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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. 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.

  6. 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.

  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. 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

  12. 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.

  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. 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.

  4. 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

  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. 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

  12. 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

  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. 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…

  17. 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.

  18. 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...

  19. 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...

  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. 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

  3. 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

  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. 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.

  11. 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

  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. 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.

  15. 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

  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. 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.

  3. 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

  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. 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.

  13. 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

  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. 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

  16. 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.

  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. 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

  19. 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…

  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. 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

  18. 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

  19. 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

  20. 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

  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. 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.

  5. 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

  6. 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

  7. 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.

  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. 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

  11. 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

  12. 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

  13. 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

  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. 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.

  17. 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

  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. 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.

  20. 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

  1. 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

  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. 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

  16. 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.

  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. 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

  1. 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

  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. 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

  10. 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

  11. 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

  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. 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

  5. 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.

  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. 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.

  19. 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.

  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. 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.

  7. 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

  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. 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

  10. 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

  11. USING INFORMATION ON SPATIAL VARIABILITY OF SMALL ESTUARIES IN DESIGNING LARGE GEOGRAPHIC SCALE ESTUARINE MONITORING PROGRAMS

    EPA Science Inventory

    In the early 1990s, EPA's Environmental Monitoring and Assessment Program (EMAP) documented the ecological condition of the overall population of small estuaries along the Mid-Atlantic coast of the United States. However, the Program did not provide information on the condition o...

  12. USING INFORMATION ON SPATIAL VARIABILITY OF SMALL ESTUARIES IN DESIGNING LARGE SCALE ESTUARINE MONITORING PROGRAMS

    EPA Science Inventory

    In the early 1990's, EPA's Environmental Monitoring and Assessment program (EMAP) documented the ecological condition of the overall population of small estuaries along the mid-Atlantic coast of the United States. However, the Program did not provide detailed information on the c...

  13. Turbidity-based sediment monitoring in northern Thailand: Hysteresis, variability, and uncertainty

    EPA Science Inventory

    Annual total suspended solid (TSS) loads in the Mae Sa Catchment in northern Thailand, determined with an automated, turbidity-based monitoring approach, were approximately 62,000, 33,000, and 14,000 Mg during the three years of observation. These loads were equivalent to basin y...

  14. Home Monitoring for Cardiovascular Implantable Electronic Devices: Benefits to Patients and to Their Follow-up Clinic.

    PubMed

    Leahy, Robin A; Davenport, Elizabeth E

    2015-01-01

    Recent technological advances in the management of patients with cardiovascular implantable electronic devices (CIEDs) have expanded clinicians' ability to remotely monitor patients with CIEDs. Remote monitoring, in addition to periodic in-person device evaluation, provides many advantages to patients and clinicians. Aside from the therapeutic and diagnostic benefits of pacemakers, implantable cardioverter-defibrillators, cardiac resynchronization therapy devices, and implantable loop recorders, improvement in clinical outcomes, clinical efficiencies, and patient experience can be realized with the adoption of remote CIED monitoring. These advantages create significant value to both patients and CIED follow-up centers. PMID:26484995

  15. The accuracy of non-invasive carbon dioxide monitoring: a clinical evaluation of two transcutaneous systems.

    PubMed

    Bolliger, D; Steiner, L A; Kasper, J; Aziz, O A; Filipovic, M; Seeberger, M D

    2007-04-01

    We determined the accuracy of two transcutaneous carbon dioxide monitoring systems (SenTec Digital Monitor with V-Sign Sensor and TOSCA 500 with TOSCA Sensor 92) for the measurement of single values and trends in the arterial partial pressure of carbon dioxide in 122 adult patients during major surgery and in 50 adult patients in the intensive care unit. One or several paired measurements were performed in each patient. The first measurement was used to determine the accuracy of a single value of transcutaneous carbon dioxide; the difference between the first and the last measurements was used to analyse the accuracy and to track trends. We defined a 95% limit of agreement of clinically useful. There was insufficient agreement between transcutaneous carbon dioxide partial pressure values derived from the two systems and arterial carbon dioxide values for both single values and trends as defined by our suggested limit of agreement. We conclude that these systems cannot replace conventional blood gas analysis in the clinical setting studied. PMID:17381578

  16. [Monitoring the safety of participants in randomised clinical trials: basis and methods].

    PubMed

    Tijssen, J G P

    2008-03-22

    --Prior to conducting a randomised trial, permission must be obtained from the medical ethics committee (METC). The METC assesses the relevance of the trial and the appropriateness of the chosen study methods. It also weighs the clinical/scientific relevance against the potential benefits, risks and burdens for participants. --Monitoring interim data is the responsibility of an independent data monitoring committee (DMC), comprised of experts in the relevant field. The DMC provides recommendations to the study directors regarding the continuation, amendment or possibly early stopping of the study (when participant safety becomes an issue or when the trial aims are achieved earlier than expected). --Reported adverse events are interpreted clinically by the DMC in the context of available safety data. A statistical protocol for this process cannot be defined prospectively. --A strict statistical protocol can be defined prospectively for the interim analysis of the efficacy of the investigational intervention. In some cases, the results can be so convincing that the study can be stopped early. In other cases, the differences between groups may be smaller than expected, and increasing the size of the study groups can be considered. --In a blinded study, only an independent statistician is aware of the treatment codes. The chair of the DMC also possesses a sealed envelope containing the codes. The envelope can be opened at the request of the entire DMC. PMID:18438062

  17. Finding Stellar Variability: Monitoring Algol with On-Line Night Sky Live Data

    NASA Astrophysics Data System (ADS)

    Muzzin, V.; Shamir, L.; Nemiroff, R. J.; Night Sky Live Collaboration

    2004-12-01

    Advanced undergraduates now have the opportunity to track the brightness and variability of famous variable stars all over the sky with no more than a web browser and a spreadsheet. The opportunity arises from the Night Sky Live global network of fisheye CONtinuous CAMeras (CONCAMs) which generate public domain, on-line data, freely available at http://NightSkyLive.net . Here we use the deep eclipses of Beta Perseus (Algol) to demonstrate the use of the automatically generated photometry tables. Useful educational concepts in statistics and practical astronomy are clearly demonstrated.

  18. Incorporation of expert variability into breast cancer treatment recommendation in designing clinical protocol guided fuzzy rule system models.

    PubMed

    Garibaldi, Jonathan M; Zhou, Shang-Ming; Wang, Xiao-Ying; John, Robert I; Ellis, Ian O

    2012-06-01

    It has been often demonstrated that clinicians exhibit both inter-expert and intra-expert variability when making difficult decisions. In contrast, the vast majority of computerized models that aim to provide automated support for such decisions do not explicitly recognize or replicate this variability. Furthermore, the perfect consistency of computerized models is often presented as a de facto benefit. In this paper, we describe a novel approach to incorporate variability within a fuzzy inference system using non-stationary fuzzy sets in order to replicate human variability. We apply our approach to a decision problem concerning the recommendation of post-operative breast cancer treatment; specifically, whether or not to administer chemotherapy based on assessment of five clinical variables: NPI (the Nottingham Prognostic Index), estrogen receptor status, vascular invasion, age and lymph node status. In doing so, we explore whether such explicit modeling of variability provides any performance advantage over a more conventional fuzzy approach, when tested on a set of 1310 unselected cases collected over a fourteen year period at the Nottingham University Hospitals NHS Trust, UK. The experimental results show that the standard fuzzy inference system (that does not model variability) achieves overall agreement to clinical practice around 84.6% (95% CI: 84.1-84.9%), while the non-stationary fuzzy model can significantly increase performance to around 88.1% (95% CI: 88.0-88.2%), p<0.001. We conclude that non-stationary fuzzy models provide a valuable new approach that may be applied to clinical decision support systems in any application domain. PMID:22265814

  19. Use of Continuous Electronic Fetal Monitoring in a Preterm Fetus: Clinical Dilemmas and Recommendations for Practice

    PubMed Central

    Afors, Karolina; Chandraharan, Edwin

    2011-01-01

    The aim of intrapartum continuous electronic fetal monitoring using a cardiotocograph (CTG) is to identify a fetus exposed to intrapartum hypoxic insults so that timely and appropriate action could be instituted to improve perinatal outcome. Features observed on a CTG trace reflect the functioning of somatic and autonomic nervous systems and the fetal response to hypoxic or mechanical insults during labour. Although, National Guidelines on electronic fetal monitoring exist for term fetuses, there is paucity of recommendations based on scientific evidence for monitoring preterm fetuses during labour. Lack of evidence-based recommendations may pose a clinical dilemma as preterm births account for nearly 8% (1 in 13) live births in England and Wales. 93% of these preterm births occur after 28 weeks, 6% between 22–27 weeks, and 1% before 22 weeks. Physiological control of fetal heart rate and the resultant features observed on the CTG trace differs in the preterm fetus as compared to a fetus at term making interpretation difficult. This review describes the features of normal fetal heart rate patterns at different gestations and the physiological responses of a preterm fetus compared to a fetus at term. We have proposed an algorithm “ACUTE” to aid management. PMID:21922045

  20. A clinical evaluation of a remote mobility monitoring system based on SMS messaging.

    PubMed

    Dalton, Anthony F; Ní Scanaill, Cliodhna; Carew, Sheila; Lyons, Declan; OLaighin, Gearóid

    2007-01-01

    The objective of this work was to evaluate the accuracy and viability of a mobility telemonitoring system, based on the short message service (SMS), to monitor the functional mobility of elderly subjects in an unsupervised environment. A clinical trial was conducted consisting of 6 elderly subjects; 3 male, 3 female (mean: 81.7, SD: 5.09). Mobility was monitored using an accelerometer based portable unit worn by each monitored subject for eleven hours. Every 15 minutes the mobility of the subject was summarized and transmitted as an SMS message from the portable unit to a remote server for long term analysis. The activPAL Trio Professional physical activity logger was simultaneously used for comparison with the portable unit. On conclusion of the trial each subject completed a questionnaire detailing their satisfaction with the portable unit and any recommendations for improvements. Overall a percentage difference of 2.31% was found between the activPAL Trio and the portable unit for the detection of sitting. For the combined postures of standing and walking the percentage difference was calculated as 2.9%. A bivariate correlation and regression analysis was performed on the entire data set of one subject. Strong positive correlation's were found for the detection of sitting (r = 0.996) and for the combined postures of standing and walking (r = 0.994). Subjects suggested that a lighter, smaller and wireless unit would be more effective. PMID:18002458

  1. Noninvasive cerebral blood oxygenation monitoring: clinical test of multiwavelength optoacoustic system

    NASA Astrophysics Data System (ADS)

    Petrov, Y. Y.; Prough, D. S.; Petrova, I.; Patrikeev, I. A.; Cicenaite, I.; Esenaliev, R. O.

    2007-02-01

    Continuous monitoring of cerebral blood oxygenation is critically important for treatment of patients with life-threatening conditions like severe brain injury or during cardiac surgery. We designed and built a novel multiwavelength optoacoustic system for noninvasive, continuous, and accurate monitoring of cerebral blood oxygenation. We use an Optical Parametric Oscillator as a light source. We successfully tested the system in vitro as well as in vivo in large animals (sheep) through thick tissues overlying blood vessels which drain venous blood out of the brain (e.g., superior sagittal sinus or jugular vein). Here we present the results of clinical tests of the system for continuous noninvasive cerebral blood oxygenation monitoring in the internal jugular vein of healthy volunteers. We applied our custom-built optoacoustic probe (which incorporated a wide-band acoustic transducer and an optical fiber) to the neck area overlying the internal jugular vein. We performed measurements with volunteers at 18 wavelengths in the near-infrared spectral range. Despite a thick layer of overlying connective tissue and low energy used in the experiments, we recorded signals with high signal-to-noise ratios for all volunteers. We found that the temporal (independent of signal amplitude) parameters of recorded profiles for different levels of blood oxygenation correlated well with the spectrum of effective attenuation coefficients of blood.

  2. Results of a five-year program of multifrequency monitoring of low-frequency variable radio sources

    NASA Technical Reports Server (NTRS)

    Mitchell, K. J.; Dennison, Brian; Condon, J. J.; Altschuler, Daniel R.; Payne, H. E.; O'Dell, S. L.; Broderick, J. J.

    1994-01-01

    We present the results of a detailed multifrequency monitoring program of low-frequency variable radio sources. This consists of light curves at 318, 430, 606, 880, and 1400 MHz over a 5 year period. The observations were carried out with the Arecibo 305 m radiotelescope and the Green Bank 91 m radio telescope. The spectral characteristics of the variations confirm the general picture that at least two mechanisms are responsible. The first is clearly intrinsic evolution of synchrotron-emitting components as it is manifested by variations that appear first and most strongly at high frequencies, subsequently drifting to lower frequencies with diminished amplitude. The more common type of low-frequency variability, however, dominates at frequencies below approximately 800 MHz, while the variations near 1 GHz are often quite weak. This spectral property is strong evidence that these variations are interstellar refractive scintillation.

  3. A wearable respiratory monitoring device--the between-days variability of calibration.

    PubMed

    Heyde, C; Mahler, H; Roecker, K; Gollhofer, A

    2015-01-01

    The between-days variability in ascertained gain factors for calibration of a wearable respiratory inductance plethysmograph (RIP) and validity thereof for the repeated use during exercise were examined. Consecutive 5-min periods of standing still, slow running at 8 km·h(-1), fast running at 14 km·h(-1) (male) or 12 km·h(-1) (female) and recovery were repeated by 10 healthy subjects on 5 days. Breath-by-breath data were recorded simultaneously by flow meter and RIP. Gain factors were determined individually for each trial (CALIND) via least square regression. Reliability and variability in gain factors were quantified respectively by intraclass correlation coefficients (ICC) and limits of agreement. Within a predefined error range of ±20% the amount of RIP-derived tidal volumes after CALIND was compared to corresponding amounts when gain factors of the first trial were applied on the following 4 trials (CALFIRST). ICC ranged within 0.96 and 0.98. The variability in gain factors (up to ± 24.06%) was reduced compensatively by their sum. Amounts of breaths within the predefined error range did not differ between CALIND and (CALFIRST) (P>0.32). The between-days variability of gain factors for a wearable RIP-device does not show impaired reliability in further derived tidal volumes. PMID:25254900

  4. Temporal and spatial variability of phytoplankton monitored by a combination of monitoring buoys, pigment analysis and fast screening microscopy in the Fehmarn Belt Estuary.

    PubMed

    Schlüter, Louise; Møhlenberg, Flemming; Kaas, Hanne

    2014-08-01

    For 2 years, a baseline investigation was carried out to collect reference information of the present environmental status in the Fehmarn Belt and adjacent area. The temporal and spatial variability of phytoplankton was monitored by a combination of monitoring buoys, pigment analysis and fast screening microscopy. The overall phytoplankton succession in the Fehmarn Belt area was found to be influenced primarily by the seasonal changes, where various diatoms dominated the spring and autumn blooms and flagellates like Chrysochromulina sp., Dictyocha speculum and various dinoflagellates were occasionally abundant in late spring and summer. The phytoplankton groups were remarkably uniform horizontally in the investigation area while large differences in both biomasses and composition of individual phytoplankton groups were seen vertically in the water column, especially in the summer periods, in which the two-layer exchange flow between the North Sea and the Baltic Sea is showing a particularly strong stratification in the Fehmarn Belt. The chlorophyll a concentrations ranged continuously from 1 to 3 μg/L at the three permanent buoy stations during the 2 years of monitoring, except for the spring and autumn blooms where chlorophyll a increased up to 18 μg/L in the spring of 2010 and up to 8 μg/L in the autumn of 2009. Recurrent blooms of filamentous cyanobacteria are common during the summer period in the Baltic Sea and adjacent areas, but excessive blooms of cyanobacteria did not occur in 2009 and 2010 in the Fehmarn Belt area. The combination of the HPLC pigment analysis method and monitoring buoys continuously measuring fluorescence at selected stations with fast screening of samples in the microscope proved advantageous for obtaining information on both the phytoplankton succession and dynamic and, at the same time, getting information on duration and intensity of the blooms as well as specific information on the dominant species present both temporally and

  5. Review of information and communication technology devices for monitoring functional and cognitive decline in Alzheimer's disease clinical trials.

    PubMed

    Pillai, Jagan A; Bonner-Jackson, Aaron

    2015-01-01

    Detecting and monitoring early cognitive impairment in Alzheimer's disease (AD) is a significant need in the field of AD therapeutics. Successful AD clinical trial designs have to overcome challenges related to the subtle nature of early cognitive changes. Continuous unobtrusive assessments using Information and Communication Technology (ICT) devices to capture markers of intra-individual change over time to assess cognitive and functional disability therefore offers significant benefits. We review the literature and provide an overview on randomized clinical trials in AD that use intelligent systems to monitor functional decline, as well as strengths, weaknesses, and future directions for the use of ICTs in a new generation of AD clinical trials. PMID:25708378

  6. Development and clinical application of a patient-position monitoring system

    NASA Astrophysics Data System (ADS)

    Gerig, Lee H.; El-Hakim, Sabry F.; Szanto, Janos; Salhani, Doug; Girard, A.

    1994-10-01

    We have developed and clinically tested a computer vision system capable of real time monitoring of the position of an oncology (cancer) patient undergoing radiation therapy. The system is able to report variations in patient setup from day to day, as well as patient motion during an individual treatment. The system consists of two CCD cameras mounted in the treatment room and focused on the treatment unit isocenter. The cameras are interfaced to a PC via a two channel video board. Special targets, placed on the patient surface are automatically recognized and extracted by our 3D vision software. The three coordinates of each target are determined using a triangulation algorithm. System accuracy, stability and reproducibility were tested in the laboratory as well as in the radiation therapy room. Beside accuracy, the system must ensure the highest reliability and safety in the actual application environment. In this paper we also report on the results of clinical testing performed on a total of 23 patients having various treatment sites and techniques. The system in its present configuration is capable of measuring multiple targets placed on the patient surface during radiation therapy. In the clinical environment the system has an accuracy and repeatability of better than 0.5 mm in Cartesian space over extended periods (> 1 month). The system can measure and report patient position in less than 5 seconds. Clinically we have found that the system can easily and accurately detect patient motion during treatment as well as variations in patient setup from day to day. A brief description of the system and detailed analysis of its performance in the laboratory and in the clinic are presented.

  7. Experiences and challenges in data monitoring for clinical trials within an international tropical disease research network

    PubMed Central

    Chen-Mok, M; VanRaden, MJ; Higgs, ES; Dominik, R

    2014-01-01

    Background Models for the structure and procedures of data and safety monitoring boards (DSMBs) continue to evolve in response to issues of new and of old concern. Some authors have called for an open dialogue on these questions through publication of the experiences of DSMBs in addressing them. Purpose The goal of this paper is to add to the current discussion about acceptable models for establishing, serving on, and reporting to monitoring committees, particularly those that oversee multiple studies in less developed countries. The paper seeks to do so by describing the establishment and subsequent operation of one such multi-trial DSMB over a five-year period. This DSMB was formed to monitor trials conducted by members of the International Centers for Tropical Disease Research (ICTDR) network of the National Institute of Allergy and Infectious Diseases (NIAID). Methods The operational model and experiences are summarized by the authors, who had immediate responsibilities for directing the DSMB's activities. Results The board played an active, traditional role in assuring that patient safety was maintained and that current standards for clinical research were met. In addition, both NIAID and the board members viewed education of investigators to be an important role for the board to play in this particular setting. This affected the threshold for identifying which trials would be monitored, and it impacted several procedures adopted by the board. Limitations This report reflects the observations of those involved in managing the DSMB, including comments offered by the DSMB and by investigators, but not data gathered in a systematic way. Conclusions The operational model described here has allowed the DSMB to fulfill its role in the oversight of the trials. We hope that the ideas we present may help others facing similar situations and may stimulate further critical thinking about DSMB structure and function. PMID:17060220

  8. Anomalous H-beta Variability in the 2014 NGC 5548 AGN-STORM Monitoring Campaign

    NASA Astrophysics Data System (ADS)

    Pei, Liuyi; AGN STORM Collaboration

    2016-06-01

    Reverberation mapping programs generally find that the continuum and H-beta flux variations in AGNs are well correlated. In the 2014 AGN STORM monitoring program for NGC 5548, we observed a distinct decorrelation of the emission-line light curves from the AGN continuum light curve during the second half of the six-month campaign. This effect was first detected for the C IV, Ly a, HeII 1640 and SiIV/OIV] 1400 lines in Hubble Space Telescope data, then observed for the H-beta line in ground-based data taken during the same monitoring period. We present measurements of the H-beta lags, equivalent width variations, and line responsivity changes during our campaign. We show that the AGN demonstrated unusual behavior in that the broad H-beta responsivity to flux variations decreased significantly during the second half of the campaign. The discovery of this decorrelation phenomenon was made possible by the high cadence and long duration of our monitoring campaign. More multi-wavelength observing campaigns with high sampling cadence, high signal-to-noise ratio, and long temporal baseline are needed for other AGNs in order to determine the prevalence of this phenomenon and to understand its physical origin.

  9. Consensus Report of the Coalition for Clinical Research—Self-Monitoring of Blood Glucose

    PubMed Central

    Klonoff, David C.; Bergenstal, Richard; Blonde, Lawrence; Boren, Suzanne Austin; Church, Timothy S.; Gaffaney, Jenifer; Jovanovič, Lois; Kendall, David M.; Kollman, Craig; Kovatchev, Boris P.; Leippert, Claudia; DDG, Diabetesberaterin; Owens, David R.; Polonsky, William H.; Reach, Gérard; Renard, Eric; Riddell, Michael C.; Rubin, Richard R.; Schnell, Oliver; Siminiero, Linda M.; Vigersky, Robert A.; Wilson, Darrell M.; Wollitzer, Alison Okada

    2008-01-01

    The Coalition for Clinical Research—Self-Monitoring of Blood Glucose Scientific Board, a group of nine academic clinicians and scientists from the United States and Europe, convened in San Francisco, California, on June 11–12, 2008, to discuss the appropriate uses of self-monitoring of blood glucose (SMBG) and the measures necessary to accurately assess the potential benefit of this practice in noninsulin-treated type 2 diabetes mellitus (T2DM). Thirteen consultants from the United States, Europe, and Canada from academia, practice, and government also participated and contributed based on their fields of expertise. These experts represent a range of disciplines that include adult endocrinology, pediatric endocrinology, health education, mathematics, statistics, psychology, nutrition, exercise physiology, and nursing. This coalition was organized by Diabetes Technology Management, Inc. Among the participants, there was consensus that: protocols assessing the performance of SMBG in noninsulin treated T2DM must provide the SMBG intervention subjects with blood glucose (BG) goals and instructions on how to respond to BG data in randomized controlled trials (RCTs);intervention subjects in clinical trials of SMBG-driven interventions must aggressively titrate their therapeutic responses or lifestyle changes in response to hyperglycemia;control subjects in clinical trials of SMBG must be isolated from SMBG-driven interventions and not be contaminated by physician experience with study subjects receiving a SMBG intervention;the best endpoints to measure in a clinical trial of SMBG in T2DM include delta Hemoglobin A1c levels, hyperglycemic events, hypoglycemic events, time to titrate noninsulin therapy to a maximum necessary dosage, and quality of life indices;either individual randomization or cluster randomization may be appropriate methods for separating control subjects from SMBG intervention subjects, provided that precautions are taken to avoid bias and that the

  10. The Parent Mealtime Action Scale revised (PMAS-R): Psychometric characteristics and associations with variables of clinical interest.

    PubMed

    Hendy, Helen; Harclerode, Whitney; Williams, Keith E

    2016-10-01

    The purpose of the present study was to provide a revised and more psychometrically-examined version of the Parent Mealtime Action Scale (PMAS-R), then to examine how well the PMAS-R subscales explained variance for four variables relevant in clinical settings. Study participants included 238 parents of children referred to a hospital-based feeding program (72.3% male children; mean age = 72.2 months; 80 with autism spectrum disorder, 77 with other special needs, 81 with no special needs). Parents completed questionnaires to report child demographics and diet habits. Parents also used a five-point rating instead of the original three-point rating to report their usage of the 31 PMAS feeding practices. Using five-point ratings, the nine subscales of the PMAS-R demonstrated improved internal reliability and test-retest reliability compared to those published for the original PMAS. ANCOVA indicated that special needs status was the child demographic variable most associated with PMAS-R feeding practices. Hierarchical multiple regression revealed that after controlling for child demographics, the nine PMAS-R subscales explained 26-49% of the variance for four variables of clinical interest (fruit and vegetable consumption, snack consumption, total food variety, and weight status). These variables of clinical interest were most often associated with "permissive" feeding practices including low Daily Fruit and Vegetable (FV) Availability, rarely using Insistence on Eating during meals, often using Many Food Choices, and often using Child-Selected Meals. The present study provides a more psychometrically-sound measure of child feeding practices, documents the association between "permissive feeding" and variables of clinical interest, and identifies specific parent practices included in "permissive feeding". PMID:27221356

  11. Predictive variables for the occurrence of early clinical mastitis in primiparous Holstein cows under field conditions in France.

    PubMed Central

    Barnouin, J; Chassagne, M

    2001-01-01

    Holstein heifers from 47 dairy herds in France were enrolled in a field study to determine predictors for clinical mastitis within the first month of lactation. Precalving and calving variables (biochemical, hematological, hygienic, and disease indicators) were collected. Early clinical mastitis (ECM) predictive variables were analyzed by using a multiple logistic regression model (99 cows with ECM vs. 571 without clinical mastitis throughout the first lactation). Two variables were associated with a higher risk of ECM: a) difficult calving and b) medium and high white blood cell (WBC) counts in late gestation. Two prepartum indicators were associated with a lower ECM risk: a) medium and high serum concentrations of immunoglobulin G1 (IgG1) and b) high percentage of eosinophils among white blood cells. Calving difficulty and certain biological blood parameters (IgG1, eosinophils) could represent predictors that would merit further experimental studies, with the aim of designing programs for reducing the risk of clinical mastitis in the first lactation. PMID:11195522

  12. Suitability of modelled and remotely sensed essential climate variables for monitoring Euro-Mediterranean droughts

    NASA Astrophysics Data System (ADS)

    Szczypta, C.; Calvet, J.-C.; Maignan, F.; Dorigo, W.; Baret, F.; Ciais, P.

    2014-05-01

    Two new remotely sensed leaf area index (LAI) and surface soil moisture (SSM) satellite-derived products are compared with two sets of simulations of the ORganizing Carbon and Hydrology In Dynamic EcosystEms (ORCHIDEE) and Interactions between Soil, Biosphere and Atmosphere, CO2-reactive (ISBA-A-gs) land surface models. We analyse the interannual variability over the period 1991-2008. The leaf onset and the length of the vegetation growing period (LGP) are derived from both the satellite-derived LAI and modelled LAI. The LGP values produced by the photosynthesis-driven phenology model of ISBA-A-gs are closer to the satellite-derived LAI and LGP than those produced by ORCHIDEE. In the latter, the phenology is based on a growing degree day model for leaf onset, and on both climatic conditions and leaf life span for senescence. Further, the interannual variability of LAI is better captured by ISBA-A-gs than by ORCHIDEE. In order to investigate how recent droughts affected vegetation over the Euro-Mediterranean area, a case study addressing the summer 2003 drought is presented. It shows a relatively good agreement of the modelled LAI anomalies with the observations, but the two models underestimate plant regrowth in the autumn. A better representation of the root-zone soil moisture profile could improve the simulations of both models. The satellite-derived SSM is compared with SSM simulations of ISBA-A-gs only, as ORCHIDEE has no explicit representation of SSM. Overall, the ISBA-A-gs simulations of SSM agree well with the satellite-derived SSM and are used to detect regions where the satellite-derived product could be improved. Finally, a correspondence is found between the interannual variability of detrended SSM and LAI. The predictability of LAI is less pronounced using remote sensing observations than using simulated variables. However, consistent results are found in July for the croplands of the Ukraine and southern Russia.

  13. Can Gait Signatures Provide Quantitative Measures for Aiding Clinical Decision-Making? A Systematic Meta-Analysis of Gait Variability Behavior in Patients with Parkinson's Disease

    PubMed Central

    König, Niklas; Singh, Navrag B.; Baumann, Christian R.; Taylor, William R.

    2016-01-01

    A disturbed, inconsistent walking pattern is a common feature of patients with Parkinson's disease (PwPD). Such extreme variability in both temporal and spatial parameters of gait has been associated with unstable walking and an elevated prevalence of falls. However, despite their ability to discretise healthy from pathological function, normative variability values for key gait parameters are still missing. Furthermore, an understanding of each parameter's response to pathology, as well as the inter-parameter relationships, has received little attention. The aim of this systematic literature review and meta-analysis was therefore to define threshold levels for pathological gait variability as well as to investigate whether all gait parameters are equally perturbed in PwPD. Based on a broader systematic literature search that included 13′195 titles, 34 studies addressed Parkinson's disease, presenting 800 PwPD and 854 healthy subjects. Eight gait parameters were compared, of which six showed increased levels of variability during walking in PwPD. The most commonly reported parameter, coefficient of variation of stride time, revealed an upper threshold of 2.4% to discriminate the two groups. Variability of step width, however, was consistently lower in PwPD compared to healthy subjects, and therefore suggests an explicit sensory motor system control mechanism to prioritize balance during walking. The results provide a clear functional threshold for monitoring treatment efficacy in patients with Parkinson's disease. More importantly, however, quantification of specific functional deficits could well provide a basis for locating the source and extent of the neurological damage, and therefore aid clinical decision-making for individualizing therapies. PMID:27445759

  14. A Qualitative Review on the Pharmacokinetics of Antibiotics in Saliva: Implications on Clinical Pharmacokinetic Monitoring in Humans.

    PubMed

    Kiang, Tony K L; Ensom, Mary H H

    2016-03-01

    We conducted a systematic search to describe the current state of knowledge regarding the utility of saliva for clinical pharmacokinetic monitoring (CPM) of antibiotics. Although the majority of identified studies lacked sufficient pharmacokinetic data needed to assign an appropriate suitability classification, most aminoglycosides, fluoroquinolones, macrolides, penicillins/cephalosporins, and tetracyclines are likely not suitable for CPM in saliva. No clear pattern of correlation was observed between physiochemical properties that favor drug distribution into saliva and the likelihood of the antibiotic being classified as suitable for CPM in saliva (and vice versa). Insufficient data were available to determine if pathophysiological conditions affected salivary distribution of antibiotics. Additional confirmatory data are required for drugs (especially in patients) that are deemed likely suitable for CPM in saliva because only a few studies were available and many focused only on healthy subjects. All studies identified had relatively small sample sizes and exhibited large variability. Very few studies reported salivary collection parameters (e.g., salivary flow, pH) that could potentially have some impact on drug distribution into saliva. The available data are heavily weighted on healthy subjects, and insufficient data were available to determine if pathophysiology had effects on saliva drug distribution. Some studies also lacked assay sensitivity for detecting antibiotics in saliva. Overall, this review can be useful to clinicians who desire an overview on the suitability of saliva for conducting CPM of specific antibiotics, or for researchers who wish to fill the identified knowledge gaps to move the science of salivary CPM further. PMID:26346776

  15. ECa-Directed Soil Sampling for Characterizing Spatial Variability: Monitoring Management- Induced Change

    NASA Astrophysics Data System (ADS)

    Corwin, D. L.

    2006-05-01

    Characterizing spatial variability is an important consideration of any landscape-scale soil-related problem. Geospatial measurements of apparent soil electrical conductivity (ECa) are useful for characterizing spatial variability by directing soil sampling. The objective of this presentation is to discuss equipment, protocols, sampling designs, and a case study of an ECa survey to characterize spatial variability. Specifically, a preliminary spatio-temporal study of management-induced changes to soil quality will be demonstrated for a drainage water reuse study site. The spatio-temporal study used electromagnetic induction ECa data and a response surface sampling design to select 40 sites that reflected the spatial variability of soil properties (i.e., salinity, Na levels, Mo, and B) impacting the intended agricultural use of a saline-sodic field in California's San Joaquin Valley. Soil samples were collected in August 1999 and April 2002. Data from 1999 indicate the presence of high salinity, which increased with depth, high sodium adsorption ratio (SAR), which also increased with depth, and moderate to high B and Mo, which showed no specific trends with depth. The application of drainage water for 32 months resulted in leaching of B from the top 0.3 of soil, leaching of salinity from the top 0.6 m of soil, and leaching of Na and Mo from the top 1.2 m of soil. The leaching fraction over the time period from 1999-2002 was estimated to be 0.10. The level of salinity in the reused drainage water (i.e., 3-5 dS/m) allowed infiltration and leaching to occur even though high sodium and high expanding-lattice clay levels posed potential water flow problems. The leaching of salinity, Na, Mo, and B has resulted in increased forage yield and improved quality of those yields. Preliminary spatio-temporal analyses indicate at least short-term feasibility of drainage water reuse from the perspective of soil quality when the goal is forage production for grazing livestock. The

  16. Variability of mineral dust concentrations over West Africa monitored by the Sahelian Dust Transect

    NASA Astrophysics Data System (ADS)

    Kaly, F.; Marticorena, B.; Chatenet, B.; Rajot, J. L.; Janicot, S.; Niang, A.; Yahi, H.; Thiria, S.; Maman, A.; Zakou, A.; Coulibaly, B. S.; Coulibaly, M.; Koné, I.; Traoré, S.; Diallo, A.; Ndiaye, T.

    2015-10-01

    The "Sahelian belt" is known as a region where mineral dust content is among the highest in the world. In the framework of the AMMA international Program, a transect of three ground based stations, the "Sahelian Dust Transect" (SDT), has been deployed in order to obtain quantitative information on the mineral dust content over the Sahel. These three stations: Banizoumbou (Niger), Cinzana (Mali) and M'Bour (Senegal) are aligned at 13°N along the east-west main pathway of the Saharan and Sahelian dust toward the Atlantic Ocean. The SDT provides a set of aerosol measurements and local meteorological parameters to describe and understand the mechanisms that control the temporal and regional variability of mineral dust content in these regions. In this work we analyze the seasonal and diurnal variability of the dust concentrations over the period 2006-2010. The analysis of the dust concentrations measured between 2006 and 2010 confirmed a regional seasonal cycle characterized by a maximum in the dry season, with median concentration ranging from 205 μg m- 3 at Banizoumbou to 144 μg m- 3 at M'Bour, and a minimum (11-32 μg m- 3) in the wet season. The five year data set allowed the quantification of the variability of the monthly concentrations. The range between the percentiles 75 and 25 varies linearly with the median concentration: it is of the same order than the median value in M'Bour, 17% slightly higher in Cinzana and 50% higher in Banizoumbou. The range between the accepted maximum and minimum is also correlated with the median value, with slopes ranging from 14 in Banizoumbou to 7 in M'Bour. Part of the variability of the concentration at the monthly scale is due to interannual variability. Extremely high or low monthly concentration can be recorded that significantly impacts the five year median concentration and its range. Compared to the 3-year data set analyzed by Marticorena et al. (2010), the two additional years used in this work appear as the less

  17. The effects of different environmental conditions on thermoregulation and clinical and hematological variables in long-distance road-transported calves.

    PubMed

    Bernardini, D; Gerardi, G; Peli, A; Nanni Costa, L; Amadori, M; Segato, S

    2012-04-01

    The aim of this study was to investigate the effects of long-distance road transport (19 h, from Poland to Italy) during 2 seasons (summer vs. winter) on clinical and hematological variables in calves. The environmental temperature range that could compromise the thermoregulation system (thermal stress) of the calves was tested. For the 7 Holstein calves in each transport, the BW and rectal temperature (RT) were measured, and blood samples were collected at the farm of origin, before loading at the transit center (T2), after unloading at the farm of destination (T3), and 1, 2, 3, and 4 d after arrival. The body temperature (BT) and heart rate (HR) were continuously monitored from T2 to T3. The data were statistically analyzed according to a mixed model that considered the fixed effects of transport (repeated measurements), season of journey, and their interaction. Within the observed temperature-humidity index (THI) range (30 to 80), effective thermoregulation allowed the calves to maintain their BT with small physiologic changes to prevent thermal stress, particularly in the summer. With no seasonal differences, the HR was greater at loading than unloading (120 vs. 115 beats per min; P = 0.012). As for the transport effect, the BW was less (P < 0.001) after unloading, and the RT was greater (P = 0.004). This effect was more marked in summer. The hematological variables indicated a moderate effect of transport on the hydration condition, reactive and muscular systems, and metabolism, although hematocrit (P = 0.004), erythrocytes, cortisol, NEFA, β-hydroxybutyrate, lactate, creatine kinase, lactate dehydrogenase, and aspartate aminotransferase activity (P < 0.001), and total protein (P = 0.007) were greater after unloading. This was confirmed by a moderate decrease in total leukocytes (P = 0.031) and glucose concentration (P = 0.002). The changes in the clinical variables were similar for both seasons even though in the summer, hematocrit (P < 0.001), urea (P = 0

  18. Clinical variables and primary tumor characteristics predictive of the development of melanoma brain metastasis and post-brain metastasis survival

    PubMed Central

    Zakrzewski, Jan; Geraghty, Laurel N.; Rose, Amy E.; Christos, Paul J.; Mazumdar, Madhu; Polsky, David; Shapiro, Richard; Berman, Russell; Darvishian, Farbod; Hernando, Eva; Pavlick, Anna; Osman, Iman

    2010-01-01

    Background Melanoma patients who develop brain metastases (B-Met) have limited survival and are excluded from most clinical trials. In this study, we sought to identify primary tumor characteristics and clinical features predictive of B-Met development and post-B-Met survival. Methods We studied a prospectively accrued cohort of 900 melanoma patients to identify clinicopathologic features of primary melanoma (e.g. thickness, ulceration, mitotic index, lymphovascular invasion) that are predictive of B-Met development and post-B-Met survival. Associations between clinical variables present at the time of B-Met diagnosis (e.g. extracranial metastases, B-Met location, presence of neurological symptoms) and post-B-Met survival were also assessed. Univariate associations were analyzed using Kaplan-Meier survival analysis, and the effect of independent predictors assessed using a multivariate Cox proportional hazards regression. Results 89 (10%) of the 900 patients developed B-Met. Ulceration and site of primary on the head and neck were independent predictors of B-Met development on multivariate analysis (p=0.001 and p=0.003, respectively). Clinical variables predictive of post-B-Met survival on multivariate analysis included the presence of neurological symptoms (p=0.008) and extracranial metastases (p=0.04). Ulceration was the only primary tumor characteristic that remained a significant predictor of post-B-Met survival on multivariate analysis (p=0.04). Conclusions Primary tumor ulceration was the strongest predictor of B-Met development and remained an independent predictor of decreased post-B-Met survival in a multivariate analysis inclusive of primary tumor characteristics and clinical variables. Our results suggest that patients with ulcerated primaries should be prospectively studied to determine if heightened surveillance for B-Met can improve clinical outcome. PMID:21472718

  19. Of the interest of monitoring complementary parameters to better understand nutrient and pesticides variability in groundwater

    NASA Astrophysics Data System (ADS)

    Gourcy, Laurence; Baran, Nicole

    2014-05-01

    Pesticides and nutrients (as NO3, NO2, NH4) are the parameters degrading most of the groundwater bodies in France. The surveillance-monitoring network described under the Water Framework Directive (2000/60/EC) has for main goal the evaluation of the groundwater chemical status and the assessment of long-term trends in natural conditions and in pollutant concentrations resulting from human activity. The operational monitoring network allows to better assessing the groundwater bodies « at risk ». For management purposes, and particularly to identify the programme of measures needed to reduce the impact of diffuse contaminant on groundwater, the monitoring mentioned under WFD is not sufficient. A better comprehension of water and solute transfer is therefore necessary. Since 2008, high resolution monitoring of nutrient and pesticides in groundwater were performed for a limited period at five sites of various lithological contexts in France. Based on the geological and hydrogeological understanding complementary parameters were selected to be analysed in addition to the main contaminants. In volcanic and mountainous context, Martinique and La Reunion Islands, stable isotopes (δ18O, δ2H) and age dating were analysed as in lowland context, alterites of granite formations in Brittany and sedimentary glacial-fluvial deposits in Rhone-Alpes region, age dating was complementing the analyses of major ions including NO2, NH4 and NO3 and selected pesticides and metabolites. At all studied sites, the pattern of monthly variation of nutrients and dissolved ions is quite different from pesticides time evolution. In the described case studies, apparent age (or CFC and SF6 concentrations) and δ18O and δ2H (and calculated d-excess) are quite stable from one month to another even during intensive rainfall episodes and pesticide concentrations may vary at the same time to a large extend. A seasonal trend is observed for chemical data when water level is significantly changes

  20. Using Essential Biodiversity Variables (EBVs) As a Framework for Coordination Between Research and Monitoring Networks: A Case Study with Phenology

    NASA Astrophysics Data System (ADS)

    Weltzin, J. F.; Jones, K. D.; Brown, J. F.; Elmendorf, S.; Enquist, C.; Rosemartin, A.; Thorpe, A.; Wee, B.

