Correlation and multiple regression analysis consumed for data analysis. Results: There is low to moderate correlations between clinical reasoning and other variables. Emotional intelligence is the only variable that contributes clinical reasoning construct (r=0.17-0.34) (R2 chnage = 0.46, P Value = 0.000). Conclusion: Although, clinical reasoning can be considered as a kind of thinking, no significant correlation detected between it and other constructs. Emotional intelligence (and its subscales) is the only variable that can be used for clinical reasoning prediction. PMID:23853636

  11. Clinical and acoustical variability in hypokinetic dysarthria

    SciTech Connect

    Metter, E.J.; Hanson, W.R.

    1986-10-01

    Ten male patients with parkinsonism secondary to Parkinson's disease or progressive supranuclear palsy had clinical neurological, speech, and acoustical speech evaluations. In addition, seven of the patients were evaluated by x-ray computed tomography (CT) and (F-18)-fluorodeoxyglucose (FDG) positron emission tomography (PET). Extensive variability of speech features, both clinical and acoustical, were found and seemed to be independent of the severity of any parkinsonian sign, CT, or FDG PET. In addition, little relationship existed between the variability across each measured speech feature. What appeared to be important for the appearance of abnormal acoustic measures was the degree of overall severity of the dysarthria. These observations suggest that a better understanding of hypokinetic dysarthria may result from more extensive examination of the variability between patients. Emphasizing a specific feature such as rapid speaking rate in characterizing hypokinetic dysarthria focuses on a single and inconstant finding in a complex speech pattern.

  12. Current clinical applications of heart rate variability.

    PubMed

    Stys, A; Stys, T

    1998-10-01

    Heart rate variability (HRV) has become a popular method for the studies of physiologic mechanisms responsible for the control of heart rate fluctuations, in which the autonomic nervous system appears to play a primary role. Depression of HRV has been observed in many clinical scenarios, including autonomic neuropathy, heart transplantation, congestive heart failure, myocardial infarction (MI), and other cardiac and noncardiac diseases. However, it is important to realize that clinical implication of HRV analysis has been clearly recognized in only two clinical conditions: (1) as a predictor of risk of arrhythmic events or sudden cardiac death after acute MI, and (2) as a clinical marker of evolving diabetic neuropathy. Recently, its role in evaluation and management of heart failure has also been recognized. It is pertinent to recognize the limitations of HRV as far as its clinical utility at present is concerned. The methodology of HRV had remained poorly standardized until the recent publication of the Special Report of the Task Force of ESC/NASPE, and thus has been presenting difficulty in comparing earlier existing data. Also, determination of the exact sensitivity, specificity, and predictive value of HRV, as well as the normal values of standard measures in the general population, still require further investigation before better standards can be set for existing and future clinical applications. This article reviews the major concepts of HRV measurements, their clinical relevance, and the recent advances in this field. PMID:9789691

  13. Esophageal Impedance Monitoring: Clinical Pearls and Pitfalls.

    PubMed

    Ravi, Karthik; Katzka, David A

    2016-09-01

    The development of intraluminal esophageal impedance monitoring has improved our ability to detect and measure gastroesophageal reflux without dependence on acid content. This ability to detect previously unrecognized weak or nonacid reflux episodes has had important clinical implications in the diagnosis and management of gastroesophageal reflux disease (GERD). In addition, with the ability to assess bolus transit within the esophageal lumen, impedance monitoring has enhanced the recognition and characterization of esophageal motility disorders in patients with nonobstructive dysphagia. The assessment of the intraluminal movement of gas and liquid has also been proven to be of diagnostic value in conditions such as rumination syndrome and excessive belching. Further, alternative applications of impedance monitoring, such as the measurement of mucosal impedance, have provided novel insights into assessing esophageal mucosal integrity changes as a consequence of inflammatory change. Future applications for esophageal impedance monitoring also hold promise in esophageal conditions other than GERD. However, despite all of the clinical benefits afforded by esophageal impedance monitoring, important clinical and technical shortcomings limit its diagnostic value and must be considered when interpreting study results. Overinterpretation of studies or application of impedance monitoring in patients can have deleterious clinical implications. This review will highlight the clinical benefits and limitations of esophageal impedance monitoring and provide clinical pearls and pitfalls associated with this technology. PMID:27325223

  14. Examination and Monitoring of delta Scuti Variables

    NASA Astrophysics Data System (ADS)

    Hintz, E. G.; Bush, T. C.; Walter, L. A.

    2002-12-01

    Using a variety of telescopes and a variety of observers we continue our program of examining and monitoring δ Scuti variables. The telescopes range from an 8-in up to a 1.8-meter. The observers include high school students, undergraduate and graduate students, and faculty. We will present information about the overall program and results for a number of stars including DQ Cephei, BO Lyncis, AN Lyncis, V407 Cephei, and V577 Ophiuchi. Many other stars have been observed as part of student projects. Therefore, other posters from our group include presentations on a number of individual stars (QS Geminorum, CQ Lyncis, and V1438 Aquilae) and a poster on our spectral observing campaign. We will also report on the installation of a 10-in telescope at Payson High School and its participation in our observing campaigns. We would like to acknowledge the following : a NSF REU grant PHY-9988852, an AAS Small Research Grant for equipment on the 10-in Payson High Telescope, an AAS Small Research Grant for purchase of two research filters, the Theodore Dunham Jr. Grants for Research in Astronomy, and use of the telescopes of the Dominion Astrophysical Observatory.

  15. Statistical models for the control phase of clinical monitoring.

    PubMed

    Stevens, Richard J; Oke, Jason; Perera, Rafael

    2010-08-01

    The rise in the prevalence of chronic conditions means that these are now the leading causes of death and disability worldwide, accounting for almost 60% of all deaths and 43% of the global burden of disease. Management of chronic conditions requires both effective treatment and ongoing monitoring. Although costs related to monitoring are substantial, there is relatively little evidence on its effectiveness. Monitoring is inherently different to diagnosis in its use of regularly repeated tests, and increasing frequency can result in poorer rather than better statistical properties because of multiple testing in the presence of high variability. We present here a general framework for modelling the control phase of a monitoring programme, and for the estimation of quantities of potential clinical interest such as the ratio of false to true positive tests. We show how four recent clinical studies of monitoring cardiovascular disease, hypertension, diabetes and HIV infection can be thought as special cases of this framework; as well as using this framework to clarify the choice of estimation and calculation methods available. Noticeably, in each of the presented examples over-frequent monitoring appears to be a greater problem than under-frequent monitoring. We also present recalculations of results under alternative conditions, illustrating conceptual decisions about modelling the true or observed value of a clinical measure. PMID:20442195

  16. [Common variable immunodeficiency: a clinical challenge].

    PubMed

    Warnatz, K; Goldacker, S

    2013-09-01

    Common variable immunodeficiency (CVID) represents the most common clinically relevant form of primary immunodeficiency. This heterogeneous antibody deficiency syndrome is characterized not only by susceptibility to bacterial respiratory tract infections but displays additional signs of immune dysregulation, such as autoimmunity, chronic inflammation and lymphoproliferation in more than 30 % of the patients. Due to poor awareness the diagnosis is often delayed by 4-6 years. A close collaboration in patient care with a center specialized in primary immunodeficiency is recommended. Regular follow-up visits include assessment of adequate immunoglobulin replacement therapy and screening for manifestation of secondary complications. Regular substitution with intravenous or subcutaneous immunoglobulins has more or less normalized life expectancy of patients with isolated susceptibility to bacterial infections. Therefore, the current core task in the management of CVID patients is the elaboration of more effective and safer forms of prophylaxis and treatment of sequelae of immune dysregulation in the lungs, intestines and liver of affected patients. PMID:23929240

  17. Impact of Remote Monitoring on Clinical Outcomes.

    PubMed

    Varma, Niraj; Ricci, Renato Pietro

    2015-12-01

    Follow-up of patients with cardiac implantable electronic devices is challenging due to both their increasing volume and technical complexity coupled to increasing clinical complexity of recipient patients. Remote monitoring (RM) offers an opportunity to resolve some of these difficulties by improving clinic efficiencies and providing a mechanism for device monitoring and patient management. Several recent randomized clinical trials and registries have demonstrated that RM may reduce in-hospital visit numbers, time required for patient follow-up, physician and nurse time, and hospital and social costs. Furthermore, patient retention and adherence to follow-up schedule are significantly improved by RM. Continuous wireless monitoring of data stored in the device memory with automatic alerts allows early detection of device malfunctions and of events, such as atrial fibrillation, ventricular arrhythmias, and heart failure suitable for clinical intervention. Early reaction may improve patient outcome. RM is easy to use and patients showed a high level of acceptance and satisfaction. Implementing RM in daily practice may require changes in clinic workflow. New organizational models promote significant efficiencies regarding physician and nursing time. Data management techniques are under development. Despite these demonstrable advantages of RM, adoption still remains modest, even in health care systems incentivized to use this follow-up method. PMID:26337400

  18. BioMEMS for multiparameter clinical monitoring

    NASA Astrophysics Data System (ADS)

    Moser, Isabella

    2003-01-01

    For diabetes patients glucose monitoring means an important improvement of their life quality and additionally it is a $3-billion-a-year business. Continuous glucose monitoring provides gapless glucose level control, an early warning of hypoglycemia, and is intended to control insulin pumps. An upgrading to multi-parameter monitoring would not only benefit patients with severe metabolism defects but also the metabolism of diabetes patient could be better controlled by monitoring an additional parameter like lactate. Multi-parameter monitoring devices are not commercially available, one of the complications in the integration of different biosensors using the same detecting molecule for all analytes is chemical cross talk between adjacent amperometric biosensors. Recently some integrated biosensors were published but either they were not mass producible or they were realized in an expensive silicon based technology. In addition to it most of them were not tested under monitoring conditions but their integration principles will be discussed. As an example a low cost multi- parameter microsystem and some applications of it in clinical diagnosis will be presented. Also an overlook of non-invasive methods and (minimal) invasive methods will be given with a focus on microdialysis.

  19. All-Sky Monitoring of Variable Sources with Fermi GBM

    NASA Technical Reports Server (NTRS)

    Wilson-Hodge, Colleen A.; Cherry, Michael L.; Case, Gary L.; Camero-Arranz, Ascension; Chaplin, Vandiver; Connaughton, Valerie; Finger, Mark H.; Jenke, Pater; Rodi, James C.; Baumgartner, Wayne H.; Beklen, Elif; Bhat, P. Narayana; Briggs, Michael S.; Gehrels, Neil; Greiner, Jochen; Jahoda, Keith; Kippen, R. Marc; Kouveliotou, Chryssa; Krimm, Hans A.; Kuulkers, Erik; Lund, Niels; Meegan, Charles A.; Natalucci, Lorenzo; Paciesas, William S.; Preece, Robert

    2011-01-01

    This slide presentation reviews the monitoring of variable sources with the Fermi Gamma Ray Burst Monitor (GBM). It reviews the use of the Earth Occultation technique, the observations of the Crab Nebula with the GBM, and the comparison with other satellite's observations. The instruments on board the four satellites indicate a decline in the Crab from 2008-2010.

  20. Perfusion Quality Improvement and the Reduction of Clinical Variability

    PubMed Central

    Stammers, Alfred H.; Trowbridge, Cody C.; Pezzuto, James; Casale, Alfred

    2009-01-01

    Abstract: The purpose of this study was to describe the development and utilization of a perfusion quality improvement program to reduce perfusion-to-perfusion variability in a large multi-center perfusion practice. Phase I of the study included the establishment of a perfusion database using standard spreadsheet format to serve multiple administrative functions including patient and procedure sequencing, predictive algorithms for yearly caseload, summary statistics, and inter-perfusionist comparison. The database used 236 separate variables, including demographic and clinical procedure-related categories. Forty of these variables are modifiable by perfusion interaction as established via protocol and algorithm. Phase II of the study used a perfusion electronic data recording system to automatically obtain patient data from physiologic monitors and the heart-lung machine. Data were transferred to a central database for perfusionist comparison. Data analysis used logical functions and macros programming, and statistical analysis used both parametric and non-parametric models within the program. Each quarter all variables underwent analysis with summary data established for the most recent 225 patients undergoing CPB. Twenty-five cases from each perfusionist (n = 9) were compared with the aggregate data of the entire staff, with reference to previous quarter’s summary statistics. The results were discussed in monthly staff meetings and methods for improving compliance were discussed. Individual variation (p < .01) varied in 17 of 40 variables (26.0 ± 8.6), with quarterly improvement (27.4 ± 2.3 vs. 24.2 ± 2.1 vs. 17.0 ± 2.1) demonstrated in seven of nine individuals. In Phase II, performance was analyzed using the same variables as in Phase I but it also included the electronically recorded data from which 27 core measures were derived. All results were discussed with the staff at monthly departmental quality improvement meetings. The perfusion quality

  1. [Current clinical aspects of ambulatory blood pressure monitoring].

    PubMed

    Sauza-Sosa, Julio César; Cuéllar-Álvarez, José; Villegas-Herrera, Karla Montserrat; Sierra-Galán, Lilia Mercedes

    2016-01-01

    Systemic arterial hypertension is the prevalentest disease worldwide that significantly increases cardiovascular risk. An early diagnosis together to achieve goals decreases the risk of complications significatly. Recently have been updated the diagnostic criteria for hypertension and the introduction of ambulatory blood pressure monitoring. The introduction into clinical practice of ambulatory blood pressure monitoring was to assist the diagnosis of «white coat hypertension» and «masked hypertension». Today has also shown that ambulatory blood pressure monitoring is better than the traditional method of recording blood pressure in the office, to the diagnosis and to adequate control and adjustment of drug treatment. Also there have been introduced important new concepts such as isloted nocturnal hypertension, morning blood pressure elevation altered and altered patterns of nocturnal dip in blood pressure; which have been associated with increased cardiovascular risk. Several studies have shown significant prognostic value in some stocks. There are still other concepts on which further study is needed to properly establish their introduction to clinical practice as hypertensive load variability, pulse pressure and arterial stiffness. In addition to setting values according to further clinical studies in populations such as elderly and children. PMID:26794338

  2. Serial Monitoring of Otoacoustic Emissions in Clinical Trials.

    PubMed

    Konrad-Martin, Dawn; Poling, Gayla L; Dreisbach, Laura E; Reavis, Kelly M; McMillan, Garnett P; Lapsley Miller, Judi A; Marshall, Lynne

    2016-09-01

    The purpose of this report is to provide guidance on the use of otoacoustic emissions (OAEs) as a clinical trial outcome measure for pharmaceutical interventions developed to prevent acquired hearing loss secondary to cochlear insult. OAEs are a rapid, noninvasive measure that can be used to monitor cochlear outer hair cell function. Serial monitoring of OAEs is most clearly established for use in hearing conservation and ototoxicity monitoring programs in which they exhibit more frequent and earlier changes compared with pure-tone audiometry. They also show promise in recent human trials of otoprotectants. Questions remain, however, concerning the most appropriate OAE protocols to use and what constitutes a "significant" OAE response change. Measurement system capabilities are expanding and test efficacy will vary across locations and patient populations. Yet, standardizing minimal measurement criteria and reporting of results is needed including documentation of test-retest variability so that useful comparisons can be made across trials. It is also clear that protocols must be theoretically sound based on known patterns of damage, generate valid results in most individuals tested, be accurate, repeatable, and involve minimal time. Based on the potential value added, OAEs should be included in clinical trials when measurement conditions and time permit. PMID:27518137

  3. Variability of capillary blood glucose monitoring measured on home glucose monitoring devices

    PubMed Central

    Kotwal, Narendra; Pandit, Aditi

    2012-01-01

    Self monitoring of blood glucose helps achieve glycemic goals. Glucometers must be accurate. Many variables affect blood glucose levels. Factors are analytical variables (intrinsic to glucometer and glucose strips) and pre analytical related to patients. Analytical variables depend on factors like shelf life, amount of blood and enzymatic reactions. Preanalytical variables include pH of blood, hypoxia, hypotension, hematocrit etc. CGMS has the potential to revolutionise diabetes care but accuracy needs to be proven beyond doubt before replacing current glucometer devices. PMID:23565391

  4. Monitoring D-Region Variability from Lightning Measurements

    NASA Technical Reports Server (NTRS)

    Simoes, Fernando; Berthelier, Jean-Jacques; Pfaff, Robert; Bilitza, Dieter; Klenzing, Jeffery

    2011-01-01

    In situ measurements of ionospheric D-region characteristics are somewhat scarce and rely mostly on sounding rockets. Remote sensing techniques employing Very Low Frequency (VLF) transmitters can provide electron density estimates from subionospheric wave propagation modeling. Here we discuss how lightning waveform measurements, namely sferics and tweeks, can be used for monitoring the D-region variability and day-night transition, and for local electron density estimates. A brief comparison among D-region aeronomy models is also presented.

  5. Monitoring variable X-ray sources in nearby galaxies

    NASA Astrophysics Data System (ADS)

    Kong, A. K. H.

    2010-12-01

    In the last decade, it has been possible to monitor variable X-ray sources in nearby galaxies. In particular, since the launch of Chandra, M31 has been regularly observed. It is perhaps the only nearby galaxy which is observed by an X-ray telescope regularly throughout operation. With 10 years of observations, the center of M31 has been observed with Chandra for nearly 1 Msec and the X-ray skies of M31 consist of many transients and variables. Furthermore, the X-ray Telescope of Swift has been monitoring several ultraluminous X-ray sources in nearby galaxies regularly. Not only can we detect long-term X-ray variability, we can also find spectral variation as well as possible orbital period. In this talk, I will review some of the important Chandra and Swift monitoring observations of nearby galaxies in the past 10 years. I will also present a "high-definition" movie of M31 and discuss the possibility of detecting luminous transients in M31 with MAXI.

  6. Variability in traffic monitoring data. Final summary report

    SciTech Connect

    Wright, T.; Hu, P.S.; Young, J.; Lu, A.

    1997-08-01

    For highway maintenance and planning purposes, it is desirable to characterize each road segment by its traffic flow [such as the annual average daily traffic (AADT) and the AADT for each vehicle class], by the weight distribution of vehicles that travel on its roads [such as the annual average daily equivalent single axle loadings (ESAL) and the annual average daily weight per vehicle for each vehicle class]. As with almost any data collection effort, the monitoring data suffer from errors from many sources. This report summarizes results of a two year empirical research effort, which was sponsored by the Federal highway Administration, (i) to study and characterize the variability in the traffic data (volume, classification, and weight) from the continuously monitored road segments, and (ii) to study the extent to which this variability is transferred to, and affects the precision of the data produced form the road segments which are monitored only one or two days each year. The ultimate hope is not only that states will eventually be able to publish an estimate of a characteristic such as AADT for each road segment, but also that each estimate will be accompanied by a statement of how good the estimate is in terms of the estimated variability or precision which will likely be experienced as a coefficient of variation (i.e., the quotient of a standard deviation and a mean). This report provides highlights of research reported in five working papers.

  7. The clinical utility of ambulatory blood pressure monitoring (ABPM): a review.

    PubMed

    Harianto, Harry; Valente, Michael; Hoetomo, Soenarno; Anpalahan, Mahesan

    2014-01-01

    The current evidence suggests that ambulatory blood pressure monitoring (ABPM) should be an integral part of the diagnosis and management of hypertension. However, its uptake in routine clinical practice has been variable. This paper reviews the current evidence for the role of ABPM in clinical practice, including in hypotensive disorders and in specific comorbidities. It further discusses the clinical significance of abnormal ambulatory blood pressure patterns and hypertensive syndromes such as white coat, masked and resistant hypertension. PMID:25801624

  8. Review and classification of variability analysis techniques with clinical applications

    PubMed Central

    2011-01-01

    Analysis of patterns of variation of time-series, termed variability analysis, represents a rapidly evolving discipline with increasing applications in different fields of science. In medicine and in particular critical care, efforts have focussed on evaluating the clinical utility of variability. However, the growth and complexity of techniques applicable to this field have made interpretation and understanding of variability more challenging. Our objective is to provide an updated review of variability analysis techniques suitable for clinical applications. We review more than 70 variability techniques, providing for each technique a brief description of the underlying theory and assumptions, together with a summary of clinical applications. We propose a revised classification for the domains of variability techniques, which include statistical, geometric, energetic, informational, and invariant. We discuss the process of calculation, often necessitating a mathematical transform of the time-series. Our aims are to summarize a broad literature, promote a shared vocabulary that would improve the exchange of ideas, and the analyses of the results between different studies. We conclude with challenges for the evolving science of variability analysis. PMID:21985357

  9. Combining clinical variables to optimize prediction of antidepressant treatment outcomes.

    PubMed

    Iniesta, Raquel; Malki, Karim; Maier, Wolfgang; Rietschel, Marcella; Mors, Ole; Hauser, Joanna; Henigsberg, Neven; Dernovsek, Mojca Zvezdana; Souery, Daniel; Stahl, Daniel; Dobson, Richard; Aitchison, Katherine J; Farmer, Anne; Lewis, Cathryn M; McGuffin, Peter; Uher, Rudolf

    2016-07-01

    The outcome of treatment with antidepressants varies markedly across people with the same diagnosis. A clinically significant prediction of outcomes could spare the frustration of trial and error approach and improve the outcomes of major depressive disorder through individualized treatment selection. It is likely that a combination of multiple predictors is needed to achieve such prediction. We used elastic net regularized regression to optimize prediction of symptom improvement and remission during treatment with escitalopram or nortriptyline and to identify contributing predictors from a range of demographic and clinical variables in 793 adults with major depressive disorder. A combination of demographic and clinical variables, with strong contributions from symptoms of depressed mood, reduced interest, decreased activity, indecisiveness, pessimism and anxiety significantly predicted treatment outcomes, explaining 5-10% of variance in symptom improvement with escitalopram. Similar combinations of variables predicted remission with area under the curve 0.72, explaining approximately 15% of variance (pseudo R(2)) in who achieves remission, with strong contributions from body mass index, appetite, interest-activity symptom dimension and anxious-somatizing depression subtype. Escitalopram-specific outcome prediction was more accurate than generic outcome prediction, and reached effect sizes that were near or above a previously established benchmark for clinical significance. Outcome prediction on the nortriptyline arm did not significantly differ from chance. These results suggest that easily obtained demographic and clinical variables can predict therapeutic response to escitalopram with clinically meaningful accuracy, suggesting a potential for individualized prescription of this antidepressant drug. PMID:27089522

  10. Global biodiversity monitoring: from data sources to essential biodiversity variables

    USGS Publications Warehouse

    Proenca, Vania; Martin, Laura J.; Pereira, Henrique M.; Fernandez, Miguel; McRae, Louise; Belnap, Jayne; Böhm, Monika; Brummitt, Neil; Garcia-Moreno, Jaime; Gregory, Richard D.; Honrado, Joao P; Jürgens, Norbert; Opige, Michael; Schmeller, Dirk S.; Tiago, Patricia; van Sway, Chris A

    2016-01-01

    Essential Biodiversity Variables (EBVs) consolidate information from varied biodiversity observation sources. Here we demonstrate the links between data sources, EBVs and indicators and discuss how different sources of biodiversity observations can be harnessed to inform EBVs. We classify sources of primary observations into four types: extensive and intensive monitoring schemes, ecological field studies and satellite remote sensing. We characterize their geographic, taxonomic and temporal coverage. Ecological field studies and intensive monitoring schemes inform a wide range of EBVs, but the former tend to deliver short-term data, while the geographic coverage of the latter is limited. In contrast, extensive monitoring schemes mostly inform the population abundance EBV, but deliver long-term data across an extensive network of sites. Satellite remote sensing is particularly suited to providing information on ecosystem function and structure EBVs. Biases behind data sources may affect the representativeness of global biodiversity datasets. To improve them, researchers must assess data sources and then develop strategies to compensate for identified gaps. We draw on the population abundance dataset informing the Living Planet Index (LPI) to illustrate the effects of data sources on EBV representativeness. We find that long-term monitoring schemes informing the LPI are still scarce outside of Europe and North America and that ecological field studies play a key role in covering that gap. Achieving representative EBV datasets will depend both on the ability to integrate available data, through data harmonization and modeling efforts, and on the establishment of new monitoring programs to address critical data gaps.

  11. Statistical challenges for central monitoring in clinical trials: a review.

    PubMed

    Oba, Koji

    2016-02-01

    Recently, the complexity and costs of clinical trials have increased dramatically, especially in the area of new drug development. Risk-based monitoring (RBM) has been attracting attention as an efficient and effective trial monitoring approach, which can be applied irrespectively of the trial sponsor, i.e., academic institution or pharmaceutical company. In the RBM paradigm, it is expected that a statistical approach to central monitoring can help improve the effectiveness of on-site monitoring by prioritizing and guiding site visits according to central statistical data checks, as evidenced by examples of actual trial datasets. In this review, several statistical methods for central monitoring are presented. It is important to share knowledge about the role and performance capabilities of statistical methodology among clinical trial team members (i.e., sponsors, investigators, data managers, monitors, and biostatisticians) in order to adopt central statistical monitoring for assessing data quality in the actual clinical trial. PMID:26499195

  12. Symbolic dynamics marker of heart rate variability combined with clinical variables enhance obstructive sleep apnea screening.

    PubMed

    Ravelo-García, A G; Saavedra-Santana, P; Juliá-Serdá, G; Navarro-Mesa, J L; Navarro-Esteva, J; Álvarez-López, X; Gapelyuk, A; Penzel, T; Wessel, N

    2014-06-01

    Many sleep centres try to perform a reduced portable test in order to decrease the number of overnight polysomnographies that are expensive, time-consuming, and disturbing. With some limitations, heart rate variability (HRV) has been useful in this task. The aim of this investigation was to evaluate if inclusion of symbolic dynamics variables to a logistic regression model integrating clinical and physical variables, can improve the detection of subjects for further polysomnographies. To our knowledge, this is the first contribution that innovates in that strategy. A group of 133 patients has been referred to the sleep center for suspected sleep apnea. Clinical assessment of the patients consisted of a sleep related questionnaire and a physical examination. The clinical variables related to apnea and selected in the statistical model were age (p < 10(-3)), neck circumference (p < 10(-3)), score on a questionnaire scale intended to quantify daytime sleepiness (p < 10(-3)), and intensity of snoring (p < 10(-3)). The validation of this model demonstrated an increase in classification performance when a variable based on non-linear dynamics of HRV (p < 0.01) was used additionally to the other variables. For diagnostic rule based only on clinical and physical variables, the corresponding area under the receiver operating characteristic (ROC) curve was 0.907 (95% confidence interval (CI) = 0.848, 0.967), (sensitivity 87.10% and specificity 80%). For the model including the average of a symbolic dynamic variable, the area under the ROC curve was increased to 0.941 (95% = 0.897, 0.985), (sensitivity 88.71% and specificity 82.86%). In conclusion, symbolic dynamics, coupled with significant clinical and physical variables can help to prioritize polysomnographies in patients with a high probability of apnea. In addition, the processing of the HRV is a well established low cost and robust technique. PMID:24985458

  13. Symbolic dynamics marker of heart rate variability combined with clinical variables enhance obstructive sleep apnea screening

    NASA Astrophysics Data System (ADS)

    Ravelo-García, A. G.; Saavedra-Santana, P.; Juliá-Serdá, G.; Navarro-Mesa, J. L.; Navarro-Esteva, J.; Álvarez-López, X.; Gapelyuk, A.; Penzel, T.; Wessel, N.

    2014-06-01

    Many sleep centres try to perform a reduced portable test in order to decrease the number of overnight polysomnographies that are expensive, time-consuming, and disturbing. With some limitations, heart rate variability (HRV) has been useful in this task. The aim of this investigation was to evaluate if inclusion of symbolic dynamics variables to a logistic regression model integrating clinical and physical variables, can improve the detection of subjects for further polysomnographies. To our knowledge, this is the first contribution that innovates in that strategy. A group of 133 patients has been referred to the sleep center for suspected sleep apnea. Clinical assessment of the patients consisted of a sleep related questionnaire and a physical examination. The clinical variables related to apnea and selected in the statistical model were age (p < 10-3), neck circumference (p < 10-3), score on a questionnaire scale intended to quantify daytime sleepiness (p < 10-3), and intensity of snoring (p < 10-3). The validation of this model demonstrated an increase in classification performance when a variable based on non-linear dynamics of HRV (p < 0.01) was used additionally to the other variables. For diagnostic rule based only on clinical and physical variables, the corresponding area under the receiver operating characteristic (ROC) curve was 0.907 (95% confidence interval (CI) = 0.848, 0.967), (sensitivity 87.10% and specificity 80%). For the model including the average of a symbolic dynamic variable, the area under the ROC curve was increased to 0.941 (95% = 0.897, 0.985), (sensitivity 88.71% and specificity 82.86%). In conclusion, symbolic dynamics, coupled with significant clinical and physical variables can help to prioritize polysomnographies in patients with a high probability of apnea. In addition, the processing of the HRV is a well established low cost and robust technique.

  14. Wearable depression monitoring system with heart-rate variability.

    PubMed

    Roh, Taehwan; Hong, Sunjoo; Yoo, Hoi-Jun

    2014-01-01

    A wearable depression monitoring system is proposed with an application-specific system-on-chip (SoC) solution. The SoC is designed to accelerate the filtering and feature extraction of heart-rate variability (HRV) from the electrocardiogram (ECG). Thanks to the SoC solution and planar-fashionable circuit board (P-FCB), the monitoring system becomes a low-power wearable system. Its dimension is 14cm × 7cm with 5mm thickness covering the chest band for convenient usage. In addition, with 3.7V 500mAh battery, its lifetime is at least 10 hours. For user's convenience, the system is interfacing to smart phones through Bluetooth communication. With the features of the HRV and Beck depression inventory (BDI), the smart phone application trains and classifies the user's depression scale with 71% of accuracy. PMID:25570021

  15. Monitoring the variability of intrinsic absorption lines in quasar spectra , ,

    SciTech Connect

    Misawa, Toru; Charlton, Jane C.; Eracleous, Michael

    2014-09-01

    We have monitored 12 intrinsic narrow absorption lines (NALs) in five quasars and seven mini-broad absorption lines (mini-BALs) in six quasars for a period of 4-12 yr (1-3.5 yr in the quasar rest-frame). We present the observational data and the conclusions that follow immediately from them, as a prelude to a more detailed analysis. We found clear variability in the equivalent widths (EWs) of the mini-BAL systems but no easily discernible changes in their profiles. We did not detect any variability in the NAL systems or in narrow components that are often located at the center of mini-BAL profiles. Variations in mini-BAL EWs are larger at longer time intervals, reminiscent of the trend seen in variable BALs. If we assume that the observed variations result from changes in the ionization state of the mini-BAL gas, we infer lower limits to the gas density ∼10{sup 3}-10{sup 5} cm{sup –3} and upper limits on the distance of the absorbers from the central engine of the order of a few kiloparsecs. Motivated by the observed variability properties, we suggest that mini-BALs can vary because of fluctuations of the ionizing continuum or changes in partial coverage while NALs can vary primarily because of changes in partial coverage.

  16. Impact of Laboratory Practices on Interlaboratory Variability in Therapeutic Drug Monitoring of Immunosuppressive Drugs.

    PubMed

    Christians, Uwe; Vinks, Alexander A; Langman, Loralie J; Clarke, William; Wallemacq, Pierre; van Gelder, Teun; Renjen, Varun; Marquet, Pierre; Meyer, Eric J

    2015-12-01

    The immunosuppressants cyclosporine, tacrolimus, sirolimus, everolimus, and probably also mycophenolic acid require therapeutic drug monitoring (TDM)-guided dosing to ensure that blood concentrations are kept within the target range in transplant patients. Reliable, accurate, and precise test methods are therefore essential to effectively monitor levels and to make proper dose adjustments. Data from proficiency testing programs have shown substantial interlaboratory variability. Only few attempts have been made to study the underlying causes. The aim of this study was to systematically document current practices used for immunosuppressant drug TDM in clinical laboratories and identify methodological and practice differences, which may cause the variability observed among laboratories. Data collection was primarily conducted by a structured Web-based survey. Invitations to participate in the survey were distributed to clinical laboratories providing immunosuppressant drug TDM. Surveys were completed by 76 laboratories in 14 countries. The results of our survey suggest that there are 3 main reasons for interlaboratory variability: (1) lack of standardization of laboratory procedures and workflows starting with sample collection and handling, (2) lack of use of appropriate reference materials (eg, isotope-labeled internal standards for liquid chromatography-tandem mass spectroscopy), and (3) poor compliance with internationally accepted good laboratory practice guidelines (eg, related to quality control, quality assurance, validation, training of personnel). The results of the survey also suggest that interlaboratory variability is a multifactorial problem. Technical-level consensus on laboratory operational procedures, quality systems, and personnel training will be of great importance to improve quality and interlaboratory comparability. PMID:26291980

  17. Clinical review: Respiratory monitoring in the ICU - a consensus of 16

    PubMed Central

    2012-01-01

    Monitoring plays an important role in the current management of patients with acute respiratory failure but sometimes lacks definition regarding which 'signals' and 'derived variables' should be prioritized as well as specifics related to timing (continuous versus intermittent) and modality (static versus dynamic). Many new techniques of respiratory monitoring have been made available for clinical use recently, but their place is not always well defined. Appropriate use of available monitoring techniques and correct interpretation of the data provided can help improve our understanding of the disease processes involved and the effects of clinical interventions. In this consensus paper, we provide an overview of the important parameters that can and should be monitored in the critically ill patient with respiratory failure and discuss how the data provided can impact on clinical management. PMID:22546221

  18. Variability of multifractal parameters in an urban precipitation monitoring network

    NASA Astrophysics Data System (ADS)

    Licznar, Paweł; De Michele, Carlo; Dżugaj, Dagmara; Niesobska, Maria

    2014-05-01

    Precipitation especially over urban areas is considered a highly non-linear process, with wide variability over a broad range of temporal and spatial scales. Despite obvious limitations of rainfall gauges location at urban sites, rainfall monitoring by gauge networks is a standard solution of urban hydrology. Often urban precipitation gauge networks are formed by modern electronic gauges and connected to control units of centralized urban drainage systems. Precipitation data, recorded online through these gauge networks, are used in so called Real-Time-Control (RTC) systems for the development of optimal strategies of urban drainage outflows management. As a matter of fact, the operation of RTC systems is motivated mainly by the urge of reducing the severity of urban floods and combined sewerage overflows, but at the same time, it creates new valuable precipitation data sources. The variability of precipitation process could be achieved by investigating multifractal behavior displayed by the temporal structure of precipitation data. There are multiply scientific communications concerning multifractal properties of point-rainfall data from different worldwide locations. However, very little is known about the close variability of multifractal parameters among closely located gauges, at the distances of single kilometers. Having this in mind, here we assess the variability of multifractal parameters among gauges of the urban precipitation monitoring network in Warsaw, Poland. We base our analysis on the set of 1-minute rainfall time series recorded in the period 2008-2011 by 25 electronic weighing type gauges deployed around the city by the Municipal Water Supply and Sewerage Company in Warsaw as a part of local RTC system. The presence of scale invariance and multifractal properties in the precipitation process was investigated with spectral analysis, functional box counting method and studying the probability distributions and statistical moments of the rainfall

  19. Monitoring the Variability of Intrinsic Absorption Lines in Quasar Spectra

    NASA Astrophysics Data System (ADS)

    Misawa, Toru; Charlton, Jane C.; Eracleous, Michael

    2014-09-01

    We have monitored 12 intrinsic narrow absorption lines (NALs) in five quasars and seven mini-broad absorption lines (mini-BALs) in six quasars for a period of 4-12 yr (1-3.5 yr in the quasar rest-frame). We present the observational data and the conclusions that follow immediately from them, as a prelude to a more detailed analysis. We found clear variability in the equivalent widths (EWs) of the mini-BAL systems but no easily discernible changes in their profiles. We did not detect any variability in the NAL systems or in narrow components that are often located at the center of mini-BAL profiles. Variations in mini-BAL EWs are larger at longer time intervals, reminiscent of the trend seen in variable BALs. If we assume that the observed variations result from changes in the ionization state of the mini-BAL gas, we infer lower limits to the gas density ~103-105 cm-3 and upper limits on the distance of the absorbers from the central engine of the order of a few kiloparsecs. Motivated by the observed variability properties, we suggest that mini-BALs can vary because of fluctuations of the ionizing continuum or changes in partial coverage while NALs can vary primarily because of changes in partial coverage. Based on data collected at Subaru telescope, which is operated by the National Astronomical Observatory of Japan. Based on observations obtained at the European Southern Observatory at La Silla, Chile in programs 65.O-0063(B), 65.O-0474(A), 67.A-0078(A), 68.A-0461(A), 69.A-0204(A), 70.B-0522(A), 072.A-0346(A), 076.A-0860(A), 079.B-0469(A), and 166.A-0106(A).

  20. Earpiece with sensors to measure/monitor multiple physiological variables

    NASA Technical Reports Server (NTRS)

    Schulze, Arthur E. (Inventor); Cooper, Tommy G. (Inventor)

    2003-01-01

    An apparatus and method for positioning sensors relative to one another and anatomic features in a non-invasive device for measuring and monitoring multiple physiological variables from a single site uses an earpiece incorporating a shielded pulse oximetry sensor (POS) having a miniaturized set of LEDs and photosensors configured for pulse oximetry measurements in the reflectance mode and located in the earpiece so as to position the POS against a rear wall of an ear canal. The earpiece also includes a thermopile of no larger than 7 mm. in diameter located on the earpiece to so as to position the thermopile past a second turn of an external auditory meatus so as to view the tympanic membrane. The thermopile includes a reference temperature sensor attached to its base for ambient temperature compensation.

  1. Cataclysmic variables to be monitored for HST observations

    NASA Astrophysics Data System (ADS)

    Waagen, Elizabeth O.

    2012-09-01

    Drs. Boris Gaensicke (Warwick University), Joseph Patterson (Columbia University, Center for Backyard Astrophysics), and Arne Henden (AAVSO), on behalf of a consortium of 16 astronomers, requested the help of AAVSO observers in monitoring the ~40 cataclysmic variables in support of Hubble Space Telescope observations in the coming months. The HST COS (Cosmic Origins Spectrograph) will be carrying out far-ultraviolet spectroscopy of ~40 CVs sequentially, with the aim to measure the temperatures, atmospheric compositions, rotation rates, and eventually masses of their white dwarfs. The primary purpose of the monitoring is to know whether each target is in quiescence immediately prior to the observation window; if it is in outburst it will be too bright for the HST instrumentation. Based on the information supplied by the AAVSO, the HST scheduling team will make the decision (usually) the evening before the scheduled observing time as to whether to go forward with the HST observations. For CCD observers, simultaneous photometry [shortly before, during, and after the HST observations] would be ideal. B filter would be best for a light curve, although for the magnitude estimates, V would be best. Finder charts may be created using the AAVSO Variable Star Plotter (http://www.aavso.org/vsp). Observations should be submitted to the AAVSO International Database. If the target is seen in outburst, please contact the AAVSO immediately and post a message to the Observations and Campaigns & Observations Reports forum (http://www.aavso.org/forum). This campaign will run the better part of a year or longer. See full Alert Notice for more details and list of objects.

