Plasma concentrations of fentanyl with subcutaneous infusion in palliative care patients.

PubMed

Miller, R S; Peterson, G M; Abbott, F; Maddocks, I; Parker, D; McLean, S

1995-12-01

1. Plasma concentrations of fentanyl were measured by g.c. in 20 patients (median age: 75 years and range: 54-86 years; eight females) in palliative care receiving the drug by continuous s.c. infusion (median rate: 1200 micrograms day-1 and range: 100-5000 micrograms day-1). 2. The infusion rate was significantly related to the duration of therapy (Spearman rho = 0.56, P < 0.05). The total steady-state plasma concentrations of fentanyl ranged between 0.1 and 9 ng ml-1, with a median of 1 ng ml-1. The unbound fraction of fentanyl in the plasma ranged from 17.8 to 44.4%, with a median value of 33.6%. Infusion rates and both total and unbound plasma concentrations of fentanyl were correlated (Spearman rho = 0.92, P < 0.05 in each case). Even with standardization for dosage, there was an eightfold variation in total plasma concentrations and 3.5-fold variation in unbound plasma concentrations of fentanyl. 3. There is considerable inter-patient variability in the pharmacokinetics of fentanyl with s.c. infusion in the palliative care setting, which necessitates careful titration of dosage according to individual clinical response.

Evolution and Determinants of Health-Related Quality-of-Life in Kidney Transplant Patients Over the First 3 Years After Transplantation.

PubMed

Villeneuve, Claire; Laroche, Marie-Laure; Essig, Marie; Merville, Pierre; Kamar, Nassim; Coubret, Anne; Lacroix, Isabelle; Bouchet, Stéphane; Fruit, Dorothée; Marquet, Pierre; Rousseau, Annick

2016-03-01

Health-related quality of life (HRQOL) usually improved after kidney transplantation; however, a non-negligible number of patients did not benefit from transplantation in HRQOL. The aims of this cohort study were to describe the evolution of HRQOL in kidney transplant recipients to search for subgroups with distinct time profiles and to investigate these determinants. Three hundred thirty-seven adult patients were followed up from 1 to 36 months after kidney transplantation. Each patient completed repeated HRQOL assessments (median, 5; range, 2-9). K-means for longitudinal data was used to identify homogeneous clusters of HRQOL time profiles obtained for the mental and physical composite scores (MCS and PCS) and for the 8 dimensions of the short-form 36 scale. Covariates associated with these clusters were investigated using random forest analysis. Magnitude and shape of the HRQOL variations over time were investigated using linear regression mixed models. Two longitudinal clusters were identified for the time profiles of PCS and MCS. Patients classified in the higher cluster (ie, 60% of the population) exhibited a steady-state HRQOL, similar on average to the general population, whereas in the lower cluster, PCS and MCS scores were significantly lower than in the general population. Muscular weakness in the first year after transplantation explained 19% of the interpatient variability of PCS 3 months after transplantation, whereas associated with anxiety, it explained 24% of interpatient MCS variability. This work suggests to promote (i) physical rehabilitation programs after transplantation to curb the muscular loss and (ii) systematic attention to the patient's anxiety.

Inter-patient image registration algorithms to disentangle regional dose bioeffects.

PubMed

Monti, Serena; Pacelli, Roberto; Cella, Laura; Palma, Giuseppe

2018-03-20

Radiation therapy (RT) technological advances call for a comprehensive reconsideration of the definition of dose features leading to radiation induced morbidity (RIM). In this context, the voxel-based approach (VBA) to dose distribution analysis in RT offers a radically new philosophy to evaluate local dose response patterns, as an alternative to dose-volume-histograms for identifying dose sensitive regions of normal tissue. The VBA relies on mapping patient dose distributions into a single reference case anatomy which serves as anchor for local dosimetric evaluations. The inter-patient elastic image registrations (EIRs) of the planning CTs provide the deformation fields necessary for the actual warp of dose distributions. In this study we assessed the impact of EIR on the VBA results in thoracic patients by identifying two state-of-the-art EIR algorithms (Demons and B-Spline). Our analysis demonstrated that both the EIR algorithms may be successfully used to highlight subregions with dose differences associated with RIM that substantially overlap. Furthermore, the inclusion for the first time of covariates within a dosimetric statistical model that faces the multiple comparison problem expands the potential of VBA, thus paving the way to a reliable voxel-based analysis of RIM in datasets with strong correlation of the outcome with non-dosimetric variables.

Single-dose pharmacokinetic study of 13-cis-retinoic acid in man.