    2014-12-01

    The United Nations Convention on Biological Diversity (CBD) was organized to encourage countries to take action to address issues of declining biodiversity. In2010, the CBD identified specific goals for 2011-2020 (the "Aichi Targets") and a tiered system of indicators necessary to achieve those targets. Essential biodiversity variables (EBVs) are the standardized measurements and observations at the base of this system; they are the basic level of information that is necessary to calculate these indicators. By providing a list of pre-defined EBVs, existing research and research planned for the future can align measurements to address common questions. We assessed the applicability of phenology EBVs for standardizing measurements across observation networks within the US as a test case for use of the standardized used of EBVs. Phenology products from the USA National Phenology Network, a citizen science observer based program, NEON, a multi-scale ecological observatory, and remotely sensed data from USGS EROS were considered for this purpose. Essential Biodiversity Variables currently defined for phenology are insufficient to support consistent measurement across monitoring networks. Specifically, phenology which is a field of study, is currently listed as a single EBV within the general category of 'species traits'. With the only guidance provided to future observation networks being that of measuring 'phenology,' there would likely be as many approaches to achieving this goal as networks participating. We propose more narrowly defined variables which may be more appropriate for standardization and demonstrate how these measurements satisfy the basic characteristics of an EBV in that they are relevant, sensitive to change, biological and generalizable, scalable, feasible, stable and, represent state variables. We map these variables to the tiered indicators identified by the CBD and, finally, to Aichi Targets to which they contribute. EBVs may be used not only to

  1. Nurse-led hepatocellular carcinoma surveillance clinic provides an effective method of monitoring patients with cirrhosis.

    PubMed

    Nazareth, Saroj; Leembruggen, Nadine; Tuma, Rhoda; Chen, Sook-Ling; Rao, Samarth; Kontorinis, Nick; Cheng, Wendy

    2016-06-01

    The aim of this study is to examine the acceptability and effectiveness of a nurse-led hepatocellular carcinoma (HCC) surveillance clinic in high-risk patients with cirrhosis/advanced fibrosis. Early detection of HCC is associated with better treatment outcomes and improved survival. International guidelines recommend 6-monthly surveillance of patients at risk of developing HCC. A nurse-led HCC surveillance protocol was established to support patients in adherence to surveillance protocols. The design used was retrospective document analysis. Retrospective analysis of healthcare records of patients referred to the clinic between August 2009 and December 2015. Extracted data included attendance of clinic visits, blood testing, ultrasound or other imaging, and outcomes. Ultrasound was attended within 6 months in 30.3% of cases and within 7 months in 71.2% of cases. The median time between Nurse-Led Clinic appointments, ultrasound scans and blood testing did not exceed 9 months. First year FibroScans were attended by 82.9% (63/76) patients; endoscopy was indicated for 42 and attended by 35 (83.3%) patients. Lesions were identified in 16 patients (21.5%) and HCC diagnosed in two patients. One patient died because of HCC and one to sub-dural haematoma. Nurse-led HCC surveillance was an effective method of monitoring patients with cirrhosis at high risk of developing HCC. Well-defined protocols enable timely identification of patients with HCC or hepatic decompensation so that management strategies can be implemented without delay. The potential benefits identified by this study warrant further, rigorous evaluation. PMID:27476494

  2. Clinical diagnostics and therapy monitoring in the congenital disorders of glycosylation.

    PubMed

    Van Scherpenzeel, Monique; Willems, Esther; Lefeber, Dirk J

    2016-06-01

    Abnormal protein glycosylation is observed in many common disorders like cancer, inflammation, Alzheimer's disease and diabetes. However, the actual use of this information in clinical diagnostics is still very limited. Information is usually derived from analysis of total serum N-glycan profiling methods, whereas the current use of glycoprotein biomarkers in the clinical setting is commonly based on protein levels. It can be envisioned that combining protein levels and their glycan isoforms would increase specificity for early diagnosis and therapy monitoring. To establish diagnostic assays, based on the mass spectrometric analysis of protein-specific glycosylation abnormalities, still many technical improvements have to be made. In addition, clinical validation is equally important as well as an understanding of the genetic and environmental factors that determine the protein-specific glycosylation abnormalities. Important lessons can be learned from the group of monogenic disorders in the glycosylation pathway, the Congenital Disorders of Glycosylation (CDG). Now that more and more genetic defects are being unraveled, we start to learn how genetic factors influence glycomics profiles of individual and total serum proteins. Although only in its initial stages, such studies suggest the importance to establish diagnostic assays for protein-specific glycosylation profiling, and the need to look beyond the single glycoprotein diagnostic test. Here, we review progress in and lessons from genetic disease, and review the increasing opportunities of mass spectrometry to analyze protein glycosylation in the clinical diagnostic setting. Furthermore, we will discuss the possibilities to expand current CDG diagnostics and how this can be used to approach glycoprotein biomarkers for more common diseases. PMID:26739145

  3. Testing the PROMIS® Depression measures for monitoring depression in a clinical sample outside the US.

    PubMed

    Vilagut, G; Forero, C G; Adroher, N D; Olariu, E; Cella, D; Alonso, J

    2015-09-01

    The Patient Reported Outcomes Measurement Information System (PROMIS) was devised to facilitate assessment of patient self-reported health status, taking advantage of Item Response Theory. We aimed to assess measurement properties of the PROMIS Depression item bank and an 8-item static short form in a Spanish clinical sample. A three-month follow-up study of patients with active mood/anxiety symptoms (n = 218) was carried out. We assessed model unidimensionality (Confirmatory Item Factor Analysis), reliability (internal consistency and Item Information Curves), and validity (convergent-discriminant with correlations; known-groups with comparison of means and effect sizes; and criterion validity with Receiver operating Characteristics (ROC) analysis). We also assessed 3-month responsiveness to change (Cohen's effect sizes (d) in stable and recovered patients). The unidimensional model showed adequate fit (CFI = 0.97, RMSEA = 0.08). Information Curves had reliabilities over 0.90 throughout most of the score continuum. As expected, we observed high correlations with external self-reported depression, and moderate with self-reported anxiety and clinical measures. The item bank showed an increasing severity gradient from no disorder (mean = 48, SE = 0.6) to depression with comorbid anxiety (mean = 55.8, SE = 0.4). PROMIS detected depression disorder with great accuracy according to the area under the curve (AUC = 0.89). Both formats, item bank and short form, were highly responsive to change in recovered patients (d > 0.7) and had small changes in stable patients (d < 0.2). The good metric properties of the Spanish PROMIS Depression measures provide further evidence of their adequacy for monitoring depression levels of patients in clinical settings. This double check of quality (within countries and populations) supports the ability of PROMIS measures for guaranteeing fair comparisons across languages and countries in specific clinical populations. PMID:26228413

  4. Monitoring the variability of active galactic nuclei from a space-based platform

    NASA Technical Reports Server (NTRS)

    Peterson, Bradley M.; Atwood, Bruce; Byard, Paul L.

    1994-01-01

    Detailed monitoring of AGN's with FRESIP can provide well-sampled light curves for a large number of AGN's. Such data are completely unprecedented in this field, and will provide powerful new constraints on the origin of the UV/optical continuum in AGN's. The FRESIP baseline design will allow 1 percent photometry on sources brighter than V approximately equals 19.6 mag, and we estimate that over 300 sources can be studied. We point out that digitization effects will have a significant negative impact on the faint limit and the number of detectable sources will decrease dramatically if a fixed gain setting (estimated to be nominally 25 e(-) per ADU) is used for all read-outs. We note that the primary limitation to studying AGN's is background (sky and read-out noise) rather than source/background contrast with a focused telescope and by longer integrations. While we believe that it may be possible to achieve the AGN-monitoring science goals with a more compact and much less expensive telescope, the proposed FRESIP satellite affords an excellent opportunity to attain the required data at essentially zero cost as a secondary goal of a more complex mission.

  5. A Wearable Patch to Enable Long-Term Monitoring of Environmental, Activity and Hemodynamics Variables.

    PubMed

    Etemadi, Mozziyar; Inan, Omer T; Heller, J Alex; Hersek, Sinan; Klein, Liviu; Roy, Shuvo

    2016-04-01

    We present a low power multi-modal patch designed for measuring activity, altitude (based on high-resolution barometric pressure), a single-lead electrocardiogram, and a tri-axial seismocardiogram (SCG). Enabled by a novel embedded systems design methodology, this patch offers a powerful means of monitoring the physiology for both patients with chronic cardiovascular diseases, and the general population interested in personal health and fitness measures. Specifically, to the best of our knowledge, this patch represents the first demonstration of combined activity, environmental context, and hemodynamics monitoring, all on the same hardware, capable of operating for longer than 48 hours at a time with continuous recording. The three-channels of SCG and one-lead ECG are all sampled at 500 Hz with high signal-to-noise ratio, the pressure sensor is sampled at 10 Hz, and all signals are stored to a microSD card with an average current consumption of less than 2 mA from a 3.7 V coin cell (LIR2450) battery. In addition to electronic characterization, proof-of-concept exercise recovery studies were performed with this patch, suggesting the ability to discriminate between hemodynamic and electrophysiology response to light, moderate, and heavy exercise. PMID:25974943

  6. Circulating extracellular vesicles in cancer diagnosis and monitoring: an appraisal of clinical potential.

    PubMed

    Choi, Dong-Sic; Lee, Jaewook; Go, Gyeongyun; Kim, Yoon-Keun; Gho, Yong Song

    2013-10-01

    Mammalian cells, including cancer cells, secrete extracellular vesicles. These vesicles are nanosized, bilayered proteolipids with diameters of 50-1,000 nm. It has been suggested that cancer cell-derived extracellular vesicles play diverse roles in cancer progression, which involve invasion, immune modulation, neovascularization, and metastasis. Moreover, their serum levels are significantly elevated in cancer patients compared with normal controls. Recent high-throughput proteomic and transcriptomic studies of these complex extracellular organelles have accelerated the discovery of cancer-specific biomarkers and the development of novel diagnostic tools based on extracellular vesicles. Although many vesicle-associated biomarker candidates have been reported for various types of cancer, few have been validated for clinical use due to preanalytical, technical, temporal, and financial problems. Here, we discuss the potential of extracellular vesicles as sources of biomarkers for cancer diagnosis and monitoring, as well as the limitations and obstacles to adoption of extracellular vesicle-based diagnosis. PMID:23729224

  7. Monitors.

    ERIC Educational Resources Information Center

    Powell, David

    1984-01-01

    Provides guidelines for selecting a monitor to suit specific applications, explains the process by which graphics images are produced on a CRT monitor, and describes four types of flat-panel displays being used in the newest lap-sized portable computers. A comparison chart provides prices and specifications for over 80 monitors. (MBR)

  8. Variable clinical manifestations of a glycine to glutamic acid substitution of the COL3A1 gene at residue 736

    SciTech Connect

    Pope, F.M.; Narcisi, P.; Richards, A.J.

    1994-09-01

    Glycine substitutions at the 3{prime} end of the COL3A1 gene generally produce a characteristic clinical phenotype including acrogeria and severe vascular fragility. Here we report a three generation British family in which the propositus presented with aneurysms of the groins. He, his mother, sister and elder daughter all had the external clinical phenotype of vascular EDS IV whilst another daughter and nephew were clinically normal. Cultured skin fibroblasts from the propositus and his clinically affected relatives poorly secreted normal and overmodified collagen III species. Normal components of secreted proteins predominated whilst overmodified molecules were prominent in intracellular material. Surprisingly the normal children also secreted less collagen type III than expected (though more than their clinically abnormal relatives). cDNA from bases 2671 to 3714 were amplified as four overlapping PCR fragments and analysed by DGGE. The region between 2671 and 3015 was heterozygous. Sequencing showed a mutation of glycine to glutamic acid at residue 736. This mutation created an extra Apa 1 restriction site which was suitable for family studies. These showed inheritance of the mutant gene by both vascular and non-vascular clinical phenotypes. This family therefore illustrates that replacement of glycine to glutamic acid at position 736 produces variable clinical and biochemical phenotypes ranging from easily recognizable vascular EDS IV with very poor collagen secretion to an EDS III-like picture and with less severe protein disturbance. The reasons for these differences are at present unexplained.

  9. Clinical usefulness of a newly developed body surface navigation and monitoring system in radiotherapy.

    PubMed

    Takagi, Hitoshi; Obata, Yasunori; Kobayashi, Hidetoshi; Takenaka, Kazuyuki; Hirose, Yasujirou; Goto, Hajime; Hattori, Tomohiko

    2011-01-01

    In radiotherapy, setup precision has great influence on the therapeutic effect. In addition, body movements during the irradiation and physical alternations during the treatment period might cause deviation from the planned irradiation dosage distribution. Both of these factors could undesirably influence the dose absorbed by the target. In order to solve these problems, we developed the "body surface navigation and monitoring system" (hereafter referred to as "Navi-system"). The purpose of this study is to review the precision of the Navi-system as well as its usefulness in clinical radiotherapy. The Navi-system consists of a LED projector, a CCD camera, and a personal computer (PC). The LED projector projects 19 stripes on the patient's body and the CCD camera captures these stripes. The processed image of these stripes in color can be displayed on the PC monitor along with the patient's body surface image, and the digitalized results can be also displayed on the same monitor. The Navi-system calculates the height of the body contour and the transverse height centroid for the 19 levels and compares them with the reference data to display the results on the monitor on a real-time basis. These results are always replaced with new data after they are used for display; so, if the results need to be recorded, such recording commands should be given to the computer. 1) Evaluating the accuracy of the body surface height measurement: from the relationship between actual height changes and calculated height changes with torso surface by the Navi-system, for the height changes from 0.0 mm to ± 10.0mm, the changes show the underestimation of 1.0-1.5 mm and for ± 11.0mm to ± 20.0 mm, the underestimation of 1.5-3.0 mm. 2) Evaluating the accuracy of the transverse height centroid measurement: displacement of the inclined flat panel to the right by 5.0 mm, 10.0 mm, 15.0 mm and 20.0 mm showed the transverse height centroid calculated by the Navi-system for 0.024 ± 0.007 line

  10. Short-term biological variation of clinical chemical values in Dumeril's monitors (Varanus dumerili).

    PubMed

    Bertelsen, Mads F; Kjelgaard-Hansen, Mads; Howell, Jennifer R; Crawshaw, Graham J

    2007-06-01

    Plasma biochemical values are routinely used in the medical management of ill reptiles, and for monitoring the health of clinically normal animals. Laboratory tests, including clinical biochemical values, are subject to biological and analytical variation, the magnitude of which determines the utility of population-based reference ranges for the detection of abnormal results in the individual animal. Nested analysis of variance of repeated measurements allows the variance to be broken into within-individual, between-individual, and analytical variation. When the within-individual variation is large and the interindividual variation is low, a sample may be accurately classified as normal or abnormal based on a population-based reference interval. However, if the intraindividual variation is low and the interindividual variation high, population-based reference intervals are of limited value as the ranges for an individual encompass only a part of the conventional reference interval. Between-lizard, within-lizard, and analytical components of variance were assessed by nested analysis of variance for 16 commonly measured plasma biochemical parameters in eight healthy adult Dumeril's monitors (Varanus dumerili). Albumin, cholesterol, phosphate, calcium, sodium, and total protein demonstrated levels of individuality suggesting that comparison of a single measurement to a conventional population-based reference range may be too insensitive to detect small but significant alterations in the value for that animal. Only for potassium and AST did the index of individuality suggest that the use of reference values may be warranted. Uric acid, globulin, glucose, and amylase fell in a gray zone, where population-based ranges should be used with caution. The critical difference indicates the difference between two consecutive analytical results that may be safely ascribed to natural variation. In the present study critical difference varied from 7 and 11%, respectively, for

  11. On the use of ultrasonic fatigue testing technique--variable amplitude loadings and crack growth monitoring.

    PubMed

    Müller, T; Sander, M

    2013-12-01

    In the very high cycle fatigue regime high-frequency testing techniques are required. Using the ultrasonic fatigue technique, testing time could be reduced significantly in comparison to conventional servo-hydraulic machines. An ultrasonic fatigue testing system developed by the BOKU Vienna with load frequencies of about 20kHz is used for variable amplitude loading investigations in the VHCF regime. Therefore, the amplitude level during fatigue tests is controlled by a PC using an own developed software. Additionally, an in situ reconstruction of a damage equivalent load spectrum based on a load time history is introduced schematically. To optimize the experimental procedure a temperature-controlled pulse-pause adaption has been developed and implemented into the software. For quantifying the influence of variable amplitude loadings on the fatigue life, e.g. load interaction effects, the crack growth is measured by using the potential drop technique that is adapted to the ultrasonic fatigue testing system. Finally, the results of two-step-block loading tests are presented. PMID:23597637

  12. Gauging intraurban variability of ambient particulate matter arsenic and other air toxic metals from a network of monitoring sites

    NASA Astrophysics Data System (ADS)

    Yadav, Varun; Turner, Jay

    2014-06-01

    A four site monitoring network was established in the Missouri portion of Metropolitan St. Louis during 2008 to characterize spatiotemporal patterns in PM10 arsenic. Arsenic measured at two urban sites in the City of St. Louis was typically higher than arsenic at two suburban sites. Spatiotemporal variability in arsenic is examined by plotting the Pearson correlation coefficient (PCC) against the coefficient of divergence (COD) for each site-pair to merge the temporal tracking ability of PCC with COD's ability to gauge spatial homogeneity. Arsenic measured across the network is apportioned into a network-wide baseline and site-specific excess concentrations to semi-quantitatively differentiate local-scale emission source contributions from sources exerting influence over larger spatial scales. Comparing measured concentrations at each site against the network-wide baseline concentration using a scattergram of PCC and COD emphasizes the impact of local sources on intraurban variability. Conditional probability function (CPF) plots constructed using site-specific measured arsenic and surface winds identify a broad emission source region towards the east, but mask the bearings of local sources in the urban core. CPF plots using site-specific arsenic in excess of the baseline concentrations provide better resolution of local emission source bearings and are triangulated to identify a likely arsenic emission source zone along the industrialized Mississippi Riverfront. Additional air toxic metals measured in this study (selenium, manganese and lead) are also investigated to examine the efficacy of this methodology to characterize intraurban variability.

  13. Ambulatory blood pressure monitoring in daily clinical practice - the Spanish ABPM Registry experience.

    PubMed

    Gorostidi, Manuel; Banegas, José R; de la Sierra, Alejandro; Vinyoles, Ernest; Segura, Julián; Ruilope, Luis M

    2016-01-01

    Many patients are hypertensive at the medical settings but show normal blood pressure out of the doctor's office, and are classified as white-coat hypertensives. On the other hand, many patients with controlled hypertension at the clinic show ambulatory blood pressure levels above the thresholds considered for an adequate blood pressure control, known as having masked hypertension. Using data from the Spanish Ambulatory Blood Pressure Monitoring Registry (Spanish ABPM Registry), a national program developed to promote the use of the ambulatory technique for hypertension management in daily practice, we have reviewed the main strengths of this approach, that is the ability to detect discrepancies of blood pressure status with respect to office blood pressure measurement, and to better assess accurate rates of hypertension control. White-coat hypertension within patients with elevated office blood pressure, and masked hypertension within office-controlled patients affected one of three patients in each office status. On the other hand, rates of ambulatory blood pressure control (50%) doubled those of office blood pressure control (25%), still remaining half the patients uncontrolled. We think that a systematic use of ambulatory blood pressure monitoring, and strategies to improve blood pressure control constitute key priorities in hypertension management. PMID:26541761

  14. Radiopharmaceuticals in Preclinical and Clinical Development for Monitoring of Therapy with PET

    PubMed Central

    Dunphy, Mark PS.; Lewis, Jason S.

    2010-01-01

    This review article discusses PET agents, other than 18F-FDG, with the potential to monitor the response to therapy before, during, or after therapeutic intervention. This review deals primarily with non–18F-FDG PET tracers that are in the final stages of preclinical development or in the early stages of clinical application for monitoring the therapeutic response. Four sections related to the nature of the tracers are included: radiotracers of DNA synthesis, such as the 2 most promising agents, the thymidine analogs 3′-18F-fluoro-3′-deoxythymidine and 18F-1-(2′-deoxy-2′-fluoro-β-d-arabinofuranosyl)thymine; agents for PET imaging of hypoxia within tumors, such as 60/62/64Cu-labeled diacetyl-bis(N4-methylthiosemicarbazone) and 18F-fluoromisonidazole; amino acids for PET imaging, including the most popular such agent, l-[methyl-11C]methionine; and agents for the imaging of tumor expression of androgen and estrogen receptors, such as 16β-18F-fluoro-5α-dihydrotestosterone and 16α-18F-fluoro-17β-estradiol, respectively. PMID:19380404

  15. Clinical monitoring of early caries lesions using cross polarization optical coherence tomography

    NASA Astrophysics Data System (ADS)

    Fried, Daniel; Staninec, Michal; Darling, Cynthia L.; Chan, Kenneth H.; Pelzner, Roger B.

    New methods are needed for the nondestructive measurement of tooth demineralization and remineralization and to monitor the progression of incipient caries lesions (tooth decay) for effective nonsurgical intervention and to evaluate the performance of anti-caries treatments such as chemical treatments or laser irradiation. Studies have shown that optical coherence tomography (OCT) has great potential to fulfill this role, since it can be used to measure the depth and severity of early lesions with an axial resolution exceeding 10-μm. It is easy to apply in vivo and it can be used to image the convoluted topography of tooth occlusal surfaces. In this paper we present early results from two clinical studies underway to measure the effect of fluoride intervention on early lesions. CP-OCT was used to monitor early lesions on enamel and root surfaces before and after intervention with fluoride varnish. The lesion depth and internal structure were resolved for all the lesions examined and some lesions had well defined surface zones of lower reflectivity that may be indicative of arrested lesions. Changes were also noted in the structure of some of the lesions after fluoride intervention.

  16. Clinical Malaria Transmission Trends and Its Association with Climatic Variables in Tubu Village, Botswana: A Retrospective Analysis.

    PubMed

    Chirebvu, Elijah; Chimbari, Moses John; Ngwenya, Barbara Ntombi; Sartorius, Benn

    2016-01-01

    Good knowledge on the interactions between climatic variables and malaria can be very useful for predicting outbreaks and preparedness interventions. We investigated clinical malaria transmission patterns and its temporal relationship with climatic variables in Tubu village, Botswana. A 5-year retrospective time series data analysis was conducted to determine the transmission patterns of clinical malaria cases at Tubu Health Post and its relationship with rainfall, flood discharge, flood extent, mean minimum, maximum and average temperatures. Data was obtained from clinical records and respective institutions for the period July 2005 to June 2010, presented graphically and analysed using the Univariate ANOVA and Pearson cross-correlation coefficient tests. Peak malaria season occurred between October and May with the highest cumulative incidence of clinical malaria cases being recorded in February. Most of the cases were individuals aged >5 years. Associations between the incidence of clinical malaria cases and several factors were strong at lag periods of 1 month; rainfall (r = 0.417), mean minimum temperature (r = 0.537), mean average temperature (r = 0.493); and at lag period of 6 months for flood extent (r = 0.467) and zero month for flood discharge (r = 0.497). The effect of mean maximum temperature was strongest at 2-month lag period (r = 0.328). Although malaria transmission patterns varied from year to year the trends were similar to those observed in sub-Saharan Africa. Age group >5 years experienced the greatest burden of clinical malaria probably due to the effects of the national malaria elimination programme. Rainfall, flood discharge and extent, mean minimum and mean average temperatures showed some correlation with the incidence of clinical malaria cases. PMID:26983035

  17. Clinical Malaria Transmission Trends and Its Association with Climatic Variables in Tubu Village, Botswana: A Retrospective Analysis

    PubMed Central

    Chimbari, Moses John; Ngwenya, Barbara Ntombi; Sartorius, Benn

    2016-01-01

    Good knowledge on the interactions between climatic variables and malaria can be very useful for predicting outbreaks and preparedness interventions. We investigated clinical malaria transmission patterns and its temporal relationship with climatic variables in Tubu village, Botswana. A 5-year retrospective time series data analysis was conducted to determine the transmission patterns of clinical malaria cases at Tubu Health Post and its relationship with rainfall, flood discharge, flood extent, mean minimum, maximum and average temperatures. Data was obtained from clinical records and respective institutions for the period July 2005 to June 2010, presented graphically and analysed using the Univariate ANOVA and Pearson cross-correlation coefficient tests. Peak malaria season occurred between October and May with the highest cumulative incidence of clinical malaria cases being recorded in February. Most of the cases were individuals aged >5 years. Associations between the incidence of clinical malaria cases and several factors were strong at lag periods of 1 month; rainfall (r = 0.417), mean minimum temperature (r = 0.537), mean average temperature (r = 0.493); and at lag period of 6 months for flood extent (r = 0.467) and zero month for flood discharge (r = 0.497). The effect of mean maximum temperature was strongest at 2-month lag period (r = 0.328). Although malaria transmission patterns varied from year to year the trends were similar to those observed in sub-Saharan Africa. Age group >5 years experienced the greatest burden of clinical malaria probably due to the effects of the national malaria elimination programme. Rainfall, flood discharge and extent, mean minimum and mean average temperatures showed some correlation with the incidence of clinical malaria cases. PMID:26983035

  18. Multiwaveband Monitoring of the Bright, Violently Variable Quasar 3C454.3

    NASA Technical Reports Server (NTRS)

    Marscher, Alan P.

    1997-01-01

    The RXTE (Rossi X Ray Timing Explorer) data of the quasar 3C 454.3 were analyzed by the PI (Principle Investigator) and his graduate students. The resulting light curve is shown. Substantial variations are seen. These, however, are not correlated with variations at either optical or radio wavelengths. For this reason, the PI decided that more observations were needed and that the project should be continued. These observations have taken place or are scheduled for Cycles 2 and 3 of RXTE. Because the project is continuing, no publications have yet resulted. The PI plans to submit a paper to the Astrophysical Journal at the conclusion of the multi-year monitoring project.

  19. Variability in colony attendance of crevice-nesting horned puffins: Implications for population monitoring

    USGS Publications Warehouse

    Harding, A.M.A.; Piatt, J.F.; Byrd, G.V.; Hatch, Shyla A.; Konyukhov, N.B.; Golubova, E.U.; Williams, J.C.

    2005-01-01

    It is difficult to survey crevice-nesting seabirds because nest-sites are hard to identify and count, and the number of adult birds attending a colony can be extremely variable within and between days. There is no standardized method for surveying crevice-nesting horned puffins (Fratercula corniculata), and consequently little is known about abundance or changes in their numbers. We examined the variability in colony attendance of horned puffins at 5 breeding colonies in the North Pacific to assess whether variation in count data can be reduced to a level that would allow us to detect changes in the number of birds attending a colony. We used within-year measures of variation in attendance to examine the power to detect a change in numbers between 2 years, and we used measures of among-year variation to examine the power to detect trends over multiple years. Diurnal patterns of attendance differed among colonies, and among-day variation in attendance was generally lowest from mid- to late-incubation to early chick rearing. Within-year variation in water counts was lower than in land counts, and variation was lower using a daily index based on 5 counts per day than it was using 1 count per day. Measures of among-year variation in attendance also were higher for land-based than water-based counts, and they were higher when we used a 10-day survey period than when we used a 30-day period. The use of either 1 or 5 counts a day during the colony-specific diurnal peak of attendance had little influence on levels of among-year variation. Overall, our study suggests that variation in count data may be reduced to a level that allows detection of trends in numbers. However, more studies of interannual variability in horned puffin attendance are needed. Further, the relationship between count data and breeding population size needs more study before the number of birds present at the colony can be used with confidence as an index of population trend.

  20. Comparison of Adherence Monitoring Tools and Correlation to Virologic Failure in a Pediatric HIV Clinical Trial

    PubMed Central

    Intasan, Jintana; Vonthanak, Saphonn; Kosalaraksa, Pope; Hansudewechakul, Rawiwan; Kanjanavanit, Suparat; Ngampiyaskul, Chaiwat; Wongsawat, Jurai; Luesomboon, Wicharn; Apornpong, Tanakorn; Kerr, Stephen; Ananworanich, Jintanat; Puthanakit, Thanyawee

    2014-01-01

    Abstract There is no consensus on a gold standard for monitoring adherence to antiretroviral therapy (ART). We compared different adherence monitoring tools in predicting virologic failure as part of a clinical trial. HIV-infected Thai and Cambodian children aged 1–12 years (N=207) were randomized to immediate-ART or deferred-ART until CD4% <15%. Virologic failure (VF) was defined as HIV-RNA >1000 copies/mL after ≥6 months of ART. Adherence monitoring tools were: (1) announced pill count, (2) PACTG adherence questionnaire (form completed by caregivers), and (3) child self-report (self-reporting from children or caregivers to direct questioning by investigators during the clinic visit) of any missed doses in the last 3 days and in the period since the last visit. The Kappa statistic was used to describe agreement between each tool. The median age at ART initiation was 7 years with median CD4% 17% and HIV-RNA 5.0 log10copies/mL and 92% received zidovudine/lamivudine/nevirapine. Over 144 weeks, 13% had VF. Mean adherence by announced pill count before VF in VF children was 92% compared to 98% in children without VF (p=0.03). Kappa statistics indicated slight to fair agreement between tools. In multivariate analysis adjusting for gender, treatment arm ethnicity and caregiver education, significant predictors of VF were poor adherence by announced pill count (OR 4.56; 95%CI 1.78–11.69), reporting any barrier to adherence in the PACTG adherence questionnaire (OR 7.08; 95%CI 2.42–20.73), and reporting a missed dose in the 24 weeks since the last HIV-RNA assessment (OR 8.64; 95%CI 1.96–38.04). In conclusion, we recommend the child self-report of any missed doses since last visit for use in HIV research and in routine care settings, because it is easy and quick to administer and a strong association with development of VF. PMID:24901463

  1. Comparison of adherence monitoring tools and correlation to virologic failure in a pediatric HIV clinical trial.

    PubMed

    Intasan, Jintana; Bunupuradah, Torsak; Vonthanak, Saphonn; Kosalaraksa, Pope; Hansudewechakul, Rawiwan; Kanjanavanit, Suparat; Ngampiyaskul, Chaiwat; Wongsawat, Jurai; Luesomboon, Wicharn; Apornpong, Tanakorn; Kerr, Stephen; Ananworanich, Jintanat; Puthanakit, Thanyawee

    2014-06-01

    There is no consensus on a gold standard for monitoring adherence to antiretroviral therapy (ART). We compared different adherence monitoring tools in predicting virologic failure as part of a clinical trial. HIV-infected Thai and Cambodian children aged 1-12 years (N=207) were randomized to immediate-ART or deferred-ART until CD4% <15%. Virologic failure (VF) was defined as HIV-RNA >1000 copies/mL after ≥6 months of ART. Adherence monitoring tools were: (1) announced pill count, (2) PACTG adherence questionnaire (form completed by caregivers), and (3) child self-report (self-reporting from children or caregivers to direct questioning by investigators during the clinic visit) of any missed doses in the last 3 days and in the period since the last visit. The Kappa statistic was used to describe agreement between each tool. The median age at ART initiation was 7 years with median CD4% 17% and HIV-RNA 5.0 log(10)copies/mL and 92% received zidovudine/lamivudine/nevirapine. Over 144 weeks, 13% had VF. Mean adherence by announced pill count before VF in VF children was 92% compared to 98% in children without VF (p=0.03). Kappa statistics indicated slight to fair agreement between tools. In multivariate analysis adjusting for gender, treatment arm ethnicity and caregiver education, significant predictors of VF were poor adherence by announced pill count (OR 4.56; 95%CI 1.78-11.69), reporting any barrier to adherence in the PACTG adherence questionnaire (OR 7.08; 95%CI 2.42-20.73), and reporting a missed dose in the 24 weeks since the last HIV-RNA assessment (OR 8.64; 95%CI 1.96-38.04). In conclusion, we recommend the child self-report of any missed doses since last visit for use in HIV research and in routine care settings, because it is easy and quick to administer and a strong association with development of VF. PMID:24901463

  2. Instantaneous monitoring of sleep fragmentation by point process heart rate variability and respiratory dynamics.

    PubMed

    Citi, Luca; Bianchi, Matt T; Klerman, Elizabeth B; Barbieri, Riccardo

    2011-01-01

    We present a novel, automatic point-process approach that is able to provide continuous, instantaneous estimates of heart rate variability (HRV) and respiratory sinus arrhythmia (RSA) in long duration data recordings such as those during an entire night of sleep. We analyze subjects with and without sleep apnea who underwent diagnostic polysomnography. The proposed algorithm is able to quantify multi-scale high time resolution autonomic signatures of sleep fragmentation, such as arousals and stage transitions, throughout an entire night. Results demonstrate the ability of our methods to track fast dynamic transitions from sleep to wake and between REM sleep and other sleep stages, providing resolution details not available in sleep scoring summaries. An automatic threshold-based procedure is further able to detect brief arousals, with the instantaneous indices characterizing specific arousal dynamic signatures. PMID:22256131

  3. A computational platform for continuous seizure anticipation, monitoring and clinical evaluation.

    PubMed

    Giannakakis, Giorgos; Pediaditis, Matthew; Stavrinidis, George; Konstantinidis, George; Kritsotakis, Vangelis; Tsakanikas, Vasilis; Ligerakis, Michael; Sakkalis, Vangelis; Vorgia, Pelagia; Tsiknakis, Manolis

    2016-01-01

    The development of platforms that are able to continuously monitor and handle epileptic seizures in a non invasive manner is of great importance as they would improve the quality of life of drug resistant epileptic patients. In this work, a device and a computational platform is presented for acquiring low noise electroencephalographic signals, for the detection/prediction of epileptic seizures and the storage of ictal activity in an electronic personal health record. In order to develop this platform, a systematic clinical protocol was established including a number of drug resistant children from the University Hospital of Heraklion. Dry electrodes with innovative micro-spike design were proposed in order to increase the signal to noise ratio of the recorded EEG signals. A wearable low cost platform and its corresponding wireless communication protocol was developed focus on minimizing the interference with the patient's body. A computational subsystem with advanced algorithms provides detection/anticipation of upcoming seizure activity and aims to protect the patient from an accident due to a seizure or to improve his/her social life. Finally, the seizure activity information is stored in an electronic health record for further clinical evaluation. PMID:27225563

  4. Managing and monitoring chronic non-communicable diseases in a primary health care clinic, Lilongwe, Malawi

    PubMed Central

    Manjomo, R. C.; Mwagomba, B.; Ade, S.; Ali, E.; Ben-Smith, A.; Khomani, P.; Bondwe, P.; Nkhoma, D.; Douglas, G. P.; Tayler-Smith, K.; Chikosi, L.; Gadabu, O. J.

    2016-01-01

    Setting: Patients with chronic non-communicable diseases attending a primary health care centre, Lilongwe, Malawi. Objective: Using an electronic medical record monitoring system, to describe the quarterly and cumulative disease burden, management and outcomes of patients registered between March 2014 and June 2015. Design: A cross-sectional study. Results: Of 1135 patients, with new registrations increasing each quarter, 66% were female, 21% were aged ⩾65 years, 20% were obese, 53% had hypertension alone, 18% had diabetes alone, 12% had asthma, 10% had epilepsy and 7% had both hypertension and diabetes. In every quarter, about 30% of patients did not attend the clinic and 19% were registered as lost to follow-up (not seen for ⩾1 year) in the last quarter. Of those attending, over 90% were prescribed medication, and 80–90% with hypertension and/or diabetes had blood pressure/blood glucose measured. Over 85% of those with epilepsy had no seizures and 60–75% with asthma had no severe attacks. Control of blood pressure (41–51%) and diabetes (15–38%) was poor. Conclusion: It is feasible to manage patients with non-communicable diseases in a primary health care setting in Malawi, although more attention is needed to improve clinic attendance and the control of hypertension and diabetes. PMID:27358797

  5. Monitoring of pulmonary endothelial enzyme function: an animal model for a simplified clinically applicable procedure

    SciTech Connect

    Toivonen, H.J.; Makari, N.; Catravas, J.D.