  2. Technological advances in perioperative monitoring: Current concepts and clinical perspectives

    PubMed Central

    Chilkoti, Geetanjali; Wadhwa, Rachna; Saxena, Ashok Kumar

    2015-01-01

    Minimal mandatory monitoring in the perioperative period recommended by Association of Anesthetists of Great Britain and Ireland and American Society of Anesthesiologists are universally acknowledged and has become an integral part of the anesthesia practice. The technologies in perioperative monitoring have advanced, and the availability and clinical applications have multiplied exponentially. Newer monitoring techniques include depth of anesthesia monitoring, goal-directed fluid therapy, transesophageal echocardiography, advanced neurological monitoring, improved alarm system and technological advancement in objective pain assessment. Various factors that need to be considered with the use of improved monitoring techniques are their validation data, patient outcome, safety profile, cost-effectiveness, awareness of the possible adverse events, knowledge of technical principle and ability of the convenient routine handling. In this review, we will discuss the new monitoring techniques in anesthesia, their advantages, deficiencies, limitations, their comparison to the conventional methods and their effect on patient outcome, if any. PMID:25788767

  3. Ambulatory Blood Pressure Monitoring in Spinal Cord Injury: Clinical Practicability

    PubMed Central

    Hubli, Michèle

    2014-01-01

    Abstract Trauma to the spinal cord often results not only in sensorimotor but also autonomic impairments. The loss of autonomic control over the cardiovascular system can cause profound blood pressure (BP) derangements in subjects with spinal cord injury (SCI) and may therefore lead to increased cardiovascular disease (CVD) risk in this population. The use of ambulatory blood pressure monitoring (ABPM) allows insights into circadian BP profiles, which have been shown to be of good prognostic value for cardiovascular morbidity and mortality in able-bodied subjects. Past studies in SCI subjects using ABPM have shown that alterations in circadian BP patterns are dependent on the spinal lesion level. Tetraplegic subjects with sensorimotor complete lesions have a decreased daytime arterial BP, loss of the physiological nocturnal BP dip, and higher circadian BP variability, including potentially life-threatening hypertensive episodes known as autonomic dysreflexia (AD), compared with paraplegic and able-bodied subjects. The proposed underlying mechanisms of these adverse BP alterations mainly are attributed to a lost or decreased central drive to sympathetic spinal preganglionic neurons controlling the heart and blood vessels. In addition, several maladaptive anatomical changes within the spinal cord and the periphery, as well as the general decrease of physical daily activity in SCI subjects, account for adverse BP changes. ABPM enables the identification of adverse BP profiles and the associated increased risk for CVD in SCI subjects. Concurrently, it also might provide a useful clinical tool to monitor improvements of AD and lost nocturnal dip after appropriate treatments in the SCI population. PMID:24175653

  4. Leveraging network connectivity for quality assurance of clinical display monitors.

    PubMed

    Gersten, Jennifer

    2012-01-01

    The VA Midwest Health Care Network, VISN 23, is one of 21 veteran integrated health service networks (VISN) under the Department of Veterans Affairs. There are approximately 300,000 imaging studies generated per year and currently more than 14,000 picture archiving and communication system (PACS) users in VISN 23. Biomedical Engineering Services within VISN 23 coordinates the provision of medical technology support. One emerging technology leverages network connectivity as a method of calibrating and continuously monitoring clinical display monitors in support of PACS. Utilizing a continuous calibration monitoring system, clinical displays can be identified as out of Digital Imaging and Communications in Medicine (DICOM) compliance through a centralized server. The technical group can receive immediate notification via e-mail and respond proactively. Previously, this problem could go unnoticed until the next scheduled preventive maintenance was performed. This system utilizes simple network management protocols (SNMP) and simple mail transfer protocols (SMTP) across a wide area network for real-time alerts from a centralized location. This central server supports and monitors approximately 320 clinical displays deployed across five states. Over the past three years of implementation in VISN 23, the remote calibration and monitoring capability has allowed for more efficient support of clinical displays and has enhanced patient safety by ensuring a consistent display of images on these clinical displays. PMID:22239357

  5. Nevada Monitoring System to Assess Climate Variability and Change

    NASA Astrophysics Data System (ADS)

    Devitt, D. A.; Arnone, J.; Biondi, F.; Fenstermaker, L. F.; Saito, L.; Young, M.; Riddle, B.; Strachan, S. D.; Bird, B.; McCurdy, G.; Lyles, B. F.

    2010-12-01

    The Nevada System of Higher Education (University of Nevada Las Vegas, University of Nevada Reno and the Desert Research Institute) was awarded a multiyear NSF EPSCoR grant to support infrastructure associated with regional climate change research. The overall project is comprised of 5 components: education, cyberinfrastructure, policy, climate modeling and water/ecology. The water and ecology components are using their infrastructure funding for the assessment of climate variability and change on ecosystem function and hydrologic services. A series of 10 m tall towers are under construction and are being equipped with a wide array of sensors to monitor atmospheric, soil and plant parameters over time. The towers are located within the Mojave and Great Basin Deserts in two transects; the Mojave Desert transect is located in the southern Nevada Sheep Mountain Range and the Great Basin transect is located in the east central Nevada Snake Mountain Range. The towers are centrally positioned in well-defined vegetation zones. In southern Nevada these zones are represented by the following plant species: Creosote/Bursage (Creosotebush scrub zone); Blackbrush/Joshua Tree (Blackbrush zone); Pinyon/ Juniper (pygmy conifer zone), Ponderosa Pine (montane zone) and Bristlecone Pine (subalpine zone). The Snake Mountain transect incorporates the eastern and western valleys on both sides of the mountain range. The vegetation zones are represented by: Greasewood and mixed shrub (salt desert zone); Big Sage (sagebrush zone); Pinyon/Juniper (pygmy conifer zone); White/Douglas Fir, Ponderosa Pine and Aspen (montane zone); and Bristlecone/Limber Pine and Engelmann Spruce (subalpine zone). We are currently in the third year of funding with a goal of having the majority of towers fully operational by winter 2010. In close collaboration with our cyberinfrastructure component team, all data acquired from the transect monitoring stations will be made available to other researchers and the

  6. Cadenced IRAC Monitoring of Infrared-Variable AGNs, Part II

    NASA Astrophysics Data System (ADS)

    Ashby, Matthew; Fouesneau, Morgan; Hora, Joseph; Krick, Jessica; Smith, Howard; Surace, Jason

    2008-03-01

    We have analyzed IRAC imaging data from all 97 Spitzer visits to a very well-studied field, the IRAC Dark Calibration Field (IRAC-CF) near the north ecliptic pole. With this extensive dataset we have already identified a unique sample of 30 IR-variable galaxies which we are now working to characterize with respect to variability amplitudes and timescales, panchromatic SEDs, and host morphologies, among other quantities. Unfortunately, the continual change in spacecraft roll angle means that our sources are typically observed for at most six months at a time by each IRAC FOV in succession -- in other words, the visibility windows are exactly out of phase. Thus the existing data, despite the fact that they extend over more than four years, present large, unavoidable gaps that frustrate the time-delay analysis we wish to perform on exactly the timescales known to be common in active galaxies. This has only changed beginning in 2007 July: since that time cadenced IRAC observations have been carried out in synchrony with the IRAC-CF dark-calibration observations as part of our approved Cycle-4 program (PID 40553). Here we are proposing to continue this successful AGN monitoring campaign until the end of the cryogenic mission. The resulting timelines (covering 1500 days thus far and expected to run ultimately to some 2200+ days), will be a unique legacy of the Spitzer mission. This dataset, especially for the sizable, unbiased AGN sample we now have, holds unique promise for measuring the colors and temperatures of IR-varying AGN, and will have much to say about the underlying physical models of the infrared AGN emission. Accordingly we ask for just 8 h to gather IRAC photometry in the temporal gaps that would otherwise accrue in Cycle 5.

  7. Considerations for Integration of a Physiological Radar Monitoring System with Gold Standard Clinical Sleep Monitoring Systems

    PubMed Central

    Singh, Aditya; Baboli, Mehran; Gao, Xiaomeng; Yavari, Ehsan; Padasdao, Bryson; Soll, Bruce; Boric-Lubecke, Olga; Lubecke, Victor M.

    2016-01-01

    A design for a physiological radar monitoring system (PRMS) that can be integrated with clinical sleep monitoring systems is presented. The PRMS uses two radar systems at 2.45GHz and 24 GHz to achieve both high sensitivity and high resolution. The system can acquire data, perform digital processing and output appropriate conventional analog outputs with a latency of 130 ms, which can be recorded and displayed by a gold standard sleep monitoring system, along with other standard sensor measurements. PMID:24110139

  8. Considerations for integration of a physiological radar monitoring system with gold standard clinical sleep monitoring systems.

    PubMed

    Singh, Aditya; Baboli, Mehran; Gao, Xiaomeng; Yavari, Ehsan; Padasdao, Bryson; Soll, Bruce; Boric-Lubecke, Olga; Lubecke, Victor

    2013-01-01

    A design for a physiological radar monitoring system (PRMS) that can be integrated with clinical sleep monitoring systems is presented. The PRMS uses two radar systems at 2.45 GHz and 24 GHz to achieve both high sensitivity and high resolution. The system can acquire data, perform digital processing and output appropriate conventional analog outputs with a latency of 130 ms, which can be recorded and displayed by a gold standard sleep monitoring system, along with other standard sensor measurements. PMID:24110139

  9. The variable clinical manifestations of ulnar neuropathies at the elbow.

    PubMed Central

    Stewart, J D

    1987-01-01

    In twenty-five cases of ulnar neuropathy at the elbow, the involvement of the fibres from three sensory and to four motor branches were examined clinically and, where possible, electrophysiologically. Of the sensory fibres, those from the terminal digital nerves were most commonly involved. The fibres to the hand muscles were much more frequently involved than those to the forearm muscles. These findings suggest that in ulnar neuropathies at the elbow there is variable damage to the fascicles within the nerve. PMID:3031220

  10. EEG Monitoring in Cerebral Ischemia: Basic Concepts and Clinical Applications.

    PubMed

    van Putten, Michel J A M; Hofmeijer, Jeannette

    2016-06-01

    EEG is very sensitive to changes in neuronal function resulting from ischemia. The authors briefly review essentials of EEG generation and the effects of ischemia on the underlying neuronal processes. They discuss the differential sensitivity of various neuronal processes to energy limitations, including synaptic disturbances. The clinical applications reviewed include continuous EEG monitoring during carotid surgery and acute ischemic stroke, and EEG monitoring for prognostication after cardiac arrest. PMID:27258443

  11. Multiparametric monitoring of tissue vitality in clinical situations

    NASA Astrophysics Data System (ADS)

    Mayevsky, Avraham; Manor, Tamar; Meilin, Sigal; Razon, Nisim; Ouknine, George E.; Ornstein, Eugene

    2001-05-01

    The monitoring of various tissue's physiological and biochemical parameters is one of the tools used by the clinicians to improve diagnosis capacity. As of today, the very few devices developed for real time clinical monitoring of tissue vitality are based on a single parameter measurement. Tissue energy balance could be defined as the ratio between oxygen or energy supply and demand. In order to determine the vitality of the brain, for example, it is necessary to measure at least the following 3 parameters: Energy Demand--potassium ion homeostasis; Energy Supply-- cerebral blood flow; Energy Balance--mitochondrial NADH redox state. For other tissues one can measure various energy demand processes specific to the tested organ. We have developed a unique multiparametric monitoring system tested in various experimental and clinical applications. The multiprobe assembly (MPA) consists of a fiber optic probe for measurement of tissue blood flow and mitochondrial NADH redox state, ion selective electrodes (K+, Ca2+, H+), electrodes for electrical activities (ECoG or ECG and DC potential), temperature probe and for monitoring the brain - Intra Cranial Pressure probe (ICP). The computerized monitoring system was used in the neurological intensive care unit to monitor comatose patients for a period of 24-48 hours. Also, a simplified MPA was used in the neurosurgical operating room or during organ transplantation procedure. It was found that the MPA could be used in clinical situations and that the data collected has a significant diagnosis value for the medical team.

  12. Classification of Variable Objects in Massive Sky Monitoring Surveys

    NASA Astrophysics Data System (ADS)

    Woźniak, Przemek; Wyrzykowski, Łukasz; Belokurov, Vasily

    2012-03-01

    The era of great sky surveys is upon us. Over the past decade we have seen rapid progress toward a continuous photometric record of the optical sky. Numerous sky surveys are discovering and monitoring variable objects by hundreds of thousands. Advances in detector, computing, and networking technology are driving applications of all shapes and sizes ranging from small all sky monitors, through networks of robotic telescopes of modest size, to big glass facilities equipped with giga-pixel CCD mosaics. The Large Synoptic Survey Telescope will be the first peta-scale astronomical survey [18]. It will expand the volume of the parameter space available to us by three orders of magnitude and explore the mutable heavens down to an unprecedented level of sensitivity. Proliferation of large, multidimensional astronomical data sets is stimulating the work on new methods and tools to handle the identification and classification challenge [3]. Given exponentially growing data rates, automated classification of variability types is quickly becoming a necessity. Taking humans out of the loop not only eliminates the subjective nature of visual classification, but is also an enabling factor for time-critical applications. Full automation is especially important for studies of explosive phenomena such as γ-ray bursts that require rapid follow-up observations before the event is over. While there is a general consensus that machine learning will provide a viable solution, the available algorithmic toolbox remains underutilized in astronomy by comparison with other fields such as genomics or market research. Part of the problem is the nature of astronomical data sets that tend to be dominated by a variety of irregularities. Not all algorithms can handle gracefully uneven time sampling, missing features, or sparsely populated high-dimensional spaces. More sophisticated algorithms and better tools available in standard software packages are required to facilitate the adoption of

  13. Clinical event monitoring at the University of Pittsburgh.

    PubMed Central

    Wagner, M. M.; Pankaskie, M.; Hogan, W.; Tsui, F. C.; Eisenstadt, S. A.; Rodriguez, E.; Vries, J. K.

    1997-01-01

    Although the literature on event monitoring is extensive, it does not cover all issues that we encountered while developing an event monitor at our institution. We had to resolve issues related to event detection, scalability, what topics were suitable for asynchronous decision support, and overlap of efforts of other groups at the institution attempting to improve quality and lower cost of care. In this paper, we describe our experience deploying CLEM, the clinical event monitor at the University of Pittsburgh with emphasis on these topics. PMID:9357614

  14. Holter Monitoring and Loop Recorders: From Research to Clinical Practice

    PubMed Central

    Ambrosini, Francesco; Lombardi, Federico

    2016-01-01

    Holter monitors are tools of proven efficacy in diagnosing and monitoring cardiac arrhythmias. Despite the fact their use is widely prescribed by general practitioners, little is known about their evolving role in the management of patients with cryptogenic stroke, paroxysmal atrial fibrillation, unexplained recurrent syncope and risk stratification in implantable cardioverter defibrillator or pacemaker candidates. New Holter monitoring technologies and loop recorders allow prolonged monitoring of heart rhythm for periods from a few days to several months, making it possible to detect infrequent arrhythmias in patients of all ages. This review discusses the advances in this area of arrhythmology and how Holter monitors have improved the clinical management of patients with suspected cardiac rhythm diseases.

  15. Data-driven risk identification in phase III clinical trials using central statistical monitoring.

    PubMed

    Timmermans, Catherine; Venet, David; Burzykowski, Tomasz

    2016-02-01

    Our interest lies in quality control for clinical trials, in the context of risk-based monitoring (RBM). We specifically study the use of central statistical monitoring (CSM) to support RBM. Under an RBM paradigm, we claim that CSM has a key role to play in identifying the "risks to the most critical data elements and processes" that will drive targeted oversight. In order to support this claim, we first see how to characterize the risks that may affect clinical trials. We then discuss how CSM can be understood as a tool for providing a set of data-driven key risk indicators (KRIs), which help to organize adaptive targeted monitoring. Several case studies are provided where issues in a clinical trial have been identified thanks to targeted investigation after the identification of a risk using CSM. Using CSM to build data-driven KRIs helps to identify different kinds of issues in clinical trials. This ability is directly linked with the exhaustiveness of the CSM approach and its flexibility in the definition of the risks that are searched for when identifying the KRIs. In practice, a CSM assessment of the clinical database seems essential to ensure data quality. The atypical data patterns found in some centers and variables are seen as KRIs under a RBM approach. Targeted monitoring or data management queries can be used to confirm whether the KRIs point to an actual issue or not. PMID:26233672

  16. Ambulatory monitoring derived blood pressure variability and cardiovascular risk factors in elderly hypertensive patients.

    PubMed

    Magdás, Annamária; Szilágyi, László; Belényi, Boglárka; Incze, Alexandru

    2014-01-01

    Hypertension in the elderly is characterized by isolated systolic hypertension and high variability, but its clinical significance is not yet fully understood. The goal of this paper was to assess circadian blood pressure variability (BPV) in elderly hypertensives, and to determine its relationship to cardiovascular risk factors. To achieve this goal, a number of 75 inefficiently treated hypertensive patients were studied, 45 elderly, aged over 60 years, 30 middle-aged, younger than 60 years. After 24-hour ambulatory blood pressure monitoring (ABPM), blood pressure (BP) values, pulse pressure (PP), morning surge were compared between the groups. BPV was calculated using average real variability (ARV). The relationships between BPV, pulse pressure, left ventricular mass index (LVMI), and cardiovascular risk factors were assessed in both groups. As a result, it was found that left ventricular mass (p=0.01), PP, morning surge, 24-hour systolic ARV were significantly higher in the elderly group (p<0.05). In both groups, higher 24-hour BPV was associated with an increase in LVMI. In the elderly population 24-hour BPV was positively correlated to increased PP, total cholesterol and triglyceride levels (p<0.05). Moreover, it was concluded that ABPM-derived BP variability index could be an early predictive marker of end-organ damage in hypertension. Its reduction might be an important objective of hypertension management in elderly. PMID:25226958

  17. Latent class instrumental variables: a clinical and biostatistical perspective.

    PubMed

    Baker, Stuart G; Kramer, Barnett S; Lindeman, Karen S

    2016-01-15

    In some two-arm randomized trials, some participants receive the treatment assigned to the other arm as a result of technical problems, refusal of a treatment invitation, or a choice of treatment in an encouragement design. In some before-and-after studies, the availability of a new treatment changes from one time period to this next. Under assumptions that are often reasonable, the latent class instrumental variable (IV) method estimates the effect of treatment received in the aforementioned scenarios involving all-or-none compliance and all-or-none availability. Key aspects are four initial latent classes (sometimes called principal strata) based on treatment received if in each randomization group or time period, the exclusion restriction assumption (in which randomization group or time period is an instrumental variable), the monotonicity assumption (which drops an implausible latent class from the analysis), and the estimated effect of receiving treatment in one latent class (sometimes called efficacy, the local average treatment effect, or the complier average causal effect). Since its independent formulations in the biostatistics and econometrics literatures, the latent class IV method (which has no well-established name) has gained increasing popularity. We review the latent class IV method from a clinical and biostatistical perspective, focusing on underlying assumptions, methodological extensions, and applications in our fields of obstetrics and cancer research. PMID:26239275

  18. Immunological monitoring of anticancer vaccines in clinical trials

    PubMed Central

    Ogi, Chizuru; Aruga, Atsushi

    2013-01-01

    Therapeutic anticancer vaccines operate by eliciting or enhancing an immune response that specifically targets tumor-associated antigens. Although intense efforts have been made for developing clinically useful anticancer vaccines, only a few Phase III clinical trials testing this immunotherapeutic strategy have achieved their primary endpoint. Here, we report the results of a retrospective research aimed at clarifying the design of previously completed Phase II/III clinical trials testing therapeutic anticancer vaccines and at assessing the value of immunological monitoring in this setting. We identified 17 anticancer vaccines that have been investigated in the context of a completed Phase II/III clinical trial. The immune response of patients receiving anticancer vaccination was assessed for only 8 of these products (in 15 distinct studies) in the attempt to identify a correlation with clinical outcome. Of these studies, 13 were supported by a statistical correlation study (Log-rank test), and no less than 12 identified a positive correlation between vaccine-elicited immune responses and disease outcome. Six trials also performed a Cox proportional hazards analysis, invariably demonstrating that vaccine-elicited immune responses have a positive prognostic value. However, despite these positive results in the course of early clinical development, most therapeutic vaccines tested so far failed to provide any clinical benefit to cancer patients in Phase II/III studies. Our research indicates that evaluating the immunological profile of patients at enrollment might constitute a key approach often neglected in these studies. Such an immunological monitoring should be based not only on peripheral blood samples but also on bioptic specimens, whenever possible. The evaluation of the immunological profile of cancer patients enrolled in early clinical trials will allow for the identification of individuals who have the highest chances to benefit from anticancer vaccination

  19. Implications of Variability in Clinical Bedside Swallowing Assessment Practices by Speech Language Pathologists.

    PubMed

    McAllister, Sue; Kruger, Samantha; Doeltgen, Sebastian; Tyler-Boltrek, Emma

    2016-10-01

    Speech language pathology (SLP) clinical bedside swallowing assessments (CBSA) are a cornerstone of quality care for patients in acute hospitals who have dysphagia. The CBSA informs clinical diagnosis and decisions regarding further instrumental assessment, and is used to develop a management plan and monitor progress. However, self-report and retrospective research shows that SLPs are highly variable in their use of assessment components considered by experts to be important for quality CBSA, casting doubt on the validity and reliability of CBSA. This prospective study describes the components included by SLPs when designing a standardised evidence based dysphagia assessment protocol for acute care patients and observed patterns of component use. The findings confirm that SLPs use the CBSA for multiple purposes beyond diagnosis of aspiration risk and dysphagia presence/severity. They are highly variable in their use of certain components, but also demonstrate consistent use of a core set. It is apparent that SLPs prioritise the application of clinical reasoning to tailor their CBSA to the patient over following a highly structured item-based protocol. The variability in component use likely reflects a complex clinical reasoning process that draws on a wide variety of information combined with expert knowledge as is also observed in many other medical specialties. Rather than promoting the standardisation of CBSA protocols that constrain SLP practice to strict item-based assessment protocols, consideration should be given to promoting the value and facilitating the clinical reasoning process that supports the utility of the CBSA for diagnosis, patient centred management and treatment planning. PMID:27405423

  20. Monitoring cancer stem cells: insights into clinical oncology

    PubMed Central

    Lin, ShuChen; Xu, YingChun; Gan, ZhiHua; Han, Kun; Hu, HaiYan; Yao, Yang; Huang, MingZhu; Min, DaLiu

    2016-01-01

    Cancer stem cells (CSCs) are a small, characteristically distinctive subset of tumor cells responsible for tumor initiation and progression. Several treatment modalities, such as surgery, glycolytic inhibition, driving CSC proliferation, immunotherapy, and hypofractionated radiotherapy, may have the potential to eradicate CSCs. We propose that monitoring CSCs is important in clinical oncology as CSC populations may reflect true treatment response and assist with managing treatment strategies, such as defining optimal chemotherapy cycles, permitting pretreatment cancer surveillance, conducting a comprehensive treatment plan, modifying radiation treatment, and deploying rechallenge chemotherapy. Then, we describe methods for monitoring CSCs. PMID:26929644

  1. Multi-modality neuro-monitoring: conventional clinical trial design.

    PubMed

    Georgiadis, Alexandros L; Palesch, Yuko Y; Zygun, David; Hemphill, J Claude; Robertson, Claudia S; Leroux, Peter D; Suarez, Jose I

    2015-06-01

    Multi-modal monitoring has become an integral part of neurointensive care. However, our approach is at this time neither standardized nor backed by data from randomized controlled trials. The goal of the second Neurocritical Care Research Conference was to discuss research priorities in multi-modal monitoring, what research tools are available, as well as the latest advances in clinical trial design. This section of the meeting was focused on how such a trial should be designed so as to maximize yield and avoid mistakes of the past. PMID:25832350

  2. Clinical Implications of Ambulatory and Home Blood Pressure Monitoring

    PubMed Central

    2010-01-01

    Because blood pressure (BP) is an ever changing hemodynamic phenomenon, a BP value, once measured at a physician's office (Office BP), is often unrepresentative of an individual's true BP status. Both ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM) provide more accurate and reproducible estimate of BP, and produce stronger predictive ability for cardiovascular outcome than conventional office BP. Two BP measuring techniques, ABPM and HBPM have been widely in clinical use for the detection and management of hypertension. However, they have different advantages and limitations in practice. At present, it has become crucial to understand the characteristics and clinical implications of these BP measuring techniques for those responsible for the care of hypertensive patients. PMID:20967142

  3. Establishment of normal reference ranges for glycemic variability in Chinese subjects using continuous glucose monitoring

    PubMed Central

    Zhou, Jian; Li, Hong; Ran, Xingwu; Yang, Wenying; Li, Qiang; Peng, Yongde; Li, Yanbing; Gao, Xin; Luan, Xiaojun; Wang, Weiqing; Jia, Weiping

    2011-01-01

    Summary Background Glycemic variability is increasingly recognized as an important issue in diabetes management. However, the lack of normative values may limit its applicability in the clinical setting. The objective of this study was to establish preliminary normal reference ranges for glycemic variability by analyzing continuous glucose monitoring (CGM) data obtained from healthy Chinese adults. Material/Methods Three-day CGM data were obtained from 434 healthy adults at 10 academic hospitals throughout China. Glycemic variability was calculated as the 24-hour mean amplitude of glycemic excursions (MAGE) and standard deviations (SD) of blood glucose readings. Results 434 healthy subjects (male 213, female 221; age 43±14, 20–69 years old; BMI 21.8±1.7 kg/m2, 18.5–24.9 kg/m2) completed the study. MAGE and SD values for the 434 healthy subjects were 1.73 (1.08) mmol/L and 0.75 (0.42) mmol/L [median (interquartile range)], respectively. In both men and women, MAGE and SD tended to increase with age. Neither MAGE nor SD showed a significant difference between men and women. Values for both parameters were non-normally distributed within the population. The 95th percentiles of MAGE and SD were 3.86 and 1.40 mmol/L, respectively. These values were adopted as the upper limits of normal. Conclusions MAGE <3.9 mmol/L and SD <1.4 mmol/L are recommended as the normal reference ranges for glycemic variability in Chinese adults. The values established in this study may facilitate the adoption of glycemic variability as a metric of overall glycemic control in diabetes. PMID:21169911

  4. All-Sky Monitoring of Variable Sources with Fermi GBM

    NASA Technical Reports Server (NTRS)

    Wilson-Hodge, Colleen A.; Finger, Mark; Camero-Arranz, Ascension; Becklen, Elif; Jenke, Peter; Cpe. K/ K/; Steele, Iain; Case, Gary; Cherry, Mike; Rodi, James; Bhat, Narayana

    2011-01-01

    Using the Gamma ray Burst Monitor (GBM) on Fermi, we monitor the transient hard X-ray/soft gamma ray sky. The twelve GBM NaI detectors span 8 keV to 1 MeV, while the two BGO detectors span 150 keV to 40 MeV. We use the Earth occultation technique to monitor a number of sources, including X-ray binaries, AGN, and solar flaring activity. Our monitoring reveals predictable and unpredictable phenomena such as transient outbursts and state changes. With GBM we also track the pulsed flux and spin frequency of accretion powered pulsars using epoch-folding techniques. Searches for quasi-periodic oscillations and X-ray bursts are also possible with GBM all-sky monitoring. Highlights from the Earth Occultation and Pulsar projects will be presented including our recent surprising discovery of variations in the total flux from the Crab. Inclusion of an all-sky monitor is crucial for a successful future X-ray timing mission.

  5. Monitoring Regulatory Immune Responses in Tumor Immunotherapy Clinical Trials

    PubMed Central

    Olson, Brian M.; McNeel, Douglas G.

    2013-01-01

    While immune monitoring of tumor immunotherapy often focuses on the generation of productive Th1-type inflammatory immune responses, the importance of regulatory immune responses is often overlooked, despite the well-documented effects of regulatory immune responses in suppressing anti-tumor immunity. In a variety of malignancies, the frequency of regulatory cell populations has been shown to correlate with disease progression and a poor prognosis, further emphasizing the importance of characterizing the effects of immunotherapy on these populations. This review focuses on the role of suppressive immune populations (regulatory T cells, myeloid-derived suppressor cells, and tumor-associated macrophages) in inhibiting anti-tumor immunity, how these populations have been used in the immune monitoring of clinical trials, the prognostic value of these responses, and how the monitoring of these regulatory responses can be improved in the future. PMID:23653893

  6. Ambulatory Blood Pressure Monitoring in Clinical Practice: A Review

    PubMed Central

    Viera, Anthony J.; Shimbo, Daichi

    2016-01-01

    Ambulatory blood pressure monitoring offers the ability to collect blood pressure readings several times an hour across a 24-hour period. Ambulatory blood pressure monitoring facilitates the identification of white-coat hypertension, the phenomenon whereby certain individuals who are not on antihypertensive medication show elevated blood pressure in a clinical setting but show non-elevated blood pressure averages when assessed by ambulatory blood pressure monitoring. Additionally, readings can be segmented into time windows of particular interest, e.g., mean daytime and nighttime values. During sleep, blood pressure typically decreases, or dips, such that mean sleep blood pressure is lower than mean awake blood pressure. A non-dipping pattern and nocturnal hypertension are strongly associated with increased cardiovascular morbidity and mortality. Approximately 70% of individuals dip ≥10% at night, while 30% have non-dipping patterns, when blood pressure remains similar to daytime average, or occasionally rises above daytime average. The various blood pressure categorizations afforded by ambulatory blood pressure monitoring are valuable for clinical management of high blood pressure since they increase accuracy for diagnosis and the prediction of cardiovascular risk. PMID:25107387

  7. [Clinical monitoring in areas of exposure to radiofrequency electromagnetic fields].

    PubMed

    Suvorov, I M

    2013-01-01

    Clinical syndromes induced by high intensity radiofrequency electromagnetic field chronic exposure are described. Persons injured by occupational exposure have been observed central nervous system changes in diencephalic syndrome form, cardio-vascular system changes revealed in atherosclerosis, isch(a)emic heart disease and coronary insufficiency rapid progressive expansion. General public living in territory of radar station exposure zone different functional disorders have been identified: vegetative dystonia (asthenovegetative syndrome), thrombocytopenia, decrease of blood coagulation index, and thyroid gland function changes. Observed diseases clinical variability may be determined by electromagnetic exposure characteristics. PMID:23785812

  8. SEP Montage Variability Comparison during Intraoperative Neurophysiologic Monitoring

    PubMed Central

    Hanson, Christine; Lolis, Athena Maria; Beric, Aleksandar

    2016-01-01

    Intraoperative monitoring is performed to provide real-time assessment of the neural structures that can be at risk during spinal surgery. Somatosensory evoked potentials (SEPs) are the most commonly used modality for intraoperative monitoring. SEP stability can be affected by many factors during the surgery. This study is a prospective review of SEP recordings obtained during intraoperative monitoring of instrumented spinal surgeries that were performed for chronic underlying neurologic and neuromuscular conditions, such as scoliosis, myelopathy, and spinal stenosis. We analyzed multiple montages at the baseline, and then followed their development throughout the procedure. Our intention was to examine the stability of the SEP recordings throughout the surgical procedure on multiple montages of cortical SEP recordings, with the goal of identifying the appropriate combination of the least number of montages that gives the highest yield of monitorable surgeries. Our study shows that it is necessary to have multiple montages for SEP recordings, as it reduces the number of non-monitorable cases, improves IOM reliability, and therefore could reduce false positives warnings to the surgeons. Out of all the typical montages available for use, our study has shown that the recording montage Cz-C4/Cz-C3 (Cz-Cc) is the most reliable and stable throughout the procedure and should be the preferred montage followed throughout the surgery. PMID:27445969

  9. Clinical and Immunological Features of Common Variable Immunodeficiency in China

    PubMed Central

    Lin, Lian-Jun; Wang, Yu-Chuan; Liu, Xin-Min

    2015-01-01

    Background: Common variable immunodeficiency (CVID) is one of the most common symptomatic primary immunodeficiency syndromes. The purpose of this article was to broaden our knowledge about CVID for better diagnosis and treatment. Methods: Clinical and immunological features of 40 Chinese patients with CVID were analyzed retrospectively. Results: The median age at onset was 11-year-old (range 4–51 years). The median age at diagnosis was 14.5-year-old (range 5–66 years). The average time of delay in diagnosis was 5.3 years (range 1–41 years). The most common main complaint was fever due to infections (35 cases, 87.5%). Pneumonia (28 cases, 70%) was the most common type of infections. Bronchiectasis was present in 6 patients (15%). Autoimmune disease was detected in 6 cases of CVID, and malignancy in 2 cases. The median total serum levels of IgG, IgA, and IgM at diagnosis were 1.07 g/L, 0.07 g/L, and 0.28 g/L, respectively. The percentages of CD3−/CD10+ B-cells were 1%–3.14%. Conclusions: Infection is the most frequent presentation of CVID. Patients with unexplainable infections should receive further examination including serum immunoglobulin (Ig) and lymphocyte subset analysis. Regular and sufficient substitution with Ig is recommended. PMID:25635425

  10. Monitoring Variability and Change in Children's Spelling Strategies

    ERIC Educational Resources Information Center

    Farrington-Flint, Lee; Stash, Amanda; Stiller, James

    2008-01-01

    This study examined the role of variability and change in children's strategy performance within the context of spelling. The spelling ability of 34 eight- to nine-year-olds was examined using an experimental spelling task comprising 45 items, which varied with regard to rime unit frequency. The spelling task incorporated a series of consistent,…

  11. Prediction of the Chemoreflex Gain by Common Clinical Variables in Heart Failure

    PubMed Central

    Mirizzi, Gianluca; Giannoni, Alberto; Ripoli, Andrea; Iudice, Giovanni; Bramanti, Francesca; Emdin, Michele; Passino, Claudio

    2016-01-01

    Background Peripheral and central chemoreflex sensitivity, assessed by the hypoxic or hypercapnic ventilatory response (HVR and HCVR, respectively), is enhanced in heart failure (HF) patients, is involved in the pathophysiology of the disease, and is under investigation as a potential therapeutic target. Chemoreflex sensitivity assessment is however demanding and, therefore, not easily applicable in the clinical setting. We aimed at evaluating whether common clinical variables, broadly obtained by routine clinical and instrumental evaluation, could predict increased HVR and HCVR. Methods and results 191 patients with systolic HF (left ventricular ejection fraction—LVEF—<50%) underwent chemoreflex assessment by rebreathing technique to assess HVR and HCVR. All patients underwent clinical and neurohormonal evaluation, comprising: echocardiogram, cardiopulmonary exercise test (CPET), daytime cardiorespiratory monitoring for breathing pattern evaluation. Regarding HVR, multivariate penalized logistic regression, Bayesian Model Averaging (BMA) logistic regression and random forest analysis identified, as predictors, the presence of periodic breathing and increased slope of the relation between ventilation and carbon dioxide production (VE/VCO2) during exercise. Again, the above-mentioned statistical tools identified as HCVR predictors plasma levels of N-terminal fragment of proBNP and VE/VCO2 slope. Conclusions In HF patients, the simple assessment of breathing pattern, alongside with ventilatory efficiency during exercise and natriuretic peptides levels identifies a subset of patients presenting with increased chemoreflex sensitivity to either hypoxia or hypercapnia. PMID:27099934

  12. Monitoring recruitment effectiveness and cost in a clinical trial.

    PubMed

    Bjornson-Benson, W M; Stibolt, T B; Manske, K A; Zavela, K J; Youtsey, D J; Buist, A S

    1993-04-01

    Recruitment effort and costs in clinical trials are very often underestimated. As funding constraints increase, more precise estimates of costs as well as methods to monitor effectiveness are needed. However, few studies exist that report recruitment cost effectiveness and costs. The study reported here was developed in Portland, Oregon as an ancillary study to the Lung Health Study. The authors developed a monitoring and evaluation system to track response rates and costs associated with each of five recruitment methods. These methods include (1) media (TV, radio, newspapers), (2) neighborhood promotion, (3) direct mail, (4) worksite promotion, and (5) referral by other study participants. The analysis is limited to a 6-month period (April 1-September 30, 1987) or the middle phase of recruitment. During the study period, 46% were recruited from media, 30% from neighborhood promotion, 1.5% from direct mail, 11% from worksites, and 12% from referrals. Neighborhood promotion and direct mail were least cost-effective, media most cost-effective, with worksite and referral moderately cost-effective. The cost-effectiveness of media promotion is explained in part by the limited number of media sources in Portland, making it possible to reach a large audience with less effort, as well as the ability to provide rapid feedback to media sources. We conclude that the effectiveness of recruitment in a clinical trial is maximized by using multiple overlapping recruitment strategies coupled with a monitoring system that can provide rapid feedback regarding the effectiveness and costs of each strategy. PMID:8500313

  13. FRAM telescope - monitoring of atmospheric extinction and variable star photometry

    NASA Astrophysics Data System (ADS)

    Jurysek, J.; Honkova, K.; Masek, M.

    2015-02-01

    The FRAM (F/(Ph)otometric Robotic Atmospheric Monitor) telescope is a part of the Pierre Auger Observatory (PAO) located near town Malargüe in Argentina. The main task of the FRAM telescope is the continuous night - time monitoring of the atmospheric extinction and its wavelength dependence. The current methodology of the measurement of a atmospheric extinction and for instrumentation properties also allows simultaneous observation of other interesting astronomical targets. The current observations of the FRAM telescope are focused on the photometry of eclipsing binaries, positional refinement of minor bodies of the Solar system and observations of optical counterparts of gamma ray bursts. In this contribution, we briefly describe the main purpose of the FRAM telescope for the PAO and we also present its current astrono mical observing program.

  14. [Common variable immunodeficiency. Epidemiology and clinical manifestations in 69 patients].