PubMed

Besner, J G; Leclaire, R; Band, P; Meloche, S; Deschamps, M; Mailhot, S; Moisan, R; Diorio, G

1985-03-01

A pharmacokinetic study of 13-cis-retinoic acid was performed in nine patients following administration of a single oral dose of 80 mg. An average lag time of 1.2 hours was observed, followed by fast absorption, with a mean half-life of 0.5 hour. Peak plasmatic concentration of 733 ng/ml occurred at 2.3 hours. The disposition profile showed a rapid distribution half-life of 1.3 hours and a terminal elimination half-life of 24.7 hours. No 13-cis-retinoic acid was detected unchanged in urine. An important interpatient variability was noted.

Population Pharmacokinetics of Atazanavir in Patients with Human Immunodeficiency Virus Infection▿

PubMed Central

Colombo, Sara ; Buclin, Thierry; Cavassini, Matthias; Décosterd, Laurent A.; Telenti, Amalio; Biollaz, Jérôme; Csajka, Chantal

2006-01-01

Atazanavir (ATV) is a new azapeptide protease inhibitor recently approved and currently used at a fixed dose of either 300 mg once per day (q.d.) in combination with 100 mg ritonavir (RTV) or 400 mg q.d. without boosting. ATV is highly bound to plasma proteins and extensively metabolized by CYP3A4. Since ATV plasma levels are highly variable and seem to be correlated with both viral response and toxicity, dosage individualization based on plasma concentration monitoring might be indicated. This study aimed to assess the ATV pharmacokinetic profile in a target population of HIV patients, to characterize interpatient and intrapatient variability, and to identify covariates that might influence ATV disposition. A population analysis was performed with NONMEM with 574 plasma samples from a cohort of 214 randomly selected patients receiving ATV. A total of 346 randomly collected ATV plasma levels and 19 full concentration-time profiles at steady state were available. The pharmacokinetic parameter estimates were an oral clearance (CL) of 12.9 liters/h (coefficient of variation [CV], 26%), a volume of distribution of 88.3 liters (CV, 29%), an absorption rate constant of 0.405 h−1 (CV, 122%), and a lag time of 0.88 h. A relative bioavailability value was introduced to account for undercompliance due to infrequent follow-ups (0.81; CV, 45%). Among the covariates tested, only RTV significantly reduced CL by 46%, thereby increasing the ATV elimination half-life from 4.6 h to 8.8 h. The pharmacokinetic parameters of ATV were adequately described by a one-compartment population model. The concomitant use of RTV improved the pharmacokinetic profile. However, the remaining high interpatient variability suggests the possibility of an impact of unmeasured covariates, such as genetic traits or environmental influences. This population pharmacokinetic model, together with therapeutic drug monitoring and Bayesian dosage adaptation, can be helpful in the selection and adaptation of ATV doses. PMID:16940065

High interpatient variability of raltegravir CSF concentrations in HIV-positive patients: a pharmacogenetic analysis.

PubMed

Calcagno, Andrea; Cusato, Jessica; Simiele, Marco; Motta, Ilaria; Audagnotto, Sabrina; Bracchi, Margherita; D'Avolio, Antonio; Di Perri, Giovanni; Bonora, Stefano

2014-01-01

To analyse the determinants of raltegravir CSF penetration, including the pharmacogenetics of drug transporters located at the blood-brain barrier or blood-CSF barrier. Plasma and CSF raltegravir concentrations were determined by a validated HPLC coupled with mass spectrometry method in adults on raltegravir-based combination antiretroviral therapy undergoing a lumbar puncture. Single nucleotide polymorphisms in the genes encoding drugs transporters (ABCB1 3435, SLCO1A2, ABCC2 and SLC22A6) and the gene encoding hepatocyte nuclear factor 4 α (HNF4α) were determined by real-time PCR. In 41 patients (73.2% male, 95.1% Caucasians), the median raltegravir plasma and CSF concentrations were 165 ng/mL (83-552) and 31 ng/mL (21-56), respectively. CSF-to-plasma ratios (CPRs) ranged from 0.005 to 1.33 (median 0.20, IQR 0.04-0.36). Raltegravir trough CSF concentrations (n = 35) correlated with raltegravir plasma levels (ρ = 0.395, P = 0.019); CPRs were higher in patients with blood-brain barrier damage (0.47 versus 0.18, P = 0.02). HNF4α 613 CG genotype carriers had lower trough CSF concentrations (20 versus 37 ng/mL, P = 0.03) and CPRs (0.12 versus 0.27, P = 0.02). Following multivariate linear regression analysis, the CSF-to-serum albumin ratio was the only independent predictor of raltegravir penetration into the CSF. Raltegravir penetration into the CSF shows a large interpatient variability, although CSF concentrations were above the wild-type IC50 in all patients (and above IC95 in 28.6%). In this cohort, blood-brain barrier permeability is the only independent predictor of raltegravir CPR. The impact of single nucleotide polymorphisms in selected genes on raltegravir penetration warrants further studies.

Radiotherapy-induced xerostomia, pre-clinical promise of LMS-611.