    1988-01-01

    The authors present a simple and clinically applicable method for the serial monitoring of pulmonary microvascular enzyme function in vivo. This method requires the intravenous injection of trace amounts of a radiolabelled substrate and the collection of a single arterial blood sample. Simultaneous measurement of pulmonary blood flow, (e.g., by dye- or thermo-dilution) and the determination of blood hematocrit are also needed for the calculations. This method was compared to the multiple blood sample indicator dilution method in normal anesthesized rabbits. Both methods gave identical results for the metabolism of the synthetic, hemodynamically inactive tripeptide, /sup 3/H-benzoyl-Phe-Ala-Pro (/sup 3/H-BPAP), by pulmonary microvascular endothelial angiotensin converting enzyme. The parameters measured were: 1) substrate utilization, expressed linearly and logarithmically, and 2) the apparent first order reaction constant. The new method was also used for the simultaneous measurement of single pass, transpulmonary metabolism of /sup 3/H-BPAP by angiotensin converting enzyme and of 5'-adenosine monophosphate by 5'-nucleotidase in rabbits in vivo. The authors propose that similar enzyme kinetic measurements could be used in clinical studies to test their usefulness as an aid in the early diagnosis of incipient pulmonary endothelial dysfunction, e.g., adult respiratory distress syndrome.

  6. Circulating Chromogranin A as A Marker for Monitoring Clinical Response in Advanced Gastroenteropancreatic Neuroendocrine Tumors

    PubMed Central

    Li, Na; Li, Yanyan; Lu, Ming; Li, Zhongwu; Lu, Zhihao; Li, Jie; Shen, Lin

    2016-01-01

    Chromogranin A (CgA), present in the chromaffin granules of neuroendocrine cells, is a useful biomarker for the diagnosis of patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs). This study was conducted to investigate the potential role of circulating CgA in monitoring clinical response in Chinese patients with advanced GEP-NETs. Eighty patients with advanced GEP-NETs treated in Peking University Cancer Hospital from September 2011 to May 2014 and 65 healthy individuals were included in this study. Serum CgA levels were analyzed for relationship with patient’s baseline characteristics and clinical outcome. Median CgA levels were significantly higher in patients with advanced GEP-NETs than in healthy individuals (93.8 ng/mL vs. 37.1 ng/mL; P<0.01), as well as significantly higher in patients with carcinoid syndrome or liver metastasis than in those without carcinoid syndrome (298.8 ng/mL vs. 82.9 ng/mL; P = 0.011) or liver metastasis (137.0 ng/mL vs. 64.4 ng/mL; P = 0.023). A CgA cutoff value of 46.2 ng/mL was used in this study with a sensitivity of 78.8% and specificity of 73.8%. Patients with CgA levels higher than 46.2 ng/mL had a worse prognosis than patients with CgA levels lower than 46.2 ng/mL (P = 0.045). Notably, a weak correlation was observed between changes in serum CgA levels and clinical response to the IP regimen as well as SSAs. Our data also indicate that serum CgA could be a useful indicator of patient prognosis though there is more research required in order to validate such claims. PMID:27159453

  7. Kilovoltage Intrafraction Monitoring for Prostate Intensity Modulated Arc Therapy: First Clinical Results

    SciTech Connect

    Ng, Jin Aun; Booth, Jeremy T.; Poulsen, Per R.; Fledelius, Walther; Worm, Esben Schjodt; Eade, Thomas; Hegi, Fiona; Kneebone, Andrew; Kuncic, Zdenka; Keall, Paul J.

    2012-12-01

    Purpose: Most linear accelerators purchased today are equipped with a gantry-mounted kilovoltage X-ray imager which is typically used for patient imaging prior to therapy. A novel application of the X-ray system is kilovoltage intrafraction monitoring (KIM), in which the 3-dimensional (3D) tumor position is determined during treatment. In this paper, we report on the first use of KIM in a prospective clinical study of prostate cancer patients undergoing intensity modulated arc therapy (IMAT). Methods and Materials: Ten prostate cancer patients with implanted fiducial markers undergoing conventionally fractionated IMAT (RapidArc) were enrolled in an ethics-approved study of KIM. KIM involves acquiring kV images as the gantry rotates around the patient during treatment. Post-treatment, markers in these images were segmented to obtain 2D positions. From the 2D positions, a maximum likelihood estimation of a probability density function was used to obtain 3D prostate trajectories. The trajectories were analyzed to determine the motion type and the percentage of time the prostate was displaced {>=}3, 5, 7, and 10 mm. Independent verification of KIM positional accuracy was performed using kV/MV triangulation. Results: KIM was performed for 268 fractions. Various prostate trajectories were observed (ie, continuous target drift, transient excursion, stable target position, persistent excursion, high-frequency excursions, and erratic behavior). For all patients, 3D displacements of {>=}3, 5, 7, and 10 mm were observed 5.6%, 2.2%, 0.7% and 0.4% of the time, respectively. The average systematic accuracy of KIM was measured at 0.46 mm. Conclusions: KIM for prostate IMAT was successfully implemented clinically for the first time. Key advantages of this method are (1) submillimeter accuracy, (2) widespread applicability, and (3) a low barrier to clinical implementation. A disadvantage is that KIM delivers additional imaging dose to the patient.

  8. Monitoring electron donor metabolism under variable electron acceptor conditions using 13C-labeled lactate

    NASA Astrophysics Data System (ADS)

    Bill, M.; Conrad, M. E.; Yang, L.; Beller, H. R.; Brodie, E. L.

    2010-12-01

    Three sets of flow-through columns constructed with aquifer sediment from Hanford (WA) were used to study reduction of Cr(VI) to poorly soluble Cr(III) under denitrifying, sulfate-reducing/fermentative, and iron-reducing conditions with lactate as the electron donor. In order to understand the relationship between electron donors and biomarkers, and to determine the differences in carbon isotope fractionation resulting from different microbial metabolic processes, we monitored the variation in carbon isotopes in dissolved inorganic carbon (DIC), in total organic carbon (TOC), and in lactate, acetate and propionate. The greatest enrichment in 13C in columns was observed under denitrifying conditions. The δ13C of DIC increased by ~1750 to ~2000‰ fifteen days after supplementation of natural abundance lactate with a 13C-labeled lactate tracer (for an influent δ13C of ~2250‰ for the lactate) indicating almost complete oxidation of the electron donor. The denitrifying columns were among the most active columns and had the highest cell counts and the denitrification rate was highly correlated with Cr(VI) reduction rate. δ13C values of DIC ranged from ~540 to ~1170‰ for iron-reducing conditions. The lower enrichment in iron columns was related to the lower biological activity observed with lower yields of RNA and cell numbers in the column effluents. The carbon isotope shift in the sulfate-reducing ~198 to ~1960‰ for sulfate-reducing conditions reflecting the lower levels of the lactate in these columns. Additionally, in two of the sulfate columns, almost complete fermentation of the lactate occurred, producing acetate and propionate with the labeled carbon signature, but relatively smaller amounts of inorganic carbon. For all electron-accepting conditions, TOC yielded similar δ13C values as lactate stock solutions. Differences in C use efficiency, metabolic rate or metabolic pathway contributed to the differing TOC δ13C to DIC δ13C ratios between treatments

  9. Intra-Gene DNA Methylation Variability Is a Clinically Independent Prognostic Marker in Women’s Cancers

    PubMed Central

    Bartlett, Thomas E.; Jones, Allison; Goode, Ellen L.; Fridley, Brooke L.; Cunningham, Julie M.; Berns, Els M. J. J.; Wik, Elisabeth; Salvesen, Helga B.; Davidson, Ben; Trope, Claes G.; Lambrechts, Sandrina; Vergote, Ignace; Widschwendter, Martin

    2015-01-01

    We introduce a novel per-gene measure of intra-gene DNA methylation variability (IGV) based on the Illumina Infinium HumanMethylation450 platform, which is prognostic independently of well-known predictors of clinical outcome. Using IGV, we derive a robust gene-panel prognostic signature for ovarian cancer (OC, n = 221), which validates in two independent data sets from Mayo Clinic (n = 198) and TCGA (n = 358), with significance of p = 0.004 in both sets. The OC prognostic signature gene-panel is comprised of four gene groups, which represent distinct biological processes. We show the IGV measurements of these gene groups are most likely a reflection of a mixture of intra-tumour heterogeneity and transcription factor (TF) binding/activity. IGV can be used to predict clinical outcome in patients individually, providing a surrogate read-out of hard-to-measure disease processes. PMID:26629914

  10. [Analysis Methods of Short-term Non-linear Heart Rate Variability and Their Application in Clinical Medicine].

    PubMed

    Chi, Xianglin; Zhou, Jianhua; Shi, Ping; Liu, Chengyu

    2016-02-01

    The linear analysis for heart rate variability (HRV), including time domain method, frequency domain method and time-frequency analysis, has reached a lot of consensus. The non-linear analysis has also been widely applied in biomedical and clinical researches. However, for non-linear HRV analysis, especially for short-term non-linear HRV analysis, controversy still exists, and a unified standard and conclusion has not been formed. This paper reviews and discusses three short-term non-linear HRV analysis methods (fractal dimension, entropy and complexity) and their principles, progresses and problems in clinical application in detail, in order to provide a reference for accurate application in clinical medicine. PMID:27382764

  11. Monitoring the variability of precipitable water vapor over the Klang Valley, Malaysia during flash flood

    NASA Astrophysics Data System (ADS)

    Suparta, W.; Rahman, R.; Singh, M. S. J.

    2014-06-01

    Klang Valley is a focal area of Malaysian economic and business activities where the local weather condition is very important to maintain its reputation. Heavy rainfalls for more than an hour were reported up to 40 mm in September 2013 and 35 mm in October 2013. Both events are monitored as the first and second cases of flash flood, respectively. Based on these cases, we investigate the water vapor, rainfall, surface meteorological data (surface pressure, relative humidity, and temperature) and river water level. The precipitable water vapor (PWV) derived from Global Positioning System (GPS) is used to indicate the impact of flash flood on the rainfall. We found that PWV was dropped 4 mm in 2 hours before rainfall reached to 40 mm and dropped 3 mm in 3 hours before 35 mm of rainfall in respective cases. Variation of PWV was higher in September case compared to October case of about 2 mm. We suggest the rainfall phenomena can disturb the GPS propagation and therefore, the impact of PWV before, during and after the flash flood event at three selected GPS stations in Klang Valley is investigated for possible mitigation in the future.

  12. Monitoring of In-Field Variability for Site Specific Crop Management Through Open Geospatial Information

    NASA Astrophysics Data System (ADS)

    Řezník, T.; Lukas, V.; Charvát, K.; Charvát, K., Jr.; Horáková, Š.; Křivánek, Z.; Herman, L.

    2016-06-01

    The agricultural sector is in a unique position due to its strategic importance around the world. It is crucial for both citizens (consumers) and the economy (both regional and global), which, ideally, should ensure that the whole sector is a network of interacting organisations. It is important to develop new tools, management methods, and applications to improve the management and logistic operations of agricultural producers (farms) and agricultural service providers. From a geospatial perspective, this involves identifying cost optimization pathways, reducing transport, reducing environmental loads, and improving the energy balance, while maintaining production levels, etc. This paper describes the benefits of, and open issues arising from, the development of the Open Farm Management Information System. Emphasis is placed on descriptions of available remote sensing and other geospatial data, and their harmonization, processing, and presentation to users. At the same time, the FOODIE platform also offers a novel approach of yield potential estimations. Validation for one farm demonstrated 70% successful rate when comparing yield results at a farm counting 1'284 hectares on one hand and results of a theoretical model of yield potential on the other hand. The presented Open Farm Management Information System has already been successfully registered under Phase 8 of the Global Earth Observation System of Systems (GEOSS) Architecture Implementation Pilot in order to support the wide variety of demands that are primarily aimed at agriculture and water pollution monitoring by means of remote sensing.

  13. Installation of a variable-angle spectrometer system for monitoring diffuse and global solar radiation

    NASA Astrophysics Data System (ADS)

    Ormachea, O.; Abrahamse, A.; Tolavi, N.; Romero, F.; Urquidi, O.; Pearce, J. M.; Andrews, R.

    2013-11-01

    We report on the design and installation of a spectrometer system for monitoring solar radiation in Cochabamba, Bolivia. Both the light intensity and the spectral distribution affect the power produced by a photovoltaic device. Local variations in the solar spectrum (especially compared to the AM1.5 standard) may have important implications for device optimization and energy yield estimation. The spectrometer system, based on an Ocean Optics USB4000 (300-900nm) spectrometer, was designed to increase functionality. Typically systems only record the global horizontal radiation. Our system moves a fiber-optic cable 0-90 degrees and takes measurements in 9 degree increments. Additionally, a shadow band allows measurement of the diffuse component of the radiation at each position. The electronic controls utilize an Arduino UNO microcontroller to synchronizes the movement of two PAP bipolar (stepper) motors with the activation of the spectrometer via an external trigger. The spectrometer was factory calibrated for wavelength and calibrated for absolute irradiance using a Sellarnet SL1-Cal light source. We present preliminary results from data taken March-June, 2013, and comment on implications for PV devices in Cochabamba.

  14. On the spatial diffusion of fertility decline: the distance-to-clinic variable in a Chilean community.

    PubMed

    Fuller, G

    1974-10-01

    Survey data collected in San Gregorio, Chile during 1967 were selected for an investigation of the importance of residence distance-from-clinic in the pattern of contraceptive acceptance. Data were obtained through interviews conducted with women of fertile age who resided in every 4th house in the community. 1163 household reports could be employed. This number included a total of 1612 women in their fertile years. The 1612 women could be divided into users of some means of contraception and non-users. Once the basic binary classification procedure has been applied, each available socioeconomic variable for users and non-users may then be compared to determine if a significant difference exists among the distribution of the variables for each group. The variables of abortions, recent births, and aspiration level were the most potent discriminators between users and non-users of birth control. The more conventional socioeconomic variables showed little discriminatory power. Distance was found to be a fairly powerful discriminator between the group of users and non-users. Several variables other than distance are correlated with birth control practice, but once the influence of the spatial variation of these correlates has been extracted, distance emerges as the single most powerful discriminator between users and non-users of contraceptive techniques. There thus appears to be a need to emphasize the distribution of contraceptive supply in order to reduce the distance which women must travel to obtain birth control information or devices. PMID:12309958

  15. Assessment of patient satisfaction with acute pain management service: Monitoring quality of care in clinical setting

    PubMed Central

    Farooq, Fizzah; Khan, Robyna; Ahmed, Aliya

    2016-01-01

    Background and Aims: Assessment of patient satisfaction is an important tool for monitoring the quality of care in hospitals. The aim of this survey was to develop a reliable tool to assess patient satisfaction with acute pain management service (APMS) and identify variables affecting this so that care can be improved. Methods: A questionnaire was developed and administered to patients after being discharged from APMS care by an unbiased person. Data collected from record included patient demographics, surgical procedure, analgesic modality, co-analgesics and dynamic and static pain scores. Questions included pain expected and pain experienced, APMS response time, quality of pain relief with treatment, professionalism of APMS team, overall experience of pain relief and choosing/suggesting same modality for themselves/family/friends again. Five-point Likert scale was used for most of the options. Statistical analysis was done using SPSS 19. Results: Frequency and percentages were computed for qualitative observation and presented on pie chart and histogram. Seventy-one per cent patients expected severe pain while 43% actually experienced it. About 79.4% would choose same analgesia modality in future for self/family/friends. Ninety-nine per cent found APMS staff courteous and professional. About 89% rated their experience of pain management as excellent to very good. Conclusion: The survey of patients’ satisfaction to monitor the quality of care provided by APMS provided positive inputs on its role. This also helps to identify areas requiring improvement in care and as a tool to gauge the quality of care. PMID:27141107

  16. Optical system design with variable working distance for monitoring of environmental contamination in infrared region

    NASA Astrophysics Data System (ADS)

    Romanova, G. E.; Zaitceva, A. S.

    2016-04-01

    The project is dedicated to a research and development of a compact optical system for an identification of dangerous substances in a surrounding environment using a spectrum of scattered laser radiation. There is a whole class of tasks for diagnostics of environments and substances which are solved by mobile systems on distances of 0.5 - 10 m from the object. The key feature of an optical system in this case is having the highest functionality, to meet this demands it should be able to work on variable distances and provide the minimal light spot. The purpose of the work is a research of the best possible initial system parameters and its components, designing of an optical system with minimum possible number of elements providing acceptable quality of the image in the required dimensions. An image quality criterion for such systems is the size of the light spot, which defines an operation speed of the system. Using the beam diameter and allowable system dimensions as initial parameters of the two components system, relations were found which helps to define optimal component parameters for future design. To provide the possibility of working on various distances the thickness between the components can be varied. An example of a two component system consisted of three lenses with spherical surfaces is presented. The system works with a laser with the wavelength of 0.785 μm and provides the light spot less than 2.3 mm for all working distances within the range of 2 - 5 m.

  17. Radio and Millimeter Monitoring of Sgr A*: Spectrum, Variability, and Constraints on the G2 Encounter

    NASA Astrophysics Data System (ADS)

    Bower, Geoffrey C.; Markoff, Sera; Dexter, Jason; Gurwell, Mark A.; Moran, James M.; Brunthaler, Andreas; Falcke, Heino; Fragile, P. Chris; Maitra, Dipankar; Marrone, Dan; Peck, Alison; Rushton, Anthony; Wright, Melvyn C. H.

    2015-03-01

    We report new observations with the Very Large Array, Atacama Large Millimeter Array, and Submillimeter Array at frequencies from 1.0 to 355 GHz of the Galactic Center black hole, Sagittarius A*. These observations were conducted between 2012 October and 2014 November. While we see variability over the whole spectrum with an amplitude as large as a factor of 2 at millimeter wavelengths, we find no evidence for a change in the mean flux density or spectrum of Sgr A* that can be attributed to interaction with the G2 source. The absence of a bow shock at low frequencies is consistent with a cross-sectional area for G2 that is less than 2× {10}29 cm2. This result fits with several model predictions including a magnetically arrested cloud, a pressure-confined stellar wind, and a stellar photosphere of a binary merger. There is no evidence for enhanced accretion onto the black hole driving greater jet and/or accretion flow emission. Finally, we measure the millimeter wavelength spectral index of Sgr A* to be flat; combined with previous measurements, this suggests that there is no spectral break between 230 and 690 GHz. The emission region is thus likely in a transition between optically thick and thin at these frequencies and requires a mix of lepton distributions with varying temperatures consistent with stratification.

  18. Developing a multipoint titration method with a variable dose implementation for anaerobic digestion monitoring.

    PubMed

    Salonen, K; Leisola, M; Eerikäinen, T

    2009-01-01

    Determination of metabolites from an anaerobic digester with an acid base titration is considered as superior method for many reasons. This paper describes a practical at line compatible multipoint titration method. The titration procedure was improved by speed and data quality. A simple and novel control algorithm for estimating a variable titrant dose was derived for this purpose. This non-linear PI-controller like algorithm does not require any preliminary information from sample. Performance of this controller is superior compared to traditional linear PI-controllers. In addition, simplification for presenting polyprotic acids as a sum of multiple monoprotic acids is introduced along with a mathematical error examination. A method for inclusion of the ionic strength effect with stepwise iteration is shown. The titration model is presented with matrix notations enabling simple computation of all concentration estimates. All methods and algorithms are illustrated in the experimental part. A linear correlation better than 0.999 was obtained for both acetate and phosphate used as model compounds with slopes of 0.98 and 1.00 and average standard deviations of 0.6% and 0.8%, respectively. Furthermore, insensitivity of the presented method for overlapping buffer capacity curves was shown. PMID:19542645

  19. Spatial and Temporal Variability in Pesticide Exposure Downstream of a Heavily Irrigated Cropping Area: Application of Different Monitoring Techniques.

    PubMed

    O'Brien, Dominique; Lewis, Stephen; Davis, Aaron; Gallen, Christie; Smith, Rachael; Turner, Ryan; Warne, Michael; Turner, Scott; Caswell, Stewart; Mueller, Jochen F; Brodie, Jon

    2016-05-25

    Pesticide exposure threatens many freshwater and estuarine ecosystems around the world. This study examined the temporal and spatial trends of pesticide concentrations in a waterway within an agriculturally developed dry-tropics catchment using a combination of grab and passive sampling methods over a continuous two-year monitoring program. A total of 43 pesticide residues were detected with 7 pesticides exceeding ecologically relevant water quality guidelines/trigger values during the study period and 4 (ametryn, atrazine, diuron, and metolachlor) of these exceeding guidelines for several months. The presence and concentration of the pesticides in the stream coincided with seasonal variability in rainfall, harvest timing/cropping cycle, and management changes. The sampling approach used demonstrates that the application of these complementary sampling techniques (both grab and passive sampling methods) was effective in establishing pesticide usage patterns in upstream locations where application data are unavailable. PMID:26755130

  20. Flexible designs for phase II comparative clinical trials involving two response variables.

    PubMed

    Bersimis, S; Sachlas, A; Papaioannou, T

    2015-01-30

    The aim of phase II clinical trials is to determine whether an experimental treatment is sufficiently promising and safe to justify further testing. The need for reduced sample size arises naturally in phase II clinical trials owing to both technical and ethical reasons, motivating a significant part of research in the field during recent years, while another significant part of the research effort is aimed at more complex therapeutic schemes that demand the consideration of multiple endpoints to make decisions. In this paper, our attention is restricted to phase II clinical trials in which two treatments are compared with respect to two dependent dichotomous responses proposing some flexible designs. These designs permit the researcher to terminate the clinical trial when high rates of favorable or unfavorable outcomes are observed early enough requiring in this way a small number of patients. From the mathematical point of view, the proposed designs are defined on bivariate sequences of multi-state trials, and the corresponding stopping rules are based on various distributions related to the waiting time until a certain number of events appear in these sequences. The exact distributions of interest, under a unified framework, are studied using the Markov chain embedding technique, which appears to be very useful in clinical trials for the sample size determination. Tables of expected sample size and power are presented. The numerical illustration showed a very good performance for these new designs. PMID:25274584

  1. Monitoring interannual variability of vegetation in the western Liaohe River Basin, Northeast China

    NASA Astrophysics Data System (ADS)

    Huang, Fang; Wang, Ping; Qin, Yujun; Li, Yanqing

    2008-10-01

    Because vegetation affect several processes including water balance, absorption and reemission of solar radiation, latent and sensible heat fluxes, and carbon cycle, the variations in the composition and distribution of vegetation represents one of the most main source of systematic change on local, regional, or global scale. To monitor and better assess natural or man-made change in vegetation of the earth is desirable for modeling and predicting interactions between land surface and atmosphere. The temporal evolution of decadal NDVI composition is regarded as an effective time window able to show the natural seasonal variations. This paper investigates vegetation change between 1998 and 2006 in the west Liao River watershed, North China, which is the east fringe of agro-pasture transitional zone in northern China and highly sensitive to global change. Time series of SPOT-VEGETATION Normalized Difference Vegetation Index (NDVI) data are used to detect the vegetation cover change during last 9 years. Results show that the yearly maximum value composite mean NDVI over the study area increased slightly from 0.277 in 1998 to 0.287 in 2006, which indicated the increasing trend of vegetation activity. The annual average NDVI value in whole area was steady. Very slight improved and slight improved area reached 113442.32 km2 and 27987.34 km2, taking up 67.81% and 16.73% of the whole study area respectively. The degraded regions occupied about 15.16%. During 1998-2006, the landscape evolution in the western Liaohe River Basin was characterized by two opposite processes, namely vegetation restoration (returning cropland for farming to grassland and close grazing) and desertification (especially land salinization). The increasing amplitude is larger than the decreasing amplitude on the whole. There was obvious decrease of monthly MNDVI in spring months, while increasing tendency of monthly MNDVI in summer and autumn was found. Results will help to provide valuable

  2. Spatial and temporal variability of ozone sensitivity over China observed from the Ozone Monitoring Instrument

    NASA Astrophysics Data System (ADS)

    Jin, Xiaomeng; Holloway, Tracey

    2015-07-01

    Surface ozone (O3) air pollution in populated regions has been attributed to emissions of nitrogen oxides (NO + NO2 = NOx) and reactive volatile organic compounds (VOCs). These constituents react with hydrogen oxide radicals (OH + HO2 = HOx) in the presence of sunlight and heat to produce O3. The question of whether to reduce NOx emissions, VOC emissions, or both is complicated by spatially and temporally heterogeneous ozone-NOx-VOC sensitivity. This study characterizes spatial and temporal variations in O3 sensitivity by analyzing the ratio of formaldehyde (HCHO, a marker of VOCs) to nitrogen dioxide (NO2), a metric known as the formaldehyde nitrogen ratio (FNR). Level 3 gridded retrievals from the Ozone Monitoring Instrument (OMI) aboard the NASA Aura satellite were used to calculate FNR, with our analysis focusing on China. Based on previous studies, we take FNR < 1.0 as indicating VOC-limited regimes, FNR > 2.0 as indicating NOx-limited regime, and FNR between 1.0 and 2.0 as indicating transitional regime (where either NOx reductions or VOC reductions would be expected to reduce O3). We find that the transitional regime is widespread over the North China Plain (NCP), the Yangtze River Delta, and the Pearl River Delta during the ozone season (defined as having near-surface air temperatures >20°C at the early afternoon OMI overpass time). Outside of these regions, the NOx-limited regime is dominant. Because HCHO and NO2 have distinct seasonal patterns, FNR also has a pronounced seasonality, consistent with the seasonal cycle of surface O3. Examining trends from 2005 to 2013 indicates rapid growth in NO2, especially over less-developed areas where O3 photochemistry is NOx limited. Over this time period, HCHO decreased in southern China, where VOC emissions are dominated by biogenic sources, but increased slightly over the NCP, where VOC emissions are dominated by anthropogenic sources. A linear regression approach suggests that most of China (70% of grid cells

  3. Spectroscopic monitoring of the luminous blue variable Westerlund1-243 from 2002 to 2009

    NASA Astrophysics Data System (ADS)

    Ritchie, B. W.; Clark, J. S.; Negueruela, I.; Najarro, F.

    2009-12-01

    Context: The massive post-main sequence star W243 in the galactic starburst cluster Westerlund 1 has undergone a spectral transformation from a B2Ia supergiant devoid of emission features in 1981 to an A-type supergiant with a rich emission-line spectrum by 2002/03. Aims: We examine the continued evolution of W243 from 2002 to 2009 to understand its evolutionary state, current physical properties and the origin of its peculiar emission line spectrum. Methods: We used VLT/UVES and VLT/FLAMES to obtain high resolution, high signal-to-noise spectra on six epochs in 2003/04 (UVES) and ten epochs in 2008/09 (FLAMES). These spectra are used alongside other lower-resolution VLT/FLAMES and NTT/EMMI spectra to follow the evolution of W243 from 2002 to 2009. Non-LTE models are used to determine the physical properties of W243. Results: W243 displays a complex, time-varying spectrum with emission lines of hydrogen, helium and Lyman-α pumped metals, forbidden lines of nitrogen and iron, and a large number of absorption lines from neutral and singly-ionized metals. Many lines are complex emission/absorption blends, with significant spectral evolution occurring on timescales of just a few days. The LBV has a temperature of ~8500 K (spectral type A3Ia+), and displays signs of photospheric pulsations and weak episodic mass loss. Nitrogen is highly overabundant, with carbon and oxygen depleted, indicative of surface CNO-processed material and considerable previous mass-loss, although current time-averaged mass-loss rates are low. The emission-line spectrum forms at large radii, when material lost by the LBV in a previous mass-loss event is ionized by an unseen hot companion. Monitoring of the near-infrared spectrum suggests that the star has not changed significantly since it finished evolving to the cool state, close to the Humphreys-Davidson limit, in early 2003. This work is based on observations collected at the European Southern Observatory, Chile, under programme IDs ESO 69

  4. Polyvinylidene fluoride film based nasal sensor to monitor human respiration pattern: an initial clinical study.

    PubMed

    Roopa Manjunatha, G; Rajanna, K; Mahapatra, D Roy; Nayak, M M; Krishnaswamy, Uma Maheswari; Srinivasa, R

    2013-12-01

    Design and development of a piezoelectric polyvinylidene fluoride (PVDF) thin film based nasal sensor to monitor human respiration pattern (RP) from each nostril simultaneously is presented in this paper. Thin film based PVDF nasal sensor is designed in a cantilever beam configuration. Two cantilevers are mounted on a spectacle frame in such a way that the air flow from each nostril impinges on this sensor causing bending of the cantilever beams. Voltage signal produced due to air flow induced dynamic piezoelectric effect produce a respective RP. A group of 23 healthy awake human subjects are studied. The RP in terms of respiratory rate (RR) and Respiratory air-flow changes/alterations obtained from the developed PVDF nasal sensor are compared with RP obtained from respiratory inductance plethysmograph (RIP) device. The mean RR of the developed nasal sensor (19.65 ± 4.1) and the RIP (19.57 ± 4.1) are found to be almost same (difference not significant, p > 0.05) with the correlation coefficient 0.96, p < 0.0001. It was observed that any change/alterations in the pattern of RIP is followed by same amount of change/alterations in the pattern of PVDF nasal sensor with k = 0.815 indicating strong agreement between the PVDF nasal sensor and RIP respiratory air-flow pattern. The developed sensor is simple in design, non-invasive, patient friendly and hence shows promising routine clinical usage. The preliminary result shows that this new method can have various applications in respiratory monitoring and diagnosis. PMID:23771706

  5. Monitoring of Bright Giant Variables requested in support of ground-based spectroscopy and for long-term study

    NASA Astrophysics Data System (ADS)

    Rector, Travis; Price, Aaron; Templeton, Matthew R.

    2011-05-01

    Dr. Steve Howell (NASA) and Dr. Travis Rector (University of Alaska, Anchorage) have requested AAVSO observations of several bright giant variable stars of diverse classes in support of spectroscopic observations to be made at Kitt Peak National Observatory between 2011 May 30 and 2011 June 01. Long-term monitoring of these objects is also encouraged. The goal of the project is to determine if the surface temperatures and radii of these stars change in a recognizable pattern over long timescales. Priority targets are Z UMa, R CrB, SX Her, TT Oph, TX Oph, AC Her, and R Sct. Additional targets are R Vir, Y CVn, g Her, UU Her, UZ Oph, V453 Oph, XX Oph, TZ Oph, V564 Oph, T Lyr, AD Aql, AR Sgr, V5569 Sgr, EP Lyr, and EU Del. Finder charts with sequence may be created using the AAVSO Variable Star Plotter (http://www.aavso.org/vsp). Observations should be submitted to the AAVSO International Database. See full Alert Notice for more details.

  6. Hydroacoustic monitoring of sorted bedforms west of Sylt (SE North Sea) - Interannual variabilities during five years

    NASA Astrophysics Data System (ADS)

    Mielck, Finn; Hass, H. Christian

    2014-05-01

    Sorted bedforms can be found in coastal shelf seas worldwide. These spatially-grain-size-sorted bedforms with lengths of up to several kilometers are consisting of small rippled medium-to-coarse sand and can remain stable for decades. However, the knowledge about their development is still fragmentary. For this study, a shallow investigation area with water depth <15 m located west of the island of Sylt (SE North Sea, Germany) was annually surveyed with high-resolution hydroacoustic means (i.e. sidescan sonar, multibeam echo sounder, and sub-bottom profiler) within a time frame of five years. Aim was to detected short-time variances regarding the stability of the prevailing bedforms in an area which is strongly influenced by distinct tidal and wind-driven currents as well as storm surges. The measurements show sinuous stripes of rippled medium sand which are surrounded by smooth fine-sand areas. These sorted bedforms are basically linked to the morphology characterized by ridges and channels and could be identified as flow-transverse features that are maintained by ebb and flood currents of almost equal strengths. The bidirectional flow field generates sharp boundaries between the coarse- and fine-sand domains in both current directions. Further to the north, where unidirectional flow field conditions prevail, asymmetric bedforms could be detected with only one sharp boundary aligned counter to the current direction. While comparing the data sets of the different years, no significant changes regarding the morphology and distribution of the sorted bedforms were detectable. However, the boundaries to the fine-sand domains reveal small-scale variabilities. New minor bedforms and small rippled excavation marks developed and disappeared during the measure campaign. We suppose that these processes mainly occur during periodically recurring storm surges: Fine-sand layers are winnowed away and the shapes of the bedforms changes. Intensity and direction of these storms are

  7. Monitoring of the Environment at the Transplant Unit—Hemato-Oncology Clinic

    PubMed Central

    Matoušková, Ivanka; Holy, Ondřej

    2014-01-01

    Aims: Aim of this study was to monitor the environment at the Transplant Unit—Hemato-Oncology Clinic, University Hospital Olomouc (Olomouc, Czech Republic) and identify risks for the patients. Methods and Results: Microorganisms were cultivated under standard aerobic conditions. Strains were biochemically identified using the BD Phoenix™ PID Panel (USA). Legionella pneumophila was identified by DNA sequencing. From the air, the most frequently isolated strains were coagulase-negative staphylococci (94.3%), Micrococcus spp. and Bacillus spp. No Gram-negative strains were isolated from the air. From the surfaces, the most frequently isolated Gram-positive strains were coagulase-negative staphylococci (67.4%), Bacillus spp., enterococci (5.5%), Staphylococcus aureus (2.3%) and Micrococcus spp. (1.7%). From the surfaces, the most frequently isolated Gram-negative strains were from genera Pseudomonas (28%), Enterobacter (28%), E. coli (6%), and Klebsiella spp. (5%). From the personnel, the most frequently isolated Gram-positive strains were coagulase-negative staphylococci (59.6%), Bacillus spp. (24.1%) and Staphylococcus aureus (9.8%). From the personnel, the most frequently isolated Gram-negative strains were Enterobacter spp. (61%), Klebsiella oxytoca (18%), and E. coli (11%). Microscopic filamentous fungi were isolated in 13 cases (2.71%). Isolated strains were Aspergillus spp. (4), Trichoderma spp. (2), Penicillium spp. (2), one case of the strains Paecilomyces spp., Eurotium spp., Monilia spp. Conclusions: The study found no significant deviations in the microbial contamination of the cleanroom air. The personnel entrance of the Transplant Unit represent a high risk area, an extreme value (7270 CFU/m3) was recorded. Regime measures are fully effective, no other deficiencies were found. Significance and Impact of the Study: This epidemiological study, which was held for the duration of one year at the Transplant Unit—Hemato-Oncology Clinic, University

  8. Neurobiological and clinical variables associated with alcohol abuse in bulimia nervosa.

    PubMed

    Vaz-Leal, Francisco J; Ramos-Fuentes, María I; Rodríguez-Santos, Laura; Flores-Mateos, Isabel S; Franco-Zambrano, Andrés; Rojo-Moreno, Luis; Beato-Fernández, Luis

    2015-05-01

    The study was aimed at analysing the reciprocal relationships of several clinical and neurobiological items in order to predict alcohol misuse in patients with bulimia nervosa (BN). Seventy BN patients and 70 healthy controls were assessed for depression, impulsivity, borderline personality traits and self-defeating behaviours using specific scales; serum cortisol and 24-hour urinary excretion of serotonin and 5-hydroxiindolacetic acid were also assessed. The study confirmed the implications of these clinical factors for alcohol misuse in BN patients, but the results suggested that depressive symptoms and hypercortisolism could lie behind these relationships. PMID:25766414

  9. Clinical significance of dynamic monitoring by transcranial doppler ultrasound and intracranial pressure monitor after surgery of hypertensive intracerebral hemorrhage

    PubMed Central

    Liu, Zaiming; Chen, Qianxue; Tian, Daofeng; Wang, Long; Liu, Baohui; Zhang, Shenqi

    2015-01-01

    The aim of this study was to investigate the surgical method of hypertensive intracerebral hemorrhage (HIH) and how to control the postoperative blood pressure. 96 HIH patients were performed the craniotomic hematoma dissection (CHD) and the hematoma-cavity drilling drainage (HCDD), respectively. Meanwhile, the intracranial pressure and mean arterial pressure of each patient were continuously monitored for 7 days, the postoperative 1st, 3rd, 7th and 14th-day average flow velocities and pulsatility indexes of the bilateral middle cerebral arteries were monitored. CHD exhibited the significant difference in the long-term quality of life (ADL classification 6 months later) of patients with hematoma >50 ml than HCDD; furthermore, the postoperative 1st, 3rd, 7th and 14th-day TCD parameter analysis revealed that CHD exhibited better results in relieving the intracranial pressure and improving the cerebral blood flow than HCDD, and the postoperative ICP and MAP monitoring towards all patients could effectively control the blood pressure and prevent the further bleeding. The patients with hematoma >50 ml should choose CHD, and all HIH patients should be routinely performed the ICP and MAP monitoring. PMID:26379963

  10. Clinical Studies of Real-Time Monitoring of Lithotripter Performance Using Passive Acoustic Sensors

    NASA Astrophysics Data System (ADS)

    Leighton, T. G.; Fedele, F.; Coleman, A. J.; McCarthy, C.; Ryves, S.; Hurrell, A. M.; De Stefano, A.; White, P. R.

    2008-09-01

    This paper describes the development and clinical testing of a passive device which monitors the passive acoustic emissions generated within the patient's body during Extracorporeal Shock Wave Lithotripsy (ESWL). Designed and clinically tested so that it can be operated by a nurse, the device analyses the echoes generated in the body in response to each ESWL shock, and so gives real time shock-by-shock feedback on whether the stone was at the focus of the lithotripter, and if so whether the previous shock contributed to stone fragmentation when that shock reached the focus. A shock is defined as being `effective' if these two conditions are satisfied. Not only can the device provide real-time feedback to the operator, but the trends in shock `effectiveness' can inform treatment. In particular, at any time during the treatment (once a statistically significant number of shocks have been delivered), the percentage of shocks which were `effective' provides a treatment score TS(t) which reflects the effectiveness of the treatment up to that point. The TS(t) figure is automatically delivered by the device without user intervention. Two clinical studies of the device were conducted, the ethics guidelines permitting only use of the value of TS(t) obtained at the end of treatment (this value is termed the treatment score TS0). The acoustically-derived treatment score was compared with the treatment score CTS2 given by the consultant urologist at the three-week patient's follow-up appointment. In the first clinical study (phase 1), records could be compared for 30 out of the 118 patients originally recruited, and the results of phase 1 were used to refine the parameter values (the `rules') with which the acoustic device provides its treatment score. These rules were tested in phase 2, for which records were compared for 49 of the 85 patients recruited. Considering just the phase 2 results (since the phase 1 data were used to draw up the `rules' under which phase 2 operated

  11. Variables influencing presenting symptoms of patients with eating disorders at psychiatric outpatient clinics.

    PubMed

    Tseng, Mei-Chih Meg; Chen, Kuan-Yu; Chang, Chin-Hao; Liao, Shih-Cheng; Chen, Hsi-Chung

    2016-04-30

    Eating disorders (EDs) have been underdiagnosed in many clinical settings. This study investigates the influence of clinical characteristics on presenting symptoms of patients with EDs. Psychiatric outpatients, aged 18-45, were enrolled sequentially and received a two-phase survey for EDs in August 2010-January 2013. Their primary reasons for seeking psychiatric help were obtained at their first encounter with outpatient psychiatrists. Patients' clinical and demographic characteristics were compared according to presenting symptoms with or without eating/weight problems. Of 2140 patients, 348 (16.3%) were diagnosed with an ED (22.6% of women and 6.3% of men). The three most common reasons for seeking psychiatric help were eating/weight problems (46.0%), emotional problems (41.3%), and sleep disturbances (19.3%). The multivariate analyses suggest that when patients with EDs presented symptoms that were less related to eating/weight problems, they were significantly more likely to be those having diagnoses other than anorexia nervosa or bulimia nervosa and less severe degree of binge-eating. Further, patients with EDs who demonstrated more impulsive behaviors and poorer functioning were less likely to report their eating problems when visiting psychiatric clinics. Thus, ED should be assessed routinely in patients with complex psychopathology to facilitate comprehensive treatment. PMID:27086254

  12. Gaussia Luciferase as a Genetic Fusion Partner with Antibody Fragments for Sensitive Immunoassay Monitoring of Clinical Biomarkers.