    PubMed

    Fernández Romero, Diego S; Juri, María C; Paolini, María V; Malbrán, Alejandro

    2013-01-01

    Common variable immunodeficiency (CVID) is characterized by an impaired antibody production and an increased susceptibility to recurrent infections of the respiratory tract, mainly by extracellular encapsulated bacteria. We analyzed the clinical characteristics of 69 patients evaluated over a period of 10 years at three centers in the city of Buenos Aires. At the onset of the study 14 patients were on follow up, and at its end the number of patients reached to 60. Most of them consulted for infection or hypogammaglobulinemia and nearly half had an established diagnosis of immunodeficiency. Sixty-five (94.2%) patients had infections by encapsulated bacteria, four (6.1%) sepsis and two tuberculosis. The average age of onset of infectious symptoms was 18.1 years; the average age at diagnosis was 29.6 years and the delay to diagnosis 11.9 years. Forty one (59.4%) patients reported a history of recurrent or chronic diarrhea. In 22 (31.9%) 13 autoimmune diseases were diagnosed, being the most frequent the hematological disorders and hypothyroidism. Eight patients had histological polyclonal lymphoproliferation, four (5.8%) with granulomatous disease affecting the liver, the larynx and/or the skin; and four as lymphoid interstitial pneumonitis (LIP). Nineteen (27.5%) patients had splenomegaly and 23/57 (40.3%) images suggestive of lymphocytic or granulomatous processes (including the 4 with LIP) in the chest CT. Three (4.3%) patients developed B cell lymphoma, four (5.8%) stomach adenocarcinoma and one breast cancer. The study had a median follow-up of 54 months, range 1-353 and four patients (5.8%) died during the follow up. PMID:23924529

  15. Spectral Monitoring of NGC 1365: Nucleus and Variable ULX

    NASA Technical Reports Server (NTRS)

    Mushotzky, Richard (Technical Monitor); Fabbiano, G.

    2004-01-01

    A letter has been submitted to ApJ, and is in the final stages of revision on the spectral variability of the nuclear source. We presented multiple Chandra and XMM-Newton observations of the Seyfert Galaxy NGC 1365, which shows the most dramatic X-ray spectral changes observed so far in an AGN: the source switched from reflection dominated to Compton- thin and back in just 6 weeks. During this time the soft thermal component, arising from a 1-kpc region around the center, remained constant. The reflection component is constant at all timescales, and its flux is a fraction of 5% or higher of the direct 2-10 keV emission, implying the presence of thick gas covering a big fraction of the solid angle. The presence of this gas, and the hst variability time scale, suggest that the Compton-thick to Compton thin change is due to variation in the line-of-sight absorber, rather than to extreme intrinsic emission variability. We discuss a structure of the circumnuclear absorbed reflector which can explain the observed X-ray spectral and temporal properties. But these important results come only from scratching the surface of the data, since we did not need any detailed spectral analysis to distinguish between the Compton thick and Compton thin states of the source, the difference in both spectral shape and flux being huge.

  16. Use of High Resolution Mobile Monitoring Techniques to Assess Near-Road Air Quality Variability

    EPA Science Inventory

    This presentation provides a description of the techniques used to develop and conduct effective mobile monitoring studies. It also provides a summary of mobile monitoring assessment studies that have been used to assess near-road concentrations and the variability of pollutant l...

  17. Use of High Resolution Mobile Monitoring Techniques to Assess Near Road Air Quality Variability

    EPA Science Inventory

    This presentation provides a description of the techniques used to develop and conduct effective mobile monitoring studies. It also provides a summary of mobile monitoring assessment studies that have been used to assess near-road concentrations and the variability of pollutant l...

  18. Students, Teachers, and Schools as Sources of Variability, Integrity, and Sustainability in Implementing Progress Monitoring

    ERIC Educational Resources Information Center

    Bolt, Daniel M.; Ysseldyke, Jim; Patterson, Michael J.

    2010-01-01

    A three-level variance decomposition analysis was used to examine the sources of variability in implementation of a technology-enhanced progress monitoring system within each year of a 2-year study using a randomized-controlled design. We show that results of technology-enhanced progress monitoring are not necessarily a measure of student…

  19. Longterm Optical Monitoring of a Sample of Low Frequency Radio Variables

    NASA Astrophysics Data System (ADS)

    Smith, A. G.; Leacock, R. J.; Pica, A. J.

    A program of long-term optical monitoring of variable extragalactic sources has been carried on at Rosemary Hill Observatory since 1968. The principal instrument used is the 76-cm reflector; the work is done photographically at the f/4 Newtonian focus. Currently about 230 extragalactic sources are monitored. Results for some selected sources are presented.

  20. Applications of Multiple Reaction Monitoring to Clinical Glycomics

    PubMed Central

    Ruhaak, L. Renee; Lebrilla, Carlito B.

    2014-01-01

    Multiple reaction monitoring or MRM is widely acknowledged for its accuracy of quantitation. The applications have mostly been in the analysis of small molecules and proteins, but its utility is expanding. Protein glycosylation was recently identified as a new paradigm in biomarker discovery for health and disease. A number of recent studies have now identified differential glycosylation patterns associated with health and disease states, including aging, pregnancy, rheumatoid arthritis and different types of cancer. While the use of MRM in clinical glycomics is still in its infancy, it can likely play a role in the quantitation of protein glycosylation in the clinical setting. Here, we aim to review the current advances in the nascent application of MRM in the field of glycomics. PMID:25892741

  1. An Early Clinical Study of Time-Domain Microwave Radar for Breast Health Monitoring.

    PubMed

    Porter, Emily; Coates, Mark; Popović, Milica

    2016-03-01

    This study reports on monthly scans of healthy patient volunteers with the clinical prototype of a microwave imaging system. The system uses time-domain measurements, and incorporates a multistatic radar approach to imaging. It operates in the 2-4 GHz range and contains 16 wideband sensors embedded in a hemispherical dielectric radome. The system has been previously tested on tissue phantoms in controlled experiments. With this system prototype, we scanned 13 patients (26 breasts) over an eight-month period, collecting a total of 342 breast scans. The goal of the study described in this paper was to investigate how the system measurements are impacted by multiple factors that are unavoidable in monthly monitoring of human subjects. These factors include both biological variability (e.g., tissue variations due to hormonal changes or weight gain) and measurement variability (e.g., inconsistencies in patient positioning, system noise). For each patient breast, we process the results of the monthly scans to assess the variability in both the raw measured signals and in the generated images. The significance of this study is that it quantifies how much variability should be anticipated when conducting microwave breast imaging of a healthy patient over a longer period. This is an important step toward establishing the feasibility of the microwave radar imaging system for frequent monitoring of breast health. PMID:26259214

  2. Assessing hospitals' clinical risk management: Development of a monitoring instrument

    PubMed Central

    2010-01-01

    Background Clinical risk management (CRM) plays a crucial role in enabling hospitals to identify, contain, and manage risks related to patient safety. So far, no instruments are available to measure and monitor the level of implementation of CRM. Therefore, our objective was to develop an instrument for assessing CRM in hospitals. Methods The instrument was developed based on a literature review, which identified key elements of CRM. These elements were then discussed with a panel of patient safety experts. A theoretical model was used to describe the level to which CRM elements have been implemented within the organization. Interviews with CRM practitioners and a pilot evaluation were conducted to revise the instrument. The first nationwide application of the instrument (138 participating Swiss hospitals) was complemented by in-depth interviews with 25 CRM practitioners in selected hospitals, for validation purposes. Results The monitoring instrument consists of 28 main questions organized in three sections: 1) Implementation and organizational integration of CRM, 2) Strategic objectives and operational implementation of CRM at hospital level, and 3) Overview of CRM in different services. The instrument is available in four languages (English, German, French, and Italian). It allows hospitals to gather comprehensive and systematic data on their CRM practice and to identify areas for further improvement. Conclusions We have developed an instrument for assessing development stages of CRM in hospitals that should be feasible for a continuous monitoring of developments in this important area of patient safety. PMID:21144039

  3. Intelligent Information: A National System for Monitoring Clinical Performance

    PubMed Central

    Bottle, Alex; Aylin, Paul

    2008-01-01

    Objective To use statistical process control charts to monitor in-hospital outcomes at the hospital level for a wide range of procedures and diagnoses. Data Sources Routine English hospital admissions data. Study Design Retrospective analysis using risk-adjusted log-likelihood cumulative sum (CUSUM) charts, comparing each hospital with the national average and its peers for in-hospital mortality, length of stay, and emergency readmission within 28 days. Data Collection Data were derived from the Department of Health administrative hospital admissions database, with monthly uploads from the clearing service. Principal Findings The tool is currently being used by nearly 100 hospitals and also a number of primary care trusts responsible for purchasing hospital care. It monitors around 80 percent of admissions and in-hospital deaths. Case-mix adjustment gives values for the area under the receiver operating characteristic curve between 0.60 and 0.86 for mortality, but the values were poorer for readmission. Conclusions CUSUMs are a promising management tool for managers and clinicians for driving improvement in hospital performance for a range of outcomes, and interactive presentation via a web-based front end has been well received by users. Our methods act as a focus for intelligently directed clinical audit with the real potential to improve outcomes, but wider availability and prospective monitoring are required to fully assess the method's utility. PMID:18300370

  4. Clinical evaluation of a novel respiratory rate monitor.

    PubMed

    Lee, Peter J

    2016-04-01

    Respiratory rate has been shown to be an important predictor of cardiac arrest, respiratory adverse events and intensive care unit admission and has been designated a vital sign. However it is often inadequately monitored in hospitals. We test the hypothesis that RespiraSense, a piezoelectric-based novel respiratory rate (RR) monitor which measures the differential motion of the chest and abdomen during respiratory effort, is not inferior to commonly used methods of respiratory rate measurement. Respiratory rate was compared between the developed RespiraSense device and both electrocardiogram and direct observation by nursing staff. Data was collected from 48 patients admitted to the post-anaesthesia care unit in a tertiary level hospital. The primary outcome measure was difference in average RR calculated over a 15 min interval between (1) RespiraSense and ECG and (2) RespiraSense and nurses' evaluation. The secondary outcome measure was the correlation between the respiratory rates measured using these three methods. The 95 % confidence interval for the difference in average RR between RespiraSense and ECG was calculated to be [-3.9, 3.1]. The 95 % confidence interval for the difference in average RR between RespiraSense and nurses' evaluation was [-5.5, 4.3]. We demonstrate a clinically relevant agreement between RR monitored by the RespiraSense device with both ECG-derived and manually observed RR in 48 post-surgical patients in a PACU environment. PMID:25900144

  5. Criminal Behavior as a Function of Clinical and Actuarial Variables in a Sexual Offender Population.

    ERIC Educational Resources Information Center

    Hall, Gordon C. Nagayama

    1988-01-01

    Investigated ability of clinical and actuarial variables to predict criminal behavior of 342 sexual offenders previously studied in 1987. Results suggested linear combination of actuarial variables was significantly predictive of sexual reoffenses against adults and of nonsexual reoffending. Clinical judgment was not significantly predictive of…

  6. Clinical variability and molecular heterogeneity in prostate cancer.

    PubMed

    Shoag, Jonathan; Barbieri, Christopher E

    2016-01-01

    Prostate cancer is a clinically heterogeneous disease, with some men having indolent disease that can safely be observed, while others have aggressive, lethal disease. Over the past decade, researchers have begun to unravel some of the genomic heterogeneity that contributes to these varying clinical phenotypes. Distinct molecular sub-classes of prostate cancer have been identified, and the uniqueness of these sub-classes has been leveraged to predict clinical outcomes, design novel biomarkers for prostate cancer diagnosis, and develop novel therapeutics. Recent work has also elucidated the temporal and spatial heterogeneity of prostate cancer, helping us understand disease pathogenesis, response to therapy, and progression. New genomic techniques have provided us with a window into the remarkable clinical and genomic heterogeneity of prostate cancer, and this new perspective will increasingly impact patient care. PMID:27080479

  7. Clinical variability and molecular heterogeneity in prostate cancer

    PubMed Central

    Shoag, Jonathan; Barbieri, Christopher E

    2016-01-01

    Prostate cancer is a clinically heterogeneous disease, with some men having indolent disease that can safely be observed, while others have aggressive, lethal disease. Over the past decade, researchers have begun to unravel some of the genomic heterogeneity that contributes to these varying clinical phenotypes. Distinct molecular sub-classes of prostate cancer have been identified, and the uniqueness of these sub-classes has been leveraged to predict clinical outcomes, design novel biomarkers for prostate cancer diagnosis, and develop novel therapeutics. Recent work has also elucidated the temporal and spatial heterogeneity of prostate cancer, helping us understand disease pathogenesis, response to therapy, and progression. New genomic techniques have provided us with a window into the remarkable clinical and genomic heterogeneity of prostate cancer, and this new perspective will increasingly impact patient care. PMID:27080479

  8. Spatiotemporal Variability in Potential Evapotranspiration across an Urban Monitoring Network

    NASA Astrophysics Data System (ADS)

    Miller, G. R.; Long, M. R.; Fipps, G.; Swanson, C.; Traore, S.

    2015-12-01

    Evapotranspiration in urban and peri-urban environments is difficult to measure and predict. Barriers to accurate assessment include: the wide range of microclimates caused by urban canyons, heat islands, and park cooling; limited instrument fetch; and the patchwork of native soils, engineered soils, and hardscape. These issues combine to make an accurate assessment of the urban water balance difficult, as evapotranspiration calculations require accurate meteorological data. This study examines nearly three years of data collected by a network of 18 weather stations in Dallas, Texas, designed to measure potential evapotranspiration (ETo) in support of the WaterMyYard conservation program (http://WaterMyYard.org). Variability amongst stations peaked during the summer irrigation months, with a maximum standard deviation of 0.3 mm/hr and 4 mm/d. However, we found a significant degree of information overlap in the network. Most stations had a high correlation (>0.75) with at least one other station in the network, and many had a high correlation with at least 10 others. Correlation strength between station ETo measurements did not necessarily decrease with Euclidean distance, as expected, but was more closely related to differences in station elevation and longitude. Stations that had low correlations with others in the network typically had siting and fetch issues. ETo showed a strong temporal persistence; average station autocorrelation was 0.79 at a 1-hour lag and 0.70 at a 24-hour lag. To supplement the larger-scale network data, we deployed a mobile, vehicle-mounted weather station to quantify deviations present in the atmospheric drivers of evapotranspiration: temperature, humidity, wind, and solar radiation. Data were collected at mid-day during the irrigation season. We found differences in mobile and station ETo predictions up to 0.2 mm/hr, primarily driven by wind speed variations. These results suggest that ETo variation at the neighborhood to municipality

  9. Wearable monitoring for mood recognition in bipolar disorder based on history-dependent long-term heart rate variability analysis.

    PubMed

    Valenza, Gaetano; Nardelli, Mimma; Lanatà, Antonio; Gentili, Claudio; Bertschy, Gilles; Paradiso, Rita; Scilingo, Enzo Pasquale

    2014-09-01

    Current clinical practice in diagnosing patients affected by psychiatric disorders such as bipolar disorder is based only on verbal interviews and scores from specific questionnaires, and no reliable and objective psycho-physiological markers are taken into account. In this paper, we propose to use a wearable system based on a comfortable t-shirt with integrated fabric electrodes and sensors able to acquire electrocardiogram, respirogram, and body posture information in order to detect a pattern of objective physiological parameters to support diagnosis. Moreover, we implemented a novel ad hoc methodology of advanced biosignal processing able to effectively recognize four possible clinical mood states in bipolar patients (i.e., depression, mixed state, hypomania, and euthymia) continuously monitored up to 18 h, using heart rate variability information exclusively. Mood assessment is intended as an intrasubject evaluation in which the patient's states are modeled as a Markov chain, i.e., in the time domain, each mood state refers to the previous one. As validation, eight bipolar patients were monitored collecting and analyzing more than 400 h of autonomic and cardiovascular activity. Experimental results demonstrate that our novel concept of personalized and pervasive monitoring constitutes a viable and robust clinical decision support system for bipolar disorders recognizing mood states with a total classification accuracy up to 95.81%. PMID:24240031

  10. Advanced clinical monitoring: considerations for real-time hemodynamic diagnostics.

    PubMed Central

    Goldman, J. M.; Cordova, M. J.

    1994-01-01

    In an effort to ease staffing burdens and potentially improve patient outcome in an intensive care unit (ICU) environment, we are developing a real-time system to accurately and efficiently diagnose cardiopulmonary emergencies. The system is being designed to utilize all relevant routinely-monitored physiological data in order to automatically diagnose potentially fatal events. The initial stage of this project involved formulating the overall system design and appropriate methods for real-time data acquisition, data storage, data trending, waveform analysis, and implementing diagnostic rules. Initially, we defined a conceptual analysis of the minimum physiologic data set, and the monitoring time-frames (trends) which would be required to diagnose cardiopulmonary emergencies. Following that analysis, we used a fuzzy logic diagnostic engine to analyze physiological data during a simulated arrhythmic cardiac arrest (ACA) in order to assess the validity of our diagnostic methodology. We used rate, trend, and morphologic data extracted from the following signals: expired CO2 time-concentration curve (capnogram), electrocardiogram, and arterial blood pressure. The system performed well: The fuzzy logic engine effectively diagnosed the likelihood of ACA from the subtle hemodynamic trends which preceded the complete arrest. As the clinical picture worsened, the fuzzy logic-based system accurately indicated the change in patient condition. Termination of the simulated arrest was rapidly detected by the diagnostic engine. In view of the effectiveness of this fuzzy logic implementation, we plan to develop additional fuzzy logic modules to diagnose other cardiopulmonary emergencies. PMID:7950025

  11. Clinical results from a noninvasive blood glucose monitor

    NASA Astrophysics Data System (ADS)

    Blank, Thomas B.; Ruchti, Timothy L.; Lorenz, Alex D.; Monfre, Stephen L.; Makarewicz, M. R.; Mattu, Mutua; Hazen, Kevin

    2002-05-01

    Non-invasive blood glucose monitoring has long been proposed as a means for advancing the management of diabetes through increased measurement and control. The use of a near-infrared, NIR, spectroscopy based methodology for noninvasive monitoring has been pursued by a number of groups. The accuracy of the NIR measurement technology is limited by challenges related to the instrumentation, the heterogeneity and time-variant nature of skin tissue, and the complexity of the calibration methodology. In this work, we discuss results from a clinical study that targeted the evaluation of individual calibrations for each subject based on a series of controlled calibration visits. While the customization of the calibrations to individuals was intended to reduce model complexity, the extensive requirements for each individual set of calibration data were difficult to achieve and required several days of measurement. Through the careful selection of a small subset of data from all samples collected on the 138 study participants in a previous study, we have developed a methodology for applying a single standard calibration to multiple persons. The standard calibrations have been applied to a plurality of individuals and shown to be persistent over periods greater than 24 weeks.

  12. [Potential clinical benefit of therapeutic drug monitoring of imatinib in oncology].

    PubMed

    Turjap, M; Juřica, J; Demlová, R

    2015-01-01

    Imatinib mesylate is a competitive inhibitor of BCR/ ABL tyrosine kinase and inhibits also several receptor tyrosin kinases. Since its launch to the market, imatinib has proven to be very valuable in the treatment of Philadelphia chromosome (BCR/ ABL) -  positive (Ph+) chronic myeloid leukemia and Kit (CD117) positive gastrointestinal stromal tumors. The drug is metabolized by cytochrome P450, and there are many clinically important pharmacokinetic drug-drug interactions described in the literature. Frequent polypharmacy in oncological patients increases probability of such interactions, and also adherence may play its role during longterm treatment. Fixed dosing therapeutic regimens fail to respect known interindividual variability in pharmacokinetics of the drug and thus, some patients may not achieve sufficient plasma concentrations. Based on current evidence, there seems to be a relationship between plasma concentration and clinical response to imatinib. Therefore, imatinib appears to be suitable candidate for therapeutic drug monitoring. Here, we present an overview of pharmacokinetics, drug-drug interactions and current knowledge and suggestions on therapeutic drug monitor-ing of imatinib, its potential benefits and limitations. PMID:25882020

  13. Monitoring multiple species: Estimating state variables and exploring the efficacy of a monitoring program

    USGS Publications Warehouse

    Mattfeldt, S.D.; Bailey, L.L.; Grant, E.H.C.

    2009-01-01

    Monitoring programs have the potential to identify population declines and differentiate among the possible cause(s) of these declines. Recent criticisms regarding the design of monitoring programs have highlighted a failure to clearly state objectives and to address detectability and spatial sampling issues. Here, we incorporate these criticisms to design an efficient monitoring program whose goals are to determine environmental factors which influence the current distribution and measure change in distributions over time for a suite of amphibians. In designing the study we (1) specified a priori factors that may relate to occupancy, extinction, and colonization probabilities and (2) used the data collected (incorporating detectability) to address our scientific questions and adjust our sampling protocols. Our results highlight the role of wetland hydroperiod and other local covariates in the probability of amphibian occupancy. There was a change in overall occupancy probabilities for most species over the first three years of monitoring. Most colonization and extinction estimates were constant over time (years) and space (among wetlands), with one notable exception: local extinction probabilities for Rana clamitans were lower for wetlands with longer hydroperiods. We used information from the target system to generate scenarios of population change and gauge the ability of the current sampling to meet monitoring goals. Our results highlight the limitations of the current sampling design, emphasizing the need for long-term efforts, with periodic re-evaluation of the program in a framework that can inform management decisions.

  14. Variability in Clinical Integration Achieved by Athletic Training Students across Different Clinical Sport Assignments

    ERIC Educational Resources Information Center

    Dodge, Thomas M.; Mazerolle, Stephanie M.; Bowman, Thomas G.

    2015-01-01

    Context: Clinical integration impacts athletic training students' (ATSs) motivation and persistence. Research has yet to elucidate the manner in which different clinical placements can influence clinical integration. Objective: To examine differences in the levels of clinical integration achieved by ATSs across various clinical sport assignments.…

  15. Variability in biological monitoring of solvent exposure. I. Development of a population physiological model.

    PubMed Central

    Droz, P O; Wu, M M; Cumberland, W G; Berode, M

    1989-01-01

    Biological indicators of exposure to solvents are often characterised by a high variability that may be due either to fluctuations in exposure or individual differences in the workers. To describe and understand this variability better a physiological model for differing workers under variable industrial environments has been developed. Standard statistical distributions are used to simulate variability in exposure concentration, physical workload, body build, liver function, and renal clearance. For groups of workers exposed daily, the model calculates air monitoring indicators and biological monitoring results (expired air, blood, and urine). The results obtained are discussed and compared with measured data, both physiological (body build, cardiac output, alveolar ventilation) and toxicokinetic for six solvents: 1,1,1-trichloroethane, trichloroethylene, tetrachloroethylene, benzene, toluene, styrene, and their main metabolites. Possible applications of this population physiological model are presented. PMID:2765418

  16. Journal of Clinical Monitoring and Computing 2015 end of year summary: respiration.

    PubMed

    Karbing, D S; Rees, S E; Jaffe, M B

    2016-02-01

    This paper reviews 17 papers or commentaries published in Journal of Clinical Monitoring and Computing in 2015, within the field of respiration. Papers were published covering monitoring and training of breathing, monitoring of gas exchange, hypoxemia and acid-base, and CO2 monitoring. PMID:26719297

  17. The future of monitoring in clinical research - a holistic approach: linking risk-based monitoring with quality management principles.

    PubMed

    Ansmann, Eva B; Hecht, Arthur; Henn, Doris K; Leptien, Sabine; Stelzer, Hans Günther

    2013-01-01

    Since several years risk-based monitoring is the new "magic bullet" for improvement in clinical research. Lots of authors in clinical research ranging from industry and academia to authorities are keen on demonstrating better monitoring-efficiency by reducing monitoring visits, monitoring time on site, monitoring costs and so on, always arguing with the use of risk-based monitoring principles. Mostly forgotten is the fact, that the use of risk-based monitoring is only adequate if all mandatory prerequisites at site and for the monitor and the sponsor are fulfilled.Based on the relevant chapter in ICH GCP (International Conference on Harmonisation of technical requirements for registration of pharmaceuticals for human use - Good Clinical Practice) this publication takes a holistic approach by identifying and describing the requirements for future monitoring and the use of risk-based monitoring. As the authors are operational managers as well as QA (Quality Assurance) experts, both aspects are represented to come up with efficient and qualitative ways of future monitoring according to ICH GCP. PMID:23382708

  18. The role of ambulatory blood pressure monitoring in clinical practice.

    PubMed

    Zanchetti, A

    1997-09-01

    The introduction of noninvasive techniques for the repetitive measurement of blood pressure in ambulant subjects has permitted improved precision in the assessment of hypertension during normal daily life. The traditional clinic (or "office") method of blood pressure measurement has the advantages of simplicity and low cost, and forms the basis of the current operational definitions of hypertension, but it is limited by the normal variability of blood pressure and the "white coat effect." By contrast, ambulatory blood pressure provides information on circadian variations in blood pressure and alterations due to changes in behavior, and may, therefore, be more appropriate for diagnosing hypertension. However, it is important to note that the values used to define normotension and hypertension for clinic blood pressure are not appropriate for ambulatory blood pressure. Recent population studies have proposed that the upper limit for 24-h ambulatory pressure should be 119 to 126/75 to 80 mm Hg, and failure to recognize this may account for at least some cases of "white-coat hypertension." There is increasing evidence that ambulatory blood pressure is more effective than clinic blood pressure in predicting the organ damage associated with hypertension, whereas data from intervention studies indicate that a reduction in ambulatory pressure is correlated with a reduction in left ventricular (LV) mass. Finally, ambulatory blood pressure measurements may provide a number of advantages in the development of antihypertensive therapies: by permitting better identification of trough and peak effects, by confirming that the efficacy of formulations for once-daily dosing is maintained throughout the 24-h period, and by minimizing the placebo effect. PMID:9324116

  19. Mitochondrial encephalomyopathy: variable clinical expression within a single kindred.

    PubMed Central

    Crimmins, D; Morris, J G; Walker, G L; Sue, C M; Byrne, E; Stevens, S; Jean-Francis, B; Yiannikas, C; Pamphlett, R

    1993-01-01

    The clinical manifestations of mitochondrial encephalomyopathy are described in four generations of a single kindred. The age of onset of major neurological disturbance varied from 3-70 years. In some patients, deafness was the only manifestation; in others, recurrent bouts of status epilepticus associated with focal neurological deficits and headache, caused severe disability or death. Examples of all three adult forms of mitochondrial encephalomyopathy: MELAS, MERFF and Kearns Sayre syndrome, were represented within the kindred. Associated features included deafness, short stature, non-insulin-dependent diabetes mellitus, migraine, peptic ulceration and severe constipation. The nt 3243 A-G MELAS mutation was detected in two members of the kindred. This study highlights the diversity of clinical expression of a mitochondrial mutation within a single kindred. Images PMID:8350109

  20. Temporal variability of the optimal monitoring setup assessed using information theory

    NASA Astrophysics Data System (ADS)

    Fahle, Marcus; Hohenbrink, Tobias L.; Dietrich, Ottfried; Lischeid, Gunnar

    2015-09-01

    Hydrology is rich in methods that use information theory to evaluate monitoring networks. Yet in most existing studies, only the available data set as a whole is used, which neglects the intraannual variability of the hydrological system. In this paper, we demonstrate how this variability can be considered by extending monitoring evaluation to subsets of the available data. Therefore, we separately evaluated time windows of fixed length, which were shifted through the data set, and successively extended time windows. We used basic information theory measures and a greedy ranking algorithm based on the criterion of maximum information/minimum redundancy. The network investigated monitored surface and groundwater levels at quarter-hourly intervals and was located at an artificially drained lowland site in the Spreewald region in north-east Germany. The results revealed that some of the monitoring stations were of value permanently while others were needed only temporally. The prevailing meteorological conditions, particularly the amount of precipitation, affected the degree of similarity between the water levels measured. The hydrological system tended to act more individually during periods of no or little rainfall. The optimal monitoring setup, its stability, and the monitoring effort necessary were influenced by the meteorological forcing. Altogether, the methodology presented can help achieve a monitoring network design that has a more even performance or covers the conditions of interest (e.g., floods or droughts) best.

  1. Stereotypies in autism: a video demonstration of their clinical variability

    PubMed Central

    Goldman, Sylvie; Greene, Paul E.

    2012-01-01

    In autism, stereotypies are frequent and disabling, and whether they correspond to a hyperkinetic movement disorder, a homeostatic response aiming at sensory modulation, or a regulator of arousal remains to be established. So far, it has been challenging to distinguish among these different possibilities, not only because of lack of objective and quantitative means to assess stereotypies, but in our opinion also because of the underappreciated diversity of their clinical presentations. Herein, we illustrate the broad spectrum of stereotypies and demonstrate the usefulness of video-assisted clinical observations of children with autism. The clips presented were extracted from play sessions of 129 children with autism disorder. We conclude that compared to widely used questionnaires and interviews, systematic video observations provide a unique means to classify and score precisely the clinical features of stereotypies. We believe this approach will prove useful to both clinicians and researchers as it offers the level of detail from retrievable images necessary to begin to assess effects of age and treatments on stereotypies, and to embark on the type of investigations required to unravel the physiological basis of motor behaviors in autism. PMID:23316144

  2. Primary Vascular Leiomyosarcoma: Clinical Observations and Molecular Variables

    PubMed Central

    Roland, Christina L.; Boland, Genevieve M.; Demicco, Elizabeth G.; Lusby, Kristelle; Ingram, Davis; May, Caitlin D.; Kivlin, Christine M.; Watson, Kelsey; Al Sannaa, Ghadah A.; Wang, Wei-Lien; Ravi, Vinod; Pollock, Raphael E.; Lev, Dina; Cormier, Janice N.; Hunt, Kelly K.; Feig, Barry W.; Lazar, Alexander J.; Torres, Keila E.

    2016-01-01

    Importance Vascular leiomyosarcomas (vLMS) are a rare subtype of leiomyosarcomas (LMS) most commonly affecting the inferior vena cava and accounting for 5% of all LMS. These tumors are aggressive malignancies for which adjuvant modalities have not shown increased efficacy compared over surgery. Our study evaluates potential molecular markers that should be evaluated in prospective studies to determine their prognostic and therapeutic utility. Objective To evaluate the outcomes of patients with vLMS and associations with immunohistochemical prognostic markers. Design Retrospective chart review Setting Single institution Participants A cohort of 77 patients that presented to MDACC from 1993–2012 was analyzed. All of the cases had a confirmed diagnosis of vascular leiomyosarcoma. Immunohistochemical studies for biomarkers were performed on a tissue microarray that included 26 primary vLMS specimens. Main Outcomes and Measures Demographic, and clinical factors were evaluated to assess clinical course, patterns of recurrence and survival outcomes for patients with primary vLMS. Univariate Cox proportional hazards model was utilized to correlate DSS and time to recurrence with potential prognostic indicators. Results Five year disease-specific survival (DSS) rates after tumor resection was 65%. Median time to local recurrence was 43 months, versus 25 months for distant recurrence versus 15 months for concurrent local and distant recurrences; p=0.04. Strong cytoplasmic β-catenin (p=0.06) and IGF-1R (p=0.04) expression were associated with inferior DSS. Conclusions and Relevance vLMS are aggressive malignancies, with high recurrence rates. Expression of β-catenin and IGF-1R were associated with poor DSS. Prospective studies should evaluate their clinical and therapeutic utility. PMID:26629783

  3. The relationships among heart rate variability, executive functions, and clinical variables in patients with panic disorder.

    PubMed

    Hovland, Anders; Pallesen, Ståle; Hammar, Åsa; Hansen, Anita Lill; Thayer, Julian F; Tarvainen, Mika P; Nordhus, Inger Hilde

    2012-12-01

    Heart rate variability (HRV) is reduced in patients who suffer from panic disorder (PD). Reduced HRV is related to hypoactivity in the prefrontal cortex (PFC), which negatively affects executive functioning. The present study assessed the relationships between vagally mediated HRV at baseline and measures of executive functioning in 36 patients with PD. Associations between these physiological and cognitive measures and panic-related variables were also investigated. HRV was measured using HF-power (ms(2)), and executive functions were assessed with the Wisconsin Card Sorting Test (WCST) and the Color-Word Interference Test (CWIT) from the Delis-Kaplan Executive Function System (D-KEFS). Panic-related variables comprised panic frequency, panic-related distress, and duration of PD. Performance on the neuropsychological measures correlated significantly with HRV. Both panic-related distress and duration of PD were inversely related with measures of HRV and cognitive inhibition. The current findings support the purported relationship between HRV and executive functions involving the PFC. PMID:23069273

  4. Monitoring variability in trends of temperature and rainfall in the Apennine Alps (Middle Italy)

    NASA Astrophysics Data System (ADS)

    D'Aprile, Fabrizio; Tapper, Nigel

    2016-04-01

    In 2006 the School of Geography and Environmental Sciences of Monash University in collaboration with the Italian Forest Corps (Corpo Forestale dello Stato), Uffici Territoriali per la Biodiversità di Vallombrosa (Florence) and Pratovecchio (Arezzo)started to monitor the variability in temperature and rainfall in the Tuscan Apennine Alps (Middle Italy). First results showed unexpected variability in trends of both the climate variables and in particular very high variability in similarity of trends among sites even at short distance. Although the time series are ultra-centenary in some sites, trends in temperature and rainfall at the monthly level would show a reduction in temperature and increase in rainfall in the last decade in some cases. This uncertainty poses the question whether the phenomenon was due to some anomaly in the periodical oscillations of 6-7 years of length (spectral Fourier analysis) or the dominant trends in variability of monthly temperature and monthly rainfall are unchanged. Recent analysis of trends would confirm warming and drying of climate in the Apennine Alps in Middle Italy; however, in some sites a relative cooling is shown in the 2000s. In the area, climate warming appears to reach levels that may have relevant implications for forest composition and shift. The relatively fast increase in temperature and reduction in rainfall during the last 3-4 decades further strengthens the importance to continue monitoring climate variability to a deeper level and extend the understanding of its effects at the local level.

  5. Variability in pathogenicity prediction programs: impact on clinical diagnostics

    PubMed Central

    Walters-Sen, Lauren C; Hashimoto, Sayaka; Thrush, Devon Lamb; Reshmi, Shalini; Gastier-Foster, Julie M; Astbury, Caroline; Pyatt, Robert E

    2015-01-01

    Current practice by clinical diagnostic laboratories is to utilize online prediction programs to help determine the significance of novel variants in a given gene sequence. However, these programs vary widely in their methods and ability to correctly predict the pathogenicity of a given sequence change. The performance of 17 publicly available pathogenicity prediction programs was assayed using a dataset consisting of 122 credibly pathogenic and benign variants in genes associated with the RASopathy family of disorders and limb-girdle muscular dystrophy. Performance metrics were compared between the programs to determine the most accurate program for loss-of-function and gain-of-function mechanisms. No one program correctly predicted the pathogenicity of all variants analyzed. A major hindrance to the analysis was the lack of output from a significant portion of the programs. The best performer was MutPred, which had a weighted accuracy of 82.6% in the full dataset. Surprisingly, combining the results of the top three programs did not increase the ability to predict pathogenicity over the top performer alone. As the increasing number of sequence changes in larger datasets will require interpretation, the current study demonstrates that extreme caution must be taken when reporting pathogenicity based on statistical online protein prediction programs in the absence of functional studies. PMID:25802880

  6. Association of clinical and pathological variables with survival in thymoma.

    PubMed

    Aydiner, Adnan; Toker, Alper; Sen, Fatma; Bicakci, Ercan; Saglam, Esra Kaytan; Erus, Suat; Eralp, Yesim; Tas, Faruk; Oral, Ethem Nezih; Topuz, Erkan; Dilege, Sukru

    2012-09-01

    Our aim was to evaluate clinical and pathological features in prognosis of thymoma patients with particular emphasis on patients with myasthenia gravis (MG). From 1995 to 2010, 140 thymoma patients (women/men: 63/77) with a median age of 46 years (11-80 years) were admitted to our institution. According to World Health Organization (WHO), there were 23 (17%) type A, 12 (9%) type AB, 24 (17%) type B1, 42 (31%) type B2 and 36 (26%) type B3. The distribution of Masaoka stages I, II, III and IV was 24 (17%), 71 (51%), 18 (13%) and 27 (19%), respectively. MG coexisted in 61% of patients. After a mean follow-up of 34 months (1-158 months), 102 (73%) patients are alive and well while 14 (10%) are alive with disease. Twenty-three patients (16%) have died, only 9 died of thymoma. In univariate analyses, completeness of resection (P < .001), WHO histology (P = .008), Masaoka stage (P < .001) and MG (P = .002) were significant prognostic factors for progression-free survival (PFS). Young age (P = .008); Masaoka stages 1 and 2 (P = .039); WHO types A, AB and B1 (P = .031); complete resection (P = .024) and presence of MG (P = .05) significantly correlated with overall survival (OS). In multivariate analysis, Masaoka stages 1 and 2 (P = .038) and presence of MG (P = .01) were significantly correlated with a longer PFS; MG (P = .021) and WHO subtype (P = .022) were found to be significant prognostic factors for OS. Adjuvant radiotherapy improved neither OS nor PFS in completely resected stage 2 thymoma. Masaoka staging, WHO and MG are major determinants of prognosis in Turkish thymoma patients. Additionally, radiotherapy did not provide survival advantage to stage 2 patients with complete resection. PMID:22057358

  7. Therapeutic Drug Monitoring and Genotypic Screening in the Clinical Use of Voriconazole

    PubMed Central

    Moriyama, Brad; Kadri, Sameer; Henning, Stacey A.; Danner, Robert L.; Walsh, Thomas J.; Penzak, Scott R.

    2015-01-01

    Voriconazole is an antifungal triazole that is the first line agent for treatment of invasive aspergillosis. It is metabolized by CYP2C19, CYP2C9, and CYP3A4 and demonstrates wide interpatient variability in serum concentrations. Polymorphisms in CYP2C19 contribute to variability in voriconazole pharmacokinetics. Here, evidence is examined for the use of voriconazole therapeutic drug monitoring (TDM) and the role of CYP2C19 genotyping in voriconazole dosing. The majority of studies exploring the impact of voriconazole TDM on efficacy and safety have found TDM to be beneficial. However, most of these studies are observational, with only one being a randomized controlled trial. High-volume multicenter randomized controlled trials of TDM are currently not available to support definitive guidelines. There is a significant relationship in healthy volunteers between CYP2C19 genotype and voriconazole pharmacokinetics, but this association is markedly less visible in actual patients. While CYP2C19 genotype data may explain variability of voriconazole serum levels, they alone are not sufficient to guide initial dosing. The timeliness of availability of CYP2C19 genotype data in treatment of individual patients also remains challenging. Additional studies are needed before implementation of CYP2C19 genotyping for voriconazole dosing into routine clinical care. PMID:26918067

  8. Using Mobile Monitoring to Assess Spatial Variability in Urban Air Pollution Levels: Opportunities and Challenges (Invited)

    NASA Astrophysics Data System (ADS)

    Larson, T.