    PubMed

    Oyama, Hiroyuki; Morita, Izumi; Kiguchi, Yuki; Miyake, Sayaka; Moriuchi, Ayaka; Akisada, Tatsuki; Niwa, Toshifumi; Kobayashi, Norihiro

    2015-12-15

    In this study, we show the utility of Gaussia luciferase (GLuc), which is much smaller than previously found luciferases, as the fusion partner with artificial antibody species for developing sensitive immunoassay systems. As an example, we constructed a bioluminescent enzyme-linked immunosorbent assay (BL-ELISA) system determining the major glucocorticoid cortisol. A monoclonal antibody was newly elicited against a cortisol-albumin conjugate, and the genes encoding its variable domains (VH and VL) were cloned and combined to encode a single-chain Fv fragment (scFv). scFv was then linked to the wild-type GLuc gene or that encoding GLuc mutants reported to show improved emission kinetics and expressed in the periplasmic space of several Escherichia coli strains. Notably, the wild-type GLuc fusion protein (scFv-wtGLuc) showed the most suitable luminescent properties for BL-ELISAs. In our system, scFv-wtGLuc was reacted competitively with the analyte and immobilized cortisol moieties, and the bound GLuc activity was monitored with coelenterazine as the substrate. Successful batch-type luminescence detection was achieved using a plate reader without built-in injectors. The midpoint and limit of detection in a typical dose-response curve were 4.1 and 0.26 pg/assay, respectively, thus exhibiting much more sensitivity than conventional cortisol immunoassays. Serum cortisol levels (as the sum with cortisone) for healthy subjects, determined without any pretreatment, were compatible with reported reference ranges. The scFv-wtGLuc probe was stable over a year under storage as periplasmic extracts at -30 °C or with repeated freeze-thawing. These results suggest that GLuc fusions with antibody fragments might serve as useful and highly sensitive immunoassay probes in various clinical settings. PMID:26625180

  13. PCNA and Ki67 expression in breast carcinoma: correlations with clinical and biological variables.

    PubMed Central

    Leonardi, E.; Girlando, S.; Serio, G.; Mauri, F. A.; Perrone, G.; Scampini, S.; Dalla Palma, P.; Barbareschi, M.

    1992-01-01

    AIMS: To investigate the expression of two cell cycle related antigens (proliferating cell nuclear antigen (PCNA) and Ki67 related antigen) in a series of breast cancers; and the possible correlations between the PCNA and Ki67 labelling indexes (PCNA-LI and Ki67-LI) and their associations with other biological and clinicopathological variables. METHODS: Ninety six ductal and 10 lobular carcinoma specimens were investigated. Samples were fixed in formalin and in Methacarnoy for localisation of PCNA. Ki67 was immunostained on frozen sections. The PCNA-LI and Ki67-LI were evaluated in relation to tumour size, mitotic count, histological grade, nodal state as well as receptor content and altered expression of the p53 gene. RESULTS: PCNA-LI did not correlate with Ki67-LI, nor was it associated with any other variable examined. A high KI67-LI (above the median value of 13.5) was associated with high grade and mitotic count, negative receptor content, and altered expression of the p53 gene, but not with other variables. CONCLUSIONS: The PCNA-LI does not seem to be a substitute for the Ki67-LI in evaluating the growth fraction in breast cancer. Images PMID:1350788

  14. Growth monitoring in the evolution of clinic based health care through a community based action program.

    PubMed

    Chaudhuri, S N

    1988-01-01

    In Calcutta, India a voluntary organization was established in 1975 called the Child in Need Institute (CINI) in order to nutritionally rehabilitate the poor. CINI detected malnutrition by utilizing "weight for age" charts and treated malnutrition with food supplements. Women must purchase a growth card to enter the program. Patients are registered, weighed and plotted, given on ort demonstration, educated in health and nutrition, shown supplementary feeding techniques, given a health check up and immunizations, and are given antenatal care. The growth card is referred to at all stages of the care, which causes mothers to realize that it is very important to their health. CINI eventually established mobile clinics run by women's groups. 50% of all children under 3 participate monthly and 30% more participate at 2-3 month intervals. Mothers are more willing to correct the nutrition of their children when they understand the growth charts. The India Institute of Medical Sciences in 1986 assessed the KAP (knowledge, awareness, performance) of 132 village mothers. They found significant appreciation for growth monitoring. Mothers have also become more aware of the importance of sanitation, frequent feeding, and clean water. The growth chart is a tool, but is also viewed as a symbol of the activities of CINI. PMID:3391668

  15. The first clinical treatment with kilovoltage intrafraction monitoring (KIM): A real-time image guidance method

    SciTech Connect

    Keall, Paul J. O’Brien, Ricky; Huang, Chen-Yu; Aun Ng, Jin; Colvill, Emma; Rugaard Poulsen, Per; Fledelius, Walther; Juneja, Prabhjot; Booth, Jeremy T.; Simpson, Emma; Bell, Linda; Alfieri, Florencia; Eade, Thomas; Kneebone, Andrew

    2015-01-15

    Purpose: Kilovoltage intrafraction monitoring (KIM) is a real-time image guidance method that uses widely available radiotherapy technology, i.e., a gantry-mounted x-ray imager. The authors report on the geometric and dosimetric results of the first patient treatment using KIM which occurred on September 16, 2014. Methods: KIM uses current and prior 2D x-ray images to estimate the 3D target position during cancer radiotherapy treatment delivery. KIM software was written to process kilovoltage (kV) images streamed from a standard C-arm linear accelerator with a gantry-mounted kV x-ray imaging system. A 120° pretreatment kV imaging arc was acquired to build the patient-specific 2D to 3D motion correlation. The kV imager was activated during the megavoltage (MV) treatment, a dual arc VMAT prostate treatment, to estimate the 3D prostate position in real-time. All necessary ethics, legal, and regulatory requirements were met for this clinical study. The quality assurance processes were completed and peer reviewed. Results: During treatment, a prostate position offset of nearly 3 mm in the posterior direction was observed with KIM. This position offset did not trigger a gating event. After the treatment, the prostate motion was independently measured using kV/MV triangulation, resulting in a mean difference of less than 0.6 mm and standard deviation of less than 0.6 mm in each direction. The accuracy of the marker segmentation was visually assessed during and after treatment and found to be performing well. During treatment, there were no interruptions due to performance of the KIM software. Conclusions: For the first time, KIM has been used for real-time image guidance during cancer radiotherapy. The measured accuracy and precision were both submillimeter for the first treatment fraction. This clinical translational research milestone paves the way for the broad implementation of real-time image guidance to facilitate the detection and correction of geometric and

  16. Variable expression and incomplete penetrance of developmental dysplasia of the hip: clinical challenge in a 71-member multigeneration family.

    PubMed

    Feldman, George J; Peters, Christopher L; Erickson, Jill A; Hozack, Bryan A; Jaraha, Ranna; Parvizi, Javad

    2012-04-01

    Developmental dysplasia of the hip is a crippling condition that affects children and adults. Identical twin studies support a strong causative genetic component. Although clinical tests for newborns can detect gross malformations, it is the subtle malformations that are often not detected, resulting in early onset osteoarthritis of the hip in adults. As a first step in identifying the causative mutation, we have recruited the largest documented affected family with 71 members spanning generations. Clinical and radiographic signs of developmental dysplasia of the hip are described, and the diagnostic challenge of identifying affected family members is discussed.Variable expression of disease allele is evident in several members of the family and greatly contributes to the diagnostic challenge facing clinicians. PMID:22177793

  17. Artificial neural network modeling using clinical and knowledge independent variables predicts salt intake reduction behavior

    PubMed Central

    Isma’eel, Hussain A.; Sakr, George E.; Almedawar, Mohamad M.; Fathallah, Jihan; Garabedian, Torkom; Eddine, Savo Bou Zein

    2015-01-01

    Background High dietary salt intake is directly linked to hypertension and cardiovascular diseases (CVDs). Predicting behaviors regarding salt intake habits is vital to guide interventions and increase their effectiveness. We aim to compare the accuracy of an artificial neural network (ANN) based tool that predicts behavior from key knowledge questions along with clinical data in a high cardiovascular risk cohort relative to the least square models (LSM) method. Methods We collected knowledge, attitude and behavior data on 115 patients. A behavior score was calculated to classify patients’ behavior towards reducing salt intake. Accuracy comparison between ANN and regression analysis was calculated using the bootstrap technique with 200 iterations. Results Starting from a 69-item questionnaire, a reduced model was developed and included eight knowledge items found to result in the highest accuracy of 62% CI (58-67%). The best prediction accuracy in the full and reduced models was attained by ANN at 66% and 62%, respectively, compared to full and reduced LSM at 40% and 34%, respectively. The average relative increase in accuracy over all in the full and reduced models is 82% and 102%, respectively. Conclusions Using ANN modeling, we can predict salt reduction behaviors with 66% accuracy. The statistical model has been implemented in an online calculator and can be used in clinics to estimate the patient’s behavior. This will help implementation in future research to further prove clinical utility of this tool to guide therapeutic salt reduction interventions in high cardiovascular risk individuals. PMID:26090333

  18. Clinical Impact of Speed Variability to Identify Ultramarathon Runners at Risk for Acute Kidney Injury

    PubMed Central

    Hou, Sen-Kuang; Chiu, Yu-Hui; Tsai, Yi-Fang; Tai, Ling-Chen; Hou, Peter C.; How, Chorng-Kuang; Yang, Chen-Chang; Kao, Wei-Fong

    2015-01-01

    Background Ultramarathon is a high endurance exercise associated with a wide range of exercise-related problems, such as acute kidney injury (AKI). Early recognition of individuals at risk of AKI during ultramarathon event is critical for implementing preventative strategies. Objectives To investigate the impact of speed variability to identify the exercise-related acute kidney injury anticipatively in ultramarathon event. Methods This is a prospective, observational study using data from a 100 km ultramarathon in Taipei, Taiwan. The distance of entire ultramarathon race was divided into 10 splits. The mean and variability of speed, which was determined by the coefficient of variation (CV) in each 10 km-split (25 laps of 400 m oval track) were calculated for enrolled runners. Baseline characteristics and biochemical data were collected completely 1 week before, immediately post-race, and one day after race. The main outcome was the development of AKI, defined as Stage II or III according to the Acute Kidney Injury Network (AKIN) criteria. Multivariate analysis was performed to determine the independent association between variables and AKI development. Results 26 ultramarathon runners were analyzed in the study. The overall incidence of AKI (in all Stages) was 84.6% (22 in 26 runners). Among these 22 runners, 18 runners were determined as Stage I, 4 runners (15.4%) were determined as Stage II, and none was in Stage III. The covariates of BMI (25.22 ± 2.02 vs. 22.55 ± 1.96, p = 0.02), uric acid (6.88 ± 1.47 vs. 5.62 ± 0.86, p = 0.024), and CV of speed in specific 10-km splits (from secondary 10 km-split (10th – 20th km-split) to 60th – 70th km-split) were significantly different between runners with or without AKI (Stage II) in univariate analysis and showed discrimination ability in ROC curve. In the following multivariate analysis, only CV of speed in 40th – 50th km-split continued to show a significant association to the development of AKI (Stage II) (p

  19. Biologic Variability of Soluble ST2 in Patients With Stable Chronic Heart Failure and Implications for Monitoring.

    PubMed

    Piper, Susan; deCourcey, Julia; Sherwood, Roy; Amin-Youssef, George; McDonagh, Theresa

    2016-07-01

    Soluble ST2 (sST2) is a novel biomarker implicated in myocardial remodeling and fibrosis. Recent studies in normal subjects have suggested that the biologic variability (BV) of sST2 is significantly lower than that of the B-type natriuretic peptides and N-terminal pro B-type natriuretic peptide (NTproBNP). It may, consequently, be a better biomarker for monitoring patients with chronic heart failure (CHF). To date, no published studies have examined the BV of sST2 in a heart failure population. Blood samples from 50 outpatients with pharmacologically optimized stable CHF and persistent left ventricular dysfunction (ejection fraction <40%) were collected at baseline, 1 hour, 1 month, 3 months, and 6 months. Using log-transformed data, mean intra-individual coefficients of variation (CVI) and subsequent reference change values were calculated for both NTproBNP and sST2. Results demonstrate significantly lower CVI and reference change values for sST2 compared with NTproBNP at 1 month (12.02 [36%] vs 36.75 [103%]), p <0.001, 3 months (12.23 [36%] vs 40.98 [114%]), p <0.001, and 6 months (16.41 [47%] vs 46.02 [128%]), p <0.001. In conclusion, the BV of sST2 is significantly lower than that of NTproBNP in patients with CHF. These results support previous indications that sST2 may be a better biomarker for monitoring such patients. PMID:27189812

  20. Passive Acoustic Monitoring of the Temporal Variability of Odontocete Tonal Sounds from a Long-Term Marine Observatory

    PubMed Central

    Lin, Tzu-Hao; Yu, Hsin-Yi; Chen, Chi-Fang; Chou, Lien-Siang

    2015-01-01

    The developments of marine observatories and automatic sound detection algorithms have facilitated the long-term monitoring of multiple species of odontocetes. Although classification remains difficult, information on tonal sound in odontocetes (i.e., toothed whales, including dolphins and porpoises) can provide insights into the species composition and group behavior of these species. However, the approach to measure whistle contour parameters for detecting the variability of odontocete vocal behavior may be biased when the signal-to-noise ratio is low. Thus, methods for analyzing the whistle usage of an entire group are necessary. In this study, a local-max detector was used to detect burst pulses and representative frequencies of whistles within 4.5–48 kHz. Whistle contours were extracted and classified using an unsupervised method. Whistle characteristics and usage pattern were quantified based on the distribution of representative frequencies and the composition of whistle repertoires. Based on the one year recordings collected from the Marine Cable Hosted Observatory off northeastern Taiwan, odontocete burst pulses and whistles were primarily detected during the nighttime, especially after sunset. Whistle usage during the nighttime was more complex, and whistles with higher frequency were mainly detected during summer and fall. According to the multivariate analysis, the diurnal variation of whistle usage was primarily related to the change of mode frequency, diversity of representative frequency, and sequence complexity. The seasonal variation of whistle usage involved the previous three parameters, in addition to the diversity of whistle clusters. Our results indicated that the species and behavioral composition of the local odontocete community may vary among seasonal and diurnal cycles. The current monitoring platform facilitates the evaluation of whistle usage based on group behavior and provides feature vectors for species and behavioral

  1. Biallelic Mutations in TMEM126B Cause Severe Complex I Deficiency with a Variable Clinical Phenotype.

    PubMed

    Alston, Charlotte L; Compton, Alison G; Formosa, Luke E; Strecker, Valentina; Oláhová, Monika; Haack, Tobias B; Smet, Joél; Stouffs, Katrien; Diakumis, Peter; Ciara, Elżbieta; Cassiman, David; Romain, Nadine; Yarham, John W; He, Langping; De Paepe, Boel; Vanlander, Arnaud V; Seneca, Sara; Feichtinger, René G; Płoski, Rafal; Rokicki, Dariusz; Pronicka, Ewa; Haller, Ronald G; Van Hove, Johan L K; Bahlo, Melanie; Mayr, Johannes A; Van Coster, Rudy; Prokisch, Holger; Wittig, Ilka; Ryan, Michael T; Thorburn, David R; Taylor, Robert W

    2016-07-01

    Complex I deficiency is the most common biochemical phenotype observed in individuals with mitochondrial disease. With 44 structural subunits and over 10 assembly factors, it is unsurprising that complex I deficiency is associated with clinical and genetic heterogeneity. Massively parallel sequencing (MPS) technologies including custom, targeted gene panels or unbiased whole-exome sequencing (WES) are hugely powerful in identifying the underlying genetic defect in a clinical diagnostic setting, yet many individuals remain without a genetic diagnosis. These individuals might harbor mutations in poorly understood or uncharacterized genes, and their diagnosis relies upon characterization of these orphan genes. Complexome profiling recently identified TMEM126B as a component of the mitochondrial complex I assembly complex alongside proteins ACAD9, ECSIT, NDUFAF1, and TIMMDC1. Here, we describe the clinical, biochemical, and molecular findings in six cases of mitochondrial disease from four unrelated families affected by biallelic (c.635G>T [p.Gly212Val] and/or c.401delA [p.Asn134Ilefs(∗)2]) TMEM126B variants. We provide functional evidence to support the pathogenicity of these TMEM126B variants, including evidence of founder effects for both variants, and establish defects within this gene as a cause of complex I deficiency in association with either pure myopathy in adulthood or, in one individual, a severe multisystem presentation (chronic renal failure and cardiomyopathy) in infancy. Functional experimentation including viral rescue and complexome profiling of subject cell lines has confirmed TMEM126B as the tenth complex I assembly factor associated with human disease and validates the importance of both genome-wide sequencing and proteomic approaches in characterizing disease-associated genes whose physiological roles have been previously undetermined. PMID:27374774

  2. Smith-Lemli-Opitz syndrome: a variable clinical and biochemical phenotype.

    PubMed Central

    Ryan, A K; Bartlett, K; Clayton, P; Eaton, S; Mills, L; Donnai, D; Winter, R M; Burn, J

    1998-01-01

    We have reviewed all known UK cases of Smith-Lemli-Opitz syndrome. Among 49 cases with proven 7-dehydrocholesterol reductase deficiency, half had been terminated or had died in infancy. The minimum incidence is 1 in 60,000. The frequent occurrence of hypospadias may account for 71% of recognised cases being male. Important common features which emerged include short thumbs, severe photosensitivity, aggressive behaviour, and atrioventricular septal defect. The typical facial appearance becomes less obvious with age and 20% of cases did not have 2/3 toe syndactyly. Biochemical measurements of serum 7-dehydrocholesterol did not correlate with clinical severity. Images PMID:9678700

  3. Anxiety Disorders in Caucasian and African American Children: A Comparison of Clinical Characteristics, Treatment Process Variables, and Treatment Outcomes.

    PubMed

    Gordon-Hollingsworth, Arlene T; Becker, Emily M; Ginsburg, Golda S; Keeton, Courtney; Compton, Scott N; Birmaher, Boris B; Sakolsky, Dara J; Piacentini, John; Albano, Anne M; Kendall, Philip C; Suveg, Cynthia M; March, John S

    2015-10-01

    This study examined racial differences in anxious youth using data from the Child/Adolescent Anxiety Multimodal Study (CAMS) [1]. Specifically, the study aims addressed whether African American (n = 44) versus Caucasian (n = 359) children varied on (1) baseline clinical characteristics, (2) treatment process variables, and (3) treatment outcomes. Participants were ages 7-17 and met DSM-IV-TR criteria for generalized anxiety disorder, social phobia, and/or separation anxiety disorder. Baseline data, as well as outcome data at 12 and 24 weeks, were obtained by independent evaluators. Weekly treatment process variables were collected by therapists. Results indicated no racial differences on baseline clinical characteristics. However, African American participants attended fewer psychotherapy and pharmacotherapy sessions, and were rated by therapists as less involved and compliant, in addition to showing lower mastery of CBT. Once these and other demographic factors were accounted for, race was not a significant predictor of response, remission, or relapse. Implications of these findings suggest African American and Caucasian youth are more similar than different with respect to the manifestations of anxiety and differences in outcomes are likely due to treatment barriers to session attendance and therapist engagement. PMID:25293650

  4. Clinical validation of a medical grade color monitor for chest radiology

    NASA Astrophysics Data System (ADS)

    Jacobs, J.; Zanca, F.; Verschakelen, J.; Marchal, G.; Bosmans, H.

    2009-02-01

    Until recently, the specifications of medical grade monochrome LCD monitors outperformed those of color LCD monitors. New generations of color LCD monitors, however, show specifications that are in many respects similar to those of monochrome monitors typically used in diagnostic workstations. The aim of present study was to evaluate the impact of different medical grade monitors in terms of detection of simulated lung nodules in chest x-ray images. Specifically, we wanted to compare a new medical grade color monitor (Barco Coronis 6MP color) to a medical grade grayscale monitor (Barco Coronis 3MP monochrome) and a consumer color monitor (Philips 200VW 1.7MP color) by means of an observer performance experiment. Using the free-response acquisition data paradigm, seven radiologists were asked to detect and locate lung nodules (170 in total), simulated in half of the 200 chest X-ray images used in the experiment. The jackknife free-response receiver operating characteristic (JAFROC) analysis of the data showed a statistically significant difference between at least two monitors, F-value=3.77 and p-value =0.0481. The different Figure of Merit values were 0.727, 0.723 and 0.697 for the new color LCD monitor, the medical grade monitor and the consumer color monitor respectively. There was no difference between the needed reading times but there was a difference between the mean calculated Euclidian distances between the position marked by the observers and the center of the simulated nodule, indicating a better accuracy with both medical grade monitors. Present data suggests that the new generation of medical grade color monitors could be used as diagnostic workstations.

  5. Factors influencing the outcome of intrauterine insemination (IUI): age, clinical variables and significant thresholds.

    PubMed

    Speyer, B E; Abramov, B; Saab, W; Doshi, A; Sarna, U; Harper, J C; Serhal, P

    2013-10-01

    The aim was to investigate the influence of various biological factors upon the outcome of intrauterine insemination (IUI). The total IUI history (856 cycles) of 352 couples was studied. Live-birth showed a strong negative correlation with female age but no correlation with male age. Antimüllerian hormone (AMH) and antral follicle count (AFC) correlated negatively with female age, and follicle stimulating hormone (FSH) correlated positively. Significant thresholds were found for all three variables, and also for total motile count (TMC) in the prepared sperm. Calculating pregnancy losses per positive pregnancy showed a strong correlation with increasing female age. This was highly significant for biochemical losses but not for fetal heart miscarriages. Male age had no effect on rate of pregnancy loss. In conclusion, female age, FSH, AMH and TMC are good predictive factors for live-birth and therefore relate to essential in vivo steps in the reproductive process. PMID:24127958

  6. AN INDEPENDENT ANALYSIS OF THE BROWN DWARF ATMOSPHERE MONITORING (BAM) DATA: LARGE-AMPLITUDE VARIABILITY IS RARE OUTSIDE THE L/T TRANSITION

    SciTech Connect

    Radigan, Jacqueline

    2014-12-20

    Observations of variability can provide valuable information about the processes of cloud formation and dissipation in brown dwarf atmospheres. Here we report the results of an independent analysis of archival data from the Brown dwarf Atmosphere Monitoring (BAM) program. Time series data for 14 L and T dwarfs reported to be significantly variable over timescales of hours were analyzed. We confirm large-amplitude variability (amplitudes >2%) for 4 out of 13 targets and place upper limits of 0.7%-1.6% on variability in the remaining sample. For two targets we find evidence of weak variability at amplitudes of 1.3% and 1.6%. Based on our revised classification of variable objects in the BAM study, we find strong variability outside the L/T transition to be rare at near infrared wavelengths. From a combined sample of 81 L0-T9 dwarfs from the revised BAM sample and the variability survey of Radigan et al., we infer an overall observed frequency for large-amplitude variability outside the L/T transition of 3.2{sub −1.8}{sup +2.8}%, in contrast to 24{sub −9}{sup +11}% for L9-T3.5 spectral types. We conclude that while strong variability is not limited to the L/T transition, it occurs more frequently in this spectral type range, indicative of larger or more highly contrasting cloud features at these spectral types.

  7. Monitoring

    DOEpatents

    Orr, Christopher Henry; Luff, Craig Janson; Dockray, Thomas; Macarthur, Duncan Whittemore

    2004-11-23

    The invention provides apparatus and methods which facilitate movement of an instrument relative to an item or location being monitored and/or the item or location relative to the instrument, whilst successfully excluding extraneous ions from the detection location. Thus, ions generated by emissions from the item or location can successfully be monitored during movement. The technique employs sealing to exclude such ions, for instance, through an electro-field which attracts and discharges the ions prior to their entering the detecting location and/or using a magnetic field configured to repel the ions away from the detecting location.

  8. Batch-to-batch pharmacokinetic variability confounds current bioequivalence regulations: A dry powder inhaler randomized clinical trial.

    PubMed

    Burmeister Getz, E; Carroll, K J; Jones, B; Benet, L Z

    2016-09-01

    Current pharmacokinetic (PK) bioequivalence guidelines do not account for batch-to-batch variability in study design or analysis. Here we evaluate the magnitude of batch-to-batch PK variability for Advair Diskus 100/50. Single doses of fluticasone propionate and salmeterol combinations were administered by oral inhalation to healthy subjects in a randomized clinical crossover study comparing three different batches purchased from the market, with one batch replicated across two treatment periods. All pairwise comparisons between different batches failed the PK bioequivalence statistical test, demonstrating substantial PK differences between batches that were large enough to demonstrate bio-inequivalence in some cases. In contrast, between-replicate PK bioequivalence was demonstrated for the replicated batch. Between-batch variance was ∼40-70% of the estimated residual error. This large additional source of variability necessitates re-evaluation of bioequivalence assessment criteria to yield a result that is both generalizable and consistent with the principles of type I and type II error rate control. PMID:27037630

  9. Can we improve the clinical utility of respiratory rate as a monitored vital sign?

    PubMed

    Chen, Liangyou; Reisner, Andrew T; Gribok, Andrei; McKenna, Thomas M; Reifman, Jaques

    2009-06-01

    Respiratory rate (RR) is a basic vital sign, measured and monitored throughout a wide spectrum of health care settings, although RR is historically difficult to measure in a reliable fashion. We explore an automated method that computes RR only during intervals of clean, regular, and consistent respiration and investigate its diagnostic use in a retrospective analysis of prehospital trauma casualties. At least 5 s of basic vital signs, including heart rate, RR, and systolic, diastolic, and mean arterial blood pressures, were continuously collected from 326 spontaneously breathing trauma casualties during helicopter transport to a level I trauma center. "Reliable" RR data were identified retrospectively using automated algorithms. The diagnostic performances of reliable versus standard RR were evaluated by calculation of the receiver operating characteristic curves using the maximum-likelihood method and comparison of the summary areas under the receiver operating characteristic curves (AUCs). Respiratory rate shows significant data-reliability differences. For identifying prehospital casualties who subsequently receive a respiratory intervention (hospital intubation or tube thoracotomy), standard RR yields an AUC of 0.59 (95% confidence interval, 0.48-0.69), whereas reliable RR yields an AUC of 0.67 (0.57-0.77), P < 0.05. For identifying casualties subsequently diagnosed with a major hemorrhagic injury and requiring blood transfusion, standard RR yields an AUC of 0.60 (0.49-0.70), whereas reliable RR yields 0.77 (0.67-0.85), P < 0.001. Reliable RR, as determined by an automated algorithm, is a useful parameter for the diagnosis of respiratory pathology and major hemorrhage in a trauma population. It may be a useful input to a wide variety of clinical scores and automated decision-support algorithms. PMID:19008777

  10. Clinical Application of in-room PET for in vivo Treatment Monitoring in Proton Radiotherapy

    PubMed Central

    Min, Chul Hee; Zhu, Xuping; Winey, Brian A.; Grogg, Kira; Testa, Mauro; Fakhri, Georges El; Bortfeld, Thomas R.; Paganetti, Harald; Shih, Helen A.

    2013-01-01

    Purpose/Objective(s) The purpose of this study is to evaluate the potential of using an in-room PET for treatment verification in proton therapy and to derive suitable PET scan times. Materials/Methods Nine patients undergoing passive scattering proton therapy were scanned immediately after treatment with an in-room PET scanner. The scanner was positioned next to the treatment head after treatment. The Monte Carlo (MC) method was employed to reproduce PET activities for each patient. To assess the proton beam range uncertainty we designed a novel concept where the measured PET activity surface distal to the target at the end of range was compared with MC predictions. The repositioning of patients for the PET scan took on average about 2 minutes. The PET images were reconstructed considering varying scan times to test the scan time dependency of the method. Results The measured PET images show overall good spatial correlations with MC predictions. Some discrepancies could be attributed to uncertainties in the local elemental composition and biological washout. For 8 patients treated with a single field, the average range differences between PET measurements and CT-image-based MC results were less than 5 mm (< 3 mm for 6 of 8 patients) and root-mean-square deviations (RMSD) were 4-11 mm with PET-CT image co-registration errors of about 2 mm. Our results also show that a short-length PET scan of 5 minutes can yield similar results compared to a 20 minutes PET scan. Conclusions Our first clinical trials of 9 patients using an in-room PET system demonstrated its potential for in vivo treatment monitoring in proton therapy. For a quantitative range prediction with arbitrary shape of target volume, we suggest employing the distal PET activity surface. PMID:23391817

  11. Conventional clinical and prognostic variables in 150 oral squamous cell carcinoma cases from the indigenous population of Karachi

    PubMed Central

    Alamgir, Muhammad Mohiuddin; Jamal, Qamar; Mirza, Talat

    2016-01-01

    Objective: To analyze clinical and prognostic variables of Oral Squamous Cell Carcinoma (OSCC) cases from the indigenous population of Karachi and to correlate with the common risk factor of tobacco habit. Methods: The study was conducted at Ziauddin University, Karachi. One hundred fifty OSCC cases were collected from the Oncology Department of Ziauddin University Hospital, North Nazimabad, Karachi and Otolaryngology ward of Civil Hospital, Karachi, during 2011 and 2015. The reporting included demographic details and variables like intra-oral subsites, clinical stage and histological grade. Recurrence of tumor after initial resection was also documented. Results: The patient’s population comprised of 98 males and 52 females. The mean age was 47.1± 12.22 (range:20-78 years). Maximum numbers were seen in the 41–50 years age group. Urdu-speaking community was the most affected ethnic group (n=75). Clinico-pathological analysis revealed that majority of cases were moderately differentiated (59%) and were either clinical stage II (35%) or IV (29%) tumors. The most common intra-oral subsite came out to be buccal mucosa of cheeks (56%) followed by lateral borders of tongue (21%), lips (13%), alveolar (6%), palate (2.6%) floor of mouth (1.3%), etc. Recurrence was observed in 08 out of 150 cases. All patients underwent primary resection±neck dissection and reconstruction where possible. Conclusions: Overall experience with oral squamous cell carcinoma shows that it has a high tendency for local invasion as well as dissemination to regional lymph nodes, i.e. cervical lymph nodes, both are associated with a poor prognosis. Preventable risk factor of tobacco chewing has been observed in majority of these cases. PMID:27375712

  12. Clinical NECR in 18F-FDG PET scans: optimization of injected activity and variable acquisition time. Relationship with SNR

    NASA Astrophysics Data System (ADS)

    Carlier, T.; Ferrer, L.; Necib, H.; Bodet-Milin, C.; Rousseau, C.; Kraeber-Bodéré, F.

    2014-10-01

    The injected activity and the acquisition time per bed position for 18F-FDG PET scans are usually optimized by using metrics obtained from phantom experiments. However, optimal activity and time duration can significantly vary from a phantom set-up and from patient to patient. An approach using a patient-specific noise equivalent count rate (NECR) modelling has been previously proposed for optimizing clinical scanning protocols. We propose using the clinical NECR on a large population as a function of the body mass index (BMI) for deriving the optimal injected activity and acquisition duration per bed position. The relationship between the NEC and the signal-to-noise ratio (SNR) was assessed both in a phantom and in a clinical setting. 491 consecutive patients were retrospectively evaluated and divided into 4 BMI subgroups. Two criteria were used to optimize the injected activity and the time per bed position was adjusted using the NECR value while keeping the total acquisition time constant. Finally, the relationship between NEC and SNR was investigated using an anthropomorphic phantom and a population of 507 other patients. While the first dose regimen suggested a unique injected activity (665 MBq) regardless of the BMI, the second dose regimen proposed a variable activity and a total acquisition time according to the BMI. The NEC improvement was around 35% as compared with the local current injection rule. Variable time per bed position was derived according to BMI and anatomical region. NEC and number of true events were found to be highly correlated with SNR for the phantom set-up and partially confirmed in the patient study for the BMI subgroup under 28 kg m-2 suggesting that for the scanner, the nonlinear reconstruction algorithm used in this study and BMI < 28 kg m-2, NEC, or the number of true events linearly correlated with SNR2.

  13. Soft X-ray irradiance measured by the Solar Aspect Monitor on the Solar Dynamic Observatory Extreme ultraviolet Variability Experiment

    NASA Astrophysics Data System (ADS)

    Lin, C. Y.; Bailey, S. M.; Jones, A.; Woodraska, D.; Caspi, A.; Woods, T. N.; Eparvier, F. G.; Wieman, S. R.; Didkovsky, L. V.

    2016-04-01

    The Solar Aspect Monitor (SAM) is a pinhole camera on the Extreme ultraviolet Variability Experiment (EVE) aboard the Solar Dynamics Observatory. SAM projects the solar disk onto the CCD through a metallic filter designed to allow only solar photons shortward of 7 nm to pass. Contamination from energetic particles and out-of-band irradiance is, however, significant in the SAM observations. We present a technique for isolating the 0.01-7 nm integrated irradiance from the SAM signal to produce the first results of broadband irradiance for the time period from May 2010 to May 2014. The results of this analysis agree with a similar data product from EVE's EUV SpectroPhotometer to within 25%. We compare our results with measurements from the Student Nitric Oxide Explorer Solar X-ray Photometer and the Thermosphere Ionosphere Mesosphere Energetics and Dynamics Solar EUV Experiment at similar levels of solar activity. We show that the full-disk SAM broadband results compared well to the other measurements of the 0.01-7 nm irradiance. We also explore SAM's capability toward resolving spatial contribution from regions of solar disk in irradiance and demonstrate this feature with a case study of several strong flares that erupted from active regions on 11 March 2011.

  14. Tau PET patterns mirror clinical and neuroanatomical variability in Alzheimer's disease.

    PubMed

    Ossenkoppele, Rik; Schonhaut, Daniel R; Schöll, Michael; Lockhart, Samuel N; Ayakta, Nagehan; Baker, Suzanne L; O'Neil, James P; Janabi, Mustafa; Lazaris, Andreas; Cantwell, Averill; Vogel, Jacob; Santos, Miguel; Miller, Zachary A; Bettcher, Brianne M; Vossel, Keith A; Kramer, Joel H; Gorno-Tempini, Maria L; Miller, Bruce L; Jagust, William J; Rabinovici, Gil D

    2016-05-01

    SEE SARAZIN ET AL DOI101093/BRAIN/AWW041 FOR A SCIENTIFIC COMMENTARY ON THIS ARTICLE: The advent of the positron emission tomography tracer (18)F-AV1451 provides the unique opportunity to visualize the regional distribution of tau pathology in the living human brain. In this study, we tested the hypothesis that tau pathology is closely linked to symptomatology and patterns of glucose hypometabolism in Alzheimer's disease, in contrast to the more diffuse distribution of amyloid-β pathology. We included 20 patients meeting criteria for probable Alzheimer's disease dementia or mild cognitive impairment due to Alzheimer's disease, presenting with a variety of clinical phenotypes, and 15 amyloid-β-negative cognitively normal individuals, who underwent (18)F-AV1451 (tau), (11)C-PiB (amyloid-β) and (18)F-FDG (glucose metabolism) positron emission tomography, apolipoprotein E (APOE) genotyping and neuropsychological testing. Voxel-wise contrasts against controls (at P < 0.05 family-wise error corrected) showed that (18)F-AV1451 and (18)F-FDG patterns in patients with posterior cortical atrophy ('visual variant of Alzheimer's disease', n = 7) specifically targeted the clinically affected posterior brain regions, while (11)C-PiB bound diffusely throughout the neocortex. Patients with an amnestic-predominant presentation (n = 5) showed highest (18)F-AV1451 retention in medial temporal and lateral temporoparietal regions. Patients with logopenic variant primary progressive aphasia ('language variant of Alzheimer's disease', n = 5) demonstrated asymmetric left greater than right hemisphere (18)F-AV1451 uptake in three of five patients. Across 30 FreeSurfer-defined regions of interest in 16 Alzheimer's disease patients with all three positron emission tomography scans available, there was a strong negative association between (18)F-AV1451 and (18)F-FDG uptake (Pearson's r = -0.49 ± 0.07, P < 0.001) and less pronounced positive associations between (11)C-PiB and (18)F

  15. Characterization of certain inflammatory variables in the peripheral blood of clinically healthy dogs.

    PubMed

    Breathnach, R; Donahy, C; Jones, B R; Bloomfield, F J

    2006-01-01

    Many laboratory techniques have been developed to study and quantify the inflammatory response, including the release of acid hydrolase enzymes, leukotriene B(4) (LTB(4)) production, reactive oxygen species (ROS) production and complement conversion studies. Although extensively studied in human health and disease, the relevance of such tests in the dog is largely unknown. After isolation of the peripheral blood mononuclear cell (PBMC) and polymorphonuclear cell (PMN) fractions from the peripheral blood of 38 clinically healthy dogs, values for ROS production were similar for both cell fractions when measured by luminol-enhanced chemiluminescence (17,853+/-9,695 U/10(6) cells versus 19,138+/-14,569 U/10(6) cells for the PBMC (n=38) and PMN (n=18) fractions, respectively). However, the mean time taken to reach maximum chemiluminescence was noticeably shorter in the PBMC fraction (5.1+/-3.3 versus 10.7+/-2.5 min for PBMCs (n=36) and PMNs (n=18), respectively). Intracellular concentrations of beta-glucuronidase, beta-galactosidase and N-acetyl-beta-glucosaminidase were assayed by spectrofluorometry. Mean values for all three enzymes were higher in PBMCs (n=31-35) than in PMNs (n=10-14). Both cell fractions released 20% of the intracellular enzyme concentration when stimulated with opsonized zymosan. Following incubation with A23187 (1 microM), mean LTB(4) production was higher in PBMCs (4.45+/-2.92 ng/10(6) cells; n=27) than in PMNs (0.96+/-2.22 ng/10(6) cells; n=13) using a validated high performance liquid chromatography (HPLC) assay. Immunoprecipitation studies revealed that the mean percentage conversion of C3 to C3b following stimulation with opsonized zymosan was 57.3+/-13.4% (n=36). The results provide normal values for clinically healthy dogs that may subsequently be used in future studies investigating dogs with various inflammatory disorders. PMID:16427586

  16. Behaviour of human immunoregulatory cells in culture. I. Variables requiring consideration for clinical studies.

    PubMed Central

    Dwyer, J M; Johnson, C; Desaules, M

    1979-01-01

    The suppressor function of lymphocytes stimulated with concanavalin A (Con A) provides a potential method for examining disorders of immunoregulation. Clinical application, however, requires definition of the culture conditions that influence the expression of normal suppressor cell activity. In the present studies culture conditions were modified until a sensitive assay for non-specific suppressor cell function was reproducible utilizing the response to varying doses of phytohaemagglutinin (PHA) as an indicator system. Practical conclusions included (1) that sensitivity was not lost if the suppressor cells and responder cells were allogenic; (2) that fresh responder cells were as sensitive as precultured responder cells; (3) that a wide range of Con A concentrations could induce suppressor activity; and (4) that the sensitivity of the assay was much enhanced by using suboptimal mitogen doses of PHA. Twelve percent of normal subjects gave false negative results but these could be avoided by studying cells at more than one time point after stimulation with Con A. Cells resting in culture for 7 days could be induced to suppress after stimulation with Con A and these suppressor cells were very sensitive to pharmacological doses of dexamethasone. Studies utilizing different times of cell pre-incubation before Con A stimulation and different periods of exposure to Con A revealed fluctuation in the induction of suppression that may represent alternating periods of suppression and amplifying activity among stimulated cells in vitro. Such variations will need to be taken into account in the application of this type of assay to clinical studies seeking disordered immunoregulation. PMID:161214

  17. Monitoring climate-driven interannual variability of European Larch phenology in an alpine environment: results of the REPHLEX project

    NASA Astrophysics Data System (ADS)

    Busetto, L.; Migliavacca, M.; Cremonese, E.; Colombo, R.; Galvagno, M.; Morra di Cella, U.; Pari, E.; Siniscalco, C.