    2010-12-01

    Measuring air pollution concentrations from a moving platform is not a new idea. Historically, however, most information on the spatial variability of air pollutants have been derived from fixed site networks operating simultaneously over space. While this approach has obvious advantages from a regulatory perspective, with the increasing need to understand ever finer scales of spatial variability in urban pollution levels, the use of mobile monitoring to supplement fixed site networks has received increasing attention. Here we present examples of the use of this approach: 1) to assess existing fixed-site fine particle networks in Seattle, WA, including the establishment of new fixed-site monitoring locations; 2) to assess the effectiveness of a regulatory intervention, a wood stove burning ban, on the reduction of fine particle levels in the greater Puget Sound region; and 3) to assess spatial variability of both wood smoke and mobile source impacts in both Vancouver, B.C. and Tacoma, WA. Deducing spatial information from the inherently spatio-temporal measurements taken from a mobile platform is an area that deserves further attention. We discuss the use of “fuzzy” points to address the fine-scale spatio-temporal variability in the concentration of mobile source pollutants, specifically to deduce the broader distribution and sources of fine particle soot in the summer in Vancouver, B.C. We also discuss the use of principal component analysis to assess the spatial variability in multivariate, source-related features deduced from simultaneous measurements of light scattering, light absorption and particle-bound PAHs in Tacoma, WA. With increasing miniaturization and decreasing power requirements of air monitoring instruments, the number of simultaneous measurements that can easily be made from a mobile platform is rapidly increasing. Hopefully the methods used to design mobile monitoring experiments for differing purposes, and the methods used to interpret those

  9. Clinical Trials With Large Numbers of Variables: Important Advantages of Canonical Analysis.

    PubMed

    Cleophas, Ton J

    2016-01-01

    Canonical analysis assesses the combined effects of a set of predictor variables on a set of outcome variables, but it is little used in clinical trials despite the omnipresence of multiple variables. The aim of this study was to assess the performance of canonical analysis as compared with traditional multivariate methods using multivariate analysis of covariance (MANCOVA). As an example, a simulated data file with 12 gene expression levels and 4 drug efficacy scores was used. The correlation coefficient between the 12 predictor and 4 outcome variables was 0.87 (P = 0.0001) meaning that 76% of the variability in the outcome variables was explained by the 12 covariates. Repeated testing after the removal of 5 unimportant predictor and 1 outcome variable produced virtually the same overall result. The MANCOVA identified identical unimportant variables, but it was unable to provide overall statistics. (1) Canonical analysis is remarkable, because it can handle many more variables than traditional multivariate methods such as MANCOVA can. (2) At the same time, it accounts for the relative importance of the separate variables, their interactions and differences in units. (3) Canonical analysis provides overall statistics of the effects of sets of variables, whereas traditional multivariate methods only provide the statistics of the separate variables. (4) Unlike other methods for combining the effects of multiple variables such as factor analysis/partial least squares, canonical analysis is scientifically entirely rigorous. (5) Limitations include that it is less flexible than factor analysis/partial least squares, because only 2 sets of variables are used and because multiple solutions instead of one is offered. We do hope that this article will stimulate clinical investigators to start using this remarkable method. PMID:23591025

  10. Sex and Gender: Critical Variables in Pre-Clinical and Clinical Medical Research.

    PubMed

    Morselli, Eugenia; Frank, Aaron P; Santos, Roberta S; Fátima, Luciana A; Palmer, Biff F; Clegg, Deborah J

    2016-08-01

    In this Essay, we discuss the critical need to incorporate sex and gender in pre-clinical and clinical research to enhance our understanding of the mechanisms by which metabolic processes differ by sex and gender. This knowledge will allow for development of personalized medicine which will optimize therapies specific for individuals. PMID:27508869

  11. [Clinical and diagnostic value of heart rate variabilities in workers exposed to noise and vibration].

    PubMed

    Serebriakov, P V; Melent'ev, A V; Demina, I D

    2010-01-01

    Noise and vibration cause disorders of vegetative regulation of cardiovascular system. Daily ECG monitoring with heart rate variabilities analysis enables quanitative evaluation of disordered vegetative control over heart rate and diagnosis of cardioneuropathy caused by long occupational exposure to noise and vibration. PMID:20857555

  12. Variable filtered photographic film as a radiation detector for environmental radiation monitoring

    NASA Astrophysics Data System (ADS)

    Majid, Zafri Azran Abdul; Junet, Laila Kalidah; Hazali, Norazlanshah; Abdullah, Abdul Adam; Hanafiah, Megat Ahmad Kamal Megat

    2013-05-01

    Environmental radiation is an ionising radiation that present in the natural environment which mostly originates from cosmic rays and radionuclide agents in the environment. This may lead the population to be exposed to the radiation. Therefore, the environmental radiation needs to be observed cautiously to minimize the impact of radiation. However, there is no specific or proper monitoring device that provides an outdoor environmental radiation monitoring. Hence, a new outdoor environmental radiation monitoring device was developed. A photographic film has been chosen as a dosimeter. The purpose of this study was to prove the covered photographic film attached with variable filter can be used to develop environmental radiation monitoring device to detect the ionising radiation. The filter used was variable thickness of plastic, aluminium (Al) and lead (Pb). The result from the study showed that the mean optical density (OD) values for medium speed film are in the range 0.41 to 0.73, and for fast speed film the OD values are in the range 0.51 to 1.35. The OD values decreased when the filter was attached. This has proven that the photographic film can be used to detect radiation and fast speed film was more sensitive compared to medium speed film.

  13. Process monitoring using automatic physical measurement based on electrical and physical variability analysis

    NASA Astrophysics Data System (ADS)

    Shauly, Eitan N.; Levi, Shimon; Schwarzband, Ishai; Adan, Ofer; Latinsky, Sergey

    2015-04-01

    A fully automated silicon-based methodology for systematic analysis of electrical features is shown. The system was developed for process monitoring and electrical variability reduction. A mapping step was created by dedicated structures such as static-random-access-memory (SRAM) array or standard cell library, or by using a simple design rule checking run-set. The resulting database was then used as an input for choosing locations for critical dimension scanning electron microscope images and for specific layout parameter extraction then was input to SPICE compact modeling simulation. Based on the experimental data, we identified two items that must be checked and monitored using the method described here: transistor's sensitivity to the distance between the poly end cap and edge of active area (AA) due to AA rounding, and SRAM leakage due to a too close N-well to P-well. Based on this example, for process monitoring and variability analyses, we extensively used this method to analyze transistor gates having different shapes. In addition, analysis for a large area of high density standard cell library was done. Another set of monitoring focused on a high density SRAM array is also presented. These examples provided information on the poly and AA layers, using transistor parameters such as leakage current and drive current. We successfully define "robust" and "less-robust" transistor configurations included in the library and identified unsymmetrical transistors in the SRAM bit-cells. These data were compared to data extracted from the same devices at the end of the line. Another set of analyses was done to samples after Cu M1 etch. Process monitoring information on M1 enclosed contact was extracted based on contact resistance as a feedback. Guidelines for the optimal M1 space for different layout configurations were also extracted. All these data showed the successful in-field implementation of our methodology as a useful process monitoring method.

  14. Clinical Development and Implementation of an Institutional Guideline for Prospective EEG Monitoring and Reporting of Delayed Cerebral Ischemia.

    PubMed

    Muniz, Carlos F; Shenoy, Apeksha V; OʼConnor, Kathryn L; Bechek, Sophia C; Boyle, Emily J; Guanci, Mary M; Tehan, Tara M; Zafar, Sahar F; Cole, Andrew J; Patel, Aman B; Westover, Michael B; Rosenthal, Eric S

    2016-06-01

    Delayed cerebral ischemia (DCI) is the most common and disabling complication among patients admitted to the hospital for subarachnoid hemorrhage (SAH). Clinical and radiographic methods often fail to detect DCI early enough to avert irreversible injury. We assessed the clinical feasibility of implementing a continuous EEG (cEEG) ischemia monitoring service for early DCI detection as part of an institutional guideline. An institutional neuromonitoring guideline was designed by an interdisciplinary team of neurocritical care, clinical neurophysiology, and neurosurgery physicians and nursing staff and cEEG technologists. The interdisciplinary team focused on (1) selection criteria of high-risk patients, (2) minimization of safety concerns related to prolonged monitoring, (3) technical selection of quantitative and qualitative neurophysiologic parameters based on expert consensus and review of the literature, (4) a structured interpretation and reporting methodology, prompting direct patient evaluation and iterative neurocritical care, and (5) a two-layered quality assurance process including structured clinician interviews assessing events of neurologic worsening and an adjudicated consensus review of neuroimaging and medical records. The resulting guideline's clinical feasibility was then prospectively evaluated. The institutional SAH monitoring guideline used transcranial Doppler ultrasound and cEEG monitoring for vasospasm and ischemia monitoring in patients with either Fisher group 3 or Hunt-Hess grade IV or V SAH. Safety criteria focused on prevention of skin breakdown and agitation. Technical components included monitoring of transcranial Doppler ultrasound velocities and cEEG features, including quantitative alpha:delta ratio and percent alpha variability, qualitative evidence of new focal slowing, late-onset epileptiform activity, or overall worsening of background. Structured cEEG reports were introduced including verbal communication for findings concerning

  15. Monitoring temporal and spatial variability in sandeel (Ammodytes hexapterus) abundance with pigeon guillemot (Cepphus columba) diets

    USGS Publications Warehouse

    Litzow, M.A.; Piatt, J.F.; Abookire, A.A.; Prichard, A.K.; Robards, M.D.

    2000-01-01

    We evaluated pigeon guillemots (Cepphus columba) as monitors of nearshore fish abundance and community composition during 1995-1999 at Kachemak Bay, Alaska. We studied the composition of chick diets at 10 colonies and simultaneously measured fish abundance around colonies with beach seines and bottom trawls. Sandeels (Ammodytes hexapterus) formed the majority of the diet at one group of colonies. Temporal variability in sandeel abundance explained 74% of inter-annual variability in diet composition at these colonies and 93% of seasonal variability. Diets at other colonies were dominated by demersal fish. Among these colonies, 81% of the variability in the proportion of sandeels in diets was explained by spatial differences in sanded abundance. Pigeon guillemots exhibited a non-linear functional response to sandeel abundance in the area where these fish were most abundant. Temporal and spatial variability in demersal fish abundance was not consistently reflected in diets. Spatial differences in the proportion of different demersal fishes in the diet may have been driven by differences in guillemot prey preference. Prey specialization by individual pigeon guillemots was common, and may operate at the colony level. Inter-annual variability in sandeel abundance may have been tracked more accurately because the magnitude of change (11-fold) was greater than that of demersal fish (three-fold). (C) 2000 International Council for the Exploration of the Sea.

  16. 21 CFR 312.87 - Active monitoring of conduct and evaluation of clinical trials.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... clinical trials. 312.87 Section 312.87 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH... and evaluation of clinical trials. For drugs covered under this section, the Commissioner and other agency officials will monitor the progress of the conduct and evaluation of clinical trials and...

  17. 21 CFR 312.87 - Active monitoring of conduct and evaluation of clinical trials.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... clinical trials. 312.87 Section 312.87 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH... and evaluation of clinical trials. For drugs covered under this section, the Commissioner and other agency officials will monitor the progress of the conduct and evaluation of clinical trials and...

  18. Near-IR Spectroscopic Monitoring of Class I Protostars: Variability of Accretion and Wind Indicators

    NASA Astrophysics Data System (ADS)

    Connelley, Michael S.; Greene, Thomas P.

    2014-06-01

    We present the results of a program that monitored the near-IR spectroscopic variability of a sample of 19 embedded protostars. Spectra were taken on time intervals from 2 days to 3 yr, over a wavelength range from 0.85 μm to 2.45 μm, for 4-9 epochs of observations per target. We found that the spectra of all targets are variable and that every emission feature observed is also variable (although not for all targets). With one exception, there were no drastic changes in the continua of the spectra, nor did any line completely disappear, nor did any line appear that was not previously apparent. This analysis focuses on understanding the connection between accretion (traced by H Br γ and CO) and the wind (traced by He I, [Fe II], and sometimes H2). For both accretion and wind tracers, the median variability was constant versus the time interval between observations; however, the maximum variability that we observed increased with the time interval between observations. Extinction is observed to vary within the minimum sampling time of 2 days, suggesting extinguishing material within a few stellar radii at high disk latitudes. The variability of [Fe II] and H2 were correlated for most (but not all) of the 7 young stellar objects showing both features, and the amplitude of the variability depends on the veiling. Although the occurrence of CO and Br γ emission are connected, their variability is uncorrelated, suggesting that these emissions originate in separate regions near the protostar (e.g., disk and wind). The variability of Br γ and wind tracers were found to be positively correlated, negatively correlated, or uncorrelated, depending on the target. The variability of Br γ, [Fe II], and H2 always lies on a plane, although the orientation of the plane in three dimensions depends on the target. While we do not understand all interactions behind the variability that we observed, we have shown that spectroscopic variability is a powerful tool toward understanding

  19. Ambient intelligence for monitoring and research in clinical neurophysiology and medicine: the MIMERICA* project and prototype.

    PubMed

    Pignolo, L; Riganello, F; Dolce, G; Sannita, W G

    2013-04-01

    Ambient Intelligence (AmI) provides extended but unobtrusive sensing and computing devices and ubiquitous networking for human/environment interaction. It is a new paradigm in information technology compliant with the international Integrating Healthcare Enterprise board (IHE) and eHealth HL7 technological standards in the functional integration of biomedical domotics and informatics in hospital and home care. AmI allows real-time automatic recording of biological/medical information and environmental data. It is extensively applicable to patient monitoring, medicine and neuroscience research, which require large biomedical data sets; for example, in the study of spontaneous or condition-dependent variability or chronobiology. In this respect, AML is equivalent to a traditional laboratory for data collection and processing, with minimal dedicated equipment, staff, and costs; it benefits from the integration of artificial intelligence technology with traditional/innovative sensors to monitor clinical or functional parameters. A prototype AmI platform (MIMERICA*) has been implemented and is operated in a semi-intensive unit for the vegetative and minimally conscious states, to investigate the spontaneous or environment-related fluctuations of physiological parameters in these conditions. PMID:23545248

  20. Nitrate Variability in Groundwater of North Carolina using Monitoring and Private Well Data Models

    PubMed Central

    2015-01-01

    Nitrate (NO3–) is a widespread contaminant of groundwater and surface water across the United States that has deleterious effects to human and ecological health. This study develops a model for predicting point-level groundwater NO3– at a state scale for monitoring wells and private wells of North Carolina. A land use regression (LUR) model selection procedure is developed for determining nonlinear model explanatory variables when they are known to be correlated. Bayesian Maximum Entropy (BME) is used to integrate the LUR model to create a LUR-BME model of spatial/temporal varying groundwater NO3– concentrations. LUR-BME results in a leave-one-out cross-validation r2 of 0.74 and 0.33 for monitoring and private wells, effectively predicting within spatial covariance ranges. Results show significant differences in the spatial distribution of groundwater NO3– contamination in monitoring versus private wells; high NO3– concentrations in the southeastern plains of North Carolina; and wastewater treatment residuals and swine confined animal feeding operations as local sources of NO3– in monitoring wells. Results are of interest to agencies that regulate drinking water sources or monitor health outcomes from ingestion of drinking water. Lastly, LUR-BME model estimates can be integrated into surface water models for more accurate management of nonpoint sources of nitrogen. PMID:25148521

  1. Nitrate variability in groundwater of North Carolina using monitoring and private well data models.

    PubMed

    Messier, Kyle P; Kane, Evan; Bolich, Rick; Serre, Marc L

    2014-09-16

    Nitrate (NO3-) is a widespread contaminant of groundwater and surface water across the United States that has deleterious effects to human and ecological health. This study develops a model for predicting point-level groundwater NO3- at a state scale for monitoring wells and private wells of North Carolina. A land use regression (LUR) model selection procedure is developed for determining nonlinear model explanatory variables when they are known to be correlated. Bayesian Maximum Entropy (BME) is used to integrate the LUR model to create a LUR-BME model of spatial/temporal varying groundwater NO3- concentrations. LUR-BME results in a leave-one-out cross-validation r2 of 0.74 and 0.33 for monitoring and private wells, effectively predicting within spatial covariance ranges. Results show significant differences in the spatial distribution of groundwater NO3- contamination in monitoring versus private wells; high NO3- concentrations in the southeastern plains of North Carolina; and wastewater treatment residuals and swine confined animal feeding operations as local sources of NO3- in monitoring wells. Results are of interest to agencies that regulate drinking water sources or monitor health outcomes from ingestion of drinking water. Lastly, LUR-BME model estimates can be integrated into surface water models for more accurate management of nonpoint sources of nitrogen. PMID:25148521

  2. Vascular Glucose Sensor Symposium: Continuous Glucose Monitoring Systems (CGMS) for Hospitalized and Ambulatory Patients at Risk for Hyperglycemia, Hypoglycemia, and Glycemic Variability.

    PubMed

    Joseph, Jeffrey I; Torjman, Marc C; Strasma, Paul J

    2015-07-01

    Hyperglycemia, hypoglycemia, and glycemic variability have been associated with increased morbidity, mortality, length of stay, and cost in a variety of critical care and non-critical care patient populations in the hospital. The results from prospective randomized clinical trials designed to determine the risks and benefits of intensive insulin therapy and tight glycemic control have been confusing; and at times conflicting. The limitations of point-of-care blood glucose (BG) monitoring in the hospital highlight the great clinical need for an automated real-time continuous glucose monitoring system (CGMS) that can accurately measure the concentration of glucose every few minutes. Automation and standardization of the glucose measurement process have the potential to significantly improve BG control, clinical outcome, safety and cost. PMID:26078254

  3. Real-time monitoring for human clinical trials

    SciTech Connect

    Harker, Y.D.

    1995-11-01

    On August 3-4, 1994, an INEL team made measurements related to a real-time monitoring system for use on the epithermal beam facility at the BMRR. BNL has installed two fission chambers in front of the beam collimator, which are to monitor the beam coming from the reactor. These two monitors are located with one just above the 16-cm dia. front aperture and the other is just below. The fission chambers contain depleted uranium, but because of the small amount of U-235 present, they respond to thermal and near thermal neutrons rather than fast neutrons. This feature combined with their relatively small size (0.6 cm dia x 4 cm long) makes them very good monitors in the BMRR epithermal neutron beam. The INEL team worked with H.B. Lui (BNL) in performing initial tests of these monitors and established the settings to achieve stable operation. The main purpose of the measurement studies was to establish a basis for a monitoring method that tracks the dose the patient is receiving rather than the neutron fluence being delivered down the beam line.

  4. Off-label psychopharmacologic prescribing for children: History supports close clinical monitoring

    PubMed Central

    Zito, Julie M; Derivan, Albert T; Kratochvil, Christopher J; Safer, Daniel J; Fegert, Joerg M; Greenhill, Laurence L

    2008-01-01

    The review presents pediatric adverse drug events from a historical perspective and focuses on selected safety issues associated with off-label use of medications for the psychiatric treatment of youth. Clinical monitoring procedures for major psychotropic drug classes are reviewed. Prior studies suggest that systematic treatment monitoring is warranted so as to both minimize risk of unexpected adverse events and exposures to ineffective treatments. Clinical trials to establish the efficacy and safety of drugs currently being used off-label in the pediatric population are needed. In the meantime, clinicians should consider the existing evidence-base for these drugs and institute close clinical monitoring. PMID:18793403

  5. A multi-layer monitoring system for clinical management of Congestive Heart Failure

    PubMed Central

    2015-01-01

    Background Congestive Heart Failure (CHF) is a serious cardiac condition that brings high risks of urgent hospitalization and death. Remote monitoring systems are well-suited to managing patients suffering from CHF, and can reduce deaths and re-hospitalizations, as shown by the literature, including multiple systematic reviews. Methods The monitoring system proposed in this paper aims at helping CHF stakeholders make appropriate decisions in managing the disease and preventing cardiac events, such as decompensation, which can lead to hospitalization or death. Monitoring activities are stratified into three layers: scheduled visits to a hospital following up on a cardiac event, home monitoring visits by nurses, and patient's self-monitoring performed at home using specialized equipment. Appropriate hardware, desktop and mobile software applications were developed to enable a patient's monitoring by all stakeholders. For the first two layers, we designed and implemented a Decision Support System (DSS) using machine learning (Random Forest algorithm) to predict the number of decompensations per year and to assess the heart failure severity based on a variety of clinical data. For the third layer, custom-designed sensors (the Blue Scale system) for electrocardiogram (EKG), pulse transit times, bio-impedance and weight allowed frequent collection of CHF-related data in the comfort of the patient's home. We also performed a short-term Heart Rate Variability (HRV) analysis on electrocardiograms self-acquired by 15 healthy volunteers and compared the obtained parameters with those of 15 CHF patients from PhysioNet's PhysioBank archives. Results We report numerical performances of the DSS, calculated as multiclass accuracy, sensitivity and specificity in a 10-fold cross-validation. The obtained average accuracies are: 71.9% in predicting the number of decompensations and 81.3% in severity assessment. The most serious class in severity assessment is detected with good

  6. Exposure–Response Modeling of Clinical End Points Using Latent Variable Indirect Response Models

    PubMed Central

    Hu, C

    2014-01-01

    Exposure–response modeling facilitates effective dosing regimen selection in clinical drug development, where the end points are often disease scores and not physiological variables. Appropriate models need to be consistent with pharmacology and identifiable from the time courses of available data. This article describes a general framework of applying mechanism-based models to various types of clinical end points. Placebo and drug model parameterization, interpretation, and assessment are discussed with a focus on the indirect response models. PMID:24897307

  7. THE LICK AGN MONITORING PROJECT: PHOTOMETRIC LIGHT CURVES AND OPTICAL VARIABILITY CHARACTERISTICS

    SciTech Connect

    Walsh, Jonelle L.; Bentz, Misty C.; Barth, Aaron J.; Minezaki, Takeo; Sakata, Yu; Yoshii, Yuzuru; Baliber, Nairn; Bennert, Vardha Nicola; Street, Rachel A.; Treu, Tommaso; Li Weidong; Filippenko, Alexei V.; Stern, Daniel; Brown, Timothy M.; Canalizo, Gabriela; Gates, Elinor L.; Greene, Jenny E.; Malkan, Matthew A.; Woo, Jong-Hak

    2009-11-01

    The Lick AGN Monitoring Project targeted 13 nearby Seyfert 1 galaxies with the intent of measuring the masses of their central black holes using reverberation mapping. The sample includes 12 galaxies selected to have black holes with masses roughly in the range 10{sup 6}-10{sup 7} M {sub sun}, as well as the well-studied active galactic nucleus (AGN) NGC 5548. In conjunction with a spectroscopic monitoring campaign, we obtained broadband B and V images on most nights from 2008 February through 2008 May. The imaging observations were carried out by four telescopes: the 0.76 m Katzman Automatic Imaging Telescope, the 2 m Multicolor Active Galactic Nuclei Monitoring telescope, the Palomar 60 inch (1.5 m) telescope, and the 0.80 m Tenagra II telescope. Having well-sampled light curves over the course of a few months is useful for obtaining the broad-line reverberation lag and black hole mass, and also allows us to examine the characteristics of the continuum variability. In this paper, we discuss the observational methods and the photometric measurements, and present the AGN continuum light curves. We measure various variability characteristics of each of the light curves. We do not detect any evidence for a time lag between the B- and V-band variations, and we do not find significant color variations for the AGNs in our sample.

  8. Confirming LBV Candidates Through Variability: A Photometric and Spectroscopic Monitoring Study

    NASA Astrophysics Data System (ADS)

    Stringfellow, Guy; Gvaramadze, Vasilii

    2012-02-01

    Luminous Blue Variable (LBV) stars represent an extremely rare class of very luminous, massive stars. About a dozen confirmed Galactic LBV stars are known, which precludes determining a solid evolutionary connection between LBV and other intermediate (e.g. Ofpe/WN9, WNL) phases in the life of very massive stars. Several catalogues of nebulae - rings and shells typical of LBVs - derived from the GLIMPSE and MIPSGAL surveys have recently been published. We conducted a near-IR spectral survey of a large subset of central stars residing within these nebulae and have identified nearly two dozen new candidate LBVs (cLBVs) based on spectral similarity alone; they remain cLBVs until 1-3 mag variability is demonstrated, securing their LBV nature. This marks a significant advancement in the study of massive stars, far outweighing the return from many studies searching for LBVs and WRs the past several decades. Using SMARTS 16 new cLBVs, 3 confirmed LBVs, and 2 previously known cLBVs will undergo photometric IR-monitoring, with 6 new cLBVs monitored spectroscopically (already being photometrically monitored elsewhere).

  9. Rapid-cadence optical monitoring for short-period variability of ɛ Aurigae

    NASA Astrophysics Data System (ADS)

    Billings, Gary

    2013-07-01

    ɛ Aurigae was observed with CCD cameras and 35 mm SLR camera lenses, at rapid cadence (>1/minute), for long runs (up to 11 hours), on multiple occasions during 2009 - 2011, to monitor for variability of the system at scales of minutes to hours. The lens and camera were changed during the period to improve results, finalizing on a 135 mm focal length Canon f/2 lens (at f/2.8), an ND8 neutral density filter, a Johnson V filter, and an SBIG ST-8XME camera (Kodak KAF-1603ME microlensed chip). Differential photometry was attempted, but because of the large separation between the variable and comparison star (η Aur), noise caused by transient extinction variations was not consistently eliminated. The lowest-noise time series for searching for short-period variability proved to be the extinction-corrected instrumental magnitude of ɛ Aur obtained on "photometric nights", with η Aur used to determine and monitor the extinction coefficient for the night. No flares or short-period variations of ɛ Aur were detected by visual inspection of the light curves from observing runs with noise levels as low as 0.008 magnitudes rms.

  10. Graduate-Entry Medical Student Variables that Predict Academic and Clinical Achievement

    ERIC Educational Resources Information Center

    Blackman, Ian; Darmawan, I Gusti Ngurah

    2004-01-01

    A hypothetical model was formulated to explore factors that influenced academic and clinical achievement for graduate-entry medical students completing their third year of university studies. Nine latent variables were considered including the students' background, previous successes with their undergraduate and postgraduate studies and their…

  11. Undergraduate Nurse Variables that Predict Academic Achievement and Clinical Competence in Nursing

    ERIC Educational Resources Information Center

    Blackman, Ian; Hall, Margaret; Darmawan, I Gusti Ngurah.

    2007-01-01

    A hypothetical model was formulated to explore factors that influenced academic and clinical achievement for undergraduate nursing students. Sixteen latent variables were considered including the students' background, gender, type of first language, age, their previous successes with their undergraduate nursing studies and status given for…

  12. Changes in Heart Rate Variability after Coronary Artery Bypass Grafting and Clinical Importance of These Findings

    PubMed Central

    Lakusic, Nenad; Mahovic, Darija; Cerkez Habek, Jasna; Novak, Miroslav; Cerovec, Dusko

    2015-01-01

    Heart rate variability is a physiological feature indicating the influence of the autonomic nervous system on the heart rate. Association of the reduced heart rate variability due to myocardial infarction and the increased postinfarction mortality was first described more than thirty years ago. Many studies have unequivocally demonstrated that coronary artery bypass grafting surgery generally leads to significant reduction in heart rate variability, which is even more pronounced than after myocardial infarction. Pathophysiologically, however, the mechanisms of heart rate variability reduction associated with acute myocardial infarction and coronary artery bypass grafting are different. Generally, heart rate variability gradually recovers to the preoperative values within six months of the procedure. Unlike the reduced heart rate variability in patients having sustained myocardial infarction, a finding of reduced heart rate variability after coronary artery bypass surgery is not considered relevant in predicting mortality. Current knowledge about changes in heart rate variability in coronary patients and clinical relevance of such a finding in patients undergoing coronary artery bypass grafting are presented. PMID:26078960

  13. Photon-monitoring attack on continuous-variable quantum key distribution with source in middle

    NASA Astrophysics Data System (ADS)

    Wang, Yijun; Huang, Peng; Guo, Ying; Huang, Dazu

    2014-12-01

    Motivated by a fact that the non-Gaussian operation may increase entanglement of an entangled system, we suggest a photon-monitoring attack strategy in the entanglement-based (EB) continuous-variable quantum key distribution (CVQKD) using the photon subtraction operations, where the entangled source originates from the center instead of one of the legal participants. It shows that an eavesdropper, Eve, can steal large information from participants after intercepting the partial beams with the photon-monitoring attach strategy. The structure of the proposed CVQKD protocol is useful in simply analyzing how quantum loss in imperfect channels can decrease the performance of the CVQKD protocol. The proposed attack strategy can be implemented under current technology, where a newly developed and versatile no-Gaussian operation can be well employed with the entangled source in middle in order to access to mass information in the EB CVQKD protocol, as well as in the prepare-and-measure (PM) CVQKD protocol.

  14. Classification Models for Neurocognitive Impairment in HIV Infection Based on Demographic and Clinical Variables

    PubMed Central

    Muñoz-Moreno, Jose A.; Pérez-Álvarez, Núria; Muñoz-Murillo, Amalia; Prats, Anna; Garolera, Maite; Jurado, M. Àngels; Fumaz, Carmina R.; Negredo, Eugènia; Ferrer, Maria J.; Clotet, Bonaventura

    2014-01-01

    Objective We used demographic and clinical data to design practical classification models for prediction of neurocognitive impairment (NCI) in people with HIV infection. Methods The study population comprised 331 HIV-infected patients with available demographic, clinical, and neurocognitive data collected using a comprehensive battery of neuropsychological tests. Classification and regression trees (CART) were developed to obtain detailed and reliable models to predict NCI. Following a practical clinical approach, NCI was considered the main variable for study outcomes, and analyses were performed separately in treatment-naïve and treatment-experienced patients. Results The study sample comprised 52 treatment-naïve and 279 experienced patients. In the first group, the variables identified as better predictors of NCI were CD4 cell count and age (correct classification [CC]: 79.6%, 3 final nodes). In treatment-experienced patients, the variables most closely related to NCI were years of education, nadir CD4 cell count, central nervous system penetration-effectiveness score, age, employment status, and confounding comorbidities (CC: 82.1%, 7 final nodes). In patients with an undetectable viral load and no comorbidities, we obtained a fairly accurate model in which the main variables were nadir CD4 cell count, current CD4 cell count, time on current treatment, and past highest viral load (CC: 88%, 6 final nodes). Conclusion Practical classification models to predict NCI in HIV infection can be obtained using demographic and clinical variables. An approach based on CART analyses may facilitate screening for HIV-associated neurocognitive disorders and complement clinical information about risk and protective factors for NCI in HIV-infected patients. PMID:25237895

  15. Method and apparatus for smart battery charging including a plurality of controllers each monitoring input variables

    DOEpatents

    Hammerstrom, Donald J.

    2013-10-15

    A method for managing the charging and discharging of batteries wherein at least one battery is connected to a battery charger, the battery charger is connected to a power supply. A plurality of controllers in communication with one and another are provided, each of the controllers monitoring a subset of input variables. A set of charging constraints may then generated for each controller as a function of the subset of input variables. A set of objectives for each controller may also be generated. A preferred charge rate for each controller is generated as a function of either the set of objectives, the charging constraints, or both, using an algorithm that accounts for each of the preferred charge rates for each of the controllers and/or that does not violate any of the charging constraints. A current flow between the battery and the battery charger is then provided at the actual charge rate.

  16. Residue variability and sampling--practical problems and consequences for residues monitoring.

    PubMed

    Hill, A R

    2000-07-01

    Data generated in the UK have indicated that pesticide residue levels can be highly variable between the individual fruit or vegetables from the same crop or lot in trade. Statistical experiments with these data showed that residues in composite samples, taken according to Codex recommendations, are unlikely to differ by more than a factor of 3-4 from the mean level in the lot. This was corroborated by results obtained from real composite samples. Many fruit or vegetables in trade are mixed after harvest to form combined lots. Analysis of composite samples provides a good indication of average residues but, where the lot has been mixed, such average values are potentially misleading. Residues monitoring is the best means available for general control of pesticide use and consumer exposure, but new strategies for sampling and analysis are required to address the combined effects of residues variability and mixing of lots. PMID:10983575

  17. A method for monitoring the variability in nuclear absorption characteristics of aviation fuels

    NASA Technical Reports Server (NTRS)

    Sprinkle, Danny R.; Shen, Chih-Ping

    1988-01-01

    A technique for monitoring variability in the nuclear absorption characteristics of aviation fuels has been developed. It is based on a highly collimated low energy gamma radiation source and a sodium iodide counter. The source and the counter assembly are separated by a geometrically well-defined test fuel cell. A computer program for determining the mass attenuation coefficient of the test fuel sample, based on the data acquired for a preset counting period, has been developed and tested on several types of aviation fuel.

  18. Using a Web-Based Database to Record and Monitor Athletic Training Students' Clinical Experiences

    ERIC Educational Resources Information Center

    Brown, Kirk W.; Williams, Lisa; Janicki, Thomas

    2008-01-01

    Objective: The purpose of this article is to introduce a documentation recording system employing the Microsoft Structured Query Language (MS-SQL) database used by the Athletic Training Education Program (ATEP) for recording and monitoring of athletic training student (ATS) clinical experiences and hours. Background: Monitoring ATSs clinical…

  19. Automated size-specific CT dose monitoring program: Assessing variability in CT dose

    SciTech Connect

    Christianson, Olav; Li Xiang; Frush, Donald; Samei, Ehsan

    2012-11-15

    Purpose: The potential health risks associated with low levels of ionizing radiation have created a movement in the radiology community to optimize computed tomography (CT) imaging protocols to use the lowest radiation dose possible without compromising the diagnostic usefulness of the images. Despite efforts to use appropriate and consistent radiation doses, studies suggest that a great deal of variability in radiation dose exists both within and between institutions for CT imaging. In this context, the authors have developed an automated size-specific radiation dose monitoring program for CT and used this program to assess variability in size-adjusted effective dose from CT imaging. Methods: The authors radiation dose monitoring program operates on an independent health insurance portability and accountability act compliant dosimetry server. Digital imaging and communication in medicine routing software is used to isolate dose report screen captures and scout images for all incoming CT studies. Effective dose conversion factors (k-factors) are determined based on the protocol and optical character recognition is used to extract the CT dose index and dose-length product. The patient's thickness is obtained by applying an adaptive thresholding algorithm to the scout images and is used to calculate the size-adjusted effective dose (ED{sub adj}). The radiation dose monitoring program was used to collect data on 6351 CT studies from three scanner models (GE Lightspeed Pro 16, GE Lightspeed VCT, and GE Definition CT750 HD) and two institutions over a one-month period and to analyze the variability in ED{sub adj} between scanner models and across institutions. Results: No significant difference was found between computer measurements of patient thickness and observer measurements (p= 0.17), and the average difference between the two methods was less than 4%. Applying the size correction resulted in ED{sub adj} that differed by up to 44% from effective dose estimates

  20. Structural and diffusion imaging versus clinical assessment to monitor amyotrophic lateral sclerosis.

    PubMed

    Cardenas-Blanco, Arturo; Machts, Judith; Acosta-Cabronero, Julio; Kaufmann, Joern; Abdulla, Susanne; Kollewe, Katja; Petri, Susanne; Schreiber, Stefanie; Heinze, Hans-Jochen; Dengler, Reinhard; Vielhaber, Stefan; Nestor, Peter J

    2016-01-01

    Amyotrophic lateral sclerosis is a progressive neurodegenerative disease that affects upper and lower motor neurons. Observational and intervention studies can be tracked using clinical measures such as the revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) but for a complete understanding of disease progression, objective in vivo biomarkers of both central and peripheral motor pathway pathology are highly desirable. The aim of this study was to determine the utility of structural and diffusion imaging as central nervous system biomarkers compared to the standard clinical measure, ALSFRS-R, to track longitudinal evolution using three time-point measurements. N = 34 patients with ALS were scanned and clinically assessed three times at a mean of three month time intervals. The MRI biomarkers were structural T1-weighted volumes for cortical thickness measurement as well as deep grey matter volumetry, voxel-based morphometry and diffusion tensor imaging (DTI). Cortical thickness focused specifically on the precentral gyrus while quantitative DTI biomarkers focused on the corticospinal tracts. The evolution of imaging biomarkers and ALSFRS-R scores over time were analysed using a mixed effects model that accounted for the scanning interval as a fixed effect variable, and, the initial measurements and time from onset as random variables. The mixed effects model showed a significant decrease in the ALSFRS-R score, (p < 0.0001, and an annual rate of change (AROC) of - 7.3 points). Similarly, fractional anisotropy of the corticospinal tract showed a significant decrease (p = 0.009, AROC = - 0.0066) that, in turn, was driven by a significant increase in radial diffusivity combined with a trend to decrease in axial diffusivity. No significant change in cortical thickness of the precentral gyrus was found (p > 0.5). In addition, deep grey matter volumetry and voxel-based morphometry also identified no significant changes. Furthermore, the

  1. Structural and diffusion imaging versus clinical assessment to monitor amyotrophic lateral sclerosis

    PubMed Central

    Cardenas-Blanco, Arturo; Machts, Judith; Acosta-Cabronero, Julio; Kaufmann, Joern; Abdulla, Susanne; Kollewe, Katja; Petri, Susanne; Schreiber, Stefanie; Heinze, Hans-Jochen; Dengler, Reinhard; Vielhaber, Stefan; Nestor, Peter J.

    2016-01-01

    Amyotrophic lateral sclerosis is a progressive neurodegenerative disease that affects upper and lower motor neurons. Observational and intervention studies can be tracked using clinical measures such as the revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) but for a complete understanding of disease progression, objective in vivo biomarkers of both central and peripheral motor pathway pathology are highly desirable. The aim of this study was to determine the utility of structural and diffusion imaging as central nervous system biomarkers compared to the standard clinical measure, ALSFRS-R, to track longitudinal evolution using three time-point measurements. N = 34 patients with ALS were scanned and clinically assessed three times at a mean of three month time intervals. The MRI biomarkers were structural T1-weighted volumes for cortical thickness measurement as well as deep grey matter volumetry, voxel-based morphometry and diffusion tensor imaging (DTI). Cortical thickness focused specifically on the precentral gyrus while quantitative DTI biomarkers focused on the corticospinal tracts. The evolution of imaging biomarkers and ALSFRS-R scores over time were analysed using a mixed effects model that accounted for the scanning interval as a fixed effect variable, and, the initial measurements and time from onset as random variables. The mixed effects model showed a significant decrease in the ALSFRS-R score, (p < 0.0001, and an annual rate of change (AROC) of − 7.3 points). Similarly, fractional anisotropy of the corticospinal tract showed a significant decrease (p = 0.009, AROC = − 0.0066) that, in turn, was driven by a significant increase in radial diffusivity combined with a trend to decrease in axial diffusivity. No significant change in cortical thickness of the precentral gyrus was found (p > 0.5). In addition, deep grey matter volumetry and voxel-based morphometry also identified no significant changes. Furthermore, the

  2. Clinical review: A review and analysis of heart rate variability and the diagnosis and prognosis of infection

    PubMed Central

    2009-01-01

    Bacterial infection leading to organ failure is the most common cause of death in critically ill patients. Early diagnosis and expeditious treatment is a cornerstone of therapy. Evaluating the systemic host response to infection as a complex system provides novel insights: however, bedside application with clinical value remains wanting. Providing an integrative measure of an altered host response, the patterns and character of heart rate fluctuations measured over intervals-in-time may be analysed with a panel of mathematical techniques that quantify overall fluctuation, spectral composition, scale-free variation, and degree of irregularity or complexity. Using these techniques, heart rate variability (HRV) has been documented to be both altered in the presence of systemic infection, and correlated with its severity. In this review and analysis, we evaluate the use of HRV monitoring to provide early diagnosis of infection, document the prognostic implications of altered HRV in infection, identify current limitations, highlight future research challenges, and propose improvement strategies. Given existing evidence and potential for further technological advances, we believe that longitudinal, individualized, and comprehensive HRV monitoring in critically ill patients at risk for or with existing infection offers a means to harness the clinical potential of this bedside application of complex systems science. PMID:20017889

  3. Saliva-Based Biosensors: Noninvasive Monitoring Tool for Clinical Diagnostics

    PubMed Central

    Malon, Radha S. P.; Balakrishnan, Malarvili; Córcoles, Emma P.

    2014-01-01

    Saliva is increasingly recognised as an attractive diagnostic fluid. The presence of various disease signalling salivary biomarkers that accurately reflect normal and disease states in humans and the sampling benefits compared to blood sampling are some of the reasons for this recognition. This explains the burgeoning research field in assay developments and technological advancements for the detection of various salivary biomarkers to improve clinical diagnosis, management, and treatment. This paper reviews the significance of salivary biomarkers for clinical diagnosis and therapeutic applications, with focus on the technologies and biosensing platforms that have been reported for screening these biomarkers. PMID:25276835

  4. A monitoring campaign for Luhman 16AB. I. Detection of resolved near-infrared spectroscopic variability

    SciTech Connect

    Burgasser, Adam J.; Gillon, Michaël; Jehin, E.; Delrez, L.; Opitom, C.; Faherty, Jacqueline K.; Radigan, Jacqueline; Triaud, Amaury H. M. J.; Plavchan, Peter

    2014-04-10

    We report resolved near-infrared spectroscopic monitoring of the nearby L dwarf/T dwarf binary WISE J104915.57–531906.1AB (Luhman 16AB), as part of a broader campaign to characterize the spectral energy distribution and temporal variability of this system. A continuous 45 minute sequence of low-resolution IRTF/SpeX data spanning 0.8-2.4 μm were obtained, concurrent with combined-light optical photometry with ESO/TRAPPIST. Our spectral observations confirm the flux reversal of this binary, and we detect a wavelength-dependent decline in the relative spectral fluxes of the two components coincident with a decline in the combined-light optical brightness of the system over the course of the observation. These data are successfully modeled as a combination of achromatic (brightness) and chromatic (color) variability in the T0.5 Luhman 16B, consistent with variations in overall cloud opacity; and no significant variability was found in L7.5 Luhman 16A, consistent with recent resolved photometric monitoring. We estimate a peak-to-peak amplitude of 13.5% at 1.25 μm over the full light curve. Using a simple two-spot brightness temperature model for Luhman 16B, we infer an average cold covering fraction of ≈30%-55%, varying by 15%-30% over a rotation period assuming a ≈200-400 K difference between hot and cold regions. We interpret these variations as changes in the covering fraction of a high cloud deck and corresponding 'holes' which expose deeper, hotter cloud layers, although other physical interpretations are possible. A Rhines scale interpretation for the size of the variable features explains an apparent correlation between period and amplitude for Luhman 16B and the variable T dwarfs SIMP 0136+0933 and 2MASS J2139+0220, and predicts relatively fast winds (1-3 km s{sup –1}) for Luhman 16B consistent with light curve evolution on an advective time scale (1-3 rotation periods). The strong variability observed in this flux reversal brown dwarf pair supports

  5. Recent developments in the diagnosis and monitoring of HBV infection and role of the genetic variability of the S gene.

    PubMed

    Weber, Bernard

    2005-01-01

    Recent developments in the laboratory diagnosis of hepatitis B virus infection include the optimization of key serologic markers, including hepatitis B virus surface antigen and antihepatitis B virus core antibody, as well as the development of automated nucleic acid amplification assays. There is still a lack of standardization for nucleic acid amplification assays that are used for the monitoring of antiviral therapy and follow-up of chronic infection and the clinical significance of hepatitis B virus DNA levels need to be clarified. Although highly sensitive automated nucleic acid amplification assays for blood donor screening are available, their implementation is still subject to discussion and certain countries rejected hepatitis B virus DNA testing for blood donation due to poor cost effectiveness. Genetic variability of hepatitis B virus constitutes a major challenge for diagnosis of hepatitis B virus infection, particularly with regard to hepatitis B virus surface antigen detection, antihepatitis B virus surface antigen quantification and nucleic acid amplification assays. The performances of hepatitis B virus surface antigen enzyme immunoassays in regard to genotype and surface antigen variability need to be further improved. Polyclonal antibody-based hepatitis B virus surface antigen enzyme immunoassays, although they cannot guarantee 100% sensitivity, demonstrate superior S gene mutant recognition to assays using monoclonal capture and tracer antibodies. Isolated antihepatitis B virus core reactivity is an unusual but frequent result, which requires a test algorithm for resolution and hepatitis B virus DNA detection with sensitive nucleic acid amplification assays in order to exclude occult hepatitis B virus infection. PMID:15723594

  6. Photometric monitoring of eta Carinae, and the general problem of accurate photometry of S Dor variables

    NASA Astrophysics Data System (ADS)

    Sterken, C.; Freyhammer, L. M.; Arentoft, T.; van Genderen, A. M.

    2001-06-01

    We review the particular problems of ground-based photometry of the composite object eta Carinae for which high-precision long-term photometric monitoring is so hard to accomplish. eta Car, by its appearance as an ultrabright extended object, by its anomalous spectral nature, and by its most outspoken variability, is the single most difficult stellar object to measure photometrically and to monitor over a long time interval. The problems belong to several levels: very limited availability of an astrophysically appropriate photometric system, the presence of strong (and variable) emission lines, the need for a telescope with a suitable f-ratio, and the steadily diminishing possibilities to collect data over a long period of time. We demonstrate that the transformation from our y measurements to V is valid for many stars, but not for eta Car nor for some less peculiar objects. Even pure Johnson V data can not be guaranteed to be accurately tied to the E-region standard stars. The'underestimated' V-magnitude of eta Car based on y-filter photometry is not to be considered a suspicious characteristic of our intermediate-band photometry, but is an inherent element of the photometric approach of discussing V magnitudes on the basis of data obtained with a Stromgren y filter. Aperture corrections of a single isolated measurement remain prone to random errors of the order of 0.005-0.015 mag.

  7. Variability sensitivity of dynamic texture based recognition in clinical CT data

    NASA Astrophysics Data System (ADS)

    Kwitt, Roland; Razzaque, Sharif; Lowell, Jeffrey; Aylward, Stephen

    2014-03-01

    Dynamic texture recognition using a database of template models has recently shown promising results for the task of localizing anatomical structures in Ultrasound video. In order to understand its clinical value, it is imperative to study the sensitivity with respect to inter-patient variability as well as sensitivity to acquisition parameters such as Ultrasound probe angle. Fully addressing patient and acquisition variability issues, however, would require a large database of clinical Ultrasound from many patients, acquired in a multitude of controlled conditions, e.g., using a tracked transducer. Since such data is not readily attainable, we advocate an alternative evaluation strategy using abdominal CT data as a surrogate. In this paper, we describe how to replicate Ultrasound variabilities by extracting subvolumes from CT and interpreting the image material as an ordered sequence of video frames. Utilizing this technique, and based on a database of abdominal CT from 45 patients, we report recognition results on an organ (kidney) recognition task, where we try to discriminate kidney subvolumes/videos from a collection of randomly sampled negative instances. We demonstrate that (1) dynamic texture recognition is relatively insensitive to inter-patient variation while (2) viewing angle variability needs to be accounted for in the template database. Since naively extending the template database to counteract variability issues can lead to impractical database sizes, we propose an alternative strategy based on automated identification of a small set of representative models.

  8. Monitoring meteorological spatial variability in viticulture using a low-cost Wireless Sensor Network

    NASA Astrophysics Data System (ADS)

    Matese, Alessandro; Crisci, Alfonso; Di Gennaro, Filippo; Primicerio, Jacopo; Tomasi, Diego; Guidoni, Silvia

    2014-05-01

    In a long-term perspective, the current global agricultural scenario will be characterize by critical issues in terms of water resource management and environmental protection. The concept of sustainable agriculture would become crucial at reducing waste, optimizing the use of pesticides and fertilizers to crops real needs. This can be achieved through a minimum-scale monitoring of the crop physiologic status and the environmental parameters that characterize the microclimate. Viticulture is often subject to high variability within the same vineyard, thus becomes important to monitor this heterogeneity to allow a site-specific management and maximize the sustainability and quality of production. Meteorological variability expressed both at vineyard scale (mesoclimate) and at single plant level (microclimate) plays an important role during the grape ripening process. The aim of this work was to compare temperature, humidity and solar radiation measurements at different spatial scales. The measurements were assessed for two seasons (2011, 2012) in two vineyards of the Veneto region (North-East Italy), planted with Pinot gris and Cabernet Sauvignon using a specially designed and developed Wireless Sensor Network (WSN). The WSN consists of various levels: the Master/Gateway level coordinates the WSN and performs data aggregation; the Farm/Server level takes care of storing data on a server, data processing and graphic rendering. Nodes level is based on a network of peripheral nodes consisting of a sensor board equipped with sensors and wireless module. The system was able to monitor the agrometeorological parameters in the vineyard: solar radiation, air temperature and air humidity. Different sources of spatial variation were studied, from meso-scale to micro-scale. A widespread investigation was conducted, building a factorial design able to evidence the role played by any factor influencing the physical environment in the vineyard, such as the surrounding climate

  9. HIV-1 Genetic Variability in Cuba and Implications for Transmission and Clinical Progression.

    PubMed

    Blanco, Madeline; Machado, Liuber Y; Díaz, Héctor; Ruiz, Nancy; Romay, Dania; Silva, Eladio

    2015-10-01

    INTRODUCTION Serological and molecular HIV-1 studies in Cuba have shown very low prevalence of seropositivity, but an increasing genetic diversity attributable to introduction of many HIV-1 variants from different areas, exchange of such variants among HIV-positive people with several coinciding routes of infection and other epidemiologic risk factors in the seropositive population. The high HIV-1 genetic variability observed in Cuba has possible implications for transmission and clinical progression. OBJECTIVE Study genetic variability for the HIV-1 env, gag and pol structural genes in Cuba; determine the prevalence of B and non-B subtypes according to epidemiologic and behavioral variables and determine whether a relationship exists between genetic variability and transmissibility, and between genetic variability and clinical disease progression in people living with HIV/AIDS. METHODS Using two molecular assays (heteroduplex mobility assay and nucleic acid sequencing), structural genes were characterized in 590 people with HIV-1 (480 men and 110 women), accounting for 3.4% of seropositive individuals in Cuba as of December 31, 2013. Nonrandom sampling, proportional to HIV prevalence by province, was conducted. Relationships between molecular results and viral factors, host characteristics, and patients' clinical, epidemiologic and behavioral variables were studied for molecular epidemiology, transmission, and progression analyses. RESULTS Molecular analysis of the three HIV-1 structural genes classified 297 samples as subtype B (50.3%), 269 as non-B subtypes (45.6%) and 24 were not typeable. Subtype B prevailed overall and in men, mainly in those who have sex with men. Non-B subtypes were prevalent in women and heterosexual men, showing multiple circulating variants and recombinant forms. Sexual transmission was the predominant form of infection for all. B and non-B subtypes were encountered throughout Cuba. No association was found between subtypes and

  10. Monitoring Urban Water Quality Variability Using Continuous In-Situ Sensors

    NASA Astrophysics Data System (ADS)

    Carey, R. O.; Wollheim, W. M.; Mulukutla, G. K.

    2011-12-01

    Water quality monitoring using continuous in-situ sensors can improve our understanding of biogeochemical variability in urban watersheds. In New Hampshire, the Lamprey River drains an urbanizing watershed and discharges to the nitrogen (N)-impaired Great Bay estuary. Multiple instruments (Satlantic Submersible Ultraviolet Nitrate Analyzer, Turner Designs C6 Multi-Sensor Platform, Hydrolab MS5, and WET Labs Cycle) were deployed continuously for three seasons (April-November, 2011) in the Lamprey River to evaluate water quality relationships under hydrologically variable conditions and across seasons. Parameters monitored at sub-hourly intervals included nitrate-N (NO3-N), chromophoric dissolved organic matter (CDOM), chlorophyll, turbidity, dissolved oxygen (DO), specific conductivity, and pH; dissolved phosphate (PO4-P) was monitored hourly. Grab samples were also collected to assess instrument performance. Preliminary results from deployment through early August 2011 indicate that baseflow was associated with both elevated NO3-N concentrations and specific conductivity, but daily NO3-N fluxes were greater during storms. Greater discharges corresponded to increased values for CDOM, chlorophyll, and DO concentrations. In addition to diurnal cycles for several parameters (i.e., CDOM, chlorophyll, DO, and pH), NO3-N and PO4-P concentrations peaked during the night and day, respectively, suggesting biotic uptake became important at lower flows. Stormwater generally diluted NO3-N concentrations and specific conductivity, indicating groundwater contamination from the predominance of septic waste management and winter road salt application in suburban communities in the watershed. However, greater NO3-N export during storms revealed the importance of stormwater discharges despite the dilution effect. Studies using high-resolution data to evaluate the effects of stormwater discharge and increasing urbanization are crucial to understanding the significance of varying land

  11. Marker-based monitoring of seated spinal posture using a calibrated single-variable threshold model.

    PubMed

    Walsh, Pauline; Dunne, Lucy E; Caulfield, Brian; Smyth, Barry

    2006-01-01

    This work, as part of a larger project developing wearable posture monitors for the work environment, seeks to monitor and model seated posture during computer use. A non-wearable marker-based optoelectronic motion capture system was used to monitor seated posture for ten healthy subjects during a calibration exercise and a typing task. Machine learning techniques were used to select overall spinal sagittal flexion as the best indicator of posture from a set of marker and vector variables. Overall flexion data from the calibration exercise were used to define a threshold model designed to classify posture for each subject, which was then applied to the typing task data. Results of the model were analysed visually by qualified physiotherapists with experience in ergonomics and posture analysis to confirm the accuracy of the calibration. The calibration formula was found to be accurate on 100% subjects. This process will be used as a comparative measure in the evaluation of several wearable posture sensors, and to inform the design of the wearable system. PMID:17946301

  12. Monitoring medicines use: the role of the clinical pharmacologist.

    PubMed

    Williams, David

    2012-10-01

    Appreciation of the potential of newly marketed medicines to produce both benefit and harm has increased the role of the clinical pharmacologist. Pharmacoepidemiology applies epidemiological reasoning, methods and knowledge to the study of the uses and effects of drugs in human populations. Pharmacovigilence identifies and then responds to safety issues about marketed drugs. Whilst adverse drug reaction (ADR) reporting systems can identify potential problems with drugs, determination of causation requires population-based studies of adverse events (including information from large clinical trials), which attempt to link unequivocally the adverse outcome to the drug in question. Pharmacovigilance is closely linked to postmarketing surveillance and is important for determining issues such as the long-term effects of drugs, identification of low-frequency ADRs, the effectiveness of drugs for their licensed indications or in new indications and other factors which may modify the efficacy and effectiveness of the drug in question. The related field of drug utilization developed in parallel with the study of adverse drug reactions, in recognition of the dramatic increase in the marketing of new drugs, the wide variations in the patterns and extent of drug prescribing, the growing concern about ADRs and the increasing costs of drugs. With the ever increasing number of recognized adverse effects of drugs, prescribing errors, patients' expectations concerning drug safety and the need for appropriate new drug appraisal, the clinical pharmacologist will play an important role both in the introduction of new drugs and in improving the safe and effective use of established drugs. PMID:22554404

  13. Monitoring medicines use: the role of the clinical pharmacologist

    PubMed Central

    Williams, David

    2012-01-01

    Appreciation of the potential of newly marketed medicines to produce both benefit and harm has increased the role of the clinical pharmacologist. Pharmacoepidemiology applies epidemiological reasoning, methods and knowledge to the study of the uses and effects of drugs in human populations. Pharmacovigilence identifies and then responds to safety issues about marketed drugs. Whilst adverse drug reaction (ADR) reporting systems can identify potential problems with drugs, determination of causation requires population-based studies of adverse events (including information from large clinical trials), which attempt to link unequivocally the adverse outcome to the drug in question. Pharmacovigilance is closely linked to postmarketing surveillance and is important for determining issues such as the long-term effects of drugs, identification of low-frequency ADRs, the effectiveness of drugs for their licensed indications or in new indications and other factors which may modify the efficacy and effectiveness of the drug in question. The related field of drug utilization developed in parallel with the study of adverse drug reactions, in recognition of the dramatic increase in the marketing of new drugs, the wide variations in the patterns and extent of drug prescribing, the growing concern about ADRs and the increasing costs of drugs. With the ever increasing number of recognized adverse effects of drugs, prescribing errors, patients' expectations concerning drug safety and the need for appropriate new drug appraisal, the clinical pharmacologist will play an important role both in the introduction of new drugs and in improving the safe and effective use of established drugs. PMID:22554404

  14. Coupled variable selection for regression modeling of complex treatment patterns in a clinical cancer registry.

    PubMed

    Schmidtmann, I; Elsäßer, A; Weinmann, A; Binder, H

    2014-12-30

    For determining a manageable set of covariates potentially influential with respect to a time-to-event endpoint, Cox proportional hazards models can be combined with variable selection techniques, such as stepwise forward selection or backward elimination based on p-values, or regularized regression techniques such as component-wise boosting. Cox regression models have also been adapted for dealing with more complex event patterns, for example, for competing risks settings with separate, cause-specific hazard models for each event type, or for determining the prognostic effect pattern of a variable over different landmark times, with one conditional survival model for each landmark. Motivated by a clinical cancer registry application, where complex event patterns have to be dealt with and variable selection is needed at the same time, we propose a general approach for linking variable selection between several Cox models. Specifically, we combine score statistics for each covariate across models by Fisher's method as a basis for variable selection. This principle is implemented for a stepwise forward selection approach as well as for a regularized regression technique. In an application to data from hepatocellular carcinoma patients, the coupled stepwise approach is seen to facilitate joint interpretation of the different cause-specific Cox models. In conditional survival models at landmark times, which address updates of prediction as time progresses and both treatment and other potential explanatory variables may change, the coupled regularized regression approach identifies potentially important, stably selected covariates together with their effect time pattern, despite having only a small number of events. These results highlight the promise of the proposed approach for coupling variable selection between Cox models, which is particularly relevant for modeling for clinical cancer registries with their complex event patterns. PMID:25345575

  15. Influence of monsoons on atmospheric CO2 spatial variability and ground-based monitoring over India.

    PubMed

    Tiwari, Yogesh K; Vellore, Ramesh K; Ravi Kumar, K; van der Schoot, Marcel; Cho, Chun-Ho

    2014-08-15

    This study examines the role of Asian monsoons on transport and spatial variability of atmospheric CO2 over the Indian subcontinent, using transport modeling tools and available surface observations from two atmospheric CO2 monitoring sites Sinhagad (SNG) and Cape Rama (CRI) in the western part of peninsular India. The regional source contributions to these sites arise from the horizontal flow in conduits within the planetary boundary layer. Greater CO2 variability, greater than 15 ppm, is observed during winter, while it is reduced nearly by half during summer. The SNG air sampling site is more susceptible to narrow regional terrestrial fluxes transported from the Indo-Gangetic Plains in January, and to wider upwind marine source regions from the Arabian Sea in July. The Western Ghats mountains appear to play a role in the seasonal variability at SNG by trapping polluted air masses associated with weak monsoonal winds. A Lagrangian back-trajectory analysis further suggests that the horizontal extent of regional sensitivity increases from north to south over the Indian subcontinent in January (Boreal winter). PMID:24880546

  16. Interpretable Probabilistic Latent Variable Models for Automatic Annotation of Clinical Text

    PubMed Central

    Kotov, Alexander; Hasan, Mehedi; Carcone, April; Dong, Ming; Naar-King, Sylvie; BroganHartlieb, Kathryn

    2015-01-01

    We propose Latent Class Allocation (LCA) and Discriminative Labeled Latent Dirichlet Allocation (DL-LDA), two novel interpretable probabilistic latent variable models for automatic annotation of clinical text. Both models separate the terms that are highly characteristic of textual fragments annotated with a given set of labels from other non-discriminative terms, but rely on generative processes with different structure of latent variables. LCA directly learns class-specific multinomials, while DL-LDA breaks them down into topics (clusters of semantically related words). Extensive experimental evaluation indicates that the proposed models outperform Naïve Bayes, a standard probabilistic classifier, and Labeled LDA, a state-of-the-art topic model for labeled corpora, on the task of automatic annotation of transcripts of motivational interviews, while the output of the proposed models can be easily interpreted by clinical practitioners. PMID:26958214

  17. Nutrition assessment and its effect on various clinical variables among patients undergoing liver transplant

    PubMed Central

    Singh, Kalyani

    2016-01-01

    Background Malnutrition is highly prevalent in patients undergoing liver transplantation and has been associated to various clinical variables and outcome of the surgery. Methods We recruited 54 adult patients undergoing living donor liver transplant (LT) as study sample. Nutrition assessment was performed by body mass index (BMI), BMI for ascites, albumin, subjective global assessment (SGA) and anthropometry [mid upper arm circumference (MUAC), mid arm muscle circumference (MAMC), and triceps skin-fold (TSF)], Hand Grip strength, and phase angle of the body. Prevalence and comparison of malnutrition was performed with various clinical variables: aetiology, Child Turcotte Pugh scores and model for end stage liver disease (ESLD) grades, degree of ascites, blood product usage, blood loss during the surgery, mortality, days [intensive care unit (ICU), Ventilator and Hospital], and Bio-impedance analysis [weight, fat mass, fat free mass (FFM), muscle mass and body fat%]. Results Assessment of nutrition status represents a major challenge because of complications like fluid retention, hypoalbuminemia and hypoproteinemia. Different nutrition assessment tools show great disparity in the level of malnutrition among ESLD patients. In the present study recipient nutrition status evaluation by different nutrition assessment tools used showed malnutrition ranging from 3.7% to 100%. BMI and anthropometric measurements showed lower prevalence of malnutrition than phase angle and SGA whereas hand grip strength showed 100% malnutrition. Agreement among nutrition assessment methods showed moderate agreement (κ=0.444) of SGA with phase angle of the body. Malnutrition by different assessment tools was significantly associated to various clinical variables except MELD and days (ICU, Ventilator and Hospital). SGA was significantly (P<0.05) associated to majority of the clinical variables like aetiology, child Turcotte Pugh grades, degree of ascites, blood product usage, blood loss

  18. Training adaptation and heart rate variability in elite endurance athletes: opening the door to effective monitoring.

    PubMed

    Plews, Daniel J; Laursen, Paul B; Stanley, Jamie; Kilding, Andrew E; Buchheit, Martin

    2013-09-01

    The measurement of heart rate variability (HRV) is often considered a convenient non-invasive assessment tool for monitoring individual adaptation to training. Decreases and increases in vagal-derived indices of HRV have been suggested to indicate negative and positive adaptations, respectively, to endurance training regimens. However, much of the research in this area has involved recreational and well-trained athletes, with the small number of studies conducted in elite athletes revealing equivocal outcomes. For example, in elite athletes, studies have revealed both increases and decreases in HRV to be associated with negative adaptation. Additionally, signs of positive adaptation, such as increases in cardiorespiratory fitness, have been observed with atypical concomitant decreases in HRV. As such, practical ways by which HRV can be used to monitor training status in elites are yet to be established. This article addresses the current literature that has assessed changes in HRV in response to training loads and the likely positive and negative adaptations shown. We reveal limitations with respect to how the measurement of HRV has been interpreted to assess positive and negative adaptation to endurance training regimens and subsequent physical performance. We offer solutions to some of the methodological issues associated with using HRV as a day-to-day monitoring tool. These include the use of appropriate averaging techniques, and the use of specific HRV indices to overcome the issue of HRV saturation in elite athletes (i.e., reductions in HRV despite decreases in resting heart rate). Finally, we provide examples in Olympic and World Champion athletes showing how these indices can be practically applied to assess training status and readiness to perform in the period leading up to a pinnacle event. The paper reveals how longitudinal HRV monitoring in elites is required to understand their unique individual HRV fingerprint. For the first time, we demonstrate how

  19. Continuous Glucose Monitoring: Evidence and Consensus Statement for Clinical Use

    PubMed Central

    Liebl, Andreas; Henrichs, Helmut R.; Heinemann, Lutz; Freckmann, Guido; Biermann, Eberhard; Thomas, Andreas

    2013-01-01

    Continuous glucose monitoring (CGM) is an essential tool for modern diabetes therapy. Randomized controlled studies have provided evidence that hemoglobin A1c (HbA1c) results can be improved in patients with type 1 diabetes with elevated baseline HbA1c when using CGM frequently enough and that the frequency and duration of hypoglycemic events can be reduced in patients with satisfactory baseline HbA1c. The CGM group within the Working Group Diabetes Technology (AGDT) of the German Diabetes Association (DDG) has defined evidence-based indications for the practical use of CGM in this consensus statement related to hypoglycemia (frequent, severe, or nocturnal) or hypoglycemia unawareness, insufficient metabolic control despite use of all possible therapeutic options and patient compliance, pregnancy associated with inadequate blood glucose results, and the need for more than 10 blood glucose measurements per day. Contraindications and defined preconditions for the successful use of CGM should be considered. PMID:23567009

  20. Clinical use of lactate monitoring in critically ill patients

    PubMed Central

    2013-01-01

    Increased blood lactate levels (hyperlactataemia) are common in critically ill patients. Although frequently used to diagnose inadequate tissue oxygenation, other processes not related to tissue oxygenation may increase lactate levels. Especially in critically ill patients, increased glycolysis may be an important cause of hyperlactataemia. Nevertheless, the presence of increased lactate levels has important implications for the morbidity and mortality of the hyperlactataemic patients. Although the term lactic acidosis is frequently used, a significant relationship between lactate and pH only exists at higher lactate levels. The term lactate associated acidosis is therefore more appropriate. Two recent studies have underscored the importance of monitoring lactate levels and adjust treatment to the change in lactate levels in early resuscitation. As lactate levels can be measured rapidly at the bedside from various sources, structured lactate measurements should be incorporated in resuscitation protocols. PMID:23663301

  1. [Primary immunodeficiency in adults: common variable immunodeficiency--clinical manifestations, immunological and genetic defects, treatment].

    PubMed

    2011-01-01

    The most prevalent form of primary immunodeficiency with a total defect of antibody production in adults is common variable immunodeficiency (CVID). Compared to other forms of primary immunodeficiency, CVID is characterized by later onset of clinical manifestations represented by infectious, autoimmune and malignant diseases. To avoid development of complications and patient incapacitation, it is necessary to make an early diagnosis and initiate regular replacement therapy with intravenous immunoglobulins. PMID:22185026

  2. Assessment of published models and prognostic variables in epithelial ovarian cancer at Mayo Clinic

    PubMed Central

    Hendrickson, Andrea Wahner; Hawthorne, Kieran M.; Goode, Ellen L.; Kalli, Kimberly R.; Goergen, Krista M.; Bakkum-Gamez, Jamie N.; Cliby, William A.; Keeney, Gary L.; Visscher, Dan W.; Tarabishy, Yaman; Oberg, Ann L.; Hartmann, Lynn C.; Maurer, Matthew J.

    2015-01-01

    Objectives Epithelial ovarian cancer (EOC) is an aggressive disease in which first line therapy consists of a surgical staging/debulking procedure and platinum based chemotherapy. There is significant interest in clinically applicable, easy to use prognostic tools to estimate risk of recurrence and overall survival. In this study we used a large prospectively collected cohort of women with EOC to validate currently published models and assess prognostic variables. Methods Women with invasive ovarian, peritoneal, or fallopian tube cancer diagnosed between 2000-2011 and prospectively enrolled into the Mayo Clinic Ovarian Cancer registry were identified. Demographics and known prognostic markers as well as epidemiologic exposure variables were abstracted from the medical record and collected via questionnaire. Six previously published models of overall and recurrence-free survival were assessed for external validity. In addition, predictors of outcome were assessed in our dataset. Results Previously published models validated with a range of c-statistics (0.587-0.827), though application of models containing variables not part of routine practice were somewhat limited by missing data; utilization of all applicable models and comparison of results is suggested. Examination of prognostic variables identified only the presence of ascites and ASA score to be independent predictors of prognosis in our dataset, albeit with marginal gain in prognostic information, after accounting for stage and debulking. Conclusions Existing prognostic models for newly diagnosed EOC showed acceptable calibration in our cohort for clinical application. However, modeling of prospective variables in our dataset reiterates that stage and debulking remain the most important predictors of prognosis in this setting. PMID:25620544

  3. Validation of a metered dose inhaler electronic monitoring device: implications for asthma clinical trial use

    PubMed Central

    Pilcher, Janine; Holliday, Mark; Ebmeier, Stefan; McKinstry, Steve; Messaoudi, Fatiha; Weatherall, Mark; Beasley, Richard

    2016-01-01

    Background The SmartTouch Ventolin monitor (Adherium, Auckland, New Zealand) is an electronic monitor for use with a Ventolin metered dose inhaler, which records the date and time of inhaler actuations. This technology has the potential to allow in-depth analysis of patterns of inhaler use in clinical trial settings. The aim of this study was to determine the accuracy of the SmartTouch Ventolin monitor in recording Ventolin actuations. Methods 20 SmartTouch Ventolin monitors were attached to Ventolin metered dose inhalers. Bench testing was performed over a 10-week period, to reflect the potential time frame between visits in a clinical trial. Inhaler actuations were recorded in a paper diary, which was compared with data uploaded from the monitors. Results 2560 actuations were performed during the 10-week study period. Monitor sensitivity for diary-recorded actuations was 99.9% with a lower 97.5% confidence bound of 99.7%. The positive predictive value for diary-recorded actuations was 100% with a 97.5% lower confidence bound of 99.9%. Conclusions The SmartTouch Ventolin monitor is highly accurate in recording and retaining electronic data. It can be recommended for use in clinical trial settings in which training and quality control systems are incorporated into study protocols to ensure accurate data acquisition. PMID:27026805

  4. Nonrepresentative PCR amplification of variable gene sequences in clinical specimens containing dilute, complex mixtures of microorganisms.

    PubMed Central

    Wright, C J; Jerse, A E; Cohen, M S; Cannon, J G; Seifert, H S

    1994-01-01

    PCR amplification and DNA sequencing of the expression locus from Neisseria gonorrhoeae contained in urine sediments collected from experimentally infected human subjects produced two observations. First, different pilin sequences were obtained when separate aliquots of the same sample were amplified and sequenced. In contrast, the same pilin sequence was obtained when repeated amplifications were performed on individual colonies grown from the clinical samples. Second, mixed sequences (i.e., more than one nucleotide at variable positions in the pilin gene sequence) were observed in both the direct clinical isolates and individual cultures grown from the isolates. These results suggest that when clinical samples are directly examined by PCR amplification and sequencing, multiple amplifications may be required to detect sequence variants in the sample and minority variant sequences will not always be detected. Images PMID:7908674

  5. Monitoring Crop Yield in USA Using a Satellite-Based Climate-Variability Impact Index

    NASA Technical Reports Server (NTRS)

    Zhang, Ping; Anderson, Bruce; Tan, Bin; Barlow, Mathew; Myneni, Ranga

    2011-01-01

    A quantitative index is applied to monitor crop growth and predict agricultural yield in continental USA. The Climate-Variability Impact Index (CVII), defined as the monthly contribution to overall anomalies in growth during a given year, is derived from 1-km MODIS Leaf Area Index. The growing-season integrated CVII can provide an estimate of the fractional change in overall growth during a given year. In turn these estimates can provide fine-scale and aggregated information on yield for various crops. Trained from historical records of crop production, a statistical model is used to produce crop yield during the growing season based upon the strong positive relationship between crop yield and the CVII. By examining the model prediction as a function of time, it is possible to determine when the in-season predictive capability plateaus and which months provide the greatest predictive capacity.

  6. Monitoring of Crop Production Using a new Satellite-Based Climate-Variability Impact Index

    NASA Astrophysics Data System (ADS)

    Zhang, P.; Anderson, B.; Tan, B.; Huang, D.; Myneni, R.

    2005-12-01

    The capabilities of the MODerate resolution Imaging Spectroradiometer (MODIS) present some exciting possibilities for improved and timely monitoring of crop production. A quantitative index is introduced in this paper to study the relationship between remotely-sensed leaf area index (LAI) and crop production. The Climate-Variability Impact Index (CVII), defined as the monthly contribution to anomalies in annual growth, quantifies the percentage of the climatological production either gained or lost due to climatic variability during a given month. By examining the integrated CVII over the growing season, this LAI-based index can provide both fine-scale and aggregated information on vegetation productivity for various crop types. Once the relationship between the CVII and crop production is developed based on the historical record, a trained statistical model can be applied to produce homogeneous production forecasts (in which the model is trained and tested for a particular region), as well as heterogeneous forecasts (in which the model is trained in a particular region and applied to a different region). Both the homogeneous and the heterogeneous model predictions are consistent with USDA/FAO estimates at regional scales. Finally, by determining the estimated production as a function of the growing-season months the CVII can provide significant in-season predictions for end-of-year production. Overall, the high temporal and spatial resolution of the satellite LAI products makes the CVII a useful tool in near-real time crop monitoring and production estimation. Case-studies from recent droughts in Niger and the U.S. Midwest Corn Belt will be presented.

  7. Monitoring pasture variability: optical OptRx(®) crop sensor versus Grassmaster II capacitance probe.

    PubMed

    Serrano, João M; Shahidian, Shakib; Marques da Silva, José Rafael

    2016-02-01

    Estimation of pasture productivity is an important step for the farmer in terms of planning animal stocking, organizing animal lots, and determining supplementary feeding needs throughout the year. The main objective of this work was to evaluate technologies which have potential for monitoring aspects related to spatial and temporal variability of pasture green and dry matter yield (respectively, GM and DM, in kg/ha) and support to decision making for the farmer. Two types of sensors were evaluated: an active optical sensor ("OptRx(®)," which measures the NDVI, "Normalized Difference Vegetation Index") and a capacitance probe ("GrassMaster II" which estimates plant mass). The results showed the potential of NDVI for monitoring the evolution of spatial and temporal patterns of vegetative growth of biodiverse pasture. Higher NDVI values were registered as pasture approached its greatest vegetative vigor, with a significant fall in the measured NDVI at the end of Spring, when the pasture began to dry due to the combination of higher temperatures and lower soil moisture content. This index was also effective for identifying different plant species (grasses/legumes) and variability in pasture yield. Furthermore, it was possible to develop calibration equations between the capacitance and the NDVI (R(2) = 0.757; p < 0.01), between capacitance and GM (R(2) = 0.799; p < 0.01), between capacitance and DM (R(2) =0.630; p < 0.01), between NDVI and GM (R(2) = 0.745; p < 0.01), and between capacitance and DM (R(2) = 0.524; p < 0.01). Finally, a direct relationship was obtained between NDVI and pasture moisture content (PMC, in %) and between capacitance and PMC (respectively, R(2) = 0.615; p < 0.01 and R(2) = 0.561; p < 0.01) in Alentejo dryland farming systems. PMID:26812951

  8. Clinical pharmacology and therapeutic drug monitoring of zonisamide.

    PubMed

    Mimaki, T

    1998-12-01

    Zonisamide (1,2-benzisoxazole-3-methanesulfonamide) is a new antiepileptic drug developed in Japan. This compound is insoluble in water, and it is available in tablet and powder form. In experimental animals, this compound has been found to have a strong inhibitory effect on convulsions of cortical origin because it suppresses focal spiking and the spread of secondary generalized seizures. In humans, a series of double-blind, placebo-controlled studies revealed the efficacy of zonisamide for patients with refractory partial seizures and for selected patients with infantile spasms. Its antiepileptic mechanism of action remains unclear, but it is likely to involve blockade of both sodium and T-type calcium channels. Oral bioavailability of zonisamide is excellent in healthy human volunteers. Zonisamide is slowly absorbed and has a mean tmax of 5 to 6 hours. Almost 100% of it is absorbed; there is no difference in bioavailability between tablets and powder. Zonisamide concentrations are highest in erythrocytes and then in whole blood and plasma. It is approximately 40% to 60% bound to plasma proteins, primarily albumin. Its volume distribution is 0.9 to 1.4 L/kg. In adults, the elimination half-life is between 50 and 62 hours, and it takes as long as 2 weeks to reach steady state. The dose-serum level correlation is linear up to doses of 10 to 15 mg/kg per day, and the therapeutic range is 10 to 40 microg/ml. However, the relationship between serum zonisamide levels, clinical response, and adverse effects appears weak. Concurrent enzyme-inducing anticonvulsants such as phenytoin, carbamazepine, or barbiturates stimulate zonisamide metabolism and decrease serum zonisamide levels at steady state. Although zonisamide has been reported to increase the serum levels of phenytoin and carbamazepine in some patients, the interactions of zonisamide with other antiepileptic drugs seem to be of minor clinical relevance. A pilot study of zonisamide suppositories revealed that it

  9. Use of a clinical event monitor to prevent and detect medication errors.

    PubMed Central

    Payne, T. H.; Savarino, J.; Marshall, R.; Hoey, C. T.