    2009-04-01

    In this contribute we present the results of the REPHLEX experiment (REmote sensing of PHenology Larix Experiment), conducted by the Environmental Dynamics Remote Sensing Laboratory of the University of Milano-Bicocca, by the Regional Protection Agency of the Aosta Valley and by Vegetation Biology Department of the University of Torino. The project was aimed at developing appropriate techniques for monitoring the interannual variability of European Larch (Larix decidua Mill.) phenological cycle in the Alpine region of Valle d'Aosta (Northern Italy), and to evaluate its relationships with environmental and climatic drivers. This was achieved by combining field observations, phenological models and satellite remote sensing. Phenological field observations were weekly conducted in 8 test sites during 2005, 2006 and 2007 in order to determine the dates of completion of different phenological phases of the analyzed Larch stands. MODIS 250 16-days composite NDVI data (Product MOD13Q1 - v005) acquired from TERRA platform for the 2000-2007 time period were used to estimate budburst and senescence dates, as well as the length of the growing season. With this aim, NDVI time series were fitted with a double logistic curve, and the dates corresponding to different characteristic points of the curve (maximum of the first derivative and zeroes of the third and fourth derivative) were determined. The comparison between MODIS estimated dates and field data showed that the points of the fitted NDVI curve that allow to better estimate larch phenological dates are the zeroes of its third derivative, which allowed to estimate the start and the end of the growing season with Mean Absolute Errors (MAE) of about 6 and 4 days, respectively. This result is particularly significant since to our knowledge these inflection points have never been used for the estimation of phenological dates in previous studies. Start and end of season were also estimated by applying the Spring Warming and the

  18. Intracranial pressure monitoring for traumatic brain injury: available evidence and clinical implications.

    PubMed

    Stocchetti, N; Longhi, L; Zanier, E R

    2008-05-01

    Following traumatic brain injury, uncontrollable intracranial hypertension remains the most frequent cause of death. Despite general agreement on the deleterious effects of elevated intracranial pressure (ICP), however, the evidence supporting the use of ICP monitoring has recently been questioned. The aim of this review was to evaluate the pros and cons of ICP monitoring and to discuss the hypothetical desirability and feasibility of a trial testing the benefits of ICP monitoring. PMID:18414362

  19. Within-Home Blood Pressure Variability on a Single Occasion Has Clinical Significance

    PubMed Central

    Shibasaki, Seiichi; Hoshide, Satoshi; Kario, Kazuomi

    2016-01-01

    There is growing evidence that diversely defined blood pressure variability (BPV) is an independent predictor of hypertensive target organ damage (TOD) and cardiovascular events. Several mechanisms have been speculated to underlie episodes of increased BPV, including the impairment of autonomic or hormonal regulation, renal dysfunction, and increased arterial stiffness. Within-home BPV, defined as differences in BP values obtained on a single occasion at home, could have prognostic significance for hypertensive TOD. It is typically thought that BP values are decreased with repeated measurements on a single occasion at home, but in the present subanalysis of 4,149 J-HOP (Japan Morning Surge-Home Blood Pressure) study patients, approximately 20% of the patients' home BP values were increased or unchanged by repeated measurements on a single occasion. In addition, those patients were likely to have hypertensive TOD. Thus, home BP measurement should be taken twice or more to detect the increase trend in home BP, which has been defined as within-home BPV. PMID:27493902

  20. Self-Monitoring in Clinical Practice: A Challenge for Medical Educators

    ERIC Educational Resources Information Center

    Epstein, Ronald M.; Siegel, Daniel J.; Silberman, Jordan

    2008-01-01

    Recent literature has described how the capacity for concurrent self-assessment--ongoing moment-to-moment self-monitoring--is an important component of the professional competence of physicians. Self-monitoring refers to the ability to notice our own actions, curiosity to examine the effects of those actions, and willingness to use those…

  1. Clinical and hormonal variables related to bone mass loss in anorexia nervosa patients.

    PubMed

    Fernández-Soto, María Luisa; González-Jiménez, Amalia; Chamorro-Fernández, Marta; Leyva-Martínez, Socorro

    2013-01-01

    A better understanding of the prognostic factors of low bone mass in anorexia nervosa (AN) and development of effective therapeutic strategies is critical. In order to determine which clinical, biochemical, and/or hormonal parameters could be related to bone mineral density (BMD), 47 female AN patients were classified according to the WHO osteoporosis criteria at lumbar spine (LS). This was a cross-sectional study of 16 AN women with osteoporosis criteria and 31without. Control group was 25 healthy, normal-weight, age-matched women. We assessed BMD using dual-energy X-ray absorptiometry at the LS and body composition. We measured serum fasting cortisol, estradiol, insulin-like growth factor-1 (IGF-1), leptin, sex hormone-binding globulin, albumin and retinol binding protein levels. The prevalence of osteoporosis was 34% and osteopenia 19% at the LS. The AN group with osteoporosis had lower IGF-1 and estradiol levels (both p<0.001), lower serum leptin (p<0.02), and higher cortisolemia (p<0.03) levels compared with AN group without osteoporosis. The BMD and T-score at LS was inversely related to the duration of amenorrhea (p<0.02) and directly related to body mass index (BMI, p<0.002), total fat mass (p<0.03), serum IGF-1 (p<0.01), and estradiol levels (p<0.001) in AN patients. We conclude that AN women with a significant BMD loss have a high risk of developing osteoporosis. A low BMD is a consequence of hormonal alterations which include hypoestrogenism, hypoleptinemia, hypercortisolism, and decreases in IGF-1 levels, as well as a low BMI and fat mass. PMID:23601428

  2. False alarms during patient monitoring in clinical intensive care units are highly related to poor quality of the monitored electrocardiogram signals.

    PubMed

    Tsimenidis, Charalampos; Murray, Alan

    2016-08-01

    Electrocardiograms (ECGs) recorded from patients in intensive care were investigated to quantify any relationship between ECG signal quality and false monitoring alarms. False alarms are a considerable problem for nursing and medical staff as they distract from clinical care, and are also a problem for patients as they disturb rest, which is important for clinical recovery. ECG and alarm data were obtained for 750 patient alarms from the PhysioNet database. The final 8 s period before the alarm was triggered was investigated. All but one ECG channel in 38 ECG recordings with out-of-range data were associated with false positive alarms (p  <  0.0001). The frequency contributions for baseline (BL) instability, electromyogram (EMG) muscle noise, and high frequency (HF) noise were calculated. For all three frequency bands, the contributions associated with false positive alarms were very significantly greater than for true positive alarms (p  <  0.0001). The greatest difference was for BL with a mean level for false positive alarms 4.0 times greater than for true positive alarms, followed by EMG and HF at 1.6 times and 1.4 times respectively. These results confirm that attention needs to be taken to improve ECG signal quality to reduce the frequency of clinical false alarms, and hence improve conditions for clinical staff and patients. PMID:27454130

  3. Variable eculizumab clearance requires pharmacodynamic monitoring to optimize therapy for thrombotic microangiopathy after hematopoietic stem cell transplantation

    PubMed Central

    Jodele, Sonata; Fukuda, Tsuyoshi; Mizuno, Kana; Vinks, Alexander A.; Laskin, Benjamin L.; Goebel, Jens; Dixon, Bradley P.; Chima, Ranjit S; Hirsch, Russel; Teusink, Ashley; Lazear, Danielle; Lane, Adam; Myers, Kasiani C.; Dandoy, Christopher E.; Davies, Stella M.

    2015-01-01

    Thrombotic microangiopathy (TMA) after hematopoietic stem cell transplant (HSCT) associated with terminal complement activation, as measured by elevated plasma terminal complement (sC5b-9) concentrations, has a very high mortality. The complement inhibitor eculizumab may be a therapeutic option for HSCT-associated TMA. We examined the pharmacokinetics and pharmacodynamics (PK/PD) of eculizumab in children and young adult HSCT recipients with TMA and activated complement to determine drug dosing requirements for future efficacy trials. We analyzed prospectively collected laboratory samples and clinical data from 18 HSCT recipients with high-risk TMA presenting with complement activation who were treated with eculizumab. We measured eculizumab serum concentrations, total hemolytic complement activity (CH50), and plasma sC5b-9 concentrations. Population PK/PD analyses correlated eculizumab concentrations with complement blockade and clinical response and determined inter-individual differences in PK parameters. We also compared transplant survival in patients treated with eculizumab (n=18) to patients with the same high-risk TMA features who did not receive any targeted therapy during a separate prospective observational study (n=11). In the PK analysis, we found significant inter-patient variability in eculizumab clearance, ranging from 16 to 237 mL/hr/70kg in the induction phase. The degree of complement activation measured by sC5b-9 concentrations at the start of therapy, in addition to actual body weight, were significant determinants of eculizumab clearance and disease response. Sixty one percent of treated patients had complete resolution of TMA and were able to safely discontinue eculizumab without disease recurrence. Overall survival was significantly higher in treated subjects compared to untreated patients (56% versus 9%, p=0.003). Complement blocking therapy is associated with improved survival in HSCT patients with high-risk TMA who historically have

  4. Serial correlation and inter-annual variability in relation to the statistical power of monitoring schemes to detect trends in fish populations.

    PubMed

    Nagelkerke, Leopold A J; van Densen, Wim L T

    2007-02-01

    We studied the effects of inter-annual variability and serial correlation on the statistical power of monitoring schemes to detect trends in biomass of bream (Abramis brama) in Lake Veluwemeer (The Netherlands). In order to distinguish between 'true' system variability and sampling variability we simulated the development of the bream population, using estimates for population structure and growth, and compared the resulting inter-annual variabilities and serial correlations with those from field data. In all cases the inter-annual variability in the field data was larger than in simulated data (e.g. for total biomass of all assessed bream sigma = 0.45 in field data, and sigma = 0.03-0.14 in simulated data) indicating that sampling variability decreased statistical power for detecting trends. Moreover, sampling variability obscured the inter-annual dependency (and thus the serial correlation) of biomass, which was expected because in this long-lived population biomass changes are buffered by the many year classes present. We did find the expected serial correlation in our simulation results and concluded that good survey data of long-lived fish populations should show low sampling variability and considerable inter-annual serial correlation. Since serial correlation decreases the power for detecting trends, this means that even when sampling variability would be greatly reduced, the number of sampling years to detect a change of 15%.year(-1) in bream populations (corresponding to a halving or doubling in a six-year period) would in most cases be more than six. This would imply that the six-year reporting periods that are required by the Water Framework Directive of the European Union are too short for the existing fish monitoring schemes. PMID:17219244

  5. Linking clinic and home: a randomized, controlled clinical effectiveness trial of real-time, wireless blood pressure monitoring for older patients with kidney disease and hypertension

    PubMed Central

    Rifkin, Dena E.; Abdelmalek, Joseph A.; Miracle, Cynthia M.; Low, Chai; Barsotti, Ryan; Rios, Phil; Stepnowsky, Carl; Agha, Zia

    2014-01-01

    Objective Older adults with chronic kidney disease have a high rate of uncontrolled hypertension. Home monitoring of blood pressure (BP) is an integral part of management, but requires that patients bring records to clinic visits. Telemonitoring interventions, however, have not targeted older, less technologically-skilled populations. Methods Veterans with stage 3 or greater chronic kidney disease and uncontrolled hypertension were randomized to a novel telemonitoring device pairing a Bluetooth-enabled BP cuff with an Internet-enabled hub, which wirelessly transmitted readings (n= 28), or usual care (n= 15). Home recordings were reviewed weekly and telemonitoring participants were contacted if BP was above goal. The prespecified primary endpoints were improved data exchange and device acceptability. Secondary endpoint was BP change. Results Forty-three participants (average age 68 years, 75% white) completed the 6-month study. Average start-of-study BP was 147/78mmHg. Those in the intervention arm had a median of 29 (IQR 22, 53) transmitted BP readings per month, with 78% continuing to use the device regularly, whereas only 20% of those in the usual care group brought readings to in-person visits. The median number of telephone contacts triggered by the wireless monitoring was 2 (IQR 1, 4) per patient. Both groups had a significant improvement in systolic BP (P< 0.05, for both changes); systolic BP fell a median of 13 mmHg in monitored participants compared with 8.5mmHg in usual care participants (P for comparison 0.31). Conclusion This low-cost wireless monitoring strategy led to greater sharing of data between patients and clinic and produced a trend toward improvements in BP control over usual care at 6 months. PMID:23275313

  6. Feasibility of Using Clinical Element Models (CEM) to Standardize Phenotype Variables in the Database of Genotypes and Phenotypes (dbGaP)

    PubMed Central

    Lin, Ko-Wei; Tharp, Melissa; Conway, Mike; Hsieh, Alexander; Ross, Mindy; Kim, Jihoon; Kim, Hyeon-Eui

    2013-01-01

    The database of Genotypes and Phenotypes (dbGaP) contains various types of data generated from genome-wide association studies (GWAS). These data can be used to facilitate novel scientific discoveries and to reduce cost and time for exploratory research. However, idiosyncrasies and inconsistencies in phenotype variable names are a major barrier to reusing these data. We addressed these challenges in standardizing phenotype variables by formalizing their descriptions using Clinical Element Models (CEM). Designed to represent clinical data, CEMs were highly expressive and thus were able to represent a majority (77.5%) of the 215 phenotype variable descriptions. However, their high expressivity also made it difficult to directly apply them to research data such as phenotype variables in dbGaP. Our study suggested that simplification of the template models makes it more straightforward to formally represent the key semantics of phenotype variables. PMID:24058713

  7. Accuracy of a radiofrequency identification (RFID) badge system to monitor hand hygiene behavior during routine clinical activities

    PubMed Central

    Pineles, Lisa L.; Morgan, Daniel J.; Limper, Heather M.; Weber, Stephen G.; Thom, Kerri A.; Perencevich, Eli N.; Harris, Anthony D.; Landon, Emily M.

    2016-01-01

    Background Hand hygiene (HH) is a critical part of infection prevention in healthcare settings. Hospitals around the world continuously struggle to improve healthcare personnel (HCP) HH compliance. The current gold standard for monitoring compliance is direct observation; however this method is time consuming and costly. One emerging area of interest involves automated systems for monitoring HH behavior such as radiofrequency identification (RFID) tracking systems. Methods To assess the accuracy of a commercially available RFID system in detecting HCP HH behavior, we compared direct observation to data collected by the RFID system in a simulated validation setting and to a real-life clinical setting over two hospitals. Results A total of 1554 HH events were observed. Accuracy for identifying HH events was high in the simulated validation setting (88.5%) but relatively low in the real-life clinical setting (52.4%). This difference was significant (p<0.01). Accuracy for detecting HCP movement into and out of patient rooms was also high in the simulated setting but not in the real-life clinical setting (100% on entry and exit in simulated setting vs. 54.3% entry and 49.5% exit in real-life clinical setting, p<.01). Conclusions In this validation study of an RFID system, almost half of the HH events were missed. More research is necessary to further develop these systems and improve accuracy prior to widespread adoption. PMID:24355492

  8. A revised monitor source method for practical deadtime count loss compensation in clinical planar and SPECT studies

    NASA Astrophysics Data System (ADS)

    Siman, W.; Silosky, M.; Kappadath, S. C.

    2015-02-01

    The aim of the study is to verify the fundamental assumption in the monitor source method, i.e. uniform fractional count loss across the field of view (FOV), and to introduce a revised monitor source method for SPECT deadtime correction that minimally interferes with the clinical protocol. SPECT images of non-uniform phantoms (4GBq 99mTc) with and without monitor sources (2  ×  20MBq 99mTc) attached to each detector were acquired nine times over 48 h in the photopeak energy window and the scatter energy window. Fractional count loss uniformity across the FOV was evaluated by correlating count rates in different regions of interest on projection images at different deadtime loss levels. The correction factors were calculated as the ratios of monitor source count rates with and without the phantom. Such factors were applied to the phantom images acquired without the monitor sources. The counting efficiency (count rate per unit activity) of the camera was calculated as a function of activity in the FOV both prior to and after the deadtime count-loss correction. The deadtime correction effectiveness was assessed by the independence of the efficiency on the activity in the FOV. Methods to interpolate the projection deadtime loss, based on limited projections, were also investigated. The fractional deadtime count loss was uniform across the FOV (r > 0.99). After the deadtime correction, the efficiency was largely independent of the activity in the FOV. The median and maximum absolute errors after the deadtime count loss correction were ≤1% and ~2%, respectively. Measured deadtime loss from five views per detector can be used to estimate deadtime count loss with errors ≤1% for all SPECT projections. The revised monitor source method can effectively correct planar and SPECT deadtime loss. Sparse sampling of the projection deadtime loss allows the acquisition of high monitor source counts with minimal time added while preserving the entire useful FOV.

  9. Chemometrics and in-line near infrared spectroscopic monitoring of a biopharmaceutical Chinese hamster ovary cell culture: prediction of multiple cultivation variables.

    PubMed

    Clavaud, Matthieu; Roggo, Yves; Von Daeniken, Ralph; Liebler, André; Schwabe, Jan-Oliver

    2013-07-15

    In the present study near infrared (NIR) spectroscopy was used to monitor the cultivation of mammalian Chinese hamster ovary (CHO) cells producing a monoclonal antibody in a fed-batch cell culture process. A temperature shift was applied during the cultivation. The cells were incubated at 37 °C and 33 °C. The Fourier transform near infrared (FT-NIR) multiplex process analyzer spectroscopy was investigated to monitor cultivation variables of the CHO cell culture from 10 independent batches using two channels of the FT-NIR. The measurements were performed on production scale bioreactors of 12,500 L. The cell cultures were analyzed with the spectrometer coupled to a transflection sterilizable fiber optic probe inserted into the bioreactors. Multivariate data analysis (MVDA) employing unsupervised principal component analysis (PCA) and partial least squares regression methods (PLS) were applied. PCA demonstrated that 96% of the observed variability was explained by the process trajectory and the inter-batch variability. PCA was found to be a significant tool in identifying batch homogeneity between lots and in detecting abnormal fermentation runs. Seven different cell culture parameters such as osmolality, glucose concentration, product titer, packed cell volume (PCV), integrated viable packed cell volume (ivPCV), viable cell density (VCD), and integrated viable cell count (iVCC) were monitored inline and predicted by NIR. NIR spectra and reference analytics data were computed using control charts to evaluate the monitoring abilities. Control charts of each media component were under control by NIR spectroscopy. The PLS calibration plots offered accurate predictive capabilities for each media. This paper underlines the capability for inline prediction of multiple cultivation variables during bioprocess monitoring. PMID:23622522

  10. Clinical variability and novel mutations in the NHEJ1 gene in patients with a Nijmegen breakage syndrome-like phenotype.

    PubMed

    Dutrannoy, Véronique; Demuth, Ilja; Baumann, Ulrich; Schindler, Detlev; Konrat, Kateryna; Neitzel, Heidemarie; Gillessen-Kaesbach, Gabriele; Radszewski, Janina; Rothe, Susanne; Schellenberger, Mario T; Nürnberg, Gudrun; Nürnberg, Peter; Teik, Keng Wee; Nallusamy, Revathy; Reis, André; Sperling, Karl; Digweed, Martin; Varon, Raymonda

    2010-09-01

    We have previously shown that mutations in the genes encoding DNA Ligase IV (LIGIV) and RAD50, involved in DNA repair by nonhomologous-end joining (NHEJ) and homologous recombination, respectively, lead to clinical and cellular features similar to those of Nijmegen Breakage Syndrome (NBS). Very recently, a new member of the NHEJ repair pathway, NHEJ1, was discovered, and mutations in patients with features resembling NBS were described. Here we report on five patients from four families of different ethnic origin with the NBS-like phenotype. Sequence analysis of the NHEJ1 gene in a patient of Spanish and in a patient of Turkish origin identified homozygous, previously reported mutations, c.168C>G (p.Arg57Gly) and c.532C>T (p.Arg178Ter), respectively. Two novel, paternally inherited truncating mutations, c.495dupA (p.Asp166ArgfsTer20) and c.526C>T (p.Arg176Ter) and two novel, maternal genomic deletions of 1.9 and 6.9 kb of the NHEJ1 gene, were found in a compound heterozygous state in two siblings of German origin and in one Malaysian patient, respectively. Our findings confirm that patients with NBS-like phenotypes may have mutations in the NHEJ1 gene including multiexon deletions, and show that considerable clinical variability could be observed even within the same family. PMID:20597108

  11. Data Quality Monitoring in Clinical Trials: Has It Been Worth It? An Evaluation and Prediction of the Future by All Stakeholders

    PubMed Central

    Kalali, Amir; West, Mark; Walling, David; Hilt, Dana; Engelhardt, Nina; Alphs, Larry; Loebel, Antony; Vanover, Kim; Atkinson, Sarah; Opler, Mark; Sachs, Gary; Nations, Kari; Brady, Chris

    2016-01-01

    This paper summarizes the results of the CNS Summit Data Quality Monitoring Workgroup analysis of current data quality monitoring techniques used in central nervous system (CNS) clinical trials. Based on audience polls conducted at the CNS Summit 2014, the panel determined that current techniques used to monitor data and quality in clinical trials are broad, uncontrolled, and lack independent verification. The majority of those polled endorse the value of monitoring data. Case examples of current data quality methodology are presented and discussed. Perspectives of pharmaceutical companies and trial sites regarding data quality monitoring are presented. Potential future developments in CNS data quality monitoring are described. Increased utilization of biomarkers as objective outcomes and for patient selection is considered to be the most impactful development in data quality monitoring over the next 10 years. Additional future outcome measures and patient selection approaches are discussed. PMID:27413584

  12. Understanding Spatial and Temporal Variability in Ozone Levels within a Remote-sensing Scale Grid Cell using Data Collected with Low-cost, Next Generation Monitoring Systems

    NASA Astrophysics Data System (ADS)

    Collier, A. M.; Hannigan, M.; Masson, N.; Piedrahita, R.; Gordon, J. L.; Russel, M.

    2014-12-01

    For the past several years, our research group has been developing low-cost (for reference, each unit costs under $1000) next generation air quality monitors, which utilize metal-oxide semiconductor sensors and non-dispersive infrared sensors to collect data on various gaseous pollutants. The pollutants of focus for this deployment were CO2, O3, and NO2. Additional data collected by the monitors includes temperature, humidity, wind speed and direction, and some information on hydrocarbon levels. A main focus of our research has been sensor characterization and exploring research applications of the technology. During summer 2014, the DISCOVER-AQ and FRAPPE sampling campaigns provided our group with the opportunity to deploy twenty monitors throughout the sampling region with the Boulder Atmospheric Observatory Tower in Erie CO at the center of our monitoring area. Thirteen of these monitors were located at ground-level within an approximately 10 by 10 km grid cell, and the rest were outside of this area at various distances. This placement was intended to provide information on pollutant variability, specifically ozone, within a remote-sensing sized grid cell. Additionally, the availability of reference monitors in the field provided opportunities for co-location during the deployment and hence, opportunities to quantify monitor performance. Analysis will include both an evaluation of low-cost sensor performance and a look at temporal and spatial variability. For example, land-use regression modeling will be used to explore population density, distance to roadways, and distance to oil and gas activity as covariates. Additionally, we will explore how the spatial distribution varies with time and look for temporal patterns.

  13. Large Controlled Observational Study on Remote Monitoring of Pacemakers and Implantable Cardiac Defibrillators: A Clinical, Economic, and Organizational Evaluation

    PubMed Central

    2016-01-01

    Background Patients with implantable devices such as pacemakers (PMs) and implantable cardiac defibrillators (ICDs) should be followed up every 3–12 months, which traditionally required in-clinic visits. Innovative devices allow data transmission and technical or medical alerts to be sent from the patient's home to the physician (remote monitoring). A number of studies have shown its effectiveness in timely detection and management of both clinical and technical events, and endorsed its adoption. Unfortunately, in daily practice, remote monitoring has been implemented in uncoordinated and rather fragmented ways, calling for a more strategic approach. Objective The objective of the study was to analyze the impact of remote monitoring for PM and ICD in a “real world” context compared with in-clinic follow-up. The evaluation focuses on how this service is carried out by Local Health Authorities, the impact on the cardiology unit and the health system, and organizational features promoting or hindering its effectiveness and efficiency. Methods A multi-center, multi-vendor, controlled, observational, prospective study was conducted to analyze the impact of remote monitoring implementation. A total of 2101 patients were enrolled in the study: 1871 patients were followed through remote monitoring of PM/ICD (I-group) and 230 through in-clinic visits (U-group). The follow-up period was 12 months. Results In-clinic device follow-ups and cardiac visits were significantly lower in the I-group compared with the U-group, respectively: PM, I-group = 0.43, U-group = 1.07, P<.001; ICD, I-group = 0.98, U-group = 2.14, P<.001. PM, I-group = 0.37, U-group = 0.85, P<.001; ICD, I-group = 1.58, U-group = 1.69, P=.01. Hospitalizations for any cause were significantly lower in the I-group for PM patients only (I-group = 0.37, U-group = 0.50, P=.005). There were no significant differences regarding use of the emergency department for both PM and ICD patients. In the I-group, 0.30 (PM

  14. Monitoring of clinical imaging guidelines part 3: norms, standards, and regulations.

    PubMed

    Babcock, Neil; Ebdon-Jackson, Steve; Remedios, Denis; Holmberg, Ola; del Rosario Perez, Maria; Bettmann, Michael A

    2015-03-01

    It is known that the use of imaging in clinical situations is not always optimal, leading to suboptimal health care and potential radiation risk. There may be overuse of imaging, underuse, or use of the wrong modality. The use of clinical imaging guidelines is likely to improve the use of imaging, but roadblocks exist. Some of these relate to regulatory oversight and mandates. There is wide variation by country and region in the regulatory setting, ranging from actual absence of regulatory authorities to mandated availability of clinical imaging guidelines in the European Community. Collaborative efforts to ensure that clinical imaging guidelines are at least available is a good starting point. Regulatory oversight and support are necessary to ensure the use of clinical imaging guidelines. Regulations should address 3 areas: availability, clinical utilization, and adherence to and revision of guidelines. The use of both internal and external audits, with the aim of both use of and adherence to guidelines and quality improvement, is the best tool for enhancing use. The major challenges that need to be addressed, collaboratively, to ensure the dissemination and use of clinical imaging guidelines are the development of regulations, of regulatory structures that can be effectively deployed, and of benchmarks for adherence and for utility. PMID:25743923

  15. Fuzzy-Arden-Syntax-based, Vendor-agnostic, Scalable Clinical Decision Support and Monitoring Platform.

    PubMed

    Adlassnig, Klaus-Peter; Fehre, Karsten; Rappelsberger, Andrea

    2015-01-01

    This study's objective is to develop and use a scalable genuine technology platform for clinical decision support based on Arden Syntax, which was extended by fuzzy set theory and fuzzy logic. Arden Syntax is a widely recognized formal language for representing clinical and scientific knowledge in an executable format, and is maintained by Health Level Seven (HL7) International and approved by the American National Standards Institute (ANSI). Fuzzy set theory and logic permit the representation of knowledge and automated reasoning under linguistic and propositional uncertainty. These forms of uncertainty are a common feature of patients' medical data, the body of medical knowledge, and deductive clinical reasoning. PMID:26262410

  16. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY 2016 OUTPATIENT GLUCOSE MONITORING CONSENSUS STATEMENT.

    PubMed

    Bailey, Timothy S; Grunberger, George; Bode, Bruce W; Handelsman, Yehuda; Hirsch, Irl B; Jovanovič, Lois; Roberts, Victor Lawrence; Rodbard, David; Tamborlane, William V; Walsh, John

    2016-02-01

    This document represents the official position of the American Association of Clinical Endocrinologists and American College of Endocrinology. Where there were no randomized controlled trials or specific U.S. FDA labeling for issues in clinical practice, the participating clinical experts utilized their judgment and experience. Every effort was made to achieve consensus among the committee members. Position statements are meant to provide guidance, but they are not to be considered prescriptive for any individual patient and cannot replace the judgment of a clinician. PMID:26848630

  17. A pilot clinical trial on a Variable Automated Speed and Sensing Treadmill (VASST) for hemiparetic gait rehabilitation in stroke patients

    PubMed Central

    Chua, Karen S. G.; Chee, Johnny; Wong, Chin J.; Lim, Pang H.; Lim, Wei S.; Hoo, Chuan M.; Ong, Wai S.; Shen, Mira L.; Yu, Wei S.

    2015-01-01

    Introduction: Impairments in walking speed and capacity are common problems after stroke which may benefit from treadmill training. However, standard treadmills, are unable to adapt to the slower walking speeds of stroke survivors and are unable to automate training progression. This study tests a Variable Automated Speed and Sensing Treadmill (VASST) using a standard clinical protocol. VASST is a semi-automated treadmill with multiple sensors and micro controllers, including wireless control to reposition a fall-prevention harness, variable pre-programmed exercise parameters and laser beam foot sensors positioned on the belt to detect subject's foot positions. Materials and Methods: An open-label study with assessor blinding was conducted in 10 community-dwelling chronic hemiplegic patients who could ambulate at least 0.1 m/s. Interventions included physiotherapist-supervised training on VASST for 60 min three times per week for 4 weeks (total 12 h). Outcome measures of gait speed, quantity, balance, and adverse events were assessed at baseline, 2, 4, and 8 weeks. Results: Ten subjects (8 males, mean age 55.5 years, 2.1 years post stroke) completed VASST training. Mean 10-m walk test speed was 0.69 m/s (SD = 0.29) and mean 6-min walk test distance was 178.3 m (84.0). After 4 weeks of training, 70% had significant positive gains in gait speed (0.06 m/s, SD = 0.08 m/s, P = 0.037); and 90% improved in walking distance. (54.3 m, SD = 30.9 m, P = 0.005). There were no adverse events. Discussion and Conclusion: This preliminary study demonstrates the initial feasibility and short-term efficacy of VASST for walking speed and distance for people with chronic post-stroke hemiplegia. PMID:26217170

  18. A new definition of pharmaceutical quality: assembly of a risk simulation platform to investigate the impact of manufacturing/product variability on clinical performance.

    PubMed

    Short, Steven M; Cogdill, Robert P; D'Amico, Frank; Drennen, James K; Anderson, Carl A

    2010-12-01

    The absence of a unanimous, industry-specific definition of quality is, to a certain degree, impeding the progress of ongoing efforts to "modernize" the pharmaceutical industry. This work was predicated on requests by Dr. Woodcock (FDA) to re-define pharmaceutical quality in terms of risk by linking production characteristics to clinical attributes. A risk simulation platform that integrates population statistics, drug delivery system characteristics, dosing guidelines, patient compliance estimates, production metrics, and pharmacokinetic, pharmacodynamic, and in vitro-in vivo correlation models to investigate the impact of manufacturing variability on clinical performance of a model extended-release theophylline solid oral dosage system was developed. Manufacturing was characterized by inter- and intra-batch content uniformity and dissolution variability metrics, while clinical performance was described by a probabilistic pharmacodynamic model that expressed the probability of inefficacy and toxicity as a function of plasma concentrations. Least-squares regression revealed that both patient compliance variables, percent of doses taken and dosing time variability, significantly impacted efficacy and toxicity. Additionally, intra-batch content uniformity variability elicited a significant change in risk scores for the two adverse events and, therefore, was identified as a critical quality attribute. The proposed methodology demonstrates that pharmaceutical quality can be recast to explicitly reflect clinical performance. PMID:20574996

  19. Monitoring and root cause analysis of clinical biochemistry turn around time at an academic hospital.

    PubMed

    Chauhan, Kiran P; Trivedi, Amit P; Patel, Dharmik; Gami, Bhakti; Haridas, N

    2014-10-01

    Quality can be defined as the ability of a product or service to satisfy the needs and expectations of the customer. Laboratories are more focusing on technical and analytical quality for reliability and accuracy of test results. Patients and clinicians however are interested in rapid, reliable and efficient service from laboratory. Turn around time (TAT), the timeliness with which laboratory personnel deliver test results, is one of the most noticeable signs of laboratory service and is often used as a key performance indicator of laboratory performance. This study is aims to provide clue for laboratory TAT monitoring and root cause analysis. In a 2 year period a total of 75,499 specimens of outdoor patient department were monitor, of this a total of 4,142 specimens exceeded TAT. With consistent efforts to monitor, root cause analysis and corrective measures, we are able to decreased the specimens exceeding TAT from 7-8 to 3.7 %. Though it is difficult task to monitor TAT with the help of laboratory information system, real time documentation and authentic data retrievable, along with identification of causes for delays and its remedial measures, improve laboratory TAT and thus patient satisfaction. PMID:25298634

  20. Lung ultrasound in systemic sclerosis: correlation with high-resolution computed tomography, pulmonary function tests and clinical variables of disease.

    PubMed

    Gigante, Antonietta; Rossi Fanelli, Filippo; Lucci, Silvio; Barilaro, Giuseppe; Quarta, Silvia; Barbano, Biagio; Giovannetti, Antonello; Amoroso, Antonio; Rosato, Edoardo

    2016-03-01

    Interstitial lung disease (ILD) is a hallmark of systemic sclerosis (SSc). Although high-resolution computed tomography (HRCT) is the gold standard to diagnose ILD, recently lung ultrasound (LUS) has emerged in SSc patients as a new promising technique for the ILD evaluation, noninvasive and radiation-free. The aim of this study was to evaluate if there is a correlation between LUS, chest HRCT, pulmonary function tests findings and clinical variables of the disease. Thirty-nine patients (33 women and 6 men; mean age 51 ± 15.2 years) underwent clinical examination, HRCT, pulmonary function tests and LUS for detection of B-lines. A positive correlation exists between the number of B-lines and the HRCT score (r = 0.81, p < 0.0001), conversely a negative correlation exists between the number of B-lines and diffusing capacity of the lung for carbon monoxide (DLCO) (r = -0.63, p < 0.0001). The number of B-lines increases along with the progression of the capillaroscopic damage. A statistically significant difference in the number of B-lines was found between patients with and without digital ulcers [42 (3-84) vs 16 (4-55)]. We found that the number of B-lines increased with the progression of both HRCT score and digital vascular damage. LUS may therefore, be a useful tool to determine the best timing for HRCT execution, thus, preventing for many patients a continuous and useless exposure to ionizing radiation. PMID:26494471

  1. Reproducibility of visit-to-visit variability of blood pressure measured as part of routine clinical care

    PubMed Central

    MUNTNER, Paul; JOYCE, Cara; LEVITAN, Emily B; HOLT, Elizabeth; SHIMBO, Daichi; WEBBER, Larry S; OPARIL, Suzanne; RE, Richard; KROUSEL-WOOD, Marie

    2016-01-01

    Objectives Secondary analysis of clinical trial data suggests visit-to-visit variability (VVV) of blood pressure is strongly associated with the incidence of cardiovascular disease. Measurement of blood pressure in usual practice settings may be subject to substantial error, calling into question the value of VVV in real-world settings. Methods We analyzed data on adults ≥ 65 years of age with diagnosed hypertension who were taking antihypertensive medication from the Cohort Study of Medication Adherence among Older Adults (n=772 with 14 or more blood pressure measurements). All blood pressure measurements, taken as part of routine out-patient care over a median of 2.8 years, were abstracted from patients’ medical charts. Results Using each participant’s first 7 systolic blood pressure (SBP) measurements, the mean intra-individual standard deviation was 13.5 mmHg. The intra-class correlation coefficient for the standard deviation based on the first 7 and second 7 SBP measurements was 0.28 (95% CI: 0.20 – 0.34). Individuals in the highest quintile of standard deviation of SBP based on their first 7 measurements were more likely to be in the highest quintile of VVV using their second 7 measurements (observed/expected ratio = 1.71, 95% CI: 1.29 – 2.22). Results were similar for other metrics of VVV. The intra-class correlation coefficient was lower for diastolic blood pressure (DBP) than SBP. Conclusions These data suggest VVV of SBP measured in a real-world setting is not random. Future studies are needed to assess the prognostic value of VVV of SBP assessed in routine clinical practice. PMID:22025235

  2. Variable tellurite resistance profiles of clinically-relevant Shiga toxin-producing Escherichia coli (STEC) influence their recovery from foodstuffs.

    PubMed

    Kerangart, Stéphane; Douëllou, Thomas; Delannoy, Sabine; Fach, Patrick; Beutin, Lothar; Sergentet-Thévenot, Delphine; Cournoyer, Benoit; Loukiadis, Estelle

    2016-10-01

    Tellurite (Tel)-amended selective media and resistance (Tel-R) are widely used for detecting Shiga toxin-producing Escherichia coli (STEC) from foodstuffs. Tel-R of 81 O157 and non-O157 STEC strains isolated from animal, food and human was thus investigated. Variations of STEC tellurite minimal inhibitory concentration (MIC) values have been observed and suggest a multifactorial and variable tellurite resistome between strains. Some clinically-relevant STEC were found highly susceptible and could not be recovered using a tellurite-based detection scheme. The ter operon was highly prevalent among highly Tel-R STEC but was not always detected among intermediately-resistant strains. Many STEC serogroup strains were found to harbor sublines showing a gradient of MIC values. These Tel-R sublines showed statistically significant log negative correlations with increasing tellurite concentration. Whatever the tellurite concentration, the highest number of resistant sublines was observed for STEC belonging to the O26 serogroup. Variations in the number of these Tel-R sublines could explain the poor recovery of some STEC serogroups on tellurite-amended media especially from food products with low levels of contamination. Comparison of tellurite MIC values and distribution of virulence-related genes showed Tel-R and virulence to be related. PMID:27375242

  3. Monitoring asthma in childhood.

    PubMed

    Lødrup Carlsen, Karin C; Pijnenburg, Mariëlle W

    2015-06-01

    The goal of asthma treatment is to obtain clinical control and reduce future risks to the patient. However, to date there is limited evidence on how to monitor patients with asthma. Childhood asthma introduces specific challenges in terms of deciding what, when, how often, by whom and in whom different assessments of asthma should be performed. The age of the child, the fluctuating course of asthma severity, variability in clinical presentation, exacerbations, comorbidities, socioeconomic and psychosocial factors, and environmental exposures may all influence disease activity and, hence, monitoring strategies. These factors will be addressed in herein. We identified large knowledge gaps in the effects of different monitoring strategies in children with asthma. Studies into monitoring strategies are urgently needed, preferably in collaborative paediatric studies across countries and healthcare systems. PMID:26028630

  4. Monitoring of anti-cancer treatment with 18F-FDG and 18F-FLT PET: a comprehensive review of pre-clinical studies

    PubMed Central

    Jensen, Mette Munk; Kjaer, Andreas

    2015-01-01

    Functional imaging of solid tumors with positron emission tomography (PET) imaging is an evolving field with continuous development of new PET tracers and discovery of new applications for already implemented PET tracers. During treatment of cancer patients, a general challenge is to measure treatment effect early in a treatment course and by that to stratify patients into responders and non-responders. With 2-deoxy-2-[18F]fluoro-D-glucose (18F-FDG) and 3’-deoxy-3’-[18F]fluorothymidine(18F-FLT) two of the cancer hallmarks, altered energy metabolism and increased cell proliferation, can be visualized and quantified non-invasively by PET. With 18F-FDG and 18F-FLT PET changes in energy metabolism and cell proliferation can thereby be determined after initiation of cancer treatment in both clinical and pre-clinical studies in order to predict, at an early time-point, treatment response. It is hypothesized that decreases in glycolysis and cell proliferation may occur in tumors that are sensitive to the applied cancer therapeutics and that tumors that are resistant to treatment will show unchanged glucose metabolism and cell proliferation. Whether 18F-FDG and/or 18F-FLT PET can be used for prediction of treatment response has been analyzed in many studies both following treatment with conventional chemotherapeutic agents but also following treatment with different targeted therapies, e.g. monoclonal antibodies and small molecules inhibitors. The results from these studies have been most variable; in some studies early changes in 18F-FDG and 18F-FLT uptake predicted later tumor regression whereas in other studies no change in tracer uptake was observed despite the treatment being effective. The present review gives an overview of pre-clinical studies that have used 18F-FDG and/or 18F-FLT PET for response monitoring of cancer therapeutics. PMID:26550536

  5. EYE LENS DOSIMETRY FOR FLUOROSCOPICALLY GUIDED CLINICAL PROCEDURES: PRACTICAL APPROACHES TO PROTECTION AND DOSE MONITORING.

    PubMed

    Martin, Colin J

    2016-06-01

    Doses to the eye lenses of clinicians undertaking fluoroscopically guided procedures can exceed the dose annual limit of 20 mSv, so optimisation of radiation protection is essential. Ceiling-suspended shields and disposable radiation absorbing pads can reduce eye dose by factors of 2-7. Lead glasses that shield against exposures from the side can lower doses by 2.5-4.5 times. Training in effective use of protective devices is an essential element in achieving good protection and acceptable eye doses. Effective methods for dose monitoring are required to identify protection issues. Dosemeters worn adjacent to the eye provide the better option for interventional clinicians, but an unprotected dosemeter worn at the neck will give an indication of eye dose that is adequate for most interventional staff. Potential requirements for protective devices and dose monitoring can be determined from risk assessments using generic values for dose linked to examination workload. PMID:26454269

  6. Implementation of Out-of-Office Blood Pressure Monitoring in the Netherlands: From Clinical Guidelines to Patients' Adoption of Innovation.

    PubMed

    Carrera, Pricivel M; Lambooij, Mattijs S

    2015-10-01

    Out-of-office blood pressure monitoring is promoted by various clinical guidelines toward properly diagnosing and effectively managing hypertension and engaging the patient in their care process. In the Netherlands, however, the Dutch cardiovascular risk management (CVRM) guidelines do not explicitly prescribe 24-hour ambulatory blood pressure measurement (ABPM) and home BP measurement (HBPM). The aim of this descriptive study was to develop an understanding of patients' and physicians' acceptance and use of out-of-office BP monitoring in the Netherlands given the CVRM recommendations.Three small focus group discussions (FGDs) with patients and 1 FGD with physicians were conducted to explore the mechanisms behind the acceptance and use of out-of-office BP monitoring and reveal real-world challenges that limit the implementation of out-of-office BP monitoring methods. To facilitate the FGDs, an analytical framework based on the technology acceptance model (TAM), the theory of planned behavior and the model of personal computing utilization was developed to guide the FGDs and analysis of the transcriptions of each FGD.ABPM was the out-of-office BP monitoring method prescribed by physicians and used by patients. HBPM was not offered to patients even with patients' feedback of poor tolerance of ABPM. Even as there was little awareness about HBPM among patients, there were a few patients who owned and used sphygmomanometers. Patients professed and seemed to exhibit self-efficacy, whereas physicians had reservations about (all of their) patients' self-efficacy in properly using ABPM. Since negative experience with ABPM impacted patients' acceptance of ABPM, the interaction of factors that determined acceptance and use was found to be dynamic among patients but not for physicians.In reference to the CVRM guidelines, physicians implemented out-of-office BP monitoring but showed a strong preference for ABPM even where there is poor tolerance of the method. We found that

  7. [Clinical safety studies based on 30 026 post-marketing cases of Shenqi Fuzheng injection by intensive hospital monitoring nested NCCS].

    PubMed

    Wang, Lian-xin; Xie, Yan-ming; Ai, Qing-hua; Xu, Wen-fu

    2015-12-01

    This study adopted a large sample, multicenter, registered hospital centralized monitoring nested prospective case-control study design. From the real world clinical application of Shenqi Fuzheng injection, monitored 30 026 cases of patients with the use of Shenqi Fuzheng injection. A total of 51 adverse drug reaction (ADR) cases was monitored, including 1 case of severe adverse reactions. ADR incidence rate was 1.7 per 1,000. Blood samples were collected from patients with allergic reactions and their matched controls. Related biological indicators of allergic reactions were unified detected and analysed in order to explore the mechanism of allergic reaction and promote the clinical safety. PMID:27245015

  8. A thermal monitoring sheet with low influence from adjacent waterbolus for tissue surface thermometry during clinical hyperthermia.

    PubMed

    Arunachalam, Kavitha; Maccarini, Paolo F; Stauffer, Paul R

    2008-10-01

    This paper presents a complete thermal analysis of a novel conformal surface thermometer design with directional sensitivity for real-time temperature monitoring during hyperthermia treatments of large superficial cancer. The thermal monitoring sheet (TMS) discussed in this paper consists of a 2-D array of fiberoptic sensors embedded between two layers of flexible, low-loss, and thermally conductive printed circuit board (PCB) film. Heat transfer across all interfaces from the tissue surface through multiple layers of insulating dielectrics surrounding the small buried temperature sensor and into an adjacent temperature-regulated water coupling bolus was studied using 3-D thermal simulation software. Theoretical analyses were carried out to identify the most effective differential TMS probe configuration possible with commercially available flexible PCB materials and to compare their thermal responses with omnidirectional probes commonly used in clinical hyperthermia. A TMS sensor design that employs 0.0508-mm Kapton MTB and 0.2032-mm Kapton HN flexible polyimide films is proposed for tissue surface thermometry with low influence from the adjacent waterbolus. Comparison of the thermal simulations with clinical probes indicates the new differential TMS probe design to outperform in terms of both transient response and steady-state accuracy in selectively reading the tissue surface temperature, while decreasing the overall thermal barrier of the probe between the coupling waterbolus and tissue surface. PMID:18838365

  9. A Thermal Monitoring Sheet with Low Influence from Adjacent Waterbolus for Tissue Surface Thermometry during Clinical Hyperthermia

    PubMed Central

    Arunachalam, K.; Maccarini, P.F.; Stauffer, P. R.

    2009-01-01

    This paper presents a complete thermal analysis of a novel conformal surface thermometer design with directional sensitivity for real time temperature monitoring during hyperthermia treatments of large superficial cancer. The thermal monitoring sheet (TMS) discussed in this paper consists of a two-dimensional array of fiberoptic sensors embedded between two layers of flexible, low loss and thermally conductive printed circuit board (PCB) film. Heat transfer across all interfaces from the tissue surface through multiple layers of insulating dielectrics surrounding the small buried temperature sensor and into an adjacent temperature regulated water coupling bolus was studied using 3D thermal simulation software. Theoretical analyses were carried out to identify the most effective differential TMS probe configuration possible with commercially available flexible PCB materials, and to compare their thermal responses with omni-directional probes commonly used in clinical hyperthermia. A TMS sensor design that employs 0.0508m Kapton MTB® and 0.2032 mm Kapton HN® flexible polyimide films is proposed for tissue surface thermometry with low influence from the adjacent waterbolus. Comparison of the thermal simulations with clinical probes indicate the new differential TMS probe design to outperform in terms of both transient response and steady state accuracy in selectively reading the tissue surface temperature, while decreasing the overall thermal barrier of the probe between the coupling waterbolus and tissue surface. PMID:18838365

  10. [Occupational lead exposure assessment: a proposal for a strategy to monitor prevention of clinical and subclinical effects].

    PubMed

    Araujo, U C; Pivetta, F R; Moreira, J C

    1999-01-01

    In developing countries, lead-acid battery factories are one of the heaviest consumers of lead. Due to lead's toxicological properties and prevalent working conditions in such factories, workers are subject to high exposure and health risk. This study discusses results obtained by lead exposure assessment of workers from a Rio de Janeiro battery factory, in light of Brazilian legislation and recent scientific data. Evaluation methods used were environmental (personal air sampling) and biological (determination of lead in blood, Pb-B) monitoring, showing a high personal exposure both in air (>0.1 mg/m3) and blood (55% of Pb-B >25 microg/dl). These results confirmed the inefficiency of current control measures, with a possible 46% of workers presenting a Pb-B range of 25-60 microg/dl in risk areas. Recent data suggest that Pb-B levels above 25 microg/dl are related to subclinical alterations in human body that should be investigated during clinical examination. Finally, we propose a strategy based on environmental and biological monitoring to prevent both clinical and subclinical effects. PMID:10203453

  11. Assuring the Proper Analytical Performance of Measurement Procedures for Immunosuppressive Drug Concentrations in Clinical Practice: Recommendations of the International Association of Therapeutic Drug Monitoring and Clinical Toxicology Immunosuppressive Drug Scientific Committee.

    PubMed

    Seger, Christoph; Shipkova, Maria; Christians, Uwe; Billaud, Elaine M; Wang, Ping; Holt, David W; Brunet, Mercè; Kunicki, Paweł K; Pawiński, Thomasz; Langman, Loralie J; Marquet, Pierre; Oellerich, Michael; Wieland, Eberhard; Wallemacq, Pierre

    2016-04-01

    Monitoring immunosuppressive drugs (ISDs) in blood or plasma is still a key therapeutic drug monitoring (TDM) application in clinical settings. Narrow target ranges and severe side effects at drug underexposure or overexposure make accurate and precise measurements a must. This overview prepared by the Immunosuppressive Drugs Scientific Committee of the International Association of Therapeutic Drug Monitoring and Clinical Toxicology is intended to serve as a summary and guidance document describing the current state-of-the-art in the TDM of ISDs. PMID:26982493

  12. Self-blood pressure monitoring in an urban, ethnically diverse population: A randomized clinical trial utilizing the electronic health record

    PubMed Central

    Yi, Stella S.; Tabaei, Bahman P.; Angell, Sonia Y.; Rapin, Anne; Buck, Michael D; Pagano, William G.; Maselli, Frank J.; Simmons, Alvaro; Chamany, Shadi

    2015-01-01

    Background Hypertension is a leading risk factor for cardiovascular disease. While control rates have improved over time, racial/ethnic disparities in hypertension control persist. Self-blood pressure monitoring (SBPM), by itself, has been shown to be an effective tool in predominantly white populations, but less studied in minority, urban communities. These types of minimally intensive approaches are important to test in all populations, especially those experiencing related health disparities, for broad implementation with limited resources. Methods and Results The New York City Health Department in partnership with community clinic networks implemented a randomized clinical trial (n=900, 450 per arm) to investigate the effectiveness of SBPM in medically underserved, and largely black and Hispanic participants. Intervention participants received a home blood pressure (BP) monitor and training on use, while control participants received usual care. After 9 months, systolic BP decreased (intervention: 14.7 mm Hg, control: 14.1 mm Hg; p=0.70). Similar results were observed when incorporating longitudinal data and calculating a mean slope over time. Control was achieved in 38.9% of intervention and 39.1% of control participants at the end of follow-up; the time-to-event experience of achieving BP control in the intervention vs. control were not different from each other (logrank p-value=0.91). Conclusions SBPM was not shown to improve control over usual care in this largely minority, urban population. The patient population in this study, which included a high proportion of Hispanics and uninsured persons is understudied. Results indicate these groups may have additional meaningful barriers to achieving BP control beyond access to the monitor itself. PMID:25737487

  13. Sexual Satisfaction and Sexual Reactivity in Infertile Women: The Contribution of The Dyadic Functioning and Clinical Variables

    PubMed Central

    Czyżkowska, Anna; Awruk, Katarzyna; Janowski, Konrad

    2016-01-01

    Background Infertility is a factor which has been linked to higher prevalence of sexual dysfunctions in women; however, ambiguous results have been reported about the impact of infertility on women’s sexual satisfaction. The purpose of this study was to compare sexual and dyadic functioning in infertile and fertile women. Furthermore, the associations between sexual variables and clinical variables (depressive symptoms, period trying to conceive, and treatment period) were assessed in infertile women sample. Materials and Methods The cross-sectional study involved 50 women with the history of infertility and 50 fertile women recruited from the general population. The Sexual Satisfaction Scale (SSS), Mell-Krat Scale (women’s version), Family Assessment Measure (FAM-III), and Beck Depression Inventory (BDI) were administered to all participants. Results Infertile women reported lower sexual satisfaction and more maladaptive patterns of dyadic functioning in comparison to the control group. As many as 45 (90%) of infertile women, compared to 13 (26%) of the control group, reported the scores on the Mell-Krat Scale indicative of the presence of dysfunctions in sexual reactivity (P≤0.001). Infertile women reported significantly higher levels of depressive symptoms than the women from the control group (P≤0.001). Negative correlations were observed between sexual satisfaction and dyadic functioning in both groups (P≤0.05); however, the patterns of these associations were different in infertile and fertile women. For example, negative correlations were found between satisfaction with control and task accomplishment, role performance, affective involvement, and values and norms in infertile women. However, these relationships were not observed in the control group. No correlations were revealed between sexual reactivity and dyadic functioning in infertile women and the control group. Negative correlations were observed between satisfaction with control and

  14. Metabolic consequences of second-generation antipsychotics in youth: appropriate monitoring and clinical management

    PubMed Central

    Krill, Rebecca A; Kumra, Sanjiv

    2014-01-01

    Objective To review the metabolic consequences of second-generation antipsychotics in youth and current monitoring and intervention guidelines for optimal treatment. Background Second-generation antipsychotics have largely replaced the use of first-generation antipsychotics in treating psychotic disorders in youth. In addition, there has been a dramatic increase in using these medications to treat a variety of nonpsychotic disorders. These medications have significant metabolic side effects, including weight gain. This raises concern, given the problem of pediatric obesity. Materials and methods A review of current literature looking at prescribing practices and possible reasons for the increased use of second-generation antipsychotics in children and adolescents was conducted. Review of the mechanisms for why youth may be particularly vulnerable to the metabolic consequences (particularly weight gain) was similarly completed. In addition, data supporting the efficacy, rationale, and unique side-effect profile of each individual second-generation drug were evaluated to help inform providers on when and what to prescribe, along with current monitoring practices. The current evidence base for possible interventions regarding the management of antipsychotic-induced weight gain was also evaluated. Results and conclusion On the basis of the literature review, there are several speculated reasons for the increase in prescriptions of second-generation antipsychotics. The choice of antipsychotic for youth should be based upon the disorder being treated along with the unique side-effect profile for the most commonly used second-generation antipsychotics. Monitoring strategies are also individualized to each antipsychotic. The current interventions recommended for antipsychotic-induced weight gain include lifestyle management, switching medication to a drug with a lower propensity for weight gain, and pharmacologic (particularly metformin) treatment. PMID:25298741

  15. Clinical monitoring and management of complications related to chelation therapy in patients with β-thalassemia.

    PubMed

    Saliba, Antoine N; El Rassi, Fuad; Taher, Ali T

    2016-01-01

    Iron chelating agents - deferoxamine (DFO), deferiprone (DFP), and deferasirox (DFX) - are used to treat chronic iron overload in patients with β-thalassemia in an attempt to reduce morbidity and mortality related to siderosis. Each of the approved iron chelating agents has its own advantages over the others and also has its own risks, whether related to over-chelation or not. In this review, we briefly discuss the methods to monitor the efficacy of iron chelation therapy (ICT) and the evidence behind the use of each iron chelating agent. We also portray the risks and complications associated with each iron chelating agent and recommend strategies to manage adverse events. PMID:26613264

  16. PET Parametric Response Mapping for Clinical Monitoring and Treatment Response Evaluation in Brain Tumors.

    PubMed

    Ellingson, Benjamin M; Chen, Wei; Harris, Robert J; Pope, Whitney B; Lai, Albert; Nghiemphu, Phioanh L; Czernin, Johannes; Phelps, Michael E; Cloughesy, Timothy F

    2013-04-01

    PET parametric response maps (PRMs) are a provocative new molecular imaging technique for quantifying brain tumor response to therapy in individual patients. By aligning sequential PET scans over time using anatomic MR imaging information, the voxel-wise change in radiotracer uptake can be quantified and visualized. PET PRMs can be performed before and after a particular therapy to test whether the tumor is responding favorably, or performed relative to a distant time point to monitor changes through the course of a treatment. This article focuses on many of the technical details involved in generating, visualizing, and quantifying PET PRMs, and practical applications and example case studies. PMID:27157948

  17. A protocol for developing a clinical practice guideline for therapeutic drug monitoring of vancomycin.

    PubMed

    Ye, Zhi-Kang; Chen, Ken; Chen, Yao-Long; Zhai, Suo-di

    2016-06-01

    This study aimed to develop a guideline for therapeutic drug monitoring (TDM) of vancomycin. We adopted the new guideline definition from the Institute of Medicine (IOM), adhered closely to the six domains of the Appraisal of Guidelines for Research & Evaluation II (AGREE II), and made recommendations based on systematic reviews. We established a Guideline Steering Group and a Guideline Development Group, formulated 12 questions in the form of Population, Intervention, Comparison, Outcome (PICO) and completed a literature search. As far as we know, we will develop the first evidenced-based guideline for vancomycin TDM under the framework of the Grade of Recommendations Assessment, Development and Evaluation (GRADE). PMID:27376822

  18. Overcoming Clinical Inertia: A Randomized Clinical Trial of a Telehealth Remote Monitoring Intervention Using Paired Glucose Testing in Adults With Type 2 Diabetes

    PubMed Central

    Blozis, Shelley A; Young, Heather M; Nesbitt, Thomas S; Quinn, Charlene C

    2015-01-01

    Background Type 2 diabetes mellitus is a worldwide challenge. Practice guidelines promote structured self-monitoring of blood glucose (SMBG) for informing health care providers about glycemic control and providing patient feedback to increase knowledge, self-efficacy, and behavior change. Paired glucose testing—pairs of glucose results obtained before and after a meal or physical activity—is a method of structured SMBG. However, frequent access to glucose data to interpret values and recommend actions is challenging. A complete feedback loop—data collection and interpretation combined with feedback to modify treatment—has been associated with improved outcomes, yet there remains limited integration of SMBG feedback in diabetes management. Incorporating telehealth remote monitoring and asynchronous electronic health record (EHR) feedback from certified diabetes educators (CDEs)—specialists in glucose pattern management—employ the complete feedback loop to improve outcomes. Objective The purpose of this study was to evaluate a telehealth remote monitoring intervention using paired glucose testing and asynchronous data analysis in adults with type 2 diabetes. The primary aim was change in glycated hemoglobin (A1c)—a measure of overall glucose management—between groups after 6 months. The secondary aims were change in self-reported Summary of Diabetes Self-Care Activities (SDSCA), Diabetes Empowerment Scale, and Diabetes Knowledge Test. Methods A 2-group randomized clinical trial was conducted comparing usual care to telehealth remote monitoring with paired glucose testing and asynchronous virtual visits. Participants were aged 30-70 years, not using insulin with A1c levels between 7.5% and 10.9% (58-96 mmol/mol). The telehealth remote monitoring tablet computer transmitted glucose data and facilitated a complete feedback loop to educate participants, analyze actionable glucose data, and provide feedback. Data from paired glucose testing were analyzed

  19. The Theory and Fundamentals of Bioimpedance Analysis in Clinical Status Monitoring and Diagnosis of Diseases

    PubMed Central

    Khalil, Sami F.; Mohktar, Mas S.; Ibrahim, Fatimah

    2014-01-01

    Bioimpedance analysis is a noninvasive, low cost and a commonly used approach for body composition measurements and assessment of clinical condition. There are a variety of methods applied for interpretation of measured bioimpedance data and a wide range of utilizations of bioimpedance in body composition estimation and evaluation of clinical status. This paper reviews the main concepts of bioimpedance measurement techniques including the frequency based, the allocation based, bioimpedance vector analysis and the real time bioimpedance analysis systems. Commonly used prediction equations for body composition assessment and influence of anthropometric measurements, gender, ethnic groups, postures, measurements protocols and electrode artifacts in estimated values are also discussed. In addition, this paper also contributes to the deliberations of bioimpedance analysis assessment of abnormal loss in lean body mass and unbalanced shift in body fluids and to the summary of diagnostic usage in different kinds of conditions such as cardiac, pulmonary, renal, and neural and infection diseases. PMID:24949644

  20. Monitoring Compliance to Promote Quality Assurance: Development of a Mental Health Clinical Chart Audit Tool in Belize, 2013.

    PubMed

    Winer, Rachel A; Bennett, Eleanor; Murillo, Illouise; Schuetz-Mueller, Jan; Katz, Craig L

    2015-09-01

    Belize trained psychiatric nurse practitioners (PNPs) in the early 1990s to provide mental health services throughout the country. Despite overwhelming success, the program is limited by lack of monitoring, evaluation, and surveillance. To promote quality assurance, we developed a chart audit tool to monitor mental healthcare delivery compliance for initial psychiatric assessment notes completed by PNPs. After reviewing the Belize Health Information System electronic medical record system, we developed a clinical audit tool to capture 20 essential components for initial assessment clinical notes. The audit tool was then piloted for initial assessment notes completed during July through September of 2013. One hundred and thirty-four initial psychiatric interviews were audited. The average chart score among all PNPs was 9.57, ranging from 3 to 15. Twenty-three charts-or 17.2%-had a score of 14 or higher and met a 70% compliance benchmark goal. Among indicators most frequently omitted included labs ordered and named (15.7%) and psychiatric diagnosis (21.6%). Explicit statement of medications initiated with dose and frequency occurred in 47.0% of charts. Our findings provide direction for training and improvement, such as emphasizing the importance of naming labs ordered, medications and doses prescribed, and psychiatric diagnoses in initial assessment clinical notes. We hope this initial assessment helps enhance mental health delivery compliance by prompting creation of BHIS templates, development of audits tools for revisit follow-up visits, and establishment of corrective actions for low-scoring practitioners. These efforts may serve as a model for implementing quality assurance programming in other low resource settings. PMID:25829167

  1. Interdisciplinary collaboration applied to clinical research: an example of remote monitoring in lung transplantation.

    PubMed

    VanWormer, Arin; Lindquist, Ruth; Robiner, William; Finkelstein, Stanley

    2012-01-01

    Collaboration across disciplines is vital in clinical practice. It is also needed to generate high-quality actionable research, yet few frameworks for interdisciplinary collaboration exit to promote effective communications among researchers with common goals, but varied backgrounds. A review of what has been learned about collaboration was undertaken to determine attributes of effective interdisciplinary collaboration and barriers to its realization in patients undergoing lung transplantation. PMID:22475710

  2. Non-epileptic clinical diagnoses in children referred for an outpatient EEG using video monitoring.

    PubMed

    Apakama, Okwuchi; Appleton, Richard

    2006-06-01

    Simultaneous video (closed circuit television [CCTV]) and EEG recordings are important in the differentiation of epileptic and non-epileptic paroxysmal episodes and in the classification of epilepsy syndromes. An additional benefit from the observation of the child on CCTV is the possible identification of specific clinical, including genetic, conditions. This three-year prospective study of 2780 consecutive children undergoing routine EEG investigations identified 17 conditions that had not previously been diagnosed by the clinicians who had requested the EEG. PMID:16793578

  3. Interdisciplinary collaboration applied to clinical research: an example of remote monitoring in lung transplantation

    PubMed Central

    VanWormer, Arin; Robiner, William; Finkelstein, Stanley

    2012-01-01

    Collaboration across disciplines is vital in clinical practice. It is also needed to generate high-quality actionable research, yet few frameworks for interdisciplinary collaboration exit to promote effective communications among researchers with common boals, but varied backgrounds. A review of that has been learned about collaboration was undertaken to determine attributes of effective interdisciplinary collaboration and barriers to its realization in patients undergoing lung transplantation. PMID:22475710

  4. Clinical evaluation of a sensory feedback device: the limb load monitor.

    PubMed

    Wannstedt, G; Craik, R L

    1978-01-01

    Based on records of 81 patients who used the LLM, and on questionnaire answers and comments from clinicians, the following can be concluded: 1. The LLM can be operated easily after a minimum of training. It does not break down with extended clinical use when handled properly. 2. The LLM manual provides sufficient information for proper operation and clinical use of the device. 3. The number of patients in a clinic who can benefit from LLM training can be predicted, if consideration is given to the type of facility and the size of the patient population and physical therapy staff. 4. The largest diagnostic group of patients who can benefit from LLM therapy are lower-limb amputees, followed by hemiplegic and orthopedic patients. 5. The general selection criteria outlined initially proved sufficient. A patient who is selected properly can be expected to respond to the feedback signal (i.e., make a weight-bearing adjustment) within the first or second session. PMID:698464

  5. The swiss neonatal quality cycle, a monitor for clinical performance and tool for quality improvement

    PubMed Central

    2013-01-01

    Background We describe the setup of a neonatal quality improvement tool and list which peer-reviewed requirements it fulfils and which it does not. We report on the so-far observed effects, how the units can identify quality improvement potential, and how they can measure the effect of changes made to improve quality. Methods Application of a prospective longitudinal national cohort data collection that uses algorithms to ensure high data quality (i.e. checks for completeness, plausibility and reliability), and to perform data imaging (Plsek’s p-charts and standardized mortality or morbidity ratio SMR charts). The collected data allows monitoring a study collective of very low birth-weight infants born from 2009 to 2011 by applying a quality cycle following the steps ′guideline – perform - falsify – reform′. Results 2025 VLBW live-births from 2009 to 2011 representing 96.1% of all VLBW live-births in Switzerland display a similar mortality rate but better morbidity rates when compared to other networks. Data quality in general is high but subject to improvement in some units. Seven measurements display quality improvement potential in individual units. The methods used fulfil several international recommendations. Conclusions The Quality Cycle of the Swiss Neonatal Network is a helpful instrument to monitor and gradually help improve the quality of care in a region with high quality standards and low statistical discrimination capacity. PMID:24074151

  6. WEATHER ON THE NEAREST BROWN DWARFS: RESOLVED SIMULTANEOUS MULTI-WAVELENGTH VARIABILITY MONITORING OF WISE J104915.57–531906.1AB

    SciTech Connect

    Biller, Beth A.; Crossfield, Ian J. M.; Mancini, Luigi; Ciceri, Simona; Kopytova, Taisiya G.; Bonnefoy, Mickaël; Deacon, Niall R.; Schlieder, Joshua E.; Buenzli, Esther; Brandner, Wolfgang; Bailer-Jones, Coryn A. L.; Henning, Thomas; Goldman, Bertrand; Southworth, John; Allard, France; Homeier, Derek; Freytag, Bernd; Greiner, Jochen

    2013-11-20

    We present two epochs of MPG/ESO 2.2 m GROND simultaneous six-band (r'i'z' JHK) photometric monitoring of the closest known L/T transition brown dwarf binary WISE J104915.57–531906.1AB. We report here the first resolved variability monitoring of both the T0.5 and L7.5 components. We obtained 4 hr of focused observations on the night of 2013 April 22 (UT), as well as 4 hr of defocused (unresolved) observations on the night of 2013 April 16 (UT). We note a number of robust trends in our light curves. The r' and i' light curves appear to be anti-correlated with z' and H for the T0.5 component and in the unresolved light curve. In the defocused dataset, J appears correlated with z' and H and anti-correlated with r' and i', while in the focused dataset we measure no variability for J at the level of our photometric precision, likely due to evolving weather phenomena. In our focused T0.5 component light curve, the K band light curve displays a significant phase offset relative to both H and z'. We argue that the measured phase offsets are correlated with atmospheric pressure probed at each band, as estimated from one-dimensional atmospheric models. We also report low-amplitude variability in i' and z' intrinsic to the L7.5 component.

  7. Neurocognitive Impairments in Deficit and Non-Deficit Schizophrenia and Their Relationships with Symptom Dimensions and Other Clinical Variables

    PubMed Central

    Zhang, XiangRong; Zhang, XiaoBin; Sha, WeiWei; Yao, ShuQiao; Shu, Ni; Zhang, XiangYang; Zhang, ZhiJun

    2015-01-01

    Background Deficit schizophrenia (DS) has been proposed as a pathophysiologically distinct subgroup within schizophrenia. Earlier studies focusing on neurocognitive function of DS patients have yielded inconsistent findings ranging from substantial deficits to no significant difference relative to non-deficit schizophrenia patients (NDS). The present study investigated the severity and characteristic patterns of neurocognitive impairments in DS and NDS patients and their relationships with clinical variables. Methods Attention, ideation fluency, cognitive flexibility and visuospatial memory function were assessed in 40 DS patients, 57 NDS patients, and 52 healthy controls by a comprehensive neuropsychological battery. Results Both schizophrenia subgroups had overall more severe cognitive impairments than controls while DS performed worse on every neuropsychological measure except the Stroop interference than the NDS patients with age and education as the covariates. Profile analysis found significantly different patterns of cognitive profiles between two patients group mainly due to their differences in attention and cognitive flexibility functions. Age, education, illness duration and negative symptoms were found to have the correlations with cognitive impairments in the NDS group, while only age and the negative symptoms were correlated with the cognitive impairments in the DS group. Multiple regression analyses revealed that sustained attention and cognitive flexibility were the core impaired cognitive domains mediating other cognitive functions in DS and NDS patients respectively. Conclusions DS patients exemplified worse in almost all cognitive domains than NDS patients. Sustained attention and cognitive flexibility might be the key impaired cognitive domains for DS and NDS patients respectively. The present study suggested the DS as a specific subgroup of schizophrenia. PMID:26381645

  8. Neural network classification of clinical neurophysiological data for acute care monitoring

    NASA Technical Reports Server (NTRS)

    Sgro, Joseph

    1994-01-01

    The purpose of neurophysiological monitoring of the 'acute care' patient is to allow the accurate recognition of changing or deteriorating neurological function as close to the moment of occurrence as possible, thus permitting immediate intervention. Results confirm that: (1) neural networks are able to accurately identify electroencephalogram (EEG) patterns and evoked potential (EP) wave components, and measuring EP waveform latencies and amplitudes; (2) neural networks are able to accurately detect EP and EEG recordings that have been contaminated by noise; (3) the best performance was obtained consistently with the back propagation network for EP and the HONN for EEG's; (4) neural network performed consistently better than other methods evaluated; and (5) neural network EEG and EP analyses are readily performed on multichannel data.

  9. IRRIGATION RETURN FLOW WATER QUALITY MONITORING, MODELING AND VARIABILITY IN THE MIDDLE RIO GRANDE VALLEY, NEW MEXICO

    EPA Science Inventory

    A 250-acre (100 hectare) irrigated farm in the middle Rio Grande valley at San Acacia, New Mexico, was intensively monitored for the five year period from 1977 through 1982. During that time there was no statistically significant change in the total dissolved solids concentration...

  10. Detection of beta-class variability in Black Hole source GRS 1915+105 by Astrosat Scanning Sky Monitor

    NASA Astrophysics Data System (ADS)

    Ramadevi, M. C.; Ravishankar, B. T.; Nandi, Anuj; Girish, V.; Singh, Brajpal; Jain, Anand; Agrawal, Vivek Kumar; Agarwal, Anil; Bhattacharya, Dipankar; Seetha, S.; Sharma, M. Ramakrishna; Sharan, Vaishali; Babu, V. C.; Yadav, Reena; Meena, G.; Murthy, N. Sitarama; Kumar; Ashoka, B. N.; Kulkarni, Ravi; Iyer, Nirmal; Radhika, D.; Kushwaha, Ankur; Balaji, K.; Nagesh, G.; Kumar, Manoj; Gaan, Dhruti Ranjan; Kulshresta, Prashanth; Agarwal, Pankaj; Sebastin, Matthew; Rajarajan, A.; Rao, S. V. S. Subba; Pandiyan; R.; Rao, K. Subba; Rao, Chaitra; Sarma, K. Suryanarayana

    2015-10-01

    The Scanning Sky Monitor (SSM) on board ASTROSAT was made operational on October 12th, 2015, the 15th day after launch (September 28th, 2015). After initial observations of the Crab Nebula, on October 14th 2015, the SSM was maneuvered for a stare at the galactic Black Hole source GRS 1915+105.

  11. Circulating Tumor Cells in Prostate Cancer Diagnosis and Monitoring: An Appraisal of Clinical Potential

    PubMed Central

    Galletti, Giuseppe; Portella, Luigi; Tagawa, Scott T.; Kirby, Brian J.; Giannakakou, Paraskevi

    2014-01-01

    Circulating tumor cells (CTCs) have emerged as a viable solution to the lack of tumor tissue availability for patients with a variety of solid tumors, including prostate cancer. Different approaches have been used to capture this tumor cell population and several of these techniques have been used to assess the potential role of CTCs as a biological marker to predict treatment efficacy and clinical outcome. CTCs are now considered a strong tool to understand the molecular characteristics of prostate cancer, and to be used and analyzed as a ‘liquid biopsy’ in the attempt to grasp the biological portrait of the disease in the individual patient. PMID:24809501

  12. Immunodynamics: a cancer immunotherapy trials network review of immune monitoring in immuno-oncology clinical trials.

    PubMed

    Kohrt, Holbrook E; Tumeh, Paul C; Benson, Don; Bhardwaj, Nina; Brody, Joshua; Formenti, Silvia; Fox, Bernard A; Galon, Jerome; June, Carl H; Kalos, Michael; Kirsch, Ilan; Kleen, Thomas; Kroemer, Guido; Lanier, Lewis; Levy, Ron; Lyerly, H Kim; Maecker, Holden; Marabelle, Aurelien; Melenhorst, Jos; Miller, Jeffrey; Melero, Ignacio; Odunsi, Kunle; Palucka, Karolina; Peoples, George; Ribas, Antoni; Robins, Harlan; Robinson, William; Serafini, Tito; Sondel, Paul; Vivier, Eric; Weber, Jeff; Wolchok, Jedd; Zitvogel, Laurence; Disis, Mary L; Cheever, Martin A

    2016-01-01

    The efficacy of PD-1/PD-L1 targeted therapies in addition to anti-CTLA-4 solidifies immunotherapy as a modality to add to the anticancer arsenal. Despite raising the bar of clinical efficacy, immunologically targeted agents raise new challenges to conventional drug development paradigms by highlighting the limited relevance of assessing standard pharmacokinetics (PK) and pharmacodynamics (PD). Specifically, systemic and intratumoral immune effects have not consistently correlated with standard relationships between systemic dose, toxicity, and efficacy for cytotoxic therapies. Hence, PK and PD paradigms remain inadequate to guide the selection of doses and schedules, both starting and recommended Phase 2 for immunotherapies. The promise of harnessing the immune response against cancer must also be considered in light of unique and potentially serious toxicities. Refining immune endpoints to better inform clinical trial design represents a high priority challenge. The Cancer Immunotherapy Trials Network investigators review the immunodynamic effects of specific classes of immunotherapeutic agents to focus immune assessment modalities and sites, both systemic and importantly intratumoral, which are critical to the success of the rapidly growing field of immuno-oncology. PMID:26981245

  13. Multifunctional Skin-like Electronics for Quantitative, Clinical Monitoring of Cutaneous Wound Healing

    PubMed Central

    Hattori, Yoshiaki; Falgout, Leo; Lee, Woosik; Jung, Sung-Young; Poon, Emily; Lee, Jung Woo; Na, Ilyoun; Geisler, Amelia; Sadhwani, Divya; Zhang, Yihui; Su, Yewang; Wang, Xiaoqi; Liu, Zhuangjian; Xia, Jing; Cheng, Huanyu; Webb, R. Chad; Bonifas, Andrew P.; Won, Philip; Jeong, Jae-Woong; Jang, Kyung-In; Song, Young Min; Nardone, Beatrice; Nodzenski, Michael; Fan, Jonathan A.; Huang, Yonggang; West, Dennis P.; Paller, Amy S.; Alam, Murad

    2014-01-01

    Non-invasive, biomedical devices have the potential to provide important, quantitative data for the assessment of skin diseases and wound healing. Traditional methods either rely on qualitative visual and tactile judgments of a professional and/or data obtained using instrumentation with forms that do not readily allow intimate integration with sensitive skin near a wound site. Here we report a skin-like electronics platform that can softly and reversibly laminate perilesionally at wounds to provide highly accurate, quantitative data of relevance to the management of surgical wound healing. Clinical studies on patients using thermal sensors and actuators in fractal layouts provide precise time-dependent mapping of temperature and thermal conductivity of the skin near the wounds. Analytical and simulation results establish the fundamentals of the sensing modalities, the mechanics of the system, and strategies for optimized design. The use of this type of ‘epidermal’ electronics system in a realistic, clinical setting with human subjects establishes a set of practical procedures in disinfection, reuse, and protocols for quantitative measurement. The results have the potential to address important unmet needs in chronic wound management. PMID:24668927

  14. In-situ monitoring of California's drought: Impacts on key hydrologic variables in the Southern Sierra Nevada

    NASA Astrophysics Data System (ADS)

    Oroza, C.; Zheng, Z.; Zhang, Z.; Glaser, S. D.; Bales, R. C.; Conklin, M. H.