    2000-01-01

    Errors in health care facilities are common and often unrecognized. We have used our clinical event monitor to prevent and detect medication errors by scrutinizing electronic messages sent to it when any medication order is written in our facility. A growing collection of medication safety rules covering dose limit errors, laboratory monitoring, and other topics may be applied to each medication order message to provide an additional layer of protection beyond existing order checks, reminders, and alerts available within our computer-based record system. During a typical day the event monitor receives 4802 messages, of which 4719 pertain to medication orders. We have found the clinical event monitor to be a valuable tool for clinicians and quality management groups charged with improving medication safety. PMID:11079962

  10. Variable Clinical Presentation of an MUC1 Mutation Causing Medullary Cystic Kidney Disease Type 1

    PubMed Central

    Kmoch, Stanislav; Antignac, Corinne; Robins, Vicki; Kidd, Kendrah; Kelsoe, John R.; Hladik, Gerald; Klemmer, Philip; Knohl, Stephen J.; Scheinman, Steven J.; Vo, Nam; Santi, Ann; Harris, Alese; Canaday, Omar; Weller, Nelson; Hulick, Peter J.; Vogel, Kristen; Rahbari-Oskoui, Frederick F.; Tuazon, Jennifer; Deltas, Constantinos; Somers, Douglas; Megarbane, Andre; Kimmel, Paul L.; Sperati, C. John; Orr-Urtreger, Avi; Ben-Shachar, Shay; Waugh, David A.; McGinn, Stella; Hodaňová, Kateřina; Vylet'al, Petr; Živná, Martina; Hart, Thomas C.; Hart, P. Suzanne

    2014-01-01

    Background and objectives The genetic cause of medullary cystic kidney disease type 1 was recently identified as a cytosine insertion in the variable number of tandem repeat region of MUC1 encoding mucoprotein-1 (MUC1), a protein that is present in skin, breast, and lung tissue, the gastrointestinal tract, and the distal tubules of the kidney. The purpose of this investigation was to analyze the clinical characteristics of families and individuals with this mutation. Design, setting, participants, & measurements Families with autosomal dominant interstitial kidney disease were referred for genetic analysis over a 14-year period. Families without UMOD or REN mutations prospectively underwent genotyping for the presence of the MUC1 mutation. Clinical characteristics were retrospectively evaluated in individuals with the MUC1 mutation and historically affected individuals (persons who were both related to genetically affected individuals in such a way that ensured that they could be genetically affected and had a history of CKD stage IV or kidney failure resulting in death, dialysis, or transplantation). Results Twenty-four families were identified with the MUC1 mutation. Of 186 family members undergoing MUC1 mutational analysis, the mutation was identified in 95 individuals, 91 individuals did not have the mutation, and111 individuals were identified as historically affected. Individuals with the MUC1 mutation suffered from chronic kidney failure with a widely variable age of onset of end stage kidney disease ranging from 16 to >80 years. Urinalyses revealed minimal protein and no blood. Ultrasounds of 35 individuals showed no medullary cysts. There were no clinical manifestations of the MUC1 mutation detected in the breasts, skin, respiratory system, or gastrointestinal tract. Conclusion MUC1 mutation results in progressive chronic kidney failure with a bland urinary sediment. The age of onset of end stage kidney disease is highly variable, suggesting that gene

  11. Comparison of stochastic and deterministic methods for mapping groundwater level spatial variability in sparsely monitored basins.

    PubMed

    Varouchakis, Epsilon A; Hristopulos, D T

    2013-01-01

    In sparsely monitored basins, accurate mapping of the spatial variability of groundwater level requires the interpolation of scattered data. This paper presents a comparison of deterministic interpolation methods, i.e. inverse distance weight (IDW) and minimum curvature (MC), with stochastic methods, i.e. ordinary kriging (OK), universal kriging (UK) and kriging with Delaunay triangulation (DK). The study area is the Mires Basin of Mesara Valley in Crete (Greece). This sparsely sampled basin has limited groundwater resources which are vital for the island's economy; spatial variations of the groundwater level are important for developing management and monitoring strategies. We evaluate the performance of the interpolation methods with respect to different statistical measures. The Spartan variogram family is applied for the first time to hydrological data and is shown to be optimal with respect to stochastic interpolation of this dataset. The three stochastic methods (OK, DK and UK) perform overall better than the deterministic counterparts (IDW and MC). DK, which is herein for the first time applied to hydrological data, yields the most accurate cross-validation estimate for the lowest value in the dataset. OK and UK lead to smooth isolevel contours, whilst DK and IDW generate more edges. The stochastic methods deliver estimates of prediction uncertainty which becomes highest near the southeastern border of the basin. PMID:22311559

  12. CYP2C19 polymorphisms and therapeutic drug monitoring of voriconazole: are we ready for clinical implementation of pharmacogenomics?

    PubMed

    Owusu Obeng, Aniwaa; Egelund, Eric F; Alsultan, Abdullah; Peloquin, Charles A; Johnson, Julie A

    2014-07-01

    Since its approval by the U.S. Food and Drug Administration in 2002, voriconazole has become a key component in the successful treatment of many invasive fungal infections including the most common, aspergillosis and candidiasis. Despite voriconazole's widespread use, optimizing its treatment in an individual can be challenging due to significant interpatient variability in plasma concentrations of the drug. Variability is due to nonlinear pharmacokinetics and the influence of patient characteristics such as age, sex, weight, liver disease, and genetic polymorphisms in the cytochrome P450 2C19 gene (CYP2C19) encoding for the CYP2C19 enzyme, the primary enzyme responsible for metabolism of voriconazole. CYP2C19 polymorphisms account for the largest portion of variability in voriconazole exposure, posing significant difficulty to clinicians in targeting therapeutic concentrations. In this review, we discuss the role of CYP2C19 polymorphisms and their influence on voriconazole's pharmacokinetics, adverse effects, and clinical efficacy. Given the association between CYP2C19 genotype and voriconazole concentrations, as well as the association between voriconazole concentrations and clinical outcomes, particularly efficacy, it seems reasonable to suggest a potential role for CYP2C19 genotype to guide initial voriconazole dose selection followed by therapeutic drug monitoring to increase the probability of achieving efficacy while avoiding toxicity. PMID:24510446

  13. CYP2C19 Polymorphisms and Therapeutic Drug Monitoring of Voriconazole: Are We Ready for Clinical Implementation of Pharmacogenomics?

    PubMed Central

    Obeng, Aniwaa Owusu; Egelund, Eric F.; Alsultan, Abdullah; Peloquin, Charles A.; Johnson, Julie A.

    2014-01-01

    Since its approval by the United States Food and Drug Administration in 2002, voriconazole has become a key component in the successful treatment of many invasive fungal infections, including the most common, aspergillosis and candidiasis. Despite voriconazole’s widespread use, optimizing its treatment in an individual can be challenging due to significant interpatient variability in plasma concentrations of the drug. Variability is due to nonlinear pharmacokinetics and the influence of patient characteristics such as age, sex, weight, liver disease, and genetic polymorphisms in the cytochrome P450 2C19 gene (CYP2C19) encoding for the CYP2C19 enzyme, the primary enzyme responsible for metabolism of voriconazole. CYP2C19 polymorphisms account for the largest portion of variability in voriconazole exposure, posing significant difficulty to clinicians in targeting therapeutic concentrations. In this review, we discuss the role of CYP2C19 polymorphisms and their influence on voriconazole’s pharmacokinetics, adverse effects, and clinical efficacy. Given the association between CYP2C19 genotype and voriconazole concentrations, as well as the association between voriconazole concentrations and clinical outcomes, particularly efficacy, it seems reasonable to suggest a potential role for CYP2C19 genotype to guide initial voriconazole dose selection followed by therapeutic drug monitoring to increase the probability of achieving efficacy while avoiding toxicity. PMID:24510446

  14. Use of heart rate variability in monitoring stress and recovery in judo athletes.

    PubMed

    Morales, José; Alamo, Juan M; García-Massó, Xavier; Buscà, Bernat; López, Jose L; Serra-Añó, Pilar; González, Luís-Millán

    2014-07-01

    The main objective of this study was to examine the effect of different judo training loads on heart rate variability (HRV) measurements, to determine if they can be used as valid indicators in monitoring stress and recovery in judo athletes. Fourteen male national-standard judo athletes were randomly divided into 2 groups, and each group followed a different type of training, namely, a high training load (HTL) and a moderate training load program (MTL). Data collection included HRV measurements, a Recovery Stress Questionnaire for athletes (RESTQ-SPORT), and strength measurements, 4 weeks before and after the training program. The HTL group had lower square root of the mean squared difference of successive RR intervals, very low frequency, high frequency, short-term variability, short-range scaling exponents, general recovery, sport-specific recovery, general stress, maximum strength, maximum power, and higher low/high frequency ratio at posttest compared with pretest (p ≤ 0.05). The HTL group showed lower short-range and long-range scaling exponents, general recovery, sport-specific recovery, and higher general stress than the MTL group in posttest measurements (p ≤ 0.05). In conclusion, judo athletes enrolled in an HTL program showed an imbalance of the autonomic nervous system with decreased vagal modulation, together with a decrease in strength parameters, higher markers for stress, and a lower perception of recovery. PMID:24276307

  15. A Stellar movie: VLBA monitoring of SiO masers around the Mira variable TX Cam

    NASA Astrophysics Data System (ADS)

    Diamond, P. J.; Kemball, A. J.

    1998-12-01

    Single dish monitoring of SiO masers around stars have revealed strong, cyclic variations of the spectra. The peak flux of the SiO masers appears to occur at a phase of 0.2 after the optical maximum, from phase 0.3 to 0.8 the average velocity of the spectrum appears to be slightly redshifted with respect to the mean velocity indicating infall of material. Recently Boboltz et al (1997) showed, using VLBA observations, that for the star R Aquarii the SiO masers were infalling at 4.3 km/s from optical phase 0.78 to 1.04. To date this has been the basis of our understanding of the nature of SiO variability. We have been performing regular VLBA observations of the SiO masers around the Mira variable TX Cam. We have been taking data every two weeks and will eventually obtain 50 epochs covering 1.25 cycles of the star's phase. We shall present a movie of the structural changes occurring for the first 80% of our program, covering phases 0.3 to 1.3. We see complex structural changes including both infalling and outflowing gas. We also have information on the changing polarization structure of the masers. We shall discuss our observations in the context of the hydrodynamic models of Bowen.

  16. Ambulatory Blood Pressure Monitoring-Derived Short-Term Blood Pressure Variability in Primary Aldosteronism.

    PubMed

    Grillo, Andrea; Bernardi, Stella; Rebellato, Andrea; Fabris, Bruno; Bardelli, Moreno; Burrello, Jacopo; Rabbia, Franco; Veglio, Franco; Fallo, Francesco; Carretta, Renzo

    2015-08-01

    The aim of this study was to investigate the short-term blood pressure (BP) variability (BPV) derived from ambulatory blood pressure monitoring (ABPM) in patients with primary aldosteronism (PA), either idiopathic hyperaldosteronism (IHA) or aldosterone-producing adenoma (APA), in comparison with patients with essential hypertension (EH) and normotensive (NT) controls. Thirty patients with PA (16 with IHA and 14 with APA), 30 patients with EH, and 30 NT controls, matched for sex, age, body mass index, and antihypertensive therapy, were studied. The standard deviation (SD) of 24-hour, daytime, and nighttime BP; 24-hour weighted SD of BP; and 24-hour BP average real variability were not different between patients with PA and those with EH (P=not significant). All BPV indices were higher in patients with PA, either IHA or APA subtypes, and patients with EH, compared with NT controls (P<.001 to P<.05). ABPM-derived short-term BPV is increased in patients with PA, and it may represent an additional cardiovascular risk factor in this disease. The role of aldosterone excess in BPV has to be clarified. PMID:25880017

  17. Photometric Monitoring of a New Sample of Candidate Luminous Blue Variables

    NASA Astrophysics Data System (ADS)

    Mauerhan, Jon; Van Dyk, Schuyler; Wachter, Stefanie

    2012-02-01

    Luminous Blue Variables (LBV) are evolved massive stars in transition from the main-sequence to the Wolf-Rayet phase. They are characterized by extreme luminosities, large photometric variations, and circumstellar nebulae. LBV variability is believed to be linked with the enigmatic processes driving recurrent outbursts of mass which liberate these stars of their hydrogen envelopes. Because of the small sample of 10 Galactic LBVs, progress toward understanding the physics of these processes has been very limited. Fortunately, the Spitzer/MIPSGAL survey revealed a population of ~100 circular nebulae surrounding bright central stars that are heavily obscured in the optical; we have determined that ~50 of them have spectral types similar to active LBVs, such as P Cyg and the Pistol Star. We suspect many of these are LBVs, and that their circumstellar shells are the result of recent mass eruptions. If they are active LBVs, we expect them to exhibit large-amplitude oscillations (~0.5-1 mag) on month-to-year timescales, and/or small eruptions (~1-2 mag) on year-to-decade timescales, like P Cyg and AG Car. Therefore we propose a SMARTS program to identify active LBVs within our sample of 43 candidates by monitoring their IR brightness with CT1.3+ANDICAM. Using an cadence of one month, we will probe for evidence of oscillations. Comparison with 2MASS will probe decade-long changes and potentially reveal evidence for eruptions.

  18. Atmospheric Parameter Climatologies from AIRS: Monitoring Short-, and Longer-Term Climate Variabilities and 'Trends'

    NASA Technical Reports Server (NTRS)

    Molnar, Gyula; Susskind, Joel

    2008-01-01

    The AIRS instrument is currently the best space-based tool to simultaneously monitor the vertical distribution of key climatically important atmospheric parameters as well as surface properties, and has provided high quality data for more than 5 years. AIRS analysis results produced at the GODDARD/DAAC, based on Versions 4 & 5 of the AIRS retrieval algorithm, are currently available for public use. Here, first we present an assessment of interrelationships of anomalies (proxies of climate variability based on 5 full years, since Sept. 2002) of various climate parameters at different spatial scales. We also present AIRS-retrievals-based global, regional and 1x1 degree grid-scale "trend"-analyses of important atmospheric parameters for this 5-year period. Note that here "trend" simply means the linear fit to the anomaly (relative the mean seasonal cycle) time series of various parameters at the above-mentioned spatial scales, and we present these to illustrate the usefulness of continuing AIRS-based climate observations. Preliminary validation efforts, in terms of intercomparisons of interannual variabilities with other available satellite data analysis results, will also be addressed. For example, we show that the outgoing longwave radiation (OLR) interannual spatial variabilities from the available state-of-the-art CERES measurements and from the AIRS computations are in remarkably good agreement. Version 6 of the AIRS retrieval scheme (currently under development) promises to further improve bias agreements for the absolute values by implementing a more accurate radiative transfer model for the OLR computations and by improving surface emissivity retrievals.

  19. Episiotomy and its relationship to various clinical variables that influence its performance

    PubMed Central

    Ballesteros-Meseguer, Carmen; Carrillo-García, César; Meseguer-de-Pedro, Mariano; Canteras-Jordana, Manuel; Martínez-Roche, Mª Emilia

    2016-01-01

    Objective: to understand the episiotomy rate and its relationship with various clinical variables. Method: a descriptive, cross-sectional, analytic study of 12,093 births in a tertiary hospital. Variables: Parity, gestational age, start of labor, use of epidural analgesia, oxytocin usage, position during fetal explusion, weight of neonate, and completion of birth. The analysis was performed with SPSS 19.0. Results: the global percentage of episiotomies was 50%. The clinical variables that presented a significant association were primiparity (RR=2.98), gestational age >41 weeks (RR=1.2), augmented or induced labor (RR=1.33), epidural analgesia use (RR=1,95), oxytocin use (RR=1.58), lithotomy position during fetal expulsion (RR=6.4), and instrumentation (RR=1.84). Furthermore, maternal age ≥35 years (RR=0.85) and neonatal weight <2500 g (RR=0.8) were associated with a lower incidence of episiotomy. Conclusions: episiotomy is dependent on obstetric interventions performed during labor. If we wish to reduce the episiotomy rate, it will be necessary to bear in mind these risk factors when establishing policies for reducing this procedure. PMID:27224064

  20. A disposable flexible skin patch for clinical optical perfusion monitoring at multiple depths

    NASA Astrophysics Data System (ADS)

    Farkas, Dana L.; Kolodziejski, Noah J.; Stapels, Christopher J.; McAdams, Daniel R.; Fernandez, Daniel E.; Podolsky, Matthew J.; Christian, James F.; Ward, Brent B.; Vartarian, Mark; Feinberg, Stephen E.; Lee, Seung Yup; Parikh, Urmi; Mycek, Mary-Ann; Joyner, Michael J.; Johnson, Christopher P.; Paradis, Norman A.

    2016-03-01

    Stable, relative localization of source and detection fibers is necessary for clinical implementation of quantitative optical perfusion monitoring methods such as diffuse correlation spectroscopy (DCS) and diffuse reflectance spectroscopy (DRS). A flexible and compact device design is presented as a platform for simultaneous monitoring of perfusion at a range of depths, enabled by precise location of optical fibers in a robust and secure adhesive patch. We will discuss preliminary data collected on human subjects in a lower body negative pressure model for hypovolemic shock. These data indicate that this method facilitates simple and stable simultaneous monitoring of perfusion at multiple depths and within multiple physiological compartments.

  1. Quality assurance for interventions in clinical trials. Multicenter data monitoring, data management, and analysis.

    PubMed

    Pollock, B H

    1994-11-01

    Quality assurance for the management of multicenter clinical trials requires timely patient and data accrual and consistency with design parameters. Data from central pathology review, treatment modality, and follow-up as well as trial end points direct the selection of appropriate compliance measures. To integrate these data to monitor group performance on a specific protocol, to monitor discipline performance, or to monitor an institution's performance is a formidable task. This is especially true for a group such as the Pediatric Oncology Group, where there are a large number of protocols, many diseases, and widely differing protocol requirements. Quality assurance methods for the Pediatric Oncology Group are discussed. PMID:7954280

  2. Difficulty in clinical identification of neonatal seizures: an EEG monitor study.

    PubMed

    Fenichel, G M

    1987-01-01

    Seventeen newborns were monitored for 24 hours using a three-channel ambulatory EEG (A/EEG). All newborns were thought to be having subtle seizures by the nursery staff. Fifteen of the 17 newborns were recorded as having 1-30 clinical seizures during the time of monitoring. Only one newborn had clinically identified seizures associated with A/EEG discharges. The seizures were characterized by eye rolling. Fifty-two episodes (thought to be seizures) of lip smacking, bicycling, jerking, fisting, staring, stiffening, or any combination of the above occurred in eight newborns without an associated discharge on A/EEG. However, two of the eight had seizure discharges at other times, not associated with any clinical manifestation. Seventy-four apnea spells, thought to be possible seizures, occurred in seven newborns. None was associated with discharges on A/EEG, but one of these newborns had 50 A/EEG discharges unrelated to apnea or other clinical manifestations. PMID:3577211

  3. IL8 gene as modifier of cystic fibrosis: unraveling the factors which influence clinical variability.

    PubMed

    Furlan, Larissa Lazzarini; Marson, Fernando Augusto Lima; Ribeiro, José Dirceu; Bertuzzo, Carmen Sílvia; Salomão Junior, João Batista; Souza, Dorotéia Rossi Silva

    2016-08-01

    The severity of cystic fibrosis (CF) is associated with classes of mutations in the CFTR gene (cystic fibrosis transmembrane regulator), physical environment and modifier genes interaction. The IL8 gene (interleukin 8), according to its respective polymorphisms, influences inflammatory responses. This study analyzed IL8 gene polymorphisms (rs4073, rs2227306 and rs2227307), by means of PCR/RFLP, and their association with pulmonary function markers and clinical severity scores in 186 patients with CF, considering the CFTR genotype. There was an association between rs2227307 and precocity of the disease. The severity of lung disease was associated with the following markers: transcutaneous arterial hemoglobin oxygen saturation (SaO2) (regardless of CFTR genotype, for the polymorphisms rs4073, rs2227306 and rs2227307); mucoid Pseudomonas aeruginosa (regardless of CFTR genotype, for the polymorphisms rs2227306 and rs2227307). Pulmonary function markers (SaO2 and spirometric variables) and clinical severity scores were also associated with IL8 gene polymorphisms. This study identified the IL8 gene, represented by rs4073 and rs2227306 polymorphisms, and particularly the rs2227307 polymorphism, as potentiating factors for the degree of variability in the severity of CF, especially in pulmonary clinical manifestation correlated with increased morbidity and mortality. PMID:27209008

  4. Clinical variables and implications of the personality on the outcome of bipolar illness: a pilot study

    PubMed Central

    Casas-Barquero, Nieves; García-López, Olga; Fernández-Argüelles, Pedro; Camacho-Laraña, Manuel

    2007-01-01

    Outcome in bipolar patients is affected by comorbidity. Comorbid personality disorders are frequent and may complicate the course of bipolar illness. This pilot study examined a series of 40 euthymic bipolar patients (DSM-IV criteria) (bipolar I disorder 31, bipolar II disorder 9) to assess the effect of clinical variables and the influence of comorbid personality on the clinical course of bipolar illness. Bipolar patients with a diagnosis of comorbid personality disorder (n = 30) were compared with “pure” bipolar patients (n = 10) with regard to demographic, clinical, and course of illness variables. Comorbid personality disorder was diagnosed in 75% of patients according to ICD-10 criteria, with obsessive-compulsive personality disorder being the most frequent type. Sixty-three per cent of subjects had more than one comorbid personality disorder. Bipolar patients with and without comorbid personality disorder showed no significant differences regarding features of the bipolar illness, although the group with comorbid personality disorder showed a younger age at onset, more depressive episodes, and longer duration of bipolar illness. In subjects with comorbid personality disorders, the number of hospitalizations correlated significantly with depressive episodes and there was an inverse correlation between age at the first episode and duration of bipolar illness. These findings, however, should be interpreted taking into account the preliminary nature of a pilot study and the contamination of the sample with too many bipolar II patients. PMID:19300559

  5. Clinical practice in perioperative monitoring in adult cardiac surgery: is there a standard of care? Results from an national survey.

    PubMed

    Bignami, Elena; Belletti, Alessandro; Moliterni, Paola; Frati, Elena; Guarnieri, Marcello; Tritapepe, Luigi

    2016-06-01

    This study was to investigate and define what is considered as a current clinical practice in hemodynamic monitoring and vasoactive medication use after cardiac surgery in Italy. A 33-item questionnaire was sent to all intensive care units (ICUs) admitting patients after cardiac surgery. 71 out of 92 identified centers (77.2 %) returned a completed questionnaire. Electrocardiogram, invasive blood pressure, central venous pressure, pulse oximetry, diuresis, body temperature and blood gas analysis were identified as routinely used hemodynamic monitoring, whereas advanced monitoring was performed with pulmonary artery catheter or echocardiography. Crystalloids were the fluids of choice for volume replacement (86.8 % of Centers). To guide volume management, central venous pressure (26.7 %) and invasive blood pressure (19.7 %) were the most frequently used parameters. Dobutamine was the first choice for treatment of left heart dysfunction (40 %) and epinephrine was the first choice for right heart dysfunction (26.8 %). Half of the Centers had an internal protocol for vasoactive drugs administration. Intra-aortic balloon pump and extra-corporeal membrane oxygenation were widely available among Cardiothoracic ICUs. Angiotensin-converting enzyme inhibitors were suspended in 28 % of the Centers. The survey shows what is considered as standard monitoring in Italian Cardiac ICUs. Standard, routinely used monitoring consists of ECG, SpO2, etCO2, invasive BP, CVP, diuresis, body temperature, and BGA. It also shows that there is large variability among the various Centers regarding hemodynamic monitoring of fluid therapy and inotropes administration. Further research is required to better standardize and define the indicators to improve the standards of intensive care after cardiac surgery among Italian cardiac ICUs. PMID:26089166

  6. Far Infrared Variability of Sagittarius A*: 25.5 hr of Monitoring with Herschel

    NASA Astrophysics Data System (ADS)

    Stone, Jordan M.; Marrone, D. P.; Dowell, C. D.; Schulz, B.; Heinke, C. O.; Yusef-Zadeh, F.

    2016-07-01

    Variable emission from Sgr A*, the luminous counterpart to the super-massive black hole at the center of our Galaxy, arises from the innermost portions of the accretion flow. Better characterization of the variability is important for constraining models of the low-luminosity accretion mode powering Sgr A*, and could further our ability to use variable emission as a probe of the strong gravitational potential in the vicinity of the 4× {10}6{M}ȯ black hole. We use the Herschel Spectral and Photometric Imaging Receiver (SPIRE) to monitor Sgr A* at wavelengths that are difficult or impossible to observe from the ground. We find highly significant variations at 0.25, 0.35, and 0.5 mm, with temporal structure that is highly correlated across these wavelengths. While the variations correspond to \\lt 1 % changes in the total intensity in the Herschel beam containing Sgr A*, comparison to independent, simultaneous observations at 0.85 mm strongly supports the reality of the variations. The lowest point in the light curves, ∼0.5 Jy below the time-averaged flux density, places a lower bound on the emission of Sgr A* at 0.25 mm, the first such constraint on the THz portion of the spectral energy distribution. The variability on few hour timescales in the SPIRE light curves is similar to that seen in historical 1.3 mm data, where the longest time series is available, but the distribution of variations in the sub-mm do not show a tail of large-amplitude variations seen at 1.3 mm. Simultaneous X-ray photometry from XMM-Newton shows no significant variation within our observing period, which may explain the lack of very large submillimeter variations in our data if X-ray and submillimeter flares are correlated. Herschel is an ESA space observatory with science instruments provided by European-led Principal Investigator consortia and with important participation from NASA.

  7. From genotype to phenotype; clinical variability in Lesch-Nyhan disease. The role of epigenetics.

    PubMed

    Trigueros Genao, M; Torres, R J

    2014-11-01

    Lesch-Nyhan disease is a rare genetic disease characterized by a deficiency in the function of the enzyme hypoxanthine-guanine phosphoribosyltransferase (HGPRT). Patients affected by this disease experience hyperuricemia, motor disorders, mental retardation and, in the most severe cases, self-mutilation. Its clinical manifestations depend on the enzymatic activity of HGPRT, which is classically linked to the type of alteration in the HGPRT gene. More than 400 mutations of this gene have been found. At present, one of the controversial aspects of the disease is the relationship between the genotype and phenotype; cases have been described lacking a mutation, such as the patient presented in this article, as well as families who despite sharing the same genetic defect show disorders with differing severity. Epigenetic processes, which modify the genetic expression without changing the sequence of the deoxyribonucleic acid (DNA), could explain the clinical variability observed in this disease. PMID:24863549

  8. [Clinical significance of nocturnal blood pressure and blood pressure variability: analysis of 522 cases].

    PubMed

    Palatini, P; Mormino, P; Martina, S; Businaro, R; Penzo, M; Racioppa, A; Guzzardi, G; Anaclerio, M; Pessina, A C

    1990-03-01

    Purpose of the study was to investigate whether and to what extent blood pressure variability and average night-time blood pressure are related to cardiovascular complications in hypertension. To this aim 60 normotensive and 462 hypertensive subjects were studied by means of non-invasive 24 hour blood pressure monitoring, using either the Avionics, or the ICR Spacelabs, or the Takeda system. Each subject was attributed a target organ damage score on the basis of 12-lead electrocardiogram, chest X-ray and fundoscopy, starting from 0 (no damage) up to 5 (maximum degree of damage). The 522 subjects were subsequently subdivided into 5 classes of increasing average daytime diastolic blood pressure. In each class a higher degree of cardiovascular complications was present in the subjects with the higher blood pressure variability and the higher average night-time blood pressure. From these results it may be inferred that both blood pressure variability and night-time blood pressure are related to the degree of target organ damage in hypertension. This stresses the importance of recording blood pressure throughout the 24 hours. PMID:2147124

  9. Use of generalised additive models to categorise continuous variables in clinical prediction

    PubMed Central

    2013-01-01

    Background In medical practice many, essentially continuous, clinical parameters tend to be categorised by physicians for ease of decision-making. Indeed, categorisation is a common practice both in medical research and in the development of clinical prediction rules, particularly where the ensuing models are to be applied in daily clinical practice to support clinicians in the decision-making process. Since the number of categories into which a continuous predictor must be categorised depends partly on the relationship between the predictor and the outcome, the need for more than two categories must be borne in mind. Methods We propose a categorisation methodology for clinical-prediction models, using Generalised Additive Models (GAMs) with P-spline smoothers to determine the relationship between the continuous predictor and the outcome. The proposed method consists of creating at least one average-risk category along with high- and low-risk categories based on the GAM smooth function. We applied this methodology to a prospective cohort of patients with exacerbated chronic obstructive pulmonary disease. The predictors selected were respiratory rate and partial pressure of carbon dioxide in the blood (PCO2), and the response variable was poor evolution. An additive logistic regression model was used to show the relationship between the covariates and the dichotomous response variable. The proposed categorisation was compared to the continuous predictor as the best option, using the AIC and AUC evaluation parameters. The sample was divided into a derivation (60%) and validation (40%) samples. The first was used to obtain the cut points while the second was used to validate the proposed methodology. Results The three-category proposal for the respiratory rate was ≤ 20;(20,24];> 24, for which the following values were obtained: AIC=314.5 and AUC=0.638. The respective values for the continuous predictor were AIC=317.1 and AUC=0.634, with no statistically

  10. Clinical applications of esophageal impedance monitoring and high-resolution manometry.

    PubMed

    Kessing, Boudewijn F; Smout, André J P M; Bredenoord, Albert J

    2012-06-01

    Esophageal impedance monitoring and high-resolution manometry (HRM) are useful tools in the diagnostic work-up of patients with upper gastrointestinal complaints. Impedance monitoring increases the diagnostic yield for gastroesophageal reflux disease in adults and children and has become the gold standard in the diagnostic work-up of reflux symptoms. Its role in the work-up for belching disorders and rumination seems promising. HRM is superior to other diagnostic tools for the evaluation of achalasia and contributes to a more specific classification of esophageal disorders in patients with non-obstructive dysphagia. The role of HRM in patients with dysphagia after laparoscopic placement of an adjustable gastric band seems promising. Future studies will further determine the clinical implications of the new insights which have been acquired with these techniques. This review aims to describe the clinical applications of impedance monitoring and HRM. PMID:22350944

  11. [Post-marketing clinical safety assessment of Shenmai injection based on active monitoring and passive monitoring in large data background].

    PubMed

    Wang, Lian-xin; Xie, Yan-ming; Ai, Qing-hua; Song, Nian-bin

    2015-12-01

    This paper adopted a series of related analysis methods to comprehensively analyze post-marketing clinical safety data of Shenmai injection from 4,220 cases of SRS and 32,358 cases of multicenter, prospective, registered hospital centralized monitoring in large data background, calculated ADR incidence rate was 0.93 per 1,000, main symptoms of ADR includes chest pain, chills, skin itching, palpitations, fever, nausea, dizziness, vomiting, flushing, numbness, allergic reaction, cyanosis, rash, low back pain, and "breath", "anaphylactoid reaction" and "flush" were the safety warning signals of Shenmai injection. Primary disease for chronic pulmonary heart disease, thyroid disease, and combined with cerebral vascular disease, prior to the injection and continuous use of alprostadil, cyclic adenosine monophosphate, combined with quinolones, penicillins were suspicious influence factors of ADR of Shenmai injection, these promot the clinical safety. PMID:27245017

  12. Lower theta inter-trial phase coherence during performance monitoring is related to higher reaction time variability: a lifespan study.

    PubMed

    Papenberg, Goran; Hämmerer, Dorothea; Müller, Viktor; Lindenberger, Ulman; Li, Shu-Chen

    2013-12-01

    Trial-to-trial reaction time (RT) variability is consistently higher in children and older adults than in younger adults. Converging evidence also indicates that higher RT variability is (a) associated with lower behavioral performance on complex cognitive tasks, (b) distinguishes patients with neurological deficits from healthy individuals, and also (c) predicts longitudinal cognitive decline in older adults. However, so far the processes underlying increased RT variability are poorly understood. Previous evidence suggests that control signals in the medial frontal cortex (MFC) are reflected in theta band activity and may implicate the coordination of distinct brain areas during performance monitoring. We hypothesized that greater trial-to-trial variability in theta power during performance monitoring may be associated with greater behavioral variability in response latencies. We analyzed event-related theta oscillations assessed during a cued-Go/NoGo task in a lifespan sample covering the age range from middle childhood to old age. Our results show that theta inter-trial coherence during NoGo trials increases from childhood to early adulthood, and decreases from early adulthood to old age. Moreover, in all age groups, individuals with higher variability in medial frontal stimulus-locked theta oscillations showed higher trial-to-trial RT variability behaviorally. Importantly, this effect was strongest at high performance monitoring demands and independent of motor response execution as well as theta power. Taken together, our findings reveal that lower theta inter-trial coherence is related to greater behavioral variability within and across age groups. These results hint at the possibility that more variable MFC control may be associated with greater performance fluctuations. PMID:23876249

  13. Physiologic and Clinical Principles behind Noninvasive Resuscitation Techniques and Cardiac Output Monitoring

    PubMed Central

    Napoli, Anthony M.

    2012-01-01

    Clinical assessment and vital signs are poor predictors of the overall hemodynamic state. Optimal measurement of the response to fluid resuscitation and hemodynamics has previously required invasive measurement with radial and pulmonary artery catheterization. Newer noninvasive resuscitation technology offers the hope of more accurately and safely monitoring a broader range of critically ill patients while using fewer resources. Fluid responsiveness, the cardiac response to volume loading, represents a dynamic method of improving upon the assessment of preload when compared to static measures like central venous pressure. Multiple new hemodynamic monitors now exist that can noninvasively report cardiac output and oxygen delivery in a continuous manner. Proper assessment of the potential future role of these techniques in resuscitation requires understanding the underlying physiologic and clinical principles, reviewing the most recent literature examining their clinical validity, and evaluating their respective advantages and limitations. PMID:21860802

  14. Clinical variables associated with suicide attempts in schizophrenia before and after the first episode.

    PubMed

    Togay, Bilge; Noyan, Handan; Tasdelen, Rumeysa; Ucok, Alp

    2015-09-30

    The aim of this study was to investigate variables associated with suicide attempts in schizophrenia before and after the first episode. We evaluated history of past sucide attempts, clinical symptoms, level of functioning and cognitive performances of 172 patients with first-episode schizophrenia at first admission. Information was collected regarding clinical symptom severity, treatment compliance, and suicide attempts during the follow-up. We found that 16.5% of the patients attempted suicide before admission, and 6.2% of them attempted suicide during the follow-up. The patients who had attempted suicide before admission were mostly women, and more likely to be hospitalized in first year of follow up. BPRS-depression subscale score at admission and alcohol/substance use appeared as independent variables that found associated with suicide attempts prior to admission in logistic regression analysis. The patients who attempted suicide during the follow-up had significantly higher BPRS-depression subcale scores at sixth months of follow-up. Treatment compliance during the first 6 months and duration of remission was lower in this group. Our findings suggest that longer duration of first hospital treatment, the presence of depressive symptoms, and nonadherence to treatment in early phases of follow up after FES are predictors of suicide attempts. On the other hand, keeping remission during the follow-up protects against suicide attempts. PMID:26210651

  15. Coherence of heart rate variability and local physical fields in monitoring studies

    NASA Astrophysics Data System (ADS)

    Tuzhilkin, D. A.; Borodin, A. S.

    2015-11-01

    Technological advances have led to a substantial modification of the physical fields of the environment, which could affect the status of living organisms under their constant exposure. In this study, the activity of human cardiovascular system under the influence of a complex natural physical environmental factors investigated. The study was conducted on a representative homogeneous sample (44 persons aged 19 to 22 years) by simultaneous monitoring of electrocardiograms and natural physical fields in Tomsk (geomagnetic field, meteorological parameters - temperature, pressure and humidity, surface wind speed, the parameters of the Schumann resonance - amplitude, frequency and quality factor of the first four modes in the range of 6 to 32 Hz, the power spectral density infrasonic background in the range of from 0,5 to 32 Hz). It was shown that among the set of parameters of physical fields present field that can resonate in the functioning of the human organism. The greatest coherence with heart rate variability detect variations eastern component of the geomagnetic field.

  16. Evaluation of heart rate variability indices using a real-time handheld remote ECG monitor.

    PubMed

    Singh, Swaroop S; Carlson, Barbara W; Hsiao, Henry S

    2007-12-01

    Studies on retrospective electrocardiogram (ECG) recordings of patients during cardiac arrest have shown significant changes in heart rate variability (HRV) indices prior to the onset of cardiac arrhythmia. The early detection of these changes in HRV indices increases the chances for a successful medical intervention by increasing the response time window. A portable, handheld remote ECG monitor designed in this research detects the QRS complex and calculates short-term HRV indices in real-time. The QRS detection of the ECG recordings of subjects from the MIT-Arrhythmia database yielded a mean sensitivity of 99.34% and a specificity of 99.31%. ECG recordings from normal subjects and subjects with congestive heart failure were used to identify the differences in HRV indices. An increase in heart rate, high-frequency spectral power (HFP), total spectral power, the ratio of HFP to low-frequency spectral power (LFP), and a decrease in root mean square sum of RR differences were observed. No difference was found on comparison of the standard deviation of normal to normal interval between adjacent R-waves, LFP, and very-low-frequency spectral power. Based on these, additional analytical calculations could be made to provide early warnings of impending cardiac conditions. PMID:18047419

  17. Heart Rate Variability Monitoring during Sleep Based on Capacitively Coupled Textile Electrodes on a Bed

    PubMed Central

    Lee, Hong Ji; Hwang, Su Hwan; Yoon, Hee Nam; Lee, Won Kyu; Park, Kwang Suk

    2015-01-01

    In this study, we developed and tested a capacitively coupled electrocardiogram (ECG) measurement system using conductive textiles on a bed, for long-term healthcare monitoring. The system, which was designed to measure ECG in a bed with no constraints of sleep position and posture, included a foam layer to increase the contact region with the curvature of the body and a cover to ensure durability and easy installation. Nine healthy subjects participated in the experiment during polysomnography (PSG), and the heart rate (HR) coverage and heart rate variability (HRV) parameters were analyzed to evaluate the system. The experimental results showed that the mean of R-peak coverage was 98.0% (95.5%–99.7%), and the normalized errors of HRV time and spectral measures between the Ag/AgCl system and our system ranged from 0.15% to 4.20%. The root mean square errors for inter-beat (RR) intervals and HR were 1.36 ms and 0.09 bpm, respectively. We also showed the potential of our developed system for rapid eye movement (REM) sleep and wake detection as well as for recording of abnormal states. PMID:26007716

  18. Higher Blood Pressure Variability in White Coat Hypertension; from the Korean Ambulatory Blood Pressure Monitoring Registry

    PubMed Central

    Kang, In Sook; Shin, Jinho; Ihm, Sang-Hyun; Kim, Ju Han; Park, Sungha; Kim, Kwang-Il; Kim, Woo-Shik; Kim, Soon Gil; Shin, Gil Ja

    2016-01-01

    Background and Objectives Blood pressure variability (BPV) was recently shown to be a risk factor of stroke. White coat hypertension (WCH) used to be regarded as innocuous, but one long-term follow-up study reported that WCH increased stroke rate compared to normotension (NT). In this study, we aimed to evaluate the relationship between WCH and BPV. Subjects and Methods We analyzed 1398 subjects from the Korean Ambulatory Blood Pressure Registry, who were divided into NT (n=364), masked hypertension (n=122), white coat hypertension (n=254), and sustained hypertension (n=658) groups. Results Baseline characteristics were similar among groups. The average real variability (ARV), a highly sensitive BPV parameter, was highest in the WCH group, followed by the sustained hypertension, masked hypertension, and NT groups. The results persisted after being adjusted for covariates. The WCH vs. sustained hypertension results (adjusted mean±standard error) were as follows: 24-h systolic ARV, 22.9±0.8 vs. 19.4±0.6; 24-h diastolic ARV, 16.8±0.6 vs. 14.3±0.5; daytime systolic ARV, 21.8±0.8 vs. 16.8±0.6; and daytime diastolic ARV, 16.2±0.6 vs. 13.4±0.5 (p<0.001 for all comparisons). Conclusion From the registry data, we found that subjects with WCH or masked hypertension had higher BPV than NT. However, long-term follow-up data assessing the clinical influences of WCH on stroke are needed.

  19. Quality assurance for the clinical implementation of kilovoltage intrafraction monitoring for prostate cancer VMAT

    SciTech Connect

    Ng, J. A.; Booth, J. T.; O’Brien, R. T.; Huang, C.-Y.; Keall, P. J.; Colvill, E.; Poulsen, P. R.

    2014-11-01

    Purpose: Kilovoltage intrafraction monitoring (KIM) is a real-time 3D tumor monitoring system for cancer radiotherapy. KIM uses the commonly available gantry-mounted x-ray imager as input, making this method potentially more widely available than dedicated real-time 3D tumor monitoring systems. KIM is being piloted in a clinical trial for prostate cancer patients treated with VMAT (NCT01742403). The purpose of this work was to develop clinical process and quality assurance (QA) practices for the clinical implementation of KIM. Methods: Informed by and adapting existing guideline documents from other real-time monitoring systems, KIM-specific QA practices were developed. The following five KIM-specific QA tests were included: (1) static localization accuracy, (2) dynamic localization accuracy, (3) treatment interruption accuracy, (4) latency measurement, and (5) clinical conditions accuracy. Tests (1)–(4) were performed using KIM to measure static and representative patient-derived prostate motion trajectories using a 3D programmable motion stage supporting an anthropomorphic phantom with implanted gold markers to represent the clinical treatment scenario. The threshold for system tolerable latency is <1 s. The tolerances for all other tests are that both the mean and standard deviation of the difference between the programmed trajectory and the measured data are <1 mm. The (5) clinical conditions accuracy test compared the KIM measured positions with those measured by kV/megavoltage (MV) triangulation from five treatment fractions acquired in a previous pilot study. Results: For the (1) static localization, (2) dynamic localization, and (3) treatment interruption accuracy tests, the mean and standard deviation of the difference are <1.0 mm. (4) The measured latency is 350 ms. (5) For the tests with previously acquired patient data, the mean and standard deviation of the difference between KIM and kV/MV triangulation are <1.0 mm. Conclusions: Clinical process and

  20. Variable clinical course in acute necrotizing encephalopathy and identification of a novel RANBP2 mutation.

    PubMed

    Sell, Katharina; Storch, Katja; Hahn, Gabriele; Lee-Kirsch, Min Ae; Ramantani, Georgia; Jackson, Sandra; Neilson, Derek; von der Hagen, Maja; Hehr, Ute; Smitka, Martin

    2016-09-01

    Acute necrotizing encephalopathy (ANE) is a rare disease presenting with rapidly progressing encephalopathy. It usually occurs in otherwise healthy children after common viral infections. The hallmarks of ANE are the neuroradiological findings of multiple symmetric lesions in the thalami, midbrain, pons and brainstem. Most cases are sporadic and non recurrent. However, recurrent or familial forms of ANE due to mutations in RANBP2 gene have been reported. It has been suggested to give these cases the term ANE1. We report the clinical course in two male infants (P1, P2) with ANE1 and a variable clinical course and outcome. One patient is heterozygous for the most common RANBP2 missense mutation p.Thr585Met. In the other patient we observed a novel de novo missense mutation p.Trp681Cys in the RANBP2 gene causing recurrent ANE. Clinical and radiological features are presented and differential diagnoses are discussed. This report adds to the current knowledge of the phenotype in ANE, caused by mutations in RANBP2 gene. PMID:26923722

  1. Association of socioeconomic and clinical variables with the state of frailty among older inpatients1

    PubMed Central

    Tavares, Darlene Mara dos Santos; Nader, Isabella Danielle; de Paiva, Mariana Mapelli; Dias, Flavia Aparecida; Pegorari, Maycon Sousa

    2015-01-01

    Objectives: to identify the prevalence of frailty among inpatient older adults in a clinical hospital and check the association of the socioeconomic and clinical characteristics with the state of frailty. Method: observational, cross-sectional and analytical study, conducted with 255 hospitalized patients. Materials used: structured instrument for the economical and clinical data and frailty phenotype of Fried. Descriptive and bivariate statistical analysis was carried out and, by means of chi-square tests and ANOVA One-way (p<0.05). Results: the prevalence of frailty corresponded to 26.3%, while pre-frailty represented 53.3%. The highest proportion of frail seniors was identified for 80 years or older (p = 0.004), widowed (p = 0.035) and with the highest average length of stay (p = 0.006). Conclusion: inpatient older adults presented high percentages of frail states associated with socioeconomic variables and hospitalization period. The identification of the health conditions related to pre-frailty and frailty can foster the planning and implementation of the assistance to older adults in this context. PMID:26626004

  2. Is it me? Verbal self-monitoring neural network and clinical insight in schizophrenia.

    PubMed

    Sapara, Adegboyega; Ffytche, Dominic H; Cooke, Michael A; Williams, Steven C R; Kumari, Veena

    2015-12-30

    Self-monitoring, defined as the ability to distinguish between self-generated stimuli from other-generated ones, is known to be impaired in schizophrenia. This impairment has been theorised as the basis for many of the core psychotic symptoms, in particular, poor clinical insight. This study aimed to investigate verbal self-monitoring related neural substrates of preserved and poor clinical insight in schizophrenia. It involved 40 stable schizophrenia outpatients, 20 with preserved and 20 with poor insight, and 20 healthy participants. All participants underwent functional magnetic resonance imaging with brain coverage covering key areas in the self-monitoring network during a verbal self-monitoring task. Healthy participants showed higher performance accuracy and greater thalamic activity than both preserved and poor insight patient groups. Preserved insight patients showed higher activity in the putamen extending into the caudate, insula and inferior frontal gyrus, compared to poor insight patients, and in the anterior cingulate and medial frontal gyrus, compared to healthy participants. Poor insight patients did not show greater activity in any brain area compared to preserved insight patients or healthy participants. Future studies may pursue therapeutic avenues, such as meta-cognitive therapies to promote self-monitoring or targeted stimulation of relevant brain areas, as means of enhancing insight in schizophrenia. PMID:26549744

  3. Is it me? Verbal self-monitoring neural network and clinical insight in schizophrenia

    PubMed Central

    Sapara, Adegboyega; ffytche, Dominic H.; Cooke, Michael A.; Williams, Steven C.R.; Kumari, Veena

    2015-01-01

    Self-monitoring, defined as the ability to distinguish between self-generated stimuli from other-generated ones, is known to be impaired in schizophrenia. This impairment has been theorised as the basis for many of the core psychotic symptoms, in particular, poor clinical insight. This study aimed to investigate verbal self-monitoring related neural substrates of preserved and poor clinical insight in schizophrenia. It involved 40 stable schizophrenia outpatients, 20 with preserved and 20 with poor insight, and 20 healthy participants. All participants underwent functional magnetic resonance imaging with brain coverage covering key areas in the self-monitoring network during a verbal self-monitoring task. Healthy participants showed higher performance accuracy and greater thalamic activity than both preserved and poor insight patient groups. Preserved insight patients showed higher activity in the putamen extending into the caudate, insula and inferior frontal gyrus, compared to poor insight patients, and in the anterior cingulate and medial frontal gyrus, compared to healthy participants. Poor insight patients did not show greater activity in any brain area compared to preserved insight patients or healthy participants. Future studies may pursue therapeutic avenues, such as meta-cognitive therapies to promote self-monitoring or targeted stimulation of relevant brain areas, as means of enhancing insight in schizophrenia. PMID:26549744

  4. Telecardiology and Remote Monitoring of Implanted Electrical Devices: The Potential for Fresh Clinical Care Perspectives

    PubMed Central

    Diemberger, Igor; Martignani, Cristian; Biffi, Mauro; Valzania, Cinzia; Bertini, Matteo; Domenichini, Giulia; Saporito, Davide; Ziacchi, Matteo; Branzi, Angelo

    2007-01-01

    Telecardiology may help confront the growing burden of monitoring the reliability of implantable defibrillators/pacemakers. Herein, we suggest that the evolving capabilities of implanted devices to monitor patients’ status (heart rhythm, fluid overload, right ventricular pressure, oximetry, etc.) may imply a shift from strictly device-centered follow-up to perspectives centered on the patient (and patient-device interactions). Such approaches could provide improvements in health care delivery and clinical outcomes, especially in the field of heart failure. Major professional, policy, and ethical issues will have to be overcome to enable real-world implementation. This challenge may be relevant for the evolution of our health care systems. PMID:18095049

  5. Longterm optical monitoring of bright BL Lacertae objects with ATOM: Spectral variability and multiwavelength correlations

    NASA Astrophysics Data System (ADS)

    Wierzcholska, Alicja; Ostrowski, Michał; Stawarz, Łukasz; Wagner, Stefan; Hauser, Marcus

    2015-01-01

    Context. Blazars are the established sources of an intense and variable non-thermal radiation extending from radio wavelengths up to high and very high-energy γ-rays. Understanding the spectral evolution of blazars in selected frequency ranges, as well as multifrequency correlations in various types of blazar sources, is of a primary importance for constraining blazar physics. Aims: We present the results of a long-term optical monitoring of a sample of 30 blazars of the BL Lac type, most of which are the confirmed TeV emitters. We study the optical color-magnitude correlation patterns emerging in the analyzed sample and compare the optical properties of the targets with the high-energy γ-ray and high-frequency radio data. Methods: The optical observations were carried out in R and B filters using the Automatic Telescope for Optical Monitoring (ATOM) located at the site of the H.E.S.S. Array. Each object in the sample was observed during at least 20 nights in the period 2007 to 2012. Results: We find significant overall color-magnitude correlations (meaning bluer-when-brighter spectral evolution) in 40% of the sample. The sources that do not display any clear chromatism in the full datasets often do exhibit bluer-when-brighter behavior but only in isolated shorter time intervals. We also discovered spectral state transitions at optical wavelengths in several of the analyzed sources. Finally, we find that the radio, optical, and γ-ray luminosities of the sources in the sample obey almost linear correlations, which seem induced, at least partly, by the redshift dependence and may also be affected by the non-simultaneity of the analyzed multifrequency dataset. Conclusions: We argue that the observed bluer-when-brighter behavior is intrinsic to the jet-emission regions, at least for some of these blazars, rather than resulting from the contamination of the measured flux by the starlight of host galaxies. We also conclude that the significance of color

  6. Dealing with incomplete and variable detectability in multi-year, multi-site monitoring of ecological populations

    USGS Publications Warehouse

    Converse, Sarah J.; Royle, J. Andrew

    2012-01-01

    An ecological monitoring program should be viewed as a component of a larger framework designed to advance science and/or management, rather than as a stand-alone activity. Monitoring targets (the ecological variables of interest; e.g. abundance or occurrence of a species) should be set based on the needs of that framework (Nichols and Williams 2006; e.g. Chapters 2–4). Once such monitoring targets are set, the subsequent step in monitoring design involves consideration of the field and analytical methods that will be used to measure monitoring targets with adequate accuracy and precision. Long-term monitoring programs will involve replication of measurements over time, and possibly over space; that is, one location or each of multiple locations will be monitored multiple times, producing a collection of site visits (replicates). Clearly this replication is important for addressing spatial and temporal variability in the ecological resources of interest (Chapters 7–10), but it is worth considering how this replication can further be exploited to increase the effectiveness of monitoring. In particular, defensible monitoring of the majority of animal, and to a lesser degree plant, populations and communities will generally require investigators to account for imperfect detection (Chapters 4, 18). Raw indices of population state variables, such as abundance or occupancy (sensu MacKenzie et al. 2002), are rarely defensible when detection probabilities are < 1, because in those cases detection may vary over time and space in unpredictable ways. Myriad authors have discussed the risks inherent in making inference from monitoring data while failing to correct for differences in detection, resulting in indices that have an unknown relationship to the parameters of interest (e.g. Nichols 1992, Anderson 2001, MacKenzie et al. 2002, Williams et al. 2002, Anderson 2003, White 2005, Kéry and Schmidt 2008). While others have argued that indices may be preferable in some

  7. Long-term Prognosis in COPD Exacerbation: Role of Biomarkers, Clinical Variables and Exacerbation Type.

    PubMed

    Grolimund, Eva; Kutz, Alexander; Marlowe, Robert J; Vögeli, Alaadin; Alan, Murat; Christ-Crain, Mirjam; Thomann, Robert; Falconnier, Claudine; Hoess, Claus; Henzen, Christoph; Zimmerli, Werner; Mueller, Beat; Schuetz, Philipp

    2015-06-01

    Long-term outcome prediction in COPD is challenging. We conducted a prospective 5-7-year follow-up study in patients with COPD to determine the association of exacerbation type, discharge levels of inflammatory biomarkers including procalctionin (PCT), C-reactive protein (CRP), white blood cell count (WBC) and plasma proadrenomedullin (ProADM), alone or combined with demographic/clinical characteristics, with long-term all-cause mortality in the COPD setting. The analyzed cohort comprised 469 patients with index hospitalization for pneumonic (n = 252) or non-pneumonic (n = 217) COPD exacerbation. Five-to-seven-year vital status was ascertained via structured phone interviews with patients or their household members/primary care physicians. We investigated predictive accuracy using univariate and multivariate Cox regression models and area under the receiver operating characteristic curve (AUC). After a median [25th-75th percentile] 6.1 [5.6-6.5] years, mortality was 55% (95%CI 50%-59%). Discharge ProADM concentration was strongly associated with 5-7-year non-survival: adjusted hazard ratio (HR)/10-fold increase (95%CI) 10.4 (6.2-17.7). Weaker associations were found for PCT and no significant associations were found for CRP or WBC. Combining ProADM with demographic/clinical variables including age, smoking status, BMI, New York Heart Association dyspnea class, exacerbation type, and comorbidities significantly improved long-term predictive accuracy over that of the demographic/clinical model alone: AUC (95%CI) 0.745 (0.701-0.789) versus 0.727 (0.681-0.772), (p) = .043. In patients hospitalized for COPD exacerbation, discharge ProADM levels appeared to accurately predict 5-7-year all-cause mortality and to improve long-term prognostic accuracy of multidimensional demographic/clinical mortality risk assessment. PMID:25230352

  8. Immune Monitoring in Cancer Vaccine Clinical Trials: Critical Issues of Functional Flow Cytometry-Based Assays

    PubMed Central

    Urbani, Francesca; Proietti, Enrico

    2013-01-01

    The development of immune monitoring assays is essential to determine the immune responses against tumor-specific antigens (TSAs) and tumor-associated antigens (TAAs) and their possible correlation with clinical outcome in cancer patients receiving immunotherapies. Despite the wide range of techniques used, to date these assays have not shown consistent results among clinical trials and failed to define surrogate markers of clinical efficacy to antitumor vaccines. Multiparameter flow cytometry- (FCM-) based assays combining different phenotypic and functional markers have been developed in the past decade for informative and longitudinal analysis of polyfunctional T-cells. These technologies were designed to address the complexity and functional heterogeneity of cancer biology and cellular immunity and to define biomarkers predicting clinical response to anticancer treatment. So far, there is still a lack of standardization of some of these immunological tests. The aim of this review is to overview the latest technologies for immune monitoring and to highlight critical steps involved in some of the FCM-based cellular immune assays. In particular, our laboratory is focused on melanoma vaccine research and thus our main goal was the validation of a functional multiparameter test (FMT) combining different functional and lineage markers to be applied in clinical trials involving patients with melanoma. PMID:24195078

  9. Psychological Variables Potentially Implicated in Opioid-Related Mortality as Observed in Clinical Practice

    PubMed Central

    Passik, Steven D.; Lowery, Amy

    2014-01-01

    Opioid-related deaths in the United States have become a public health problem, with accidental and unintended overdoses being especially troubling. Screening for psychological risk factors is an important first step in safeguarding against nonadherence practices and identifying patients who may be vulnerable to the risks associated with opioid therapy. Validated screening instruments can aid in this attempt as a complementary tool to clinicians’ assessments. A structured screening is imperative as part of an assessment, as clinician judgment is not the most reliable method of identifying nonadherence. As a complement to formal screening, we present for discussion and possible future study certain psychological variables observed during years of clinical practice that may be linked to medication nonadherence and accidental overdose. These variables include catastrophizing, fear, impulsivity, attention deficit disorders, existential distress, and certain personality disorders. In our experience, chronic pain patients with dual diagnoses may become “chemical copers” as a way of coping with their negative emotion. For these patients, times of stress could lead to accidental overdose. Behavioral, cognitive-behavioral (acceptance and commitment, dialectical behavior), existential (meaning-centered, dignity), and psychotropic therapies have been effective in treating these high-risk comorbidities, while managing expectations of pain relief appears key to preventing accidental overdose. PMID:21668755

  10. Variable number of tandem repeats in clinical strains of Haemophilus influenzae.

    PubMed Central

    van Belkum, A; Scherer, S; van Leeuwen, W; Willemse, D; van Alphen, L; Verbrugh, H

    1997-01-01

    An algorithm capable of identifying short repeat motifs was developed and used to screen the whole genome sequence available for Haemophilus influenzae, since some of these repeats have been shown to affect bacterial virulence. Various di- to hexanucleotide repeats were identified, confirming and extending previous findings on the existence of variable-number-of-tandem-repeat loci (VNTRs). Repeats with units of 7 or 8 nucleotides were not encountered. For all of the 3- to 6-nucleotide repeats in the H. influenzae chromosome, PCR tests capable of detecting allelic polymorphisms were designed. Fourteen of 18 of the potential VNTRs were indeed highly polymorphic when different strains were screened. Two of the potential VNTRs appeared to be short and homogeneous in length; another one may be specific for the H. influenzae Rd strain only. One of the primer sets generated fingerprint-type DNA banding patterns. The various repeat types differed with respect to intrinsic stability as well. It was noted for separate colonies derived from a single clinical specimen or strains passaged for several weeks on chocolate agar plates that the lengths of the VNTRs did not change. When several strains from different patients infected during an outbreak of lung disease were analyzed, increased but limited variation was encountered in all VNTR sites analyzed. One of the 5-nucleotide VNTRs proved to be hypervariable. This variability may reflect the molecular basis of a mechanism used by H. influenzae bacteria to successfully colonize and infect different human individuals. PMID:9393791

  11. Clinical Utility and Limitations of Intraoperative Monitoring of Visual Evoked Potentials

    PubMed Central

    Luo, Yeda; Regli, Luca; Bozinov, Oliver; Sarnthein, Johannes

    2015-01-01

    Objectives During surgeries that put the visual pathway at risk of injury, continuous monitoring of the visual function is desirable. However, the intraoperative monitoring of the visual evoked potential (VEP) is not yet widely used. We evaluate here the clinical utility of intraoperative VEP monitoring. Methods We analyzed retrospectively 46 consecutive surgeries in 2011-2013. High luminance stimulating devices delivered flash stimuli on the closed eyelid during intravenous anesthesia. We monitored VEP features N75 and P100 and took patients' preoperative and postoperative visual function from patient charts. Postoperative ophthalmologic workup was performed in 25 (54%) patients and preoperatively in 28 (61%) patients. Results VEP recordings were feasible in 62 of 85 eyes (73%) in 46 patients. All 23 eyes without VEP had impaired vision. During surgery, VEPs remained stable throughout surgery in 50 eyes. In 44 of these, visual function did not deteriorate and three patients (6 eyes) developed hemianopia. VEP decreased transiently in 10 eyes and visual function of all was preserved. VEPs were lost permanently in 2 eyes in two patients without new postoperative visual impairment. Conclusions Satisfactory intraoperative VEP monitoring was feasible in all patients except in those with severe visual impairment. Preservation of VEPs predicted preserved visual function. During resection of lesions in the visual cortex, VEP monitoring could not detect new major visual field defects due to injury in the posterior visual pathway. Intraoperative VEPs were sensitive enough to detect vascular damage during aneurysm clipping and mechanical manipulation of the anterior visual pathway in an early reversible stage. Intraoperative VEP monitoring influenced surgical decisions in selected patients and proved to be a useful supplement to the toolbox of intraoperative neurophysiological monitoring. PMID:25803287

  12. Quality Assessment for Therapeutic Drug Monitoring in AIDS Clinical Trials Group (ACTG 5146): A Multicenter Clinical Trial

    PubMed Central

    DiFrancesco, Robin; Rosenkranz, Susan; Mukherjee, A. Lisa; Demeter, Lisa M.; Jiang, Hongyu; DiCenzo, Robert; Dykes, Carrie; Rinehart, Alex; Albrecht, Mary; Morse, Gene D.

    2010-01-01

    In a randomized trial, AIDS Clinical Trials Group (ACTG) protocol 5146 (A5146) investigated the use of TDM to adjust doses of HIV-1 protease inhibitors (PIs) in patients with prior virologic failure on PI-based therapy who were starting a new PI-based regimen. The overall percentage of “PI trough repeats”, such as rescheduled visits or redrawn PI trough specimens, increased from 2% to 5% to 10% as the process progressed from the clinical sites, the PSL, and the study team, respectively. Cumulatively, this represents a 17% rate of failure to obtain adequate PI trough sample. While targeting a turn-around of ≤ 7 days from sample receipt to a drug concentration report, 12% of the received specimens required a longer period to report concentrations. The implementation of dosing changes in the TDM arm were achieved within ≤7 days for 56% of the dose change events, and within ≤14 days for 77% of dose change events. This quality assurance analysis provides a valuable summary of the specific points in the TDM process that could be improved during a multicenter clinical trial including: [1] shortening the timeline of sample shipment from clinical site to the lab, [2] performing the collection of PI trough specimen within the targeted sampling window by careful monitoring of the last dose times and collection times by the clinicians [3] increasing patient adherence counseling to reduce the number of samples that are redrawn due to suspecting inconsistent adherence, and [4] decreasing the time to successful TDM-based dose adjustment. The application of some of these findings may also be relevant to single center studies or clinical TDM programs within a hospital. PMID:20592644

  13. Clinical-HINTS: integrated intelligent ICU patient monitoring and information management system.

    PubMed

    Kalogeropoulos, D; Carson, E R; Collinson, P O

    1997-01-01

    Clinical-HINTS (Health Intelligence System) is a horizontally integrated decision support system (DSS) designed to meet the requirements for intelligent real-time clinical information management in critical care medical environments and to lay the foundation for the development of the next generation of intelligent medical instrumentation. The system presented was developed to refine and complement the information yielded by clinical laboratory investigations, thereby benefiting the management of the intensive care unit (ICU) patient. More specifically, Clinical-HINTS was developed to provide computer-based assistance with the acquisition, organisation and display, storage and retrieval, communication and generation of real-time patient-specific clinical information in an ICU. Clinical-HINTS is an object-oriented system developed in C+2 to run under Microsoft Windows as an embryo intelligent agent. Current generic reasoning skills include perception and reactive cognition of patient status but exclude therapeutic action. The system monitors the patient by communicating with the available sources of data and uses generic reasoning skills to generate intelligent alarms, or HINTS, on various levels of interpretation of an observed dysfunction, even in the presence of complex disorders. The system's communication and information management capabilities are used to acquire physiological data, and to store them along with their interpretations and any interventions for the dynamic recognition of interrelated pathophysiological states or clinical events. PMID:10179800

  14. Design and clinical feasibility of personal wearable monitor for measurement of activity and environmental exposure.

    PubMed

    Fletcher, Richard Ribón; Oreskovic, Nicolas M; Robinson, Alyssa I

    2014-01-01

    Human exposure to specific environmental factors (e.g. air quality, lighting, and sound) is known to play an important role in the pathogenesis of many chronic diseases (e.g. asthma) and mental health disorders (e.g. anxiety). However, conventional fixed environmental monitoring stations are sparsely located and, despite environmental models, cannot adequately assess individual exposure levels. New forms of low-cost portable monitors have begun to emerge that enable the collection of higher spatial density "crowd sourced" data; however, the first generation of these low-cost environmental monitors have generally not been suitable for clinical environmental health studies due to practical challenges such as calibration, reproducibility, form factor, and battery life. In this paper, we present a wearable environmental monitor that overcomes these challenges and can be used in clinical studies The new device, called "Eco-Mini," can be used without a smart phone and is capable of locally sampling and recording a variety of environmental parameters (Ozone, Sulfur Dioxide, Volatile Organic Compounds, humidity, temperature, ambient light color balance, and sound level) as well as individual activity (3-axis accelerometer) and location (GPS). In this paper, we also report findings and discuss lessons learned from a feasibility study conducted for one week with pediatric patients as part of an ongoing asthma research study. PMID:25570098

  15. ECT of major depressed patients in relation to biological and clinical variables: a brief overview.

    PubMed

    Wahlund, Björn; von Rosen, Dietrich

    2003-07-01

    The knowledge that spontaneous or induced convulsions can improve mental disorders has been present for several centuries. electroconvulsive therapy (ECT) has undergone fundamental changes since its introduction, and in the last 15-20 years there has been a legitimate renewal of interest for this therapy. Today the indications for use of ECT seem well codified, and its technique and practices have evolved considerably. It is now firmly established as an important and effective method of treating certain severe forms of depression. However, still very little is known about the mechanism of ECT. In this paper, first, we will give a short overview as to how far we have got concerning ECT in relation to various clinical and biological variables. Second, we will describe ECT in relation to electroencephalographic (EEG) technique and clinical outcome as well as give some proposals as to how to go on with the data analysis of EEG. In conclusion, the superior effect of ECT compared to other antidepressives in severe depression may depend on neurochemical and neurobiological cascade effects initiated by repeated treatments. Above all, ECT offers a unique experimental opportunity to study how neuromodulation of the major transmitter systems may be involved in brain dynamics and alteration of connectivity. PMID:12827140

  16. Demographic variables, clinical aspects, and medicolegal implications in a population of patients with adjustment disorder

    PubMed Central

    Anastasia, Annalisa; Colletti, Chiara; Cuoco, Valentina; Quartini, Adele; Urso, Stefania; Rinaldi, Raffaella; Bersani, Giuseppe

    2016-01-01

    Introduction Although adjustment disorder (AD) is considered as residual diagnosis and receives little attention in research, it plays an important role in clinical practice and also assumes an increasingly important role in the field of legal medicine, where the majority of diagnostic frameworks (eg, mobbing) often refer to AD. Our study aimed to look for specific stressor differences among demographic and clinical variables in a naturalistic setting of patients with AD. Methods A restrospective statistical analysis of the data of patients diagnosed with AD from November 2009 to September 2012, identified via manual search from the archive of the outpatient setting at the University Unit of Psychiatry “A. Fiorini” Hospital, Terracina (Latina, Italy), was performed. Results The sample consisted of 93 patients (46 males and 47 females), aged between 26 and 85, with medium–high educational level who were mainly employed. In most cases (54.80%), a diagnosis of AD with mixed anxiety and depressed mood was made. In all, 72% of the sample reported a negative family history for psychiatric disorders. In 22.60%, a previous history of psychopathology, especially mood disorders (76.19%), was reported. The main stressors linked to the development of AD were represented by working problems (32.30%), family problems (23.70%), and/or somatic disease (22.60%) with significant differences with respect to age and sex. Half of the patients were subjected to a single first examination; 24.47% requested a copy of medical records. Conclusion Confirming previous data from previous reports, our results suggest that AD may have a distinct profile in demographic and clinical terms. Increased scientific attention is hoped, particularly focused on addressing a better definition of diagnostic criteria, whose correctness and accuracy are critical, especially in situations with medicolegal implications. PMID:27099504

  17. State-of-the-Art Sensor Technology in Spain: Invasive and Non-Invasive Techniques for Monitoring Respiratory Variables

    PubMed Central

    Domingo, Christian; Blanch, Lluis; Murias, Gaston; Luján, Manel

    2010-01-01

    The interest in measuring physiological parameters (especially arterial blood gases) has grown progressively in parallel to the development of new technologies. Physiological parameters were first measured invasively and at discrete time points; however, it was clearly desirable to measure them continuously and non-invasively. The development of intensive care units promoted the use of ventilators via oral intubation ventilators via oral intubation and mechanical respiratory variables were progressively studied. Later, the knowledge gained in the hospital was applied to out-of-hospital management. In the present paper we review the invasive and non-invasive techniques for monitoring respiratory variables. PMID:22399898

  18. Clinical significance of automatic warning function of cardiac remote monitoring systems in preventing acute cardiac episodes

    PubMed Central

    Chen, Shou-Qiang; Xing, Shan-Shan; Gao, Hai-Qing

    2014-01-01

    Objective: In addition to ambulatory Holter electrocardiographic recording and transtelephonic electrocardiographic monitoring (TTM), a cardiac remote monitoring system can provide an automatic warning function through the general packet radio service (GPRS) network, enabling earlier diagnosis, treatment and improved outcome of cardiac diseases. The purpose of this study was to estimate its clinical significance in preventing acute cardiac episodes. Methods: Using 2 leads (V1 and V5 leads) and the automatic warning mode, 7160 patients were tested with a cardiac remote monitoring system from October 2004 to September 2007. If malignant arrhythmias or obvious ST-T changes appeared in the electrocardiogram records was automatically transferred to the monitoring center, the patient and his family members were informed, and the corresponding precautionary or therapeutic measures were implemented immediately. Results: In our study, 274 cases of malignant arrhythmia, including sinus standstill and ventricular tachycardia, and 43 cases of obvious ST-segment elevation were detected and treated. Because of early detection, there was no death or deformity. Conclusions: A cardiac remote monitoring system providing an automatic warning function can play an important role in preventing acute cardiac episodes. PMID:25674124

  19. Monitoring Climate Variability and Change in Northern Alaska: Updates to the U.S. Geological Survey (USGS) Climate and Permafrost Monitoring Network

    NASA Astrophysics Data System (ADS)

    Urban, F. E.; Clow, G. D.; Meares, D. C.

    2004-12-01

    Observations of long-term climate and surficial geological processes are sparse in most of the Arctic, despite the fact that this region is highly sensitive to climate change. Instrumental networks that monitor the interplay of climatic variability and geological/cryospheric processes are a necessity for documenting and understanding climate change. Improvements to the spatial coverage and temporal scale of Arctic climate data are in progress. The USGS, in collaboration with The Bureau of Land Management (BLM) and The Fish and Wildlife Service (FWS) currently maintains two types of monitoring networks in northern Alaska: (1) A 15 site network of continuously operating active-layer and climate monitoring stations, and (2) a 21 element array of deep bore-holes in which the thermal state of deep permafrost is monitored. Here, we focus on the USGS Alaska Active Layer and Climate Monitoring Network (AK-CLIM). These 15 stations are deployed in longitudinal transects that span Alaska north of the Brooks Range, (11 in The National Petroleum Reserve Alaska, (NPRA), and 4 in The Arctic National Wildlife Refuge (ANWR)). An informative overview and update of the USGS AK-CLIM network is presented, including insight to current data, processing and analysis software, and plans for data telemetry. Data collection began in 1998 and parameters currently measured include air temperature, soil temperatures (5-120 cm), snow depth, incoming and reflected short-wave radiation, soil moisture (15 cm), wind speed and direction. Custom processing and analysis software has been written that calculates additional parameters such as active layer thaw depth, thawing-degree-days, albedo, cloudiness, and duration of seasonal snow cover. Data from selected AK-CLIM stations are now temporally sufficient to begin identifying trends, anomalies, and inter-annual variability in the climate of northern Alaska.

  20. Variability in the microcanonical cascades parameters among gauges of urban precipitation monitoring network

    NASA Astrophysics Data System (ADS)

    Licznar, Paweł; Rupp, David; Adamowski, Witold

    2013-04-01

    In the fall of 2008, Municipal Water Supply and Sewerage Company (MWSSC) in Warsaw began operating the first large precipitation monitoring network dedicated to urban hydrology in Poland. The process of establishing the network as well as the preliminary phase of its operation, raised a number of questions concerning optimal gauge location and density and revealed the urgent need for new data processing techniques. When considering the full-field precipitation as input to hydrodynamic models of stormwater and combined sewage systems, standard processing techniques developed previously for single gauges and concentrating mainly on the analysis of maximum rainfall rates and intensity-duration-frequency (IDF) curves development were found inadequate. We used a multifractal rainfall modeling framework based on microcanonical multiplicative random cascades to analyze properties of Warsaw precipitation. We calculated breakdown coefficients (BDC) for the hierarchy of timescales from λ=1 (5-min) up to λ=128 (1280-min) for all 25 gauges in the network. At small timescales histograms of BDCs were strongly deformed due to the recording precision of rainfall amounts. A randomization procedure statistically removed the artifacts due to precision errors in the original series. At large timescales BDC values were sparse due to relatively short period of observations (2008-2011). An algorithm with a moving window was proposed to increase the number of BDC values at large timescales and to smooth their histograms. The resulting empirical BDC histograms were modeled by a theoretical "2N-B" distribution, which combined 2 separate normal (N) distributions and one beta (B) distribution. A clear evolution of BDC histograms from a 2N-B distribution for small timescales to a N-B distributions for intermediate timescales and finally to a single beta distributions for large timescales was observed for all gauges. Cluster analysis revealed close patterns of BDC distributions among almost

  1. A TWO-STAGE MONITORING PROCEDURE FOR QUANTIFYING FLOW IN VARIABLY-SATURATED HETEROGENEOUS SOILS

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Ground water recharge monitoring is an important component in assessing contaminant migration at sites where contaminants have been released at or near the surface. An innovative two-stage monitoring procedure that uses multiple soil moisture probes in a short duration first stage, followed by a sma...

  2. Relationship of psychological and physiological variables in long-term self-monitored data during work ability rehabilitation program.

    PubMed

    Pärkkä, Juha; Merilahti, Juho; Mattila, Elina M; Malm, Esko; Antila, Kari; Tuomisto, Martti T; Saarinen, Ari Viljam; van Gils, Mark; Korhonen, Ilkka

    2009-03-01

    Individual wellness comprises both psychological and physiological wellbeing, which are interrelated. In long-term monitoring of wellness, both components should be included. Work-related stress and burnout are persistent problems in industrial countries. Early identification of work-related stress symptoms and early intervention could reduce individual suffering and improve the working productivity and creativity. The goal of this study was to explore the relationship between physiological and psychological variables measured at home by the users themselves or automatically. In all, 17 (3 males and 14 females, age 40-62) people participating in a work ability rehabilitation program (due to work overload) were monitored for three months. Physiological and behavioral variables (activity, bed occupancy, heart rate (HR) and respiration during night, HR during day, blood pressure, steps, weight, room illumination, and temperature) were measured with different unobtrusive wireless sensors. Daily self-assessment of stress, mood, and behaviors (exercise, sleep) were collected using a mobile phone diary. The daily self-assessment of stress and the Derogatis stress profile questionnaire were used as reference for stress status. Results show modest, but significant pooled overall correlations between self-assessed stress level, and physiological and behavioral variables (e.g., sleep length measured with wrist-worn activity monitor: rho = -0.22, p < 0.001, and variance of nightly bedroom illumination: rho = 0.13, p < 0.001). Strong, but sometimes conflicting correlations can be found at individual level, suggesting individual reactions to stress in daily life. PMID:19272856

  3. Clinical variables impacting on the estimation of utilities in chronic obstructive pulmonary disease

    PubMed Central

    Miravitlles, Marc; Huerta, Alicia; Valle, Manuel; García-Sidro, Patricia; Forné, Carles; Crespo, Carlos; López-Campos, José Luis

    2015-01-01

    Purpose Health utilities are widely used in health economics as a measurement of an individual’s preference and show the value placed on different health states over a specific period. Thus, health utilities are used as a measure of the benefits of health interventions in terms of quality-adjusted life years. This study aimed to determine the demographic and clinical variables significantly associated with health utilities for chronic obstructive pulmonary disease (COPD) patients. Patients and methods This was a multicenter, observational, cross-sectional study conducted between October 2012 and April 2013. Patients were aged ≥40 years, with spirometrically confirmed COPD. Utility values were derived from the preference-based generic questionnaire EQ-5D-3L applying weighted Spanish societal preferences. Demographic and clinical variables associated with utilities were assessed by univariate and multivariate linear regression models. Results Three hundred and forty-six patients were included, of whom 85.5% were male. The mean age was 67.9 (standard deviation [SD] =9.7) years and the mean forced expiratory volume in 1 second (%) was 46.2% (SD =15.5%); 80.3% were former smokers, and the mean smoking history was 54.2 (SD =33.2) pack-years. Median utilities (interquartile range) were 0.81 (0.26) with a mean value of 0.73 (SD =0.29); 22% of patients had a utility value of 1 (ceiling effect) and 3.2% had a utility value lower than 0. The factors associated with utilities in the multivariate analysis were sex (beta =-0.084, 95% confidence interval [CI]: −0.154; -0.013 for females), number of exacerbations the previous year (−0.027, 95% CI: −0.044; -0.010), and modified Medical Research Council Dyspnea Scale (mMRC) score (−0.123 [95% CI: −0.185; −0.061], −0.231 [95% CI: −0.301; −0.161], and −0.559 [95% CI: −0.660; −0.458] for mMRC scores 2, 3, and 4 versus 1), all P<0.05. Conclusion Multivariate analysis showed that female sex, frequent

  4. Non-invasive diagnosis and continuous monitoring of thrombosis in clinics by near-infrared spectroscopy

    NASA Astrophysics Data System (ADS)

    Li, Ting; Sun, Yunglong; Chen, Xiao; Zhao, Yue; Ren, Rongrong; Liu, Mushuang

    2015-03-01

    Thrombosis became one of the most severe disease hazard to human health, and it incidence rate grows increasingly higher throughout the world. The conventional diagnosis and monitoring thrombosis mainly relied on the invasive techniques, e.g., digital subtraction angiography and blood sample analysis, and expensive and ionizing techniques, e.g., magnetic resonance angiography. And those techniques can not measure continuously. Here we reported our preliminary exploration of using near-infrared spectroscopy (NIRS) in clinical monitoring of thrombosis. 7 healthy subjects and 6 thrombosis patients at similar age participated the NIRS measurements of oxy- and deoxy- hemoglobin ([HbO2] and [Hb]) on 6 particular parts of legs. We repeated [HbO2] measurement at the same specified time each day after thrombolytic therapy for one single-leg-DVT patient, and terminated till the patient was cured and left hospital. We found that - (1) [HbO2] kept lower in thrombosis patients and [Hb] kept lower in healthy people (p<0.001) (2) [HbO2] kept increasing in the thrombosis leg but decreasing in healthy leg for the patients after thrombolytic therapy, and coincidently, [HbO2] acted consistent just when the patients were cured and left. Our study successfully extended the application of NIRS in noninvasive, continuous, and low-cost monitoring of thrombosis in clinics. Our findings showed the powerful potential of [HbO2] by NIRS in diagnosis and therapeutic effect evaluation of thrombosis.