    2015-12-01

    Like many semi-arid regions, California relies on seasonal snowmelt from the Sierra Nevada mountain range to provide freshwater allocations for multiple stakeholders throughout the year. The magnitude and timing of runoff from these regions is being altered by consecutive years of drought, affecting downstream ecosystems, hydropower operations, and deliveries to agriculture and urban water users. Understanding the long-term effect of drought on the montane water balance requires temporally continuous, in-situ measurements of key hydrologic variables across large spatial domains. We discuss a seven-year dataset from the Southern Sierra Critical Zone Observatory, which includes co-located measurements of snowpack, soil moisture, and soil temperature in the Kings River watershed. We investigate how these key hydrologic variables are affected as the region transitions from winters that have nearly continuous snow cover (2008-2011) to winters with extended snow-on, snow-off periods (2012-2014). For water year 2014, we observe a 93% decline in average snowpack, a 35% decline in average soil moisture, and a 25% increase in average soil temperature compared to a wet-year index of each variable. We discuss the effect of physiographic features, including slope, aspect, elevation, and canopy coverage on the changes observed in each variable. Finally, we use sparse inverse covariance estimation to investigate the changing conditional relationships throughout the observatory in wet and dry years.

  15. A Large Systematic Search for Close Supermassive Binary and Rapidly Recoiling Black Holes. II. Continued Spectroscopic Monitoring and Optical Flux Variability

    NASA Astrophysics Data System (ADS)

    Runnoe, Jessie C.; Eracleous, Michael; Mathes, Gavin; Pennell, Alison; Boroson, Todd; Sigurðsson, Steinn; Bogdanović, Tamara; Halpern, Jules P.; Liu, Jia

    2015-11-01

    We present new spectroscopic observations that are part of our continuing monitoring campaign of 88 quasars at z < 0.7 whose broad Hβ lines are offset from their systemic redshifts by a few thousand km s-1. These quasars have been considered as candidates for hosting supermassive black hole binaries (SBHBs) by analogy with single-lined spectroscopic binary stars. We present the data and describe our improved analysis techniques, which include an extensive evaluation of uncertainties. We also present a variety of measurements from the spectra that are of general interest and will be useful in later stages of our analysis. Additionally, we take this opportunity to study the variability of the optical continuum and integrated flux of the broad Hβ line. We compare the variability properties of the SBHB candidates to those of a sample of typical quasars with similar redshifts and luminosities observed multiple times during the Sloan Digital Sky Survey. We find that the variability properties of the two samples are similar (variability amplitudes of 10%-30% on timescales of approximately 1-7 years) and that their structure functions can be described by a common model with parameters characteristic of typical quasars. These results suggest that the broad-line regions of SBHB candidates have a similar extent as those of typical quasars. We discuss the implications of this result for the SBHB scenario and the ensuing constraints on the orbital parameters.

  16. Bone Health Monitoring in Astronauts: Recommended Use of Quantitative Computed Tomography [QCT] for Clinical and Operational Decisions

    NASA Technical Reports Server (NTRS)

    Sibonga, J. D.; Truskowski, P.

    2010-01-01

    This slide presentation reviews the concerns that astronauts in long duration flights might have a greater risk of bone fracture as they age than the general population. A panel of experts was convened to review the information and recommend mechanisms to monitor the health of bones in astronauts. The use of Quantitative Computed Tomography (QCT) scans for risk surveillance to detect the clinical trigger and to inform countermeasure evaluation is reviewed. An added benefit of QCT is that it facilitates an individualized estimation of bone strength by Finite Element Modeling (FEM), that can inform approaches for bone rehabilitation. The use of FEM is reviewed as a process that arrives at a composite number to estimate bone strength, because it integrates multiple factors.

  17. Multiwavelength optoacoustic system for noninvasive monitoring of cerebral venous oxygenation: a pilot clinical test in the internal jugular vein

    NASA Astrophysics Data System (ADS)

    Petrov, Yuriy Y.; Petrova, Irina Y.; Patrikeev, Igor A.; Esenaliev, Rinat O.; Prough, Donald S.

    2006-06-01

    A noninvasive, high-resolution optoacoustic technique is a promising alternative to currently used invasive methods of brain oxygenation monitoring. We present the results of our pilot clinical test of this technique in healthy volunteers. Multiwavelength optoacoustic measurements (with nanosecond optical parametric oscillator as a source of radiation) were performed on the area of the neck overlying the internal jugular vein, a deeply located large vein that drains blood from the brain and from extracranial tissues. Optoacoustic signals induced in venous blood were measured with high resolution and signal-to-noise ratio despite the presence of a thick layer of overlying tissue (up to 10 mm). The characteristic parameters of the signal at different wavelengths correlated well with the spectrum of the effective attenuation coefficient of blood.

  18. A clinical case study of a psychoanalytic psychotherapy monitored with functional neuroimaging

    PubMed Central

    Buchheim, Anna; Labek, Karin; Walter, Steffen; Viviani, Roberto

    2013-01-01

    This case study describes 1 year of the psychoanalytic psychotherapy using clinical data, a standardized instrument of the psychotherapeutic process (Psychotherapy process Q-Set, PQS), and functional neuroimaging (fMRI). A female dysthymic patient with narcissistic traits was assessed at monthly intervals (12 sessions). In the fMRI scans, which took place immediately after therapy hours, the patient looked at pictures of attachment-relevant scenes (from the Adult Attachment Projective Picture System, AAP) divided into two groups: those accompanied by a neutral description, and those accompanied by a description tailored to core conflicts of the patient as assessed in the AAP. Clinically, this patient presented defense mechanisms that influenced the relationship with the therapist and that was characterized by fluctuations of mood that lasted whole days, following a pattern that remained stable during the year of the study. The two modes of functioning associated with the mood shifts strongly affected the interaction with the therapist, whose quality varied accordingly (“easy” and “difficult” hours). The PQS analysis showed the association of “easy” hours with the topic of the involvement in significant relationships and of “difficult hours” with self-distancing, a defensive maneuver common in narcissistic personality structures. In the fMRI data, the modes of functioning visible in the therapy hours were significantly associated with modulation of the signal elicited by personalized attachment-related scenes in the posterior cingulate (p = 0.017 cluster-level, whole-volume corrected). This region has been associated in previous studies to self-distancing from negatively valenced pictures presented during the scan. The present study may provide evidence of the possible involvement of this brain area in spontaneously enacted self-distancing defensive strategies, which may be of relevance in resistant reactions in the course of a psychoanalytic

  19. A clinical case study of a psychoanalytic psychotherapy monitored with functional neuroimaging.

    PubMed

    Buchheim, Anna; Labek, Karin; Walter, Steffen; Viviani, Roberto

    2013-01-01

    This case study describes 1 year of the psychoanalytic psychotherapy using clinical data, a standardized instrument of the psychotherapeutic process (Psychotherapy process Q-Set, PQS), and functional neuroimaging (fMRI). A female dysthymic patient with narcissistic traits was assessed at monthly intervals (12 sessions). In the fMRI scans, which took place immediately after therapy hours, the patient looked at pictures of attachment-relevant scenes (from the Adult Attachment Projective Picture System, AAP) divided into two groups: those accompanied by a neutral description, and those accompanied by a description tailored to core conflicts of the patient as assessed in the AAP. Clinically, this patient presented defense mechanisms that influenced the relationship with the therapist and that was characterized by fluctuations of mood that lasted whole days, following a pattern that remained stable during the year of the study. The two modes of functioning associated with the mood shifts strongly affected the interaction with the therapist, whose quality varied accordingly ("easy" and "difficult" hours). The PQS analysis showed the association of "easy" hours with the topic of the involvement in significant relationships and of "difficult hours" with self-distancing, a defensive maneuver common in narcissistic personality structures. In the fMRI data, the modes of functioning visible in the therapy hours were significantly associated with modulation of the signal elicited by personalized attachment-related scenes in the posterior cingulate (p = 0.017 cluster-level, whole-volume corrected). This region has been associated in previous studies to self-distancing from negatively valenced pictures presented during the scan. The present study may provide evidence of the possible involvement of this brain area in spontaneously enacted self-distancing defensive strategies, which may be of relevance in resistant reactions in the course of a psychoanalytic psychotherapy. PMID

  20. Simultaneous Radio to (Sub-) Mm-Monitoring of Variability and Spectral Shape Evolution of Potential GLAST Blazars

    SciTech Connect

    Fuhrmann, L.; Zensus, J.A.; Krichbaum, T.P.; Angelakis, E.; Readhead, A.C.S.; /Caltech

    2011-11-29

    The Large Area Telescope (LAT) instrument onboard GLAST offers a tremendous opportunity for future blazar studies. In order to fully benefit from its capabilities and to maximize the scientific return from the LAT, it is of great importance to conduct dedicated multi-frequency monitoring campaigns that will result comprehensive observations. Consequently, we initiated an effort to conduct a GLAST-dedicated, quasi-simultaneous, broad-band flux-density (and polarization) monitoring of potential GLAST blazars with the Effelsberg and OVRO radio telescopes (11 cm to 7mm wavelength). Here, we present a short overview of these activities which will complement the multi-wavelengths activities of the GLAST/LAT collaboration towards the 'low-energy' radio bands. Further we will give a brief outlook including the extension of this coordinated campaign towards higher frequencies and future scientific aims.

  1. [Metastatic castration-resistant prostate cancer : Clinical data, new treatment options and therapy monitoring].

    PubMed

    Miller, K; Albers, P; Eichenauer, R; Geiges, G; Grimm, M-O; König, F; Mickisch, G; Pfister, D; Schwentner, C; Suttmann, H; Zastrow, S

    2016-09-01

    Therapies currently available in Germany for metastatic castration-resistant prostate cancer (mCRPC) include docetaxel, cabazitaxel, abiraterone acetate, enzalutamide and radium-223, all of which offer a potential survival benefit that adds up in their sequential application to a significant overall survival benefit. However, the optimal sequencing of these agents is still unclear. In the absence of evidence, treatment selection is based on the particular situation and on comorbid conditions of each individual patient. Furthermore, predictive markers to facilitate the selection of patients for a specific therapy or sequence of therapies remain an unmet need. However, with the recently discovered androgen receptor splice variant V7, which mediates (cross)resistance to or between abiraterone and enzalutamide, the first such marker has been identified. It is critical to monitor the response to treatments at prespecified intervals in order to optimize treatment sequencing so that the patient does not miss a valuable therapeutic window to receive alternative treatment that may prolong his life along with good symptom control and preservation of quality of life. PMID:27411995

  2. Noninvasive monitoring of systolic blood pressure on the arm utilizing photoplethysmography (PPG): clinical report

    NASA Astrophysics Data System (ADS)

    Laurent, Claes; Jonsson, Bjorn; Vegfors, Magnus; Eneling, Martin; Lindberg, Lars-Goran

    2004-07-01

    A soft (silicone) probe, containing six light emitting diodes (880 nm) and three photo detectors, utilizes photoplethysmography (PPG) to monitor pulsations from the brachialis artery under an occluding cuff during deflation. When the arterial pulse returns, measured by PPG, the corresponding pressure in the cuff is determined. This pressure is assumed to equal the systolic pressure. An assessment trial was performed on 21 patients (9 women and 12 men, aged 27-69) at the Neuro-Intensive care unit. Since the patients were already provided with arterial needles, invasive blood pressure could be used as the reference. By choosing a threshold, for detecting pulses, as a fraction (4%) of the maximum amplitude, the systolic blood pressure was underestimated (-0.57 mmHg, SD 12.1). The range of systolic pressure for the patients was 95.5 - 199.0 mmHg, n=14. The method is promising, but improvements still have to be made in order to improve the technique.

  3. Endogenous CO monitoring in exhalation with tunable diode lasers: applications to clinical and biomedical diagnostics

    NASA Astrophysics Data System (ADS)

    Stepanov, Eugene V.; Zyrianov, Pavel V.; Miliaev, Valerii A.; Shulagin, Yurii A.; D'yachenko, Alexander I.

    1999-07-01

    Middle IR tunable diode lasers were applied to studies of pulmonary excretion of endogenous carbon monoxide (CO). Variations of the CO content level in exhaled air of healthy nonsmokers were investigated for different environmental conditions with the applied laser technique. Correlation of the obtained data with atmospheric CO contamination and elevated oxygen content were studied as well as diurnal variations of the endogenous CO in exhalation was observed. Criteria for correct conditions of the endogenous CO detection in breath could be derive don this basis. Developed laser approach and methods were applied for the analysis of the excreted CO level in different diseases like bronchial asthma, cystic fibrosis, idiopathic pulmonary fibrosis, chronic obstructive pulmonary disease, anemia and hepatitis. Laser based close-to-real-time monitoring of the endogenous CO elimination with breath in the course of different dynamic tests was demonstrated to be informative in studies of blood oxygen transport and pH variations in tissues for different challenges tests in human physiology.

  4. Clinical impact of laboratory error on therapeutic drug monitoring of once-daily tobramycin in cystic fibrosis: Case series

    PubMed Central

    Mancuso, Michelle A

    2014-01-01

    Once-daily dosing intravenous tobramycin is commonly used to treat cystic fibrosis pulmonary exacerbations. Clinicians often utilize historical therapeutic drug monitoring data to individualize the dose among patients who have been treated with tobramycin previously. This case series involves three patients with cystic fibrosis who had supra-therapeutic tobramycin levels despite use of a once-daily dosing that produced therapeutic drug levels during a previous hospital admission, raising questions about the validity of these levels. Investigation into several potential sources of error led to the discovery of an analyzer error in the laboratory. Once the laboratory’s tobramycin analyzer was recalibrated, the reported levels were comparable to historical levels. This case series emphasizes the clinical importance of critically analyzing reported levels, and specifically, the importance of utilizing past therapeutic drug monitoring data, if available, for all patients treated with intravenous tobramycin. If a patient was therapeutic on a similar dose of tobramycin during a previous admission, a dose adjustment may not be necessary, and clinicians should consider repeating levels while pursuing alternative explanations for the discrepant serum levels. PMID:27489639

  5. Performance and Logistical Challenges of Alternative HIV-1 Virological Monitoring Options in a Clinical Setting of Harare, Zimbabwe

    PubMed Central

    Bronze, Michelle; Wellington, Maureen; Boender, Tamara Sonia; Manting, Corry; Steegen, Kim; Luethy, Rudi; Rinke de Wit, Tobias

    2014-01-01

    We evaluated a low-cost virological failure assay (VFA) on plasma and dried blood spot (DBS) specimens from HIV-1 infected patients attending an HIV clinic in Harare. The results were compared to the performance of the ultrasensitive heat-denatured p24 assay (p24). The COBAS AmpliPrep/COBAS TaqMan HIV-1 test, version 2.0, served as the gold standard. Using a cutoff of 5,000 copies/mL, the plasma VFA had a sensitivity of 94.5% and specificity of 92.7% and was largely superior to the VFA on DBS (sensitivity = 61.9%; specificity = 99.0%) or to the p24 (sensitivity = 54.3%; specificity = 82.3%) when tested on 302 HIV treated and untreated patients. However, among the 202 long-term ART-exposed patients, the sensitivity of the VFA decreased to 72.7% and to 35.7% using a threshold of 5,000 and 1,000 RNA copies/mL, respectively. We show that the VFA (either on plasma or on DBS) and the p24 are not reliable to monitor long-term treated, HIV-1 infected patients. Moreover, achieving acceptable assay sensitivity using DBS proved technically difficult in a less-experienced laboratory. Importantly, the high level of virological suppression (93%) indicated that quality care focused on treatment adherence limits virological failure even when PCR-based viral load monitoring is not available. PMID:25025031

  6. Performance and logistical challenges of alternative HIV-1 virological monitoring options in a clinical setting of Harare, Zimbabwe.

    PubMed

    Ondoa, Pascale; Shamu, Tinei; Bronze, Michelle; Wellington, Maureen; Boender, Tamara Sonia; Manting, Corry; Steegen, Kim; Luethy, Rudi; Rinke de Wit, Tobias

    2014-01-01

    We evaluated a low-cost virological failure assay (VFA) on plasma and dried blood spot (DBS) specimens from HIV-1 infected patients attending an HIV clinic in Harare. The results were compared to the performance of the ultrasensitive heat-denatured p24 assay (p24). The COBAS AmpliPrep/COBAS TaqMan HIV-1 test, version 2.0, served as the gold standard. Using a cutoff of 5,000 copies/mL, the plasma VFA had a sensitivity of 94.5% and specificity of 92.7% and was largely superior to the VFA on DBS (sensitivity = 61.9%; specificity = 99.0%) or to the p24 (sensitivity = 54.3%; specificity = 82.3%) when tested on 302 HIV treated and untreated patients. However, among the 202 long-term ART-exposed patients, the sensitivity of the VFA decreased to 72.7% and to 35.7% using a threshold of 5,000 and 1,000 RNA copies/mL, respectively. We show that the VFA (either on plasma or on DBS) and the p24 are not reliable to monitor long-term treated, HIV-1 infected patients. Moreover, achieving acceptable assay sensitivity using DBS proved technically difficult in a less-experienced laboratory. Importantly, the high level of virological suppression (93%) indicated that quality care focused on treatment adherence limits virological failure even when PCR-based viral load monitoring is not available. PMID:25025031

  7. Multiple-locus variable-number tandem repeat analysis and clinical characterization of Leptospira interrogans canine isolates.

    PubMed

    Koizumi, Nobuo; Muto, Maki Mizutani; Izumiya, Hidemasa; Suzuki, Motoi; Ohnishi, Makoto

    2015-03-01

    Canine leptospirosis occurs worldwide; however, information on the relationship between Leptospira serotypes/genotypes and virulence in dogs remains limited. We investigated the molecular characteristics of Leptospira interrogans canine isolates belonging to three serogroups using multiple-locus variable-number tandem repeat analysis (MLVA) and the effects of each serotype/genotype on the clinical characteristics of leptospirosis in dogs. MLVA using 11 loci of the three major L. interrogans serogroups in Japan, Australis (32 strains from 21 dogs), Autumnalis (12; 7) and Hebdomadis (66; 39), revealed more divergent genetic heterogeneity within each serogroup than multilocus sequence typing (MLST), and they formed two, three and five clusters (CLs), respectively. Lethal infections were caused by all Leptospira serogroup isolates (70.3 % with Hebdomadis, 83.3 % with Australis and 100 % with Autumnalis) or Leptospira isolates belonging to all the CLs (57.1-100 %) without any significant differences. A significant difference in hyperaemia and haemorrhage of mucus membrane was observed between serogroups Australis and Autumnalis (P = 0.03). Leptospira isolates of Australis CL2 caused no hyperaemia and haemorrhage from mucus membrane, whereas those of Australis CL1, Autumnalis CL3 and Hebdomadis CL1 and CL3 did (P<0.05). Significant differences in creatinine (Cre) levels were observed between serogroups Australis and Hebdomadis (P = 0.02). In addition, significant differences in blood urea nitrogen levels were observed between serogroups Australis and Hebdomadis (P = 0.004) and Australis and Autumnalis (P = 0.02). Based on MLVA types, a significant difference in Cre levels was observed between Hebdomadis CL1 and CL4 (P = 0.0018). Our results indicated that MLVA had a higher discriminatory power and was more concordant with serotyping than MLST. Although all Leptospira serotypes and genotypes caused lethal infections in dogs, the L. interrogans

  8. Impact of hypobaric hypoxia in pressurized cabins of simulated long-distance flights on the 24 h patterns of biological variables, fatigue, and clinical status.

    PubMed

    Coste, Olivier; Van Beers, Pascal; Touitou, Yvan

    2007-01-01

    Long-distance flights can cause a number of clinical problems in both passengers and crewmembers. Jet lag as well as mild hypoxia resulting from incomplete cabin pressurization could contribute to these problems. The objective of this study was to assess, using a chronobiological approach, the clinical impact of diurnal hypobaric, hypoxic exposure on fatigue and other common symptoms encountered during high-altitude exposure and to measure changes in blood chemistry (i.e., plasma creatinine, urea, uric acid, sodium, calcium, phosphorus, glycemia, and lipids). Fourteen healthy, diurnally active (from 07:00 to 23:00 h) male volunteers, aged 23 to 39 yrs, spent 8.5 h in a hypobaric chamber (08:00 to 16:30 h), at a simulated altitude of 8,000 ft (2,438 m). This was followed by an additional 8.5 h of study four weeks later at a simulated altitude of 12,000 ft (3,658 m). Clinical data were collected every 2 h between 08:00 and 18:00 h, and biological variables were assayed every 2 h over two (control and hypoxic-exposure) 24 h cycles. Clinical symptoms were more frequent with the 12,000 ft exposure. Wide interindividual variability was observed in the clinical tolerance to prolonged hypobaric hypoxia. The 24 h profiles of most biochemical variables were significantly altered at each altitude, with changes in mean plasma levels and a tendency toward phase delay, except for uric acid, which showed a phase advance. Changes in appetite mainly occurred with the simulated 12,000 ft exposure and may have been associated with changes in the postprandial glycemia profile. Finally, though the observed biochemical changes were significant, their clinical relevance must be clarified in studies involving actual long-distance flights. PMID:18075804

  9. The design of a rule-based clinical event monitor in a multi-vendor hospital computing environment.

    PubMed Central

    Nguyen, L. T.; Margulies, D. M.

    1992-01-01

    The Clinical Event Monitor (CEM) described here is a prototype system designed to explore the issues involved in building an institutional CEM that permits rapid, automated evaluation of clinical transactions and notification to clinicians of exceptional events in a multi-vendor computing environment. The CEM uses expert systems, database, and systems integration techniques. Ancillary (departmental) applications, including as Patient Registration, Laboratories, and Pharmacy have been licensed from commercial vendors. Application-to-application and application-to-database interfaces were built to mirror subsets of the ancillary patient databases into an institutional relational database (Oracle). The CEM receives registration updates via an HL7 message and evaluates data dependencies in rules via an interface to the relational database. The CEM engine was built using Nexpert, a commercially available expert system shell. Our short term goals were to: (1) build and maintain a patient census within the expert system environment via net based HL7 update broadcasts; (2) explore the data-driven features of Nexpert, (3) deliver prototype exception reports. This paper describes in general terms the design features of the CEM and in detail the features of a patient registry to NEXPERT bridge (from Oracle via HL7 structured transactions to NEXPERT) and the delivery of exception reports. PMID:1482912

  10. LONG-TERM X-RAY MONITORING OF LS I +61{sup 0}303: ANALYSIS OF SPECTRAL VARIABILITY AND FLARES

    SciTech Connect

    Li Jian; Zhang Shu; Chen Yupeng; Wang Jianmin; Torres, Diego F.; Hadasch, Daniela; Rea, Nanda; Ray, Paul S.; Kretschmar, Peter

    2011-06-01

    We report on the full analysis of a Rossi X-ray Timing Explorer Proportional Counter Array monitoring of the {gamma}-ray binary system LS I +61{sup 0}303. The data set covers 42 contiguous cycles of the system orbital motion. Analyzing this X-ray monitoring data set, the largest to date for this source, we report on the variability of the orbital profile and the spectral distribution, and provide strong evidence for an anti-correlation between flux and spectral index (the higher the flux, the harder the spectral index). Furthermore, we present the analysis of two newly discovered kilosecond-timescale flares, which present significant variability also on shorter timescales and tend to occur at orbital phases between 0.6 and 0.9. However, a detailed timing analysis of the flares does not show any coherent or quasi-coherent (QPO) structure in their power spectra. We also investigated the possible appearance of the radio super-orbital modulation at X-ray energies, but we could not unambiguously detect such modulation in the system flux history nor in the evolution of its orbital modulation fraction.

  11. The predictive distribution of the residual variability in the linear-fixed effects model for clinical cross-over trials.

    PubMed

    Bertsche, Anja; Nehmiz, Gerhard; Beyersmann, Jan; Grieve, Andrew P

    2016-07-01

    In the linear model for cross-over trials, with fixed subject effects and normal i.i.d. random errors, the residual variability corresponds to the intraindividual variability. While population variances are in general unknown, an estimate can be derived that follows a gamma distribution, where the scale parameter is based on the true unknown variability. This gamma distribution is often used for the sample size calculation for trial planning with the precision approach, where the aim is to achieve in the next trial a predefined precision with a given probability. But then the imprecision in the estimated residual variability or, from a Bayesian perspective, the uncertainty of the unknown variability is not taken into account. Here, we present the predictive distribution for the residual variability, and we investigate a link to the F distribution. The consequence is that in the precision approach more subjects will be necessary than with the conventional calculation. For values of the intraindividual variability that are typical of human pharmacokinetics, that is a gCV of 17-36%, we would need approximately a sixth more subjects. PMID:27003464

  12. Characterizing intra and inter annual variability of storm events based on very high frequency monitoring of hydrological and chemical variables: what can we learn about hot spots and hot moments from continuous hydro-chemical sensors ?

    NASA Astrophysics Data System (ADS)

    Fovet, O.; Thelusma, G.; Humbert, G.; Dupas, R.; Jaffrezic, A.; Grimaldi, C.; Faucheux, M.; Gilliet, N.; Hamon, Y.; Gruau, G.

    2015-12-01

    Storm events are hot moments of emission for several dissolved and particulate chemical species at major stake for water quality (e.g. dissolved organic carbon DOC, suspended sediments, phosphorus, NH4). During such events, the solutes or particles are exported from heterogeneous sources through various pathways to stream or are possibly stored in retention hot spots temporary. This leads to specific integrated signals at the outlet at the scale of storm events. The dynamics of such events are also very short especially in headwater catchments where their total duration ranges over 10h to 3 days, with very quick variations in stream flow and concentrations at the outlet occurring in a few hours. Thus for investigating properly event processes, high frequency monitoring of flow and water quality is required. We analysed 103 storm events in a 5 km2 agricultural headwater catchment, part of the AgrHys Observatory, on the basis of a 3-year-long data set which combined meterological (Rainfall), hydrological (flow and piezometry), and water quality (turbidity, conductivity, DOC and NO3 concentrations) data recorded at very high frequencies (from 1 to 20 min) thanks to dedicated sensors. We described the storm events using simple (1 variable) and combined (2 variables) descriptors for characterizing level and dynamics of flow (Q), groundwater levels, and concentrations (C) but also the C-Q relationships. Three intra annual periods have been previously defined for base flow dynamic according to shallow groundwater table variations so that they correspond to different connectivity status in the catchment. The seasonal and inter-annual variability of the storm events have been analysed using the descriptors and based on these predefined periods. Principal component analysis based on storm chemical descriptors led to discriminate these three seasons while storm hydrological descriptors are less variable between them. Finally we used a clustering method to build a typology of

  13. The value of automated high-frequency nutrient monitoring in inference of biogeochemical processes, temporal variability and trends

    NASA Astrophysics Data System (ADS)

    Bieroza, Magdalena; Heathwaite, Louise

    2013-04-01

    Stream water quality signals integrate catchment-scale processes responsible for delivery and biogeochemical transformation of the key biotic macronutrients (N, C, P). This spatial and temporal integration is particularly pronounced in the groundwater-dominated streams, as in-stream nutrient dynamics are mediated by the processes occurring within riparian and hyporheic ecotones. In this paper we show long-term high-frequency in-stream macronutrient dynamics from a small agricultural catchment located in the North West England. Hourly in-situ measurements of total and reactive phosphorus (Systea, IT), nitrate (Hach Lange, DE) and physical water quality parameters (turbidity, specific conductivity, dissolved oxygen, temperature, pH; WaterWatch, UK) were carried out on the lowland, gaining reach of the River Leith. High-frequency data show complex non-linear nutrient concentration-discharge relationships. The dominance of hysteresis effects suggests the presence of a temporally varying apportionment of allochthonous and autochthonous nutrient sources. Varying direction, magnitude and dynamics of the hysteretic responses between storm events is driven by the variation in the contributing source areas and shows the importance of the coupling of catchment-scale, in-stream, riparian and hyporheic biogeochemical cycles. The synergistic effect of physical (temperature-driven, the hyporheic exchange controlled by diffusion) and biogeochemical drivers (stream and hyporheic metabolism) on in-stream nutrient concentrations manifests itself in observed diurnal patterns. As inferred from the high-frequency nutrient monitoring, the diurnal dynamics are of the greatest importance under baseflow conditions. Understanding the role and relative importance of these processes can be difficult due to spatial and temporal heterogeneity of the key mechanisms involved. This study shows the importance of in-situ, fine temporal resolution, automated monitoring approaches in providing evidence

  14. Otofaciocervical syndrome and metachondromatosis in a girl: Presentation of a novel association and remarks on clinical variability of branchial-arch disorders.

    PubMed

    Salinas-Torres, Victor M; Salinas-Torres, Rafael A

    2016-06-01

    Otofaciocervical syndrome (OFCS) is a rare disorder characterized by facial, ear, branchial, and musculoskeletal anomalies, along with hearing loss and mild intellectual disability. Clinically, its distinction from branchiootorenal syndrome can be difficult. To date, the coexistence of OFCS and metachondromatosis has not been reported. Here, we describe a sporadic patient with both OFCS and metachondromatosis. This novel association prompts us to do some remarks on the clinical variability of branchial-arch disorders; in fact, our observations are consistent with the highly variable expressivity of OFCS and illustrate the need of a more accurate characterization of these branchial-arch disorders. In the meantime, involvement of clavicles, scapulae and shoulders remains a distinctive feature of OFCS. PMID:27240490

  15. A UV-to-MIR Monitoring of DR Tau: Exploring How Water Vapor in the Planet Formation Region is Affected by Stellar Accretion Variability

    NASA Astrophysics Data System (ADS)

    Banzatti, A.; Meyer, M. R.; Manara, C. F.; Pontoppidan, K. M.; Testi, L.

    2014-01-01

    Young stars are known to show variability due to non-steady mass accretion rate from their circumstellar disks. Accretion flares can produce strong energetic irradiation and heating that may affect the disk in the planet formation region, close to the central star. During an extreme accretion outburst in the young star EX Lupi, the prototype of EXor variables, remarkable changes in molecular gas emission from ~1 AU in the disk have recently been observed. Here, we focus on water vapor and explore how it is affected by variable accretion luminosity in T Tauri stars. We monitored a young highly variable solar-mass star, DR Tau, using simultaneously two high/medium-resolution spectrographs at the European Southern Observatory Very Large Telescope: VISIR at 12.4 μm to observe water lines from the disk and X-shooter covering from 0.3 to 2.5 μm to constrain the stellar accretion. Three epochs spanning timescales from several days to several weeks were obtained. The accretion luminosity was estimated to change within a factor of ~2 and no change in water emission was detected at a significant level. In comparison with EX Lupi and EXor outbursts, DR Tau suggests that the less long-lived and weaker variability phenomena typical of T Tauri stars may leave water at planet-forming radii in the disk mostly unaffected. We propose that these systems may provide evidence for two processes that act over different timescales: ultraviolet photochemistry in the disk atmosphere (faster) and heating of the deeper disk layers (slower).

  16. A UV-to-MIR monitoring of DR Tau: Exploring how water vapor in the planet formation region is affected by stellar accretion variability

    SciTech Connect

    Banzatti, A.; Meyer, M. R.; Manara, C. F.; Testi, L.; Pontoppidan, K. M.

    2014-01-01

    Young stars are known to show variability due to non-steady mass accretion rate from their circumstellar disks. Accretion flares can produce strong energetic irradiation and heating that may affect the disk in the planet formation region, close to the central star. During an extreme accretion outburst in the young star EX Lupi, the prototype of EXor variables, remarkable changes in molecular gas emission from ∼1 AU in the disk have recently been observed. Here, we focus on water vapor and explore how it is affected by variable accretion luminosity in T Tauri stars. We monitored a young highly variable solar-mass star, DR Tau, using simultaneously two high/medium-resolution spectrographs at the European Southern Observatory Very Large Telescope: VISIR at 12.4 μm to observe water lines from the disk and X-shooter covering from 0.3 to 2.5 μm to constrain the stellar accretion. Three epochs spanning timescales from several days to several weeks were obtained. The accretion luminosity was estimated to change within a factor of ∼2 and no change in water emission was detected at a significant level. In comparison with EX Lupi and EXor outbursts, DR Tau suggests that the less long-lived and weaker variability phenomena typical of T Tauri stars may leave water at planet-forming radii in the disk mostly unaffected. We propose that these systems may provide evidence for two processes that act over different timescales: ultraviolet photochemistry in the disk atmosphere (faster) and heating of the deeper disk layers (slower).

  17. Molecular cytogenetics in the monitoring of bone marrow engraftment: Pathophysiological and clinical implications

    SciTech Connect

    Gyger, M.; Lapointe, C.; Forest, L.

    1994-09-01

    1. Background: Bone marrow engraftment is mediated by stem cells with complex self-renewal, proliferative and differentiation potentials. This process is empirically documented by the progressive rise in the absolute neutrophil count occurring 2 to 3 weeks post-marrow infusion. 2. Purpose: To investigate the kinetics of early engraftment using in situ hybridization with an X and Y chromosome probe mixture in a sex-mismatch allogeneic setting. 3. Methods: Interphase cells from peripheral blood smears consisting of 98% pure granulocytic and lymphocytic populations were studied according to the following time frame: (a) 2 HR before marrow infusion, 12, 24, 48, 72 and 96 HR post-infusion in 3 pts (b) 5, 10, 15, 20, 25 and 50 days posttransplantation in 4 pts. The X and Y chromosome probes were indirectly labeled with different colour fluorochromes and could be observed simultaneously. The X-chromosome component was a single probe that hybridizes to the centromeric region while the Y chromosome component was a collection of probes that hybridizes to most of the Y chromosome q-arm. 4. Results: Donor neutrophils were documented as early as 12 HR post-infusion with a steady rise beginning 24 HR post. By day 5, all circulating neutrophils were of donor origin. A steady rise of donor lymphoid cells could be documented only between day 10 and 15 post-marrow infusion. By day 25 most of the lymphoid cells were of donor origin. 5. Conclusion: This molecular study reveals that donor hematopoietic cells appear very early post-marrow infusion and are presumed to be the progeny of stem cells in a late stage of differentiation, responsible for a transitory phase of engraftment. The timing of permanent engraftment remains to be determined by other molecular approaches. In situ hybridization in sexmismatch transplants can be of great clinical benefit in predicting very early graft rejection especially in the setting of unrelated donors.

  18. Photoacoustic spectroscopy in the monitoring of breast tumor development: a pre-clinical study

    NASA Astrophysics Data System (ADS)

    Priya, Mallika; Rao, Bola Sadashiva Satish; Ray, Satadru; Mahato, Krishna Kishore

    2014-03-01

    Breast cancer is the most frequently diagnosed cancer type and its detection at an early stage can reduce the mortality rate substantially. With the aim to detect breast cancer early, by studying tumor progression in nude mice, a pulsed laser induced photoacoustic spectroscopy set up has been designed and developed. MCF-7 cells xenografts were developed using six to eight weeks old female nude mice and tumor tissues were extracted on different days (10th, 15th and 20th Day) post injection and the corresponding photoacoustic spectra were recorded at 281nm excitation. A total of 144 time domain spectra were recorded from 36 animals belonging to the three time points (10th, 15th and 20th day post injection) and converted into frequency domains by Fast Fourier Transform (FFT) tools of the MATLAB algorithms and analyzed. The frequency patterns of the tumor masses on 10th, 15th and 20th day of tumor development showed a gradual increase in intensity at certain frequencies, 5.93 x103 Hz, 15.9 x103 Hz, 29.69 x103 Hz and 32.5 x103 Hz in the FFT patterns indicating that these frequencies were more sensitive towards tumor development. Further analysis of the data yielded a clear variation in the spectral parameters with progression of the disease suggesting that the technique may be suitable for early detection of the disease. Thus, we expect that the developed setup may be useful in assessing the different phases of tumor development which may have clinical implications.

  19. Clinical experience with two frameless stereotactic radiosurgery (fSRS) systems using optical surface imaging for motion monitoring

    PubMed Central

    Li, Guang; Ballangrud, Ase; Chan, Maria; Ma, Ruimei; Beal, Kathryn; Yamada, Yoshiya; Chan, Timothy; Lee, James; Parhar, Preeti; Mechalakos, James; Hunt, Margie

    2016-01-01

    The purpose of this study was to compare two clinical immobilization systems for intracranial frameless stereotactic radiosurgery (fSRS) under the same clinical procedure using cone-beam computed tomography (CBCT) for setup and video-based optical surface imaging (OSI) for initial head alignment and intrafractional motion monitoring. A previously established fSRS procedure was applied using two intracranial immobilization systems: PinPoint system (head mold and mouthpiece) and Freedom system (head mold and open face mask). The CBCT was used for patient setup with four degrees of freedom (4DOF), while OSI was used for 6DOF alignment prior to CBCT, post-CBCT setup verification at all treatment couch angles (zero and nonzero), and intrafractional motion monitoring. Quantitative comparison of the two systems includes residual head rotation, head restriction capacity, and patient setup time in 25 patients (29 lesions) using PinPoint and 8 patients (29 fractions) using Freedom. The maximum possible motion was assessed in nine volunteers with deliberate, forced movement in Freedom system. A consensus-based comparison of patient comfort level and clinical ease of use is reported. Using OSI-guided corrections, the maximum residual rotations in all directions were 1.1° ± 0.5° for PinPoint and 0.6° ± 0.3° for Freedom. The time spent performing rotation corrections was 5.0 ± 4.1 min by moving the patient with PinPoint and 2.7 ± 1.0 min by adjusting Freedom couch extension. After CBCT, the OSI–CBCT discrepancy due to different anatomic landmarks for alignment was 2.4 ± 1.3 mm using PinPoint and 1.5 ± 0.7 mm using Freedom. Similar results were obtained for setup verification at couch angles (< 1.5 mm) and for motion restriction: 0.4± 0.3 mm/0.2° ± 0.2° in PinPoint and 0.6 ± 0.3 mm/0.3° ± 0.1° in Freedom. The maximum range of forced head motion was 2.2 ± 1.0 mm using Freedom. Both intracranial fSRS immobilization systems can restrict head motion within 1.5 mm

  20. Monitoring Phenological Variability across a Tropical Savanna Aridity Gradient with Remote Sensing across Seasonal to Annualand Extreme Events

    NASA Astrophysics Data System (ADS)

    Huete, A.; Eamus, D.; Ma, X.; Restrepo-Coupe, N.; Boulain, N.; Hutley, L.

    2011-08-01

    Tropical savannas are key components of the global carbon and water cycles and understanding their functioning is critical to understanding ecosystem feedbacks to global climate. By observing broad scale vegetation responses to climatic variability, remote sensing offers powerful insights into the patterns and processes underlying savanna behaviour. However, savannas are highly complex, multi-layer and heterogenous ecosystems composed of C3 (herbaceous) and C4 (woodland) components with asynchronous phenological responses to environmental controls. There are concerns about optimizing the detection of savanna functioning as well as in understanding their environmental controls with remote-sensing data due to their coarse resolution. Furthermore, seasonalphenologic variations in satellite observations need to be sufficiently accurate to ensure confidence in interpreting vegetation responses to interannual climatic variation and to aid in constraining models of carbon and water fluxes. In this study, we analysed several years of high temporal frequency MODIS and TRMM satellite data sets of vegetation dynamics and rainfall, respectively, to seasonal and interannual responses of savanna multifunctional components to climate variability across a tropical savanna aridity gradient (1760 to 580 mm annual rainfall) in northern Australia. We compared our results with a series of eddy covariance (EC) tower flux data of gross primary production and analyzed a wide set of ecosystem processes including photosynthesis, net primary productivity, phenological metrics in timing of the growing season, and rain use efficiencies. We found MODIS satellite measurements to yield highly accurate spatial and temporal variability in ecosystem functioning and able to replicate interannual patterns and responses to rainfall observed with the EC tower data. Although these results appear promising for regional extensions of satelliteflux tower relationships at the landscape level, we also

  1. Temporal Variability and Annual Fluxes of Water, Sediment and Particulate Phosphorus from a Headwater River in the Tropical Andes: Results from a High-frequency Monitoring Program

    NASA Astrophysics Data System (ADS)

    Wemple, B. C.; Schloegel, C.

    2015-12-01

    The Mazar River Project, a high-frequency hydrological monitoring program, aims to generate ecohydrological information to inform watershed management in high-mountain areas of southern Ecuador. Rapid development of hydropower, accompanied by new and improved road networks, has resulted in swift changes in land-use and land cover in Ecuador's tropical Andes, all of which underscore the need for detailed information on flow and sediment production from these river systems. National and regional payment for the protection of ecosystem services (PES) programs seek to target critical areas, such as these, for watershed conservation, but are often informed by minimal information on sustainable flows and impacts of land use activities. As part of a program to inform conservation and sustainable water management in the region, we established a hydrological monitoring station in southern Ecuador on the Mazar River, a tributary of the Paute River Basin, situated on the eastern Andean cordillera. The station is equipped with sensors to continuously monitor stream stage and turbidity and an automated sampler for event-based collection of stream water samples, providing high frequency data that reduces the uncertainty of observations. Here, we report observations of continuous runoff and turbidity over the first year of observation, present relationships between turbidity and concentrations of total suspended solids (TSS) and total particulate phosphorus (TP), and provide estimates of annual loads of TSS and TP. Runoff was highly variable over the monitoring period with flows ranging from less than 3 m3/s during baseflow to nearly 80 m3/s during the flood of record. During measured storm events, TSS exceeded 1000 mg/l with maximum measured concentrations exceeding 13 g/l during storm peaks. Turbidity was highly correlated with TSS, which was in turn highly correlated with TP, providing a robust data set for load estimation. We compare our results to other montane rivers in the

  2. In-situ Real-Time Monitoring of Volatile Organic Compound Exposure and Heart Rate Variability for Patients with Multiple Chemical Sensitivity.

    PubMed

    Mizukoshi, Atsushi; Kumagai, Kazukiyo; Yamamoto, Naomichi; Noguchi, Miyuki; Yoshiuchi, Kazuhiro; Kumano, Hiroaki; Sakabe, Kou; Yanagisawa, Yukio

    2015-10-01

    In-situ real-time monitoring of volatile organic compound (VOC) exposure and heart rate variability (HRV) were conducted for eight multiple chemical sensitivity (MCS) patients using a VOC monitor, a Holter monitor, and a time-activity questionnaire for 24 h to identify the relationship between VOC exposure, biological effects, and subjective symptoms in actual life. The results revealed no significantly different parameters for averaged values such as VOC concentration, HF (high frequency), and LF (low frequency) to HF ratio compared with previous data from healthy subjects (Int. J. Environ. Res. Public Health 2010, 7, 4127-4138). Significant negative correlations for four subjects were observed between HF and amounts of VOC change. These results suggest that some patients show inhibition of parasympathetic activities along with VOC exposure as observed in healthy subjects. Comparing the parameters during subjective symptoms and normal condition, VOC concentration and/or VOC change were high except for one subject. HF values were low for five subjects during subjective symptoms. Examining the time-series data for VOC exposure and HF of each subject showed that the subjective symptoms, VOC exposure, and HF seemed well related in some symptoms. Based on these characteristics, prevention measures of symptoms for each subject may be proposed. PMID:26445055

  3. In-situ Real-Time Monitoring of Volatile Organic Compound Exposure and Heart Rate Variability for Patients with Multiple Chemical Sensitivity

    PubMed Central

    Mizukoshi, Atsushi; Kumagai, Kazukiyo; Yamamoto, Naomichi; Noguchi, Miyuki; Yoshiuchi, Kazuhiro; Kumano, Hiroaki; Sakabe, Kou; Yanagisawa, Yukio

    2015-01-01

    In-situ real-time monitoring of volatile organic compound (VOC) exposure and heart rate variability (HRV) were conducted for eight multiple chemical sensitivity (MCS) patients using a VOC monitor, a Holter monitor, and a time-activity questionnaire for 24 h to identify the relationship between VOC exposure, biological effects, and subjective symptoms in actual life. The results revealed no significantly different parameters for averaged values such as VOC concentration, HF (high frequency), and LF (low frequency) to HF ratio compared with previous data from healthy subjects (Int. J. Environ. Res. Public Health 2010, 7, 4127–4138). Significant negative correlations for four subjects were observed between HF and amounts of VOC change. These results suggest that some patients show inhibition of parasympathetic activities along with VOC exposure as observed in healthy subjects. Comparing the parameters during subjective symptoms and normal condition, VOC concentration and/or VOC change were high except for one subject. HF values were low for five subjects during subjective symptoms. Examining the time-series data for VOC exposure and HF of each subject showed that the subjective symptoms, VOC exposure, and HF seemed well related in some symptoms. Based on these characteristics, prevention measures of symptoms for each subject may be proposed. PMID:26445055

  4. First Long-term Optical Spectral Monitoring of a Binary Black Hole Candidate E1821+643. I. Variability of Spectral Lines and Continuum

    NASA Astrophysics Data System (ADS)

    Shapovalova, A. I.; Popović, L. Č.; Chavushyan, V. H.; Burenkov, A. N.; Ilić, D.; Kollatschny, W.; Kovačević, A.; Valdés, J. R.; Patiño-Álvarez, V.; León-Tavares, J.; Torrealba, J.; Zhdanova, V. E.

    2016-02-01

    We report the results of the first long-term (1990-2014) optical spectrophotometric monitoring of a binary black hole candidate QSO E1821+643, a low-redshift, high-luminosity, radio-quiet quasar. In the monitored period, the continua and Hγ fluxes changed about two times, while the Hβ flux changed about 1.4 times. We found periodical variations in the photometric flux with periods of 1200, 1850, and 4000 days, and 4500-day periodicity in the spectroscopic variations. However, the periodicity of 4000-4500 days covers only one cycle of variation and should be confirmed with a longer monitoring campaign. There is an indication of the period around 1300 days in the spectroscopic light curves, buts with small significance level, while the 1850-day period could not be clearly identified in the spectroscopic light curves. The line profiles have not significantly changed, showing an important red asymmetry and broad line peak redshifted around +1000 km s-1. However, Hβ shows a broader mean profile and has a larger time lag (τ ˜ 120 days) than Hγ (τ ˜ 60 days). We estimate that the mass of the black hole is ˜2.6 × 109 M⊙. The obtained results are discussed in the frame of the binary black hole hypothesis. To explain the periodicity in the flux variability and high redshift of the broad lines, we discuss a scenario where dense, gas-rich, cloudy-like structures are orbiting around a recoiling black hole.

  5. Long-term monitoring programme of the hydrological variability in the Mediterranean Sea: a first overview of the HYDROCHANGES network

    NASA Astrophysics Data System (ADS)

    Schroeder, K.; Millot, C.; Bengara, L.; Ben Ismail, S.; Bensi, M.; Borghini, M.; Budillon, G.; Cardin, V.; Coppola, L.; Curtil, C.; Drago, A.; El Moumni, B.; Font, J.; Fuda, J. L.; García-Lafuente, J.; Gasparini, G. P.; Kontoyiannis, H.; Lefevre, D.; Puig, P.; Raimbault, P.; Rougier, G.; Salat, J.; Sammari, C.; Sánchez Garrido, J. C.; Sanchez-Roman, A.; Sparnocchia, S.; Tamburini, C.; Taupier-Letage, I.; Theocharis, A.; Vargas-Yáñez, M.; Vetrano, A.

    2013-03-01

    The long-term monitoring of basic hydrological parameters (temperature and salinity), collected as time series with adequate temporal resolution (i.e. with a sampling interval allowing the resolution of all important timescales) in key places of the Mediterranean Sea (straits and channels, zones of dense water formation, deep parts of the basins), constitute a priority in the context of global changes. This led CIESM (The Mediterranean Science Commission) to support, since 2002, the HYDROCHANGES programme (http//www.ciesm.org/marine/programs/hydrochanges.htm), a network of autonomous conductivity, temperature, and depth (CTD) sensors, deployed on mainly short and easily manageable subsurface moorings, within the core of a certain water mass. The HYDROCHANGES strategy is twofold and develops on different scales. To get information about long-term changes of hydrological characteristics, long time series are needed. But before these series are long enough they allow the detection of links between them at shorter timescales that may provide extremely valuable information about the functioning of the Mediterranean Sea. The aim of this paper is to present the history of the programme and the current set-up of the network (monitored sites, involved groups) as well as to provide for the first time an overview of all the time series collected under the HYDROCHANGES umbrella, discussing the results obtained thanks to the programme.

  6. Development of variable pathlength UV-vis spectroscopy combined with partial-least-squares regression for wastewater chemical oxygen demand (COD) monitoring.

    PubMed

    Chen, Baisheng; Wu, Huanan; Li, Sam Fong Yau

    2014-03-01

    To overcome the challenging task to select an appropriate pathlength for wastewater chemical oxygen demand (COD) monitoring with high accuracy by UV-vis spectroscopy in wastewater treatment process, a variable pathlength approach combined with partial-least squares regression (PLSR) was developed in this study. Two new strategies were proposed to extract relevant information of UV-vis spectral data from variable pathlength measurements. The first strategy was by data fusion with two data fusion levels: low-level data fusion (LLDF) and mid-level data fusion (MLDF). Predictive accuracy was found to improve, indicated by the lower root-mean-square errors of prediction (RMSEP) compared with those obtained for single pathlength measurements. Both fusion levels were found to deliver very robust PLSR models with residual predictive deviations (RPD) greater than 3 (i.e. 3.22 and 3.29, respectively). The second strategy involved calculating the slopes of absorbance against pathlength at each wavelength to generate slope-derived spectra. Without the requirement to select the optimal pathlength, the predictive accuracy (RMSEP) was improved by 20-43% as compared to single pathlength spectroscopy. Comparing to nine-factor models from fusion strategy, the PLSR model from slope-derived spectroscopy was found to be more parsimonious with only five factors and more robust with residual predictive deviation (RPD) of 3.72. It also offered excellent correlation of predicted and measured COD values with R(2) of 0.936. In sum, variable pathlength spectroscopy with the two proposed data analysis strategies proved to be successful in enhancing prediction performance of COD in wastewater and showed high potential to be applied in on-line water quality monitoring. PMID:24468377

  7. Clinical application of the SADL scale in private practice II: predictive validity of fitting variables. Satisfaction with Amplification in Daily Life.

    PubMed

    Hosford-Dunn, H; Halpern, J

    2001-01-01

    Predictive validity of 44 independent variables and their interactions with Satisfaction with Amplification in Daily Life (SADL) scores was assessed. SADL scores were influenced by patient age, years of hearing aid experience, hours of use per day, perceived hearing difficulty, pure-tone average, hearing aid style, processor type, and manufacturer's invoice cost. The relative importance of these variables to SADL measures was complex and very small, but the variables and their squares and interactions improved r2 predictions of SADL Global and subscale scores in a separate stepwise multiple linear regression procedure by 12 to 33 percent compared to SADL norms alone. More research with additional variables is needed to develop a clinically useful model for predicting wearer satisfaction. Clinically, SADL scores yield subscale-specific patterns of satisfaction and dissatisfaction that help in intervention planning and serve as graphic "snapshots" of satisfaction status. A series of patient profiles are presented illustrating the potential usefulness of the SADL in predicting hearing aid satisfaction. With its good construct and psychometric properties, the SADL could serve as a gold standard for satisfaction outcomes and a basis for development of a predictive model of hearing aid fitting success. PMID:11214976

  8. Inter-individual differences in CpG methylation at D4Z4 correlate with clinical variability in FSHD1 and FSHD2

    PubMed Central

    Lemmers, Richard J.L.F.; Goeman, Jelle J.; van der Vliet, Patrick J.; van Nieuwenhuizen, Merlijn P.; Balog, Judit; Vos-Versteeg, Marianne; Camano, Pilar; Ramos Arroyo, Maria Antonia; Jerico, Ivonne; Rogers, Mark T.; Miller, Daniel G.; Upadhyaya, Meena; Verschuuren, Jan J.G.M.; Lopez de Munain Arregui, Adolfo; van Engelen, Baziel G.M.; Padberg, George W.; Sacconi, Sabrina; Tawil, Rabi; Tapscott, Stephen J.; Bakker, Bert; van der Maarel, Silvère M.

    2015-01-01

    Facioscapulohumeral muscular dystrophy (FSHD: MIM#158900) is a common myopathy with marked but largely unexplained clinical inter- and intra-familial variability. It is caused by contractions of the D4Z4 repeat array on chromosome 4 to 1–10 units (FSHD1), or by mutations in the D4Z4-binding chromatin modifier SMCHD1 (FSHD2). Both situations lead to a partial opening of the D4Z4 chromatin structure and transcription of D4Z4-encoded polyadenylated DUX4 mRNA in muscle. We measured D4Z4 CpG methylation in control, FSHD1 and FSHD2 individuals and found a significant correlation with the D4Z4 repeat array size. After correction for repeat array size, we show that the variability in clinical severity in FSHD1 and FSHD2 individuals is dependent on individual differences in susceptibility to D4Z4 hypomethylation. In FSHD1, for individuals with D4Z4 repeat arrays of 1–6 units, the clinical severity mainly depends on the size of the D4Z4 repeat. However, in individuals with arrays of 7–10 units, the clinical severity also depends on other factors that regulate D4Z4 methylation because affected individuals, but not non-penetrant mutation carriers, have a greater reduction of D4Z4 CpG methylation than can be expected based on the size of the pathogenic D4Z4 repeat array. In FSHD2, this epigenetic susceptibility depends on the nature of the SMCHD1 mutation in combination with D4Z4 repeat array size with dominant negative mutations being more deleterious than haploinsufficiency mutations. Our study thus identifies an epigenetic basis for the striking variability in onset and disease progression that is considered a clinical hallmark of FSHD. PMID:25256356

  9. Investigating the Implications of a Variable RBE on Proton Dose Fractionation Across a Clinical Pencil Beam Scanned Spread-Out Bragg Peak

    PubMed Central

    Marshall, Thomas I.; Chaudhary, Pankaj; Michaelidesová, Anna; Vachelová, Jana; Davídková, Marie; Vondráček, Vladimir; Schettino, Giuseppe; Prise, Kevin M.

    2016-01-01

    Purpose To investigate the clinical implications of a variable relative biological effectiveness (RBE) on proton dose fractionation. Using acute exposures, the current clinical adoption of a generic, constant cell killing RBE has been shown to underestimate the effect of the sharp increase in linear energy transfer (LET) in the distal regions of the spread-out Bragg peak (SOBP). However, experimental data for the impact of dose fractionation in such scenarios are still limited. Methods and Materials Human fibroblasts (AG01522) at 4 key depth positions on a clinical SOBP of maximum energy 219.65 MeV were subjected to various fractionation regimens with an interfraction period of 24 hours at Proton Therapy Center in Prague, Czech Republic. Cell killing RBE variations were measured using standard clonogenic assays and were further validated using Monte Carlo simulations and parameterized using a linear quadratic formalism. Results Significant variations in the cell killing RBE for fractionated exposures along the proton dose profile were observed. RBE increased sharply toward the distal position, corresponding to a reduction in cell sparing effectiveness of fractionated proton exposures at higher LET. The effect was more pronounced at smaller doses per fraction. Experimental survival fractions were adequately predicted using a linear quadratic formalism assuming full repair between fractions. Data were also used to validate a parameterized variable RBE model based on linear α parameter response with LET that showed considerable deviations from clinically predicted isoeffective fractionation regimens. Conclusions The RBE-weighted absorbed dose calculated using the clinically adopted generic RBE of 1.1 significantly underestimates the biological effective dose from variable RBE, particularly in fractionation regimens with low doses per fraction. Coupled with an increase in effective range in fractionated exposures, our study provides an RBE dataset that can be used

  10. Inter-individual differences in CpG methylation at D4Z4 correlate with clinical variability in FSHD1 and FSHD2.

    PubMed

    Lemmers, Richard J L F; Goeman, Jelle J; van der Vliet, Patrick J; van Nieuwenhuizen, Merlijn P; Balog, Judit; Vos-Versteeg, Marianne; Camano, Pilar; Ramos Arroyo, Maria Antonia; Jerico, Ivonne; Rogers, Mark T; Miller, Daniel G; Upadhyaya, Meena; Verschuuren, Jan J G M; Lopez de Munain Arregui, Adolfo; van Engelen, Baziel G M; Padberg, George W; Sacconi, Sabrina; Tawil, Rabi; Tapscott, Stephen J; Bakker, Bert; van der Maarel, Silvère M

    2015-02-01

    Facioscapulohumeral muscular dystrophy (FSHD: MIM#158900) is a common myopathy with marked but largely unexplained clinical inter- and intra-familial variability. It is caused by contractions of the D4Z4 repeat array on chromosome 4 to 1-10 units (FSHD1), or by mutations in the D4Z4-binding chromatin modifier SMCHD1 (FSHD2). Both situations lead to a partial opening of the D4Z4 chromatin structure and transcription of D4Z4-encoded polyadenylated DUX4 mRNA in muscle. We measured D4Z4 CpG methylation in control, FSHD1 and FSHD2 individuals and found a significant correlation with the D4Z4 repeat array size. After correction for repeat array size, we show that the variability in clinical severity in FSHD1 and FSHD2 individuals is dependent on individual differences in susceptibility to D4Z4 hypomethylation. In FSHD1, for individuals with D4Z4 repeat arrays of 1-6 units, the clinical severity mainly depends on the size of the D4Z4 repeat. However, in individuals with arrays of 7-10 units, the clinical severity also depends on other factors that regulate D4Z4 methylation because affected individuals, but not non-penetrant mutation carriers, have a greater reduction of D4Z4 CpG methylation than can be expected based on the size of the pathogenic D4Z4 repeat array. In FSHD2, this epigenetic susceptibility depends on the nature of the SMCHD1 mutation in combination with D4Z4 repeat array size with dominant negative mutations being more deleterious than haploinsufficiency mutations. Our study thus identifies an epigenetic basis for the striking variability in onset and disease progression that is considered a clinical hallmark of FSHD. PMID:25256356

  11. Radio Monitoring of the Periodically Variable IR Source LRLL 54361: No Direct Correlation between the Radio and IR Emissions

    NASA Astrophysics Data System (ADS)

    Forbrich, Jan; Rodríguez, Luis F.; Palau, Aina; Zapata, Luis A.; Muzerolle, James; Gutermuth, Robert A.

    2015-11-01

    LRLL 54361 is an infrared source located in the star-forming region IC 348 SW. Remarkably, its infrared luminosity increases by a factor of 10 over roughly one week every 25.34 days. To understand the origin of these remarkable periodic variations, we obtained sensitive 3.3 cm JVLA radio continuum observations of LRLL 54361 and its surroundings in six different epochs: three of them during the IR-on state and three during the IR-off state. The radio source associated with LRLL 54361 remained steady and did not show a correlation with the IR variations. We suggest that the IR is tracing the results of fast (with a timescale of days) pulsed accretion from an unseen binary companion, while the radio traces an ionized outflow with an extent of ∼100 AU that smooths out the variability over a period of the order of a year. The average flux density measured in these 2014 observations, 27 ± 5 μJy, is about a factor of two less than that measured about 1.5 years before, 53 ± 11 μJy, suggesting that variability in the radio is present, but over larger timescales than in the IR. We discuss other sources in the field, in particular two infrared/X-ray stars that show rapidly varying gyrosynchrotron emission.

  12. A comparison of two phenological variables derived from VEGETATION NDVI and MERIS MTCI: A feasibility study in the context of Global Monitoring for Environment and Security (GMES)

    NASA Astrophysics Data System (ADS)

    Dash, Jadunandan; Rumsey, Jonathan; Lankester, Thomas; Hubbard, Steven; Curran, Paul

    Terrestrial carbon sequestration is the process by which atmospheric carbon dioxide is absorbed by plants through photosynthesis and stored as carbon in biomass and soil. Change in climate can influence the growth, health and phenology (e.g., season length) of vegetation and so change productivity and the degree of carbon sequestration. Phenological variables are a key input to global carbon modelling and as a result the GMES Land Monitoring Core Services are developing and validating remotely-sensed products that are related to seasonal vegetation growth cycles and similar change indicators. Many attempts have been made to define and estimate the two key phenological variables of start of growing season (‘greening up') and end of growing season (‘senescence') using remotely sensed data. However, no standard definition or methodology has yet emerged. This paper compares these two phenological variables derived from two different vegetation indices (Normalised Difference Vegetation Index (NDVI) derived from a SPOT VEGETATION dekad (10 days) time series and MERIS Terrestrial Chlorophyll Index (MTCI) derived from an Envisat MERIS dekad time series. Both dataset were processed using the same techniques to ensure spatial and temporal comparability. These two phenological variables were derived for eight dominant landcovers in Africa using a methodology developed for the generation of operational products in the VGT4AFRICA project. Start of growing season was defined as the local minima before a constant rise in vegetation index values. End of growing season was defined as the point of ‘half senescence' where the vegetation index value was less than half of its growth amplitude (difference between maximum and minimum index value). There was a statistically significant difference between phenological variables calculated using the NDVI and MTCI time series. MTCI detected an earlier start and end of growing season than NDVI. The degree of difference varied with

  13. Tide-related variability of TAG hydrothermal activity observed by deep-sea monitoring system and OBSH

    NASA Astrophysics Data System (ADS)

    Fujioka, Kantaro; Kobayashi, Kazuo; Kato, Kazuhiro; Aoki, Misumi; Mitsuzawa, Kyohiko; Kinoshita, Masataka; Nishizawa, Azusa

    1997-12-01

    Hydrothermal activities were monitored by an ocean bottom seismometer with hydrophone (OBSH) and a composite measuring system (Manatee) including CTD, current meter, transmission meter and cameras at a small depression on the TAG hydrothermal mound in the Mid-Atlantic Ridge. Low-frequency pressure pulses detected by the hydrophone with semi-diurnal periodicity seem to correspond to cycles of hydrothermal upflow from a small and short-lived smoker vent close to the observing site. The peaks of pressure pulses are synchronous with the maximum gradient of areal strain decrease due to tidal load release. Microearthquakes with very near epicenters occur sporadically and do not appear to be directly correlatable to hydrothermal venting. Temporal variations in bottom water temperature also have semi-diurnal periodicity but are more complicated than the pressure events. Temperatures may be affected both by upwelling of hot water and by lateral flow of the bottom current changing its directions with ocean tide.

  14. On the sensitivity of long-term magnetotelluric monitoring in Southern Italy and source-dependent robust single station transfer function variability

    NASA Astrophysics Data System (ADS)

    Romano, Gerardo; Balasco, Marianna; Lapenna, Vincenzo; Siniscalchi, Agata; Telesca, Luciano; Tripaldi, Simona

    2014-06-01

    Since 2007, a permanent magnetotelluric (MT) monitoring station has been working in the seismic area of the Agri Valley (Basilicata region, southern Italy) in order to investigate the stability of the MT transfer function. The station was installed in a rural area near the supposed seismogenic fault of the strong earthquake (Mw = 6.9) that struck the Agri Valley in 1857. Analysing about 4 yr of MT data characterized by a low seismic activity, the long-term systematic variations of robust single station MT transfer function estimates were observed in two different sounding period ranges. First, a significant seasonal component of variability for short periods was noted; these short periods were up to 16 s and were linked to variations in wetting/drying of soil moisture in the shallower layers. Second, a connection between the monitored estimates and global geomagnetic activity, Ap index, was found, particularly in the [20-100 s] period range. Analysing remote reference results and tipper estimates in shorter monitoring window, it was shown that such effect cannot be explained by a local or incoherent noise, and a large-scale coherent source should be claimed. We show that this effect is subtle because it produces smooth estimates, satisfying the dispersion relationship between apparent resistivity and phase, with small error bars. As the global geomagnetic activity level increases, robust estimators, like the median value, can be considered as a representative of the estimates due to the natural source, and they tend to stabilize when the Ap index approaches 10. It is also worth noting that our monitored time window includes the recent global minimum of solar activity which occurred in 2009, thus enhancing the estimate dependence on the Ap index.

  15. Understanding the Long-Term Spectral Variability of Cygnus X-1 with Burst and Transient Source Experiment and All-Sky Monitor Observations

    NASA Technical Reports Server (NTRS)

    Zdziarski, Andrzej A.; Poutanen, Juri; Paciesas, William S.; Wen, Lin-Qing

    2002-01-01

    We present a comprehensive analysis of all observations of Cyg X-1 by the Compton Gamma Ray Observatory Burst and Transient Source Experiment (BATSE; 20-300 keV) and by the Rossi X-Ray Timing Explorer all-sky monitor (ASM; 1.5-12 keV) until 2002 June, including approximately 1200 days of simultaneous data. We find a number of correlations between fluxes and hardnesses in different energy bands. In the hard (low) spectral state, there is a negative correlation between the ASM 1.5-12 keV flux and the hardness at any energy. In the soft (high) spectral state, the ASM flux is positively correlated with the ASM hardness but uncorrelated with the BATSE hardness. In both spectral states, the BATSE hardness correlates with the flux above 100 keV, while it shows no correlation with the 20-100 keV flux. At the same time, there is clear correlation between the BATSE fluxes below and above 100 keV. In the hard state, most of the variability can be explained by softening the overall spectrum with a pivot at approximately 50 keV. There is also another, independent variability pattern of lower amplitude where the spectral shape does not change when the luminosity changes. In the soft state, the variability is mostly caused by a variable hard (Comptonized) spectral component of a constant shape superposed on a constant soft blackbody component. These variability patterns are in agreement with the dependencies of the rms variability on the photon energy in the two states. We also study in detail recent soft states from late 2000 until 2002. The last of them has lasted thus far for more than 200 days. Their spectra are generally harder in the 1.5-5 keV band and similar or softer in the 3-12 keV band than the spectra of the 1996 soft state, whereas the rms variability is stronger in all the ASM bands. On the other hand, the 1994 soft state transition observed by BATSE appears very similar to the 1996 one. We interpret the variability patterns in terms of theoretical Comptonization

  16. The global distribution and variability of stratospheric constituents measured by LIMS. [Limb Infrared Monitor of the Stratosphere

    NASA Technical Reports Server (NTRS)

    Russell, J. M., III

    1984-01-01

    The purpose of the Nimbus 7 LIMS experiment was to sound the composition and structure of the upper atmosphere and provide data for study of photochemistry, radiation, and dynamics processes. Vertical profiles were measured of temperature and ozone (O3) over the 10-km to 65-km range and water vapor, nitrogen dioxide, and nitric acid over the 10-km to 50-km range. Latitude coverage extended from 64 deg S to 84 deg N. Several general features of the atmosphere have emerged from data analyzes thus far. Nitrogen dioxide exhibits rapid latitudinal variations in winter and shows hemispheric asymmetry with generally higher vertical column amount in the summer hemisphere. HNO3 data show that this gas is highly variable with altitude, latitude, and season. Smallest mixing ratios occur in the tropics, and the largest values occur in the high latitude winter hemisphere. The results show that O3, NO2, and HNO3 are strongly affected during a stratospheric warming.

  17. Clinical performance of a low cost near infrared sensor for continuous glucose monitoring applied with subcutaneous microdialysis.

    PubMed

    Ben Mohammadi, Lhoucine; Klotzbuecher, T; Sigloch, S; Welzel, K; Goeddel, M; Pieber, T R; Schaupp, L

    2015-08-01

    In this work we present a low cost, minimally invasive, and chip-based near infrared (NIR) sensor, combined with subcutaneous microdialysis, for continuous glucose monitoring (CGM). The sensor principle is based on difference absorption spectroscopy in the 1st overtone band known to be dominated by glucose-specific absorption features. The device comprises a multi-emitter LED and InGaAs-photodiodes, which are located on a single electronic board (non-disposable part), connected to a personal computer via Bluetooth. The disposable part consists of a chip containing the fluidic connections for microdialysis, two fluidic channels acting as optical transmission cells and total internally reflecting mirrors for in- and out-coupling of the light to the chip and to the detectors. The use of the sensor in conjunction with a subcutaneous microdialysis catheter to separate the glucose from the cells and proteins has been demonstrated to be extremely useful and advantageous for obtaining continuous glucose monitoring data and detecting glycemic levels in real time for a long period. Several in vitro and in vivo experiments were conducted to test the reliability of the device. In vitro measurements showed a linear relationship between glucose concentration and the integrated difference signal with a coefficient of determination of 99 % at the physiological concentration range. Clinical trial on 6 subjects with Type 1 diabetes showed that the NIR-CGM sensor data reflects the blood reference values adequately, if a proper calibration and signal drift compensation is applied. The MARD (mean absolute relative difference) value taken on retrospective data over all subjects is 8.5 % (range 6-11.5 %). PMID:26141039

  18. Fourteen Years of Pond Monitoring in Boreal Plain, northern Alberta, Canada: The effects of climate variability and harvesting practices

    NASA Astrophysics Data System (ADS)

    Abnizova, A.; Devito, K. J.; Petrone, R. M.

    2013-12-01

    Western Boreal forest of Canada is experiencing rapid increase in rates of cumulative impacts of disturbance for resource extraction, climate change and forest fires. To understand their sensitivity and response to multi-decadal natural and anthropogenic disturbances a long-term (1998-2013) and extensive pond ecosystem monitoring has been conducted on the Boreal Plains at the Utikuma Region Study Area (URSA) (56o N, 115o W). Hydrological, chemical and nutrient data were collected along a forest-peatland-pond transect in a paired catchment aspen harvest study in the area underlain by fine-grained till moraines glacial deposits. The aims of this study were (1) to identify the main characteristics in pond hydrologic regime, specifically water level dynamics, both seasonally and between years; (2) to identify factors controlling variation in measured hydro-chemistry and nutrients; and (3) to provide evidence on how water quality conditions in the ponds are changing on long (multi-year to decadal) time scales in response to harvesting practices and climatic trends during wet and dry cycles. No difference in pond or catchment hydrologic and hydro-chemical response was observed between harvested and reference sites pre- or post- harvesting. Wetland and pond waters were not affected by the harvesting practices due to lack of hydrologic connectivity between pond and forest systems. The hydrologic relationship between forestlands and open-water wetlands is a response in their water balance differences driven by their storage characteristics. Temporal trends in ponds' water levels, chemical and nutrient concentrations during the 14 year record were most closely related to relative connectivity to groundwater systems and flow direction in response to climatic cycles and vegetation water use and were the most useful parameters for characterizing duration and type of connectivity during wet and dry cycles. Using empirical relationships from such long-term monitoring, this study

  19. Understanding data in clinical research: a simple graphical display for plotting data (up to four independent variables) after binary logistic regression analysis.

    PubMed

    Mesa, José Luis

    2004-01-01

    In clinical research, suitable visualization techniques of data after statistical analysis are crucial for the researches' and physicians' understanding. Common statistical techniques to analyze data in clinical research are logistic regression models. Among these, the application of binary logistic regression analysis (LRA) has greatly increased during past years, due to its diagnostic accuracy and because scientists often want to analyze in a dichotomous way whether some event will occur or not. Such an analysis lacks a suitable, understandable, and widely used graphical display, instead providing an understandable logit function based on a linear model for the natural logarithm of the odds in favor of the occurrence of the dependent variable, Y. By simple exponential transformation, such a logit equation can be transformed into a logistic function, resulting in predicted probabilities for the presence of the dependent variable, P(Y-1/X). This model can be used to generate a simple graphical display for binary LRA. For the case of a single predictor or explanatory (independent) variable, X, a plot can be generated with X represented by the abscissa (i.e., horizontal axis) and P(Y-1/X) represented by the ordinate (i.e., vertical axis). For the case of multiple predictor models, I propose here a relief 3D surface graphic in order to plot up to four independent variables (two continuous and two discrete). By using this technique, any researcher or physician would be able to transform a lesser understandable logit function into a figure easier to grasp, thus leading to a better knowledge and interpretation of data in clinical research. For this, a sophisticated statistical package is not necessary, because the graphical display may be generated by using any 2D or 3D surface plotter. PMID:14962632

  20. Approaches for monitoring of non virus-specific and virus-specific T-cell response in solid organ transplantation and their clinical applications.

    PubMed

    Calarota, Sandra A; Aberle, Judith H; Puchhammer-Stöckl, Elisabeth; Baldanti, Fausto

    2015-09-01

    Opportunistic viral infections are still a major complication following solid organ transplantation. Immune monitoring may allow the identification of patients at risk of infection and, eventually, the modulation of immunosuppressive strategies. Immune monitoring can be performed using virus-specific and non virus-specific assays. This article describes and summarizes the pros and cons of the different technical approaches. Among the assays based on non virus-specific antigens, the enumeration of T-cell subsets, the quantification of cytokines and chemokines and the quantification of intracellular adenosine triphosphate following mitogen stimulation are described and their clinical applications to determine the risk for viral infection are discussed. In addition, current specific methods available for monitoring viral-specific T-cell responses are summarized, such as peptide-MHC multimer staining, intracellular cytokine staining, enzyme-linked immunospot and virus-specific IFN-γ ELISA assays, and their clinical applications to determine the individual risk for opportunistic viral infections with human cytomegalovirus, Epstein-Barr virus and polyoma BK virus are discussed. The standardization of the procedure, the choice of the antigen(s) and the criteria to define cut-off values for positive responses are needed for some of these approaches before their implementation in the clinic. Nevertheless, immune monitoring combined with virological monitoring in transplant recipients is increasingly regarded as a helpful tool to identify patients at risk of infection as well as to assess treatment efficacy. PMID:26305832

  1. Use of Self-Organizing Maps for Balanced Scorecard analysis to monitor the performance of dialysis clinic chains.

    PubMed

    Cattinelli, Isabella; Bolzoni, Elena; Barbieri, Carlo; Mari, Flavio; Martin-Guerrero, José David; Soria-Olivas, Emilio; Martinez-Martinez, José Maria; Gomez-Sanchis, Juan; Amato, Claudia; Stopper, Andrea; Gatti, Emanuele

    2012-03-01

    The Balanced Scorecard (BSC) is a validated tool to monitor enterprise performances against specific objectives. Through the choice and the evaluation of strategic Key Performance Indicators (KPIs), it provides a measure of the past company's outcome and allows planning future managerial strategies. The Fresenius Medical Care (FME) BSC makes use of 30 KPIs for a continuous quality improvement strategy within its dialysis clinics. Each KPI is monthly associated to a score that summarizes the clinic efficiency for that month. Standard statistical methods are currently used to analyze the BSC data and to give a comprehensive view of the corporate improvements to the top management. We herein propose the Self-Organizing Maps (SOMs) as an innovative approach to extrapolate information from the FME BSC data and to present it in an easy-readable informative form. A SOM is a computational technique that allows projecting high-dimensional datasets to a two-dimensional space (map), thus providing a compressed representation. The SOM unsupervised (self-organizing) training procedure results in a map that preserves similarity relations existing in the original dataset; in this way, the information contained in the high-dimensional space can be more easily visualized and understood. The present work demonstrates the effectiveness of the SOM approach in extracting useful information from the 30-dimensional BSC dataset: indeed, SOMs enabled both to highlight expected relationships between the KPIs and to uncover results not predictable with traditional analyses. Hence we suggest SOMs as a reliable complementary approach to the standard methods for BSC interpretation. PMID:22083440

  2. OPTICAL SPECTROPHOTOMETRIC MONITORING OF THE EXTREME LUMINOUS BLUE VARIABLE STAR GR 290 (ROMANO's STAR) IN M 33

    SciTech Connect

    Polcaro, V. F.; Viotti, R. F.; Rossi, C.; Galleti, S.; Gualandi, R.; Norci, L.

    2011-01-15

    We study the long-term, S Dor-type variability and the present hot phase of the luminous blue variable (LBV) star GR 290 (Romano's Star) in M 33 in order to investigate possible links between the LBV and the late, nitrogen sequence Wolf-Rayet Stars (WNL) stages of very massive stars. We use intermediate-resolution spectra, obtained with the William Herschel Telescope (WHT) in 2008 December, when GR 290 was at minimum (V = {approx}18.6), as well as new low-resolution spectra and BVRI photometry obtained with the Loiano and Cima Ekar telescopes during 2007-2010. We identify more than 80 emission lines in the 3100-10000 A range covered by the WHT spectra, belonging to different species: the hydrogen Balmer and Paschen series, neutral and ionized helium, C III, N II-III, S IV, Si III-IV, and many forbidden lines of [N II], [O III], [S III], [A III], [Ne III], and [Fe III]. Many lines, especially the He I triplets, show a P Cygni profile with an a-e radial velocity difference of -300 to -500 km s{sup -1}. The shape of the 4630-4713 A