  5. Comparison of invasive and non-invasive blood pressure monitoring during clinical anaesthesia in dogs.

    PubMed

    MacFarlane, Paul D; Grint, Nicola; Dugdale, Alexandra

    2010-03-01

    Monitoring blood pressure during anaesthesia is widely recommended in man and animals. The accuracy of any device used to measure blood pressure is an important consideration when selecting monitoring equipment, the ANSI/AAMI SP10 standard is widely cited in this respect in recent veterinary publications. Blood pressure was monitored using invasive and non-invasive techniques during clinical anaesthesia in 19 dogs. The results were compared using Bland-Altman analysis. The bias (and limits of agreement) between invasive and non-invasive measurement was 7.1 mmHg (+/-34.7) for systolic blood pressure, -1.8 mmHg (+/-27.4) for mean blood pressure and 6.9 mmHg (+/-27.5) for diastolic blood pressure. In a clinical setting the bias between invasive and non-invasive measurement techniques was similar or smaller than laboratory reports, however the limits of agreement were considerably wider suggesting that care should be exercised when interpreting NIBP values. PMID:20306347

  6. Incidence and clinical variables associated with streptococcal throat infections: a prospective diagnostic cohort study

    PubMed Central

    Little, Paul; Hobbs, FD Richard; Mant, David; McNulty, Cliodna AM; Mullee, Mark

    2012-01-01

    Background Management of pharyngitis is commonly based on features which are thought to be associated with Lancefield group A beta-haemolytic streptococci (GABHS) but it is debatable which features best predict GABHS. Non-group A strains share major virulence factors with group A, but it is unclear how commonly they present and whether their presentation differs. Aim To assess the incidence and clinical variables associated with streptococcal infections. Design and setting Prospective diagnostic cohort study in UK primary care. Method The presence of pathogenic streptococci from throat swabs was assessed among patients aged ≥5 years presenting with acute sore throat. Results Pathogenic streptococci were found in 204/597 patients (34%, 95% CI = 31 to 38%): 33% (68/204) were non-group A streptococci, mostly C (n = 29), G (n = 18) and B (n = 17); rarely D (n = 3) and Streptococcus pneumoniae (n = 1). Patients presented with similar features whether the streptococci were group A or non-group A. The features best predicting A, C or G beta-haemolytic streptococci were patient’s assessment of severity (odds ratio [OR] for a bad sore throat 3.31, 95% CI = 1.24 to 8.83); doctors’ assessment of severity (severely inflamed tonsils OR 2.28, 95% CI = 1.39 to 3.74); absence of a bad cough (OR 2.73, 95% CI = 1.56 to 4.76), absence of a coryza (OR 1.54, 95% CI = 0.99 to 2.41); and moderately bad or worse muscle aches (OR 2.20, 95% CI = 1.41 to 3.42). Conclusion Non-group A strains commonly cause streptococcal sore throats, and present with similar symptomatic clinical features to group A streptococci. The best features to predict streptococcal sore throat presenting in primary care deserve revisiting. PMID:23211183

  7. Components of health: an analysis in rheumatoid arthritis using quality of life questionnaires and clinical and laboratory variables.

    PubMed Central

    Borstlap, M; van de Laar, M; Zant, J; van der Korst, J

    1993-01-01

    OBJECTIVE--To gain insight into the overlap between additional information supplied by recently developed health status instruments for rheumatoid arthritis (RA) and traditional clinical and laboratory tests. METHODS--A cross sectional study of 282 outpatients with RA was made. From each patient, variables of clinical and laboratory measurements were obtained and the modified health assessment questionnaire (MHAQ) and a Dutch quality of life questionnaire, the IRGL, were completed. These variables were analysed for their interrelationship. RESULTS--Clinical and laboratory variables correlated significantly with the scales of the physical dimension and the disease impact scale of the IRGL. Their significant correlations with the IRGL psychological scales were weak. There were no significant correlations between any of the traditional variables and the IRGL social scales. Factor analysis yielded five factors: functionality, pain, depressive mood, social support, and laboratory. The laboratory factor is a measure of the disease process. The other four factors provide a health model. CONCLUSION--The results suggest that the IRGL questionnaire that was studied covers a complete health model that incorporates aspects of health that are not measured by clinical and laboratory tests. A simple questionnaire for the psychological and social dimension of health status, however, would probably be more cost effective and easier to use in clinical practice. PMID:8239759

  8. Is abeta a sufficient biomarker for monitoring anti-abeta clinical studies? A critical review.

    PubMed

    Moreth, Jens; Mavoungou, Chrystelle; Schindowski, Katharina

    2013-01-01

    Amyloid-beta (Aβ) in Alzheimer's disease (AD) appeared to be a promising target for disease-modifying therapeutic strategies like passive immunotherapy with anti-Aβ monoclonal antibodies (mAbs). Biochemical markers in cerebrospinal fluid (CSF) include alterations of Aβ that allow the diagnosis of AD. Biomarker strategies, such as the levels of Aβ in CSF and plasma, currently play an important role in early clinical trials for AD. Indeed, these strategies have a relevant impact on the outcome of such studies, since the biomarkers are used to monitor the bioactivity of anti-Aβ mAbs. The clinical trials of Solanezumab were mainly based on the readout of Aβ levels in CSF and plasma, whereas those of Bapineuzumab were based on cognition; however, little is known about the mechanisms altering these biomarker levels, and no biomarker has yet been proven to be a successful predictor for AD therapy. In addition, the Aβ biomarkers allow for the determination of free and bound anti-Aβ mAb in order to monitor the available amount of bioactive drug and could give hints to the mechanism of action. In this review, we discuss clinical Aβ biomarker data and the latest regulatory strategies. PMID:23847530

  9. Relative effectiveness of clinic and home blood pressure monitoring compared with ambulatory blood pressure monitoring in diagnosis of hypertension: systematic review

    PubMed Central

    Hodgkinson, J; Mant, J; Martin, U; Guo, B; Hobbs, F D R; Deeks, J J; Heneghan, C; Roberts, N

    2011-01-01

    Objective To determine the relative accuracy of clinic measurements and home blood pressure monitoring compared with ambulatory blood pressure monitoring as a reference standard for the diagnosis of hypertension. Design Systematic review with meta-analysis with hierarchical summary receiver operating characteristic models. Methodological quality was appraised, including evidence of validation of blood pressure measurement equipment. Data sources Medline (from 1966), Embase (from 1980), Cochrane Database of Systematic Reviews, DARE, Medion, ARIF, and TRIP up to May 2010. Eligibility criteria for selecting studies Eligible studies examined diagnosis of hypertension in adults of all ages using home and/or clinic blood pressure measurement compared with those made using ambulatory monitoring that clearly defined thresholds to diagnose hypertension. Results The 20 eligible studies used various thresholds for the diagnosis of hypertension, and only seven studies (clinic) and three studies (home) could be directly compared with ambulatory monitoring. Compared with ambulatory monitoring thresholds of 135/85 mm Hg, clinic measurements over 140/90 mm Hg had mean sensitivity and specificity of 74.6% (95% confidence interval 60.7% to 84.8%) and 74.6% (47.9% to 90.4%), respectively, whereas home measurements over 135/85 mm Hg had mean sensitivity and specificity of 85.7% (78.0% to 91.0%) and 62.4% (48.0% to 75.0%). Conclusions Neither clinic nor home measurement had sufficient sensitivity or specificity to be recommended as a single diagnostic test. If ambulatory monitoring is taken as the reference standard, then treatment decisions based on clinic or home blood pressure alone might result in substantial overdiagnosis. Ambulatory monitoring before the start of lifelong drug treatment might lead to more appropriate targeting of treatment, particularly around the diagnostic threshold. PMID:21705406

  10. Variability amongst radiographers in the categorization of clinical acceptability for digital trauma radiography

    NASA Astrophysics Data System (ADS)

    Decoster, Robin; Toomey, Rachel; Smits, Dirk; Mol, Harrie; Verhelle, Filip; Butler, Marie-Louise

    2016-03-01

    Introduction: Radiographers evaluate anatomical structures to judge clinical acceptability of a radiograph. Whether a radiograph is deemed acceptable for diagnosis or not depends on the individual decision of the radiographer. Individual decisions cause variation in the accepted image quality. To minimise these variations definitions of acceptability, such as in RadLex, were developed. On which criteria radiographers attribute a RadLex categories to radiographs is unknown. Insight into these criteria helps to further optimise definitions and reduce variability in acceptance between radiographers. Therefore, this work aims the evaluation of the correlation between the RadLex classification and the evaluation of anatomical structures, using a Visual Grading Analysis (VGA) Methods: Four radiographers evaluated the visibility of five anatomical structures of 25 lateral cervical spine radiographs on a secondary class display with a VGA. They judged clinical acceptability of each radiograph using RadLex. Relations between VGAS and RadLex category were analysed with Kendall's Tau correlation and Nagelkerke pseudo-R². Results: The overall VGA score (VGAS) and the RadLex score correlate (rτ= 0.62, p<0.01, R2=0.72) strongly. The observers' evaluation of contrast between bone, air (trachea) and soft tissue has low value in predicting (rτ=0.55, p<0.01, R2=0.03) the RadLex score. The reproduction of spinous processes (rτ=0.67, p<0.01, R2=0.31) and the evaluation of the exposure (rτ=0.65, p<0.01, R2=0.56) have a strong correlation with high predictive value for the RadLex score. Conclusion: RadLex scores and VGAS correlate positively, strongly and significantly. The predictive value of bony structures may support the use of these in the judgement of clinical acceptability. Considerable inter-observer variations in the VGAS within a certain RadLex category, suggest that observers use of observer specific cut

  11. Thrombocytopenia in common variable immunodeficiency patients – clinical course, management, and effect of immunoglobulins

    PubMed Central

    Siedlar, Maciej; Kowalczyk, Danuta; Szaflarska, Anna; Błaut-Szlósarczyk, Anita; Zwonarz, Katarzyna

    2015-01-01

    Common variable immunodeficiency (CVID) is a primary immunodeficiency of humoral immunity with heterogeneous clinical features. Diagnosis of CVID is based on hypogammaglobulinaemia, low production of specific antibodies, and disorders of cellular immunity. The standard therapy includes replacement of specific antibodies with human immunoglobulin, prophylaxis, and symptomatic therapy of infections. High prevalence of autoimmunity is characteristic for CVID, most commonly: thrombocytopaenia and neutropaenia, celiac disease, and systemic autoimmune diseases. The study included seven children diagnosed with CVID and treated with immunoglobulin substitution from 2 to 12 years. Thrombocytopenia was diagnosed prior to CVID in four children, developed during immunoglobulin substitution in three children. In one boy with CVID and thrombocytopaenia, haemolytic anaemia occurred, so a diagnosis of Evans syndrome was established. Therapy of thrombocytopaenia previous to CVID included steroids and/or immunoglobulins in high dose, and azathioprine. In children with CVID on regular immunoglobulin substitution, episodes of acute thrombocytopaenia were associated with infections and were treated with high doses of immunoglobulins and steroids. In two patients only chronic thrombocytopaenia was noted. Splenectomy was necessary in one patient because of severe course of thrombocytopaenia. The results of the study indicated a supportive role of regular immunoglobulin substitution in patients with CVID and chronic thrombocytopaenia. However, regular substitution of immunoglobulins in CVID patients did not prevent the occurrence of autoimmune thrombocytopaenia episodes or exacerbations of chronic form. In episodes of acute thrombocytopaenia or exacerbations of chronic thrombocytopaenia, infusions of immunoglobulins in high dose are effective, despite previous regular substitution in the replacing dose. PMID:26155188

  12. Staphylococcus agnetis sp. nov., a coagulase-variable species from bovine subclinical and mild clinical mastitis.

    PubMed

    Taponen, Suvi; Supré, Karlien; Piessens, Veerle; Van Coillie, Els; De Vliegher, Sarne; Koort, Joanna M K

    2012-01-01

    Thirteen Gram-positive-staining coagulase-variable staphylococci were isolated from subclinical and mild clinical mastitic bovine milk (n=12) and a teat apex (n=1). The results of sequence analysis of the 16S rRNA gene and two housekeeping genes, rpoB and tuf, and DNA fingerprinting with amplified fragment length polymorphism (AFLP) analysis showed that the isolates formed a separate branch within the genus Staphylococcus. The phylogenetically most closely related species were Staphylococcus hyicus and Staphylococcus chromogenes. DNA-DNA hybridization with S. hyicus DSM 20459(T) and S. chromogenes DSM 20674(T) confirmed that the isolates belonged to a separate species. The predominant fatty acids were i-C(15:0), ai-C(15:0), i-C(17:0) and C(20:0) and the peptidoglycan type was A3α L-Lys-Gly(5). Based on the results of genotypic and phenotypic analyses, it is proposed that the thirteen isolates represent a novel species, for which the name Staphylococcus agnetis sp. nov. is proposed. Strain 6-4(T) (=DSM 23656(T)=CCUG 59809(T)) is the type strain. PMID:21335502

  13. Bayesian sequential monitoring design for two-arm randomized clinical trials with noncompliance

    PubMed Central

    Shen, Weining; Ning, Jing; Yuan, Ying

    2015-01-01

    In early-phase clinical trials, interim monitoring is commonly conducted based on the estimated intent-to-treat effect, which is subject to bias in the presence of noncompliance. To address this issue, we propose a Bayesian sequential monitoring trial design based on the estimation of the causal effect using a principal stratification approach. The proposed design simultaneously considers efficacy and toxicity outcomes, and utilizes covariates to predict a patient’s potential compliance behavior and identify the causal effects. Based on accumulating data, we continuously update the posterior estimates of the causal treatment effects, and adaptively make the go/no-go decision for the trial. Numerical results show that the proposed method has desirable operating characteristics and addresses the issue of noncompliance. PMID:25756852

  14. AARC clinical practice guideline: transcutaneous monitoring of carbon dioxide and oxygen: 2012.

    PubMed

    Restrepo, Ruben D; Hirst, Keith R; Wittnebel, Leonard; Wettstein, Richard

    2012-11-01

    An electronic literature search for articles published between January 1990 and September 2011 was conducted by using the PubMed, CINAHL, SCOPUS, and Cochrane Library databases. The update of this clinical practice guideline is the result of reviewing a total of 124 articles: 3 randomized controlled trials, 103 prospective trials, 1 retrospective study, 3 case studies, 11 review articles, 2 surveys and 1 consensus paper on transcutaneous monitoring (TCM) for P(tcO(2)) and P(tcCO(2)). The following recommendations are made following the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria: (1) Although P(tcCO(2)) has a good correlation with P(aCO(2)) and is a reliable method to evaluate plasma CO(2) levels, it is recommended that arterial blood gas values be compared to transcutaneous readings taken at the time of arterial sampling, in order to verify the transcutaneous values, and periodically as dictated by the patient's clinical condition. (2) It is suggested that P(tcCO(2)) may be used in clinical settings where monitoring the adequacy of ventilation is indicated. (3) It is suggested that P(tcO(2)) and P(tcCO(2)) may be used in determining the adequacy of tissue perfusion and monitoring of reperfusion. (4) It is suggested that TCM should be avoided in the presence of increased thickness or edema of the skin and/or subcutaneous tissue where the sensor is applied. (5) It is recommended that sites used for a TCM be changed as often as necessary and that they be alternated and observed to avoid thermal injury. Manufacturer recommendations should be followed. PMID:23107301

  15. The Effect of Clozapine on Premature Mortality: An Assessment of Clinical Monitoring and Other Potential Confounders

    PubMed Central

    Hayes, Richard D.; Downs, Johnny; Chang, Chin-Kuo; Jackson, Richard G.; Shetty, Hitesh; Broadbent, Matthew; Hotopf, Matthew; Stewart, Robert

    2015-01-01

    Clozapine can cause severe adverse effects yet it is associated with reduced mortality risk. We test the hypothesis this association is due to increased clinical monitoring and investigate risk of premature mortality from natural causes. We identified 14 754 individuals (879 deaths) with serious mental illness (SMI) including schizophrenia, schizoaffective and bipolar disorders aged ≥ 15 years in a large specialist mental healthcare case register linked to national mortality tracing. In this cohort study we modeled the effect of clozapine on mortality over a 5-year period (2007–2011) using Cox regression. Individuals prescribed clozapine had more severe psychopathology and poorer functional status. Many of the exposures associated with clozapine use were themselves risk factors for increased mortality. However, we identified a strong association between being prescribed clozapine and lower mortality which persisted after controlling for a broad range of potential confounders including clinical monitoring and markers of disease severity (adjusted hazard ratio 0.4; 95% CI 0.2–0.7; p = .001). This association remained after restricting the sample to those with a diagnosis of schizophrenia or those taking antipsychotics and after using propensity scores to reduce the impact of confounding by indication. Among individuals with SMI, those prescribed clozapine had a reduced risk of mortality due to both natural and unnatural causes. We found no evidence to indicate that lower mortality associated with clozapine in SMI was due to increased clinical monitoring or confounding factors. This is the first study to report an association between clozapine and reduced risk of mortality from natural causes. PMID:25154620

  16. Correlation between genetic variability and virulence factors in clinical strains of Malassezia pachydermatis of animal origin.

    PubMed

    Buommino, Elisabetta; Nocera, Francesca Paola; Parisi, Annamaria; Rizzo, Antonietta; Donnarumma, Giovanna; Mallardo, Karina; Fiorito, Filomena; Baroni, Adone; De Martino, Luisa

    2016-09-01

    Malassezia pachydermatis is a yeast belonging to the microbiota of the skin and mucous membranes of dog and cat, but it can also act as pathogen, causing dermatitis. The aim of this work was to evaluate the genetic variability of M. pachydermatis strains isolated from symptomatic dogs and cats and determine a correlation between genotype and phenotype. For this purpose eleven strains of M. pachydermatis were molecularly classified by nested-polymerase chain reaction (nested-PCR) based on ITS-1 and ITS-2 regions, specific for fungal rRNA genes. Furthermore, random amplification of polymorphic DNA (RAPD) was applied for genetic typing of M. pachydermatis isolates identifying four different genotypes. Strains belonging to genotype 1 produced the highest amount of biofilm and phospholipase activity. The inflammatory response induced by M. pachydermatis strains in immortalized human keratinocytes (HaCat cells) was significantly different when we compared the results obtained from each strain. In particular, HaCat cells infected with the strains belonging to genotypes 1 and 2 triggered the highest levels of increase in TLR-2, IL-1β, IL-6, IL-8, COX-2 and MMP-9 expression. By contrast, cells infected with the strains of genotype 3 and those of genotype 4 did not significantly induce TLR-2 and cytokines. The results obtained might suggest a possible association between genotype and virulence factors expressed by M. pachydermatis strains. This highlights the need for a more accurate identification of the yeast to improve the therapeutic approach and to monitor the onset of human infections caused by this emergent zoonotic pathogen. PMID:27602421

  17. Clinical validation of LTMS-S: A wearable system for vital signs monitoring.

    PubMed

    Chételat, Olivier; Ferrario, Damien; Proença, Martin; Porchet, Jacques-André; Falhi, Abdessamad; Grossenbacher, Olivier; Delgado-Gonzalo, Ricard; Della Ricca, Nicolas; Sartori, Claudio

    2015-01-01

    LTMS-S is a new wearable system for the monitoring of several physiological signals--including a two-lead electrocardiogram (ECG)--and parameters, such as the heart rate, the breathing rate, the peripheral oxygen saturation (SpO2), the core body temperature (CBT), and the physical activity. All signals are measured using only three sensors embedded within a vest. The sensors are standalone with their own rechargeable battery, memory, wireless communication and with an autonomy exceeding 24 hours. This paper presents the results of the clinical validation of the LTMS-S system. PMID:26736954

  18. Optic Nerve Sheath Diameter: Translating a Terrestrial Focused Technique into a Clinical Monitoring Tool for Spaceflight

    NASA Technical Reports Server (NTRS)

    Mason, Sara; Foy, Millennia; Sargsyan, Ashot; Garcia, Kathleen; Wear, Mary L.; Bedi, Deepak; Ernst, Randy; Van Baalen, Mary

    2015-01-01

    Ultrasonography is increasingly used to quickly measure optic nerve sheath diameter (ONSD) when increased intracranial pressure (ICP) is suspected. NASA Space and Clinical Operations Division has been using ground and on-orbit ultrasound since 2009 as a proxy for ICP in non-acute monitoring for space medicine purposes. In the terrestrial emergency room population, an ONSD greater than 0.59 cm is considered highly predictive of elevated intracranial pressure. However, this cut-off limit is not applicable to the spaceflight setting since over 50% of US Operating Segment (USOS) astronauts have an ONSD greater than 0.60 cm even before launch. Crew Surgeon clinical decision-making is complicated by the fact that many astronauts have history of previous spaceflights. Our data characterize the distribution of baseline ONSD in the astronaut corps, its longitudinal trends in long-duration spaceflight, and the predictive power of this measure related to increased ICP outcomes.

  19. Monitoring of radiation dose rates around a clinical nuclear medicine site

    NASA Astrophysics Data System (ADS)

    Shao, Chia-Ho; Lu, Cheng-Chang; Chen, Tou-Rong; Weng, Jui-Hung; Kao, Pan-Fu; Dong, Shang-Lung; Chou, Ming-Jen

    2014-11-01

    The monitoring of radiation dose around the nuclear medicine site is an important study issue. In this study, TLD-100H radiation dosimeters were used to measure the ambient radiation dose rates around a clinical nuclear medicine site in order to investigate the latent hot zones of radiation exposure. Results of this study showed that the radiation doses measured from all piping and storage systems were comparable to the background dose. A relatively high dose was observed at the single bend point of waste water piping of the PET/CT. Another important finding was the unexpected high dose rates observed at the non-restricted waiting area (NRWA) of SPECT. To conclude, this study provides useful information for further determination of an appropriate dose reduction strategy to achieve the ALARA principle in a clinical nuclear medicine site.

  20. Clinical accuracy of a continuous glucose monitoring system with an advanced algorithm.

    PubMed

    Bailey, Timothy S; Chang, Anna; Christiansen, Mark

    2015-03-01

    We assessed the performance of a modified Dexcom G4 Platinum system with an advanced algorithm, in comparison with frequent venous samples measured on a laboratory reference (YSI) during a clinic session and in comparison to self-monitored blood glucose (SMBG) during home use. Fifty-one subjects with diabetes were enrolled in a prospective multicenter study. Subjects wore 1 sensor for 7-day use and participated in one 12-hour in-clinic session on day 1, 4, or 7 to collect YSI reference venous glucose every 15 minutes and capillary SMBG test every 30 minutes. Carbohydrate consumption and insulin dosing and timing were manipulated to obtain data in low and high glucose ranges. In comparison with the laboratory reference method (n = 2,263) the system provided a mean and median absolute relative differences (ARD) of 9.0% and 7.0%, respectively. The mean absolute difference for CGM was 6.4 mg/dL when the YSIs were within hypoglycemia ranges (≤ 70 mg/dL). The percentage in the clinically accurate Clarke error grid A zone was 92.4% and in the benign error B zone was 7.1%. Majority of the sensors (73%) had an aggregated MARD in reference to YSI ≤ 10%. The MARD of CGM-SMBG for home use was 11.3%. The study showed that the point and rate accuracy, clinical accuracy, reliability, and consistency over the duration of wear and across glycemic ranges were superior to current commercial real-time CGM systems. The performance of this CGM is reaching that of a self-monitoring blood glucose meter in real use environment. PMID:25370149

  1. Design and Evaluation of an Intelligent Remote Tidal Volume Variability Monitoring System in E-Health Applications.

    PubMed

    Fekr, Atena Roshan; Radecka, Katarzyna; Zilic, Zeljko

    2015-09-01

    A reliable long-term monitoring and diagnosis of breath disorders at an early stage provides an improvement of medical act, life expectancy, and quality of life while decreasing the costs of treatment and medical services. Therefore, a real-time unobtrusive monitoring of respiration patterns, as well as breath parameters, is a critical need in medical applications. In this paper, we propose an intelligent system for patient home care, capable of measuring respiration rate and tidal volume variability via a wearable sensing technology. The proposed system is designed particularly for the goal of diagnosis and treatment in patients with pathological breathing, e.g., respiratory complications after surgery or sleep disorders. The complete system was comprised of wearable calibrated accelerometer sensor, Bluetooth low energy, and cloud database. The experiments are conducted with eight subjects and the overall error in respiration rate calculation is obtained 0.29%±0.33% considering SPR-BTA spirometer as the reference. We also introduce a method for tidal volume variability estimation while validated using Pearson correlation. Furthermore, since it is essential to detect the critical events resulted from sudden rise or fall in per breath tidal volume of the patients, we provide a technique to automatically find the accurate threshold values based on each individual breath characteristics. Therefore, the system is able to detect the major changes, precisely by more than 98%, and provide immediate feedback such as sound alarm for round-the-clock respiration monitoring. PMID:26087508

  2. Combination of process and vibration data for improved condition monitoring of industrial systems working under variable operating conditions

    NASA Astrophysics Data System (ADS)

    Ruiz-Cárcel, C.; Jaramillo, V. H.; Mba, D.; Ottewill, J. R.; Cao, Y.

    2016-01-01

    The detection and diagnosis of faults in industrial processes is a very active field of research due to the reduction in maintenance costs achieved by the implementation of process monitoring algorithms such as Principal Component Analysis, Partial Least Squares or more recently Canonical Variate Analysis (CVA). Typically the condition of rotating machinery is monitored separately using vibration analysis or other specific techniques. Conventional vibration-based condition monitoring techniques are based on the tracking of key features observed in the measured signal. Typically steady-state loading conditions are required to ensure consistency between measurements. In this paper, a technique based on merging process and vibration data is proposed with the objective of improving the detection of mechanical faults in industrial systems working under variable operating conditions. The capabilities of CVA for detection and diagnosis of faults were tested using experimental data acquired from a compressor test rig where different process faults were introduced. Results suggest that the combination of process and vibration data can effectively improve the detectability of mechanical faults in systems working under variable operating conditions.

  3. Future clinical uses of neurophysiological biomarkers to predict and monitor treatment response for schizophrenia

    PubMed Central

    Light, Gregory A.; Swerdlow, Neal R.

    2015-01-01

    Advances in psychiatric neuroscience have transformed our understanding of impaired and spared brain functions in psychotic illnesses. Despite substantial progress, few if any laboratory tests have graduated to clinics to inform diagnoses, guide treatments, and monitor treatment response. Providers must rely on careful behavioral observation and interview techniques to make inferences about patients’ inner experiences and then secondary deductions about impacted neural systems. Development of more effective treatments has also been hindered by a lack of translational quantitative biomarkers that can span the brain–behavior–treatment knowledge gap. Here, we describe an example of a simple, low-cost, and translatable electroencephalography (EEG) measure that offers promise for improving our understanding and treatment of psychotic illnesses: mismatch negativity (MMN). MMN is sensitive to and/or predicts response to some pharmacologic and non-pharmacologic interventions and accounts for substantial portions of variance in clinical, cognitive, and psychosocial functioning in schizophrenia. This measure has recently been validated for use in large-scale multisite clinical studies of schizophrenia. Lastly, MMN greatly improves our ability to forecast which individuals at high clinical risk actually develop a psychotic illness. These attributes suggest that MMN can contribute to personalized biomarker-guided treatment strategies aimed at ameliorating or even preventing the onset of psychosis. PMID:25752648

  4. Clinical Use of Anti-Xa Monitoring in Malignancy-Associated Thrombosis.

    PubMed

    Yentz, Sarah; Onwuemene, Oluwatoyosi A; Stein, Brady L; Cull, Elizabeth H; McMahon, Brandon

    2015-01-01

    Introduction. Low molecular weight heparin (LMWH) is preferred for malignancy-associated venous thromboembolism (VTE). Many providers monitor LMWH with anti-Xa levels, despite little validation on correspondence with patient outcome. Methods. This is a retrospective, single institution study of anti-Xa measurement in malignancy-associated thrombosis. Cases were identified using the Electronic Data Warehouse, and inclusion was confirmed by two independent reviewers. Malignancy type, thrombotic history, measurement rationale and accuracy, clinical context, and management changes were evaluated. Results. 167 cases met inclusion criteria. There was no clear rationale for anti-Xa testing in 56%. Impaired renal function (10%), documented or suspected recurrent thrombosis despite anticoagulation (9%), and bleeding (6%) were the most common reasons for testing. Incorrect measurement occurred in 44%. Renal impairment was not a significant impetus for testing, as 70% had a GFR > 60. BMI > 30 was present in 40%, and 28% had a BMI < 25. Clinical impact was low, as only 11% of patients had management changes. Conclusions. Provider education in accuracy and rationale for anti-Xa testing is needed. Our study illustrates uncertainty of interpretation and clinical impact of routine anti-Xa testing, as management was affected in few patients. It is not yet clear in which clinical context providers should send anti-Xa levels. PMID:26543644

  5. Evaluating measurement models in clinical research: covariance structure analysis of latent variable models of self-conception.

    PubMed

    Hoyle, R H

    1991-02-01

    Indirect measures of psychological constructs are vital to clinical research. On occasion, however, the meaning of indirect measures of psychological constructs is obfuscated by statistical procedures that do not account for the complex relations between items and latent variables and among latent variables. Covariance structure analysis (CSA) is a statistical procedure for testing hypotheses about the relations among items that indirectly measure a psychological construct and relations among psychological constructs. This article introduces clinical researchers to the strengths and limitations of CSA as a statistical procedure for conceiving and testing structural hypotheses that are not tested adequately with other statistical procedures. The article is organized around two empirical examples that illustrate the use of CSA for evaluating measurement models with correlated error terms, higher-order factors, and measured and latent variables. PMID:2002144

  6. Effects of CD4 monitoring frequency on clinical endpoints in clinically stable HIV-infected patients with viral suppression

    PubMed Central

    Ahn, Jin Young; Boettiger, David; Law, Matthew; Kumarasamy, Nagalingeswaran; Yunihastuti, Evy; Chaiwarith, Romanee; Lee, Man Po; Sim, Benedict LH; Oka, Shinichi; Wong, Wingwai; Kamarulzaman, Adeeba; Kantipong, Pacharee; Phanuphak, Praphan; Ng, Oon Tek; Kiertiburanakul, Sasisopin; Zhang, Fujie; Pujari, Sanjay; Ditangco, Rossana; Ratanasuwan, Winai; Merati, Tuti Parwati; Saphonn, Vonthanak; Sohn, Annette H.; Choi, Jun Yong

    2015-01-01

    Background Current treatment guidelines for HIV infection recommend routine CD4+ lymphocyte (CD4) count monitoring in patients with viral suppression. This may have a limited impact on influencing care as clinically meaningful CD4 decline rarely occurs during viral suppression. Methods In a regional HIV observational cohort in the Asia-Pacific, patients with viral suppression (2 consecutive viral loads <400 copies/mL) and a CD4 count ≥200 cells/μL who had CD4 testing 6 monthly were analyzed. Main study endpoints were occurrence of one CD4 count <200 cells/μL (single CD4<200) and two CD4 counts <200 cells/μL within a 6-month period (confirmed CD4<200). A comparison of time to single and confirmed CD4<200 with biannual or annual CD4 assessment was performed by generating a hypothetical group comprised of the same patients with annual CD4 testing by removing every second CD4 count. Results Among 1538 patients, the rate of single CD4<200 was 3.45/100 patient-years, and of confirmed CD4<200 was 0.77/100 patient-years. During 5 years of viral suppression, patients with baseline CD4 200-249 cells/μL were significantly more likely to experience confirmed CD4<200 compared with patients with higher baseline CD4 (hazard ratio 55.47 [95% confidence interval 7.36–418.20], p<0.001 versus baseline CD4 ≥500 cells/μL). Cumulative probabilities of confirmed CD4<200 was also higher in patients with baseline CD4 200-249 cells/μL compared with patients with higher baseline CD4. There was no significant difference in time to confirmed CD4<200 between biannual and annual CD4 measurement (p=0.336). Conclusions Annual CD4 monitoring in virally suppressed HIV patients with a baseline CD4 ≥250 cells/μL may be sufficient for clinical management. PMID:25850606

  7. Variability in young very low mass stars: two surprises from spectrophotometric monitoring

    NASA Astrophysics Data System (ADS)

    Bozhinova, I.; Scholz, A.; Eislöffel, J.

    2016-05-01

    We present simultaneous photometric and spectroscopic observations of seven young and highly variable M dwarfs in star-forming regions in Orion, conducted in four observing nights with FOcal Reducer and low dispersion Spectrograph2 at European Southern Observatory/VLT. All seven targets show significant photometric variability in the I band, with amplitudes between 0.1-0.8 mag, The spectra, however, remain remarkably constant, with spectral type changes less than 0.5 subtypes. Thus, the brightness changes are not caused by veiling that `fills in' absorption features. Three objects in the σ Ori cluster (age ˜3 Myr) exhibit strong Hα emission and Hα variability, in addition to the continuum variations. Their behaviour is mostly consistent with the presence of spots with temperature of ˜300 K above the photosphere and filling factors between 0.2-0.4, in contrast to typical hotspots observed in more massive stars. The remaining targets near ɛ Ori, likely to be older, show eclipse-like light curves, no significant Hα activity and are better represented by variable extinction due to circumstellar material. Interestingly, two of them show no evidence of infrared excess emission. Our study shows that high-amplitude variability in young very low mass stars can be caused by different phenomena than in more massive T Tauri stars and can persist when the disc has disappeared and accretion has ceased.

  8. Methodology and technology for peripheral and central blood pressure and blood pressure variability measurement: current status and future directions - Position statement of the European Society of Hypertension Working Group on blood pressure monitoring and cardiovascular variability.

    PubMed

    Stergiou, George S; Parati, Gianfranco; Vlachopoulos, Charalambos; Achimastos, Apostolos; Andreadis, Emanouel; Asmar, Roland; Avolio, Alberto; Benetos, Athanase; Bilo, Grzegorz; Boubouchairopoulou, Nadia; Boutouyrie, Pierre; Castiglioni, Paolo; de la Sierra, Alejandro; Dolan, Eamon; Head, Geoffrey; Imai, Yutaka; Kario, Kazuomi; Kollias, Anastasios; Kotsis, Vasilis; Manios, Efstathios; McManus, Richard; Mengden, Thomas; Mihailidou, Anastasia; Myers, Martin; Niiranen, Teemu; Ochoa, Juan Eugenio; Ohkubo, Takayoshi; Omboni, Stefano; Padfield, Paul; Palatini, Paolo; Papaioannou, Theodore; Protogerou, Athanasios; Redon, Josep; Verdecchia, Paolo; Wang, Jiguang; Zanchetti, Alberto; Mancia, Giuseppe; O'Brien, Eoin

    2016-09-01

    Office blood pressure measurement has been the basis for hypertension evaluation for almost a century. However, the evaluation of blood pressure out of the office using ambulatory or self-home monitoring is now strongly recommended for the accurate diagnosis in many, if not all, cases with suspected hypertension. Moreover, there is evidence that the variability of blood pressure might offer prognostic information that is independent of the average blood pressure level. Recently, advancement in technology has provided noninvasive evaluation of central (aortic) blood pressure, which might have attributes that are additive to the conventional brachial blood pressure measurement. This position statement, developed by international experts, deals with key research and practical issues in regard to peripheral blood pressure measurement (office, home, and ambulatory), blood pressure variability, and central blood pressure measurement. The objective is to present current achievements, identify gaps in knowledge and issues concerning clinical application, and present relevant research questions and directions to investigators and manufacturers for future research and development (primary goal). PMID:27214089

  9. Yoga for Heart Rate Variability: A Systematic Review and Meta-analysis of Randomized Clinical Trials.

    PubMed

    Posadzki, Paul; Kuzdzal, Adrian; Lee, Myeong Soo; Ernst, Edzard

    2015-09-01

    The objective of this systematic review is to summarize and critically assess the effects of yoga on heart rate variability (HRV). Nine databases were searched from their inceptions to June 2014. We included randomized clinical trials (RCTs) comparing yoga against any type of control intervention in healthy individuals or patients with any medical condition. Risk of bias was assessed using the Cochrane criteria. Two reviewers performed the selection of studies, data extraction, and quality assessments independent of one another. Fourteen trials met the inclusion criteria. Only two of them were of acceptable methodological quality. Ten RCTs reported favourable effects of yoga on various domains of HRV, whereas nine of them failed to do so. One RCT did not report between-group comparisons. The meta-analysis (MA) of two trials did not show favourable effects of yoga compared to usual care on E:I ratio (n = 61, SMDs = 0.63; 95% CIs [-0.72 to 1.99], p = 0.36; heterogeneity: r(2) = 0.79, χ(2) = 5.48, df = 1, (p = 0.02); I(2) = 82%). The MA also failed to show statistically significant differences between the groups regarding the 30:15 ratio (n = 61, SMDs = 0.20; 95% CIs [-0.43 to 0.84], p = 0.53; heterogeneity: r(2) = 0.07, χ(2) = 1.45, df = 1, (p = 0.23); I(2) = 31%). The data from the remaining RCTs were too heterogeneous for pooling. These results provide no convincing evidence for the effectiveness of yoga in modulating HRV in patients or healthy subjects. Future investigations in this area should overcome the multiple methodological weaknesses of the previous research. PMID:26059998

  10. Hyposecretion of the adrenal androgen dehydroepiandrosterone sulfate and its relation to clinical variables in inflammatory arthritis.

    PubMed

    Dessein, P H; Joffe, B I; Stanwix, A E; Moomal, Z

    2001-01-01

    Hypothalamic-pituitary-adrenal underactivity has been reported in rheumatoid arthritis (RA). This phenomenon has implications with regard to the pathogenesis and treatment of the disease. The present study was designed to evaluate the secretion of the adrenal androgen dehydroepiandrosterone sulfate (DHEAS) and its relation to clinical variables in RA, spondyloarthropathy (Spa), and undifferentiated inflammatory arthritis (UIA). Eighty-seven patients (38 with RA, 29 with Spa, and 20 with UIA) were studied, of whom 54 were women. Only 12 patients (14%) had taken glucocorticoids previously. Age-matched, healthy women (134) and men (149) served as controls. Fasting blood samples were taken for determination of the erythrocyte sedimentation rate (ESR), serum DHEAS and insulin, and plasma glucose. Insulin resistance was estimated by the homeostasis-model assessment (HOMAIR). DHEAS concentrations were significantly decreased in both women and men with inflammatory arthritis (IA) (P < 0.001). In 24 patients (28%), DHEAS levels were below the lower extreme ranges found for controls. Multiple intergroup comparisons revealed similarly decreased concentrations in each disease subset in both women and men. After the ESR, previous glucocorticoid usage, current treatment with nonsteroidal anti-inflammatory drugs, duration of disease and HOMAIR were controlled for, the differences in DHEAS levels between patients and controls were markedly attenuated in women (P = 0.050) and were no longer present in men (P = 0.133). We concluded that low DHEAS concentrations are commonly encountered in IA and, in women, this may not be fully explainable by disease-related parameters. The role of hypoadrenalism in the pathophysiology of IA deserves further elucidation. DHEA replacement may be indicated in many patients with IA, even in those not taking glucocorticoids. PMID:11299059