PubMed

Paterson, Claire; Caldwell, B; Porteous, S; McLean, A; Messow, C M; Thomson, M

2016-02-01

Radiotherapy-induced xerostomia (RIX) is the most common permanent side effect of radiotherapy (RT) to the head and neck (H&N). There is no effective topical treatment. LMS-611 is a mimetic of a natural lamellar body which prevents thick secretions like saliva from congesting organs. The primary objective of this study was to assess saliva properties before and during RT to the H&N. The secondary objectives were to re-assess saliva properties with the addition of LMS-611, measure inter-patient variability, correlate patient-reported symptoms with laboratory measurements and design subsequent first-in-human clinical trial of LMS-611. Patients with H&N cancer receiving RT as primary treatment were recruited. Patients completed the Groningen RIX (GRIX) questionnaire and provided saliva samples at baseline and weeks 2, 4 and 6 of RT. Saliva adhesiveness and viscosity were tested by measuring time taken to travel 5 cm down an inclined plane. Thirty patients were enrolled. The inclined plane test (IPT) results (s) were as follows: baseline 31.3, week 2 49.7, week 4 51.1 and week 6 55.7. Wide inter-patient variability was seen at baseline. GRIX scores increased as RT progressed. Spearman rank correlation coefficient of inclined plane tests with GRIX scores was -0.06 at baseline, 0.25 at week 2, 0.12 at week 4 and 0.08 at week 6. LMS-611 concentrations of 10 and 20 mg/ml significantly reduced IPT times on saliva samples. Saliva becomes more visco-adhesive and RIX worsens as RT progresses. There is little correlation between objective and subjective measures of RIX. The addition of LMS-611 to thick, sticky saliva restores its fluidity ex vivo. This warrants in vivo analysis of the effect of LMS-611 upon RIX.

5-ALA based photodynamic management of glioblastoma

NASA Astrophysics Data System (ADS)

Rühm, Adrian; Stepp, Herbert; Beyer, Wolfgang; Hennig, Georg; Pongratz, Thomas; Sroka, Ronald; Schnell, Oliver; Tonn, Jörg-Christian; Kreth, Friedrich-Wilhelm

2014-03-01

Objective: Improvement of the clinical outcome of glioblastoma (GBM) patients by employment of fluorescence and photosensitization on the basis of 5-aminolevulinic acid (5-ALA) induced protoporphyrin IX (PpIX). Methods: In this report the focus is laid on the use of tumor selective PpIX fluorescence for stereotactic biopsy sampling and intra-operative treatment monitoring. In addition, our current concept for treatment planning is presented. For stereotactic interstitial photodynamic therapy (iPDT), radial diffusers were implanted into the contrast enhancing tumor volume. Spectroscopic measurements of laser light transmission and fluorescence between adjacent fibers were performed prior, during and post PDT. Results: PpIX concentrations in primary glioblastoma tissue show high intra- and inter-patient variability, but are usually sufficient for an effective PDT. During individual treatment attempts with 5-ALA based GBM-iPDT, transmission and fluorescence measurements between radial diffusers gave the following results: 1. In some cases, transmission after PDT is considerably reduced compared to the value before PDT, which may be attributable to a depletion of oxygenated hemoglobin and/or diffuse bleeding. 2. PpIX fluorescence is efficiently photobleached during PDT in all cases. Conclusion: iPDT with assessment of PpIX fluorescence and photobleaching is a promising treatment option. Individualization of treatment parameters appears to bear a potential to further improve clinical outcomes.

PDT dose dosimetry for Photofrin-mediated pleural photodynamic therapy (pPDT)

NASA Astrophysics Data System (ADS)

Ong, Yi Hong; Kim, Michele M.; Finlay, Jarod C.; Dimofte, Andreea; Singhal, Sunil; Glatstein, Eli; Cengel, Keith A.; Zhu, Timothy C.

2018-01-01

Photosensitizer fluorescence excited by photodynamic therapy (PDT) treatment light can be used to monitor the in vivo concentration of the photosensitizer and its photobleaching. The temporal integral of the product of in vivo photosensitizer concentration and light fluence is called PDT dose, which is an important dosimetry quantity for PDT. However, the detected photosensitizer fluorescence may be distorted by variations in the absorption and scattering of both excitation and fluorescence light in tissue. Therefore, correction of the measured fluorescence for distortion due to variable optical properties is required for absolute quantification of photosensitizer concentration. In this study, we have developed a four-channel PDT dose dosimetry system to simultaneously acquire light dosimetry and photosensitizer fluorescence data. We measured PDT dose at four sites in the pleural cavity during pleural PDT. We have determined an empirical optical property correction function using Monte Carlo simulations of fluorescence for a range of physiologically relevant tissue optical properties. Parameters of the optical property correction function for Photofrin fluorescence were determined experimentally using tissue-simulating phantoms. In vivo measurements of photosensitizer fluorescence showed negligible photobleaching of Photofrin during the PDT treatment, but large intra- and inter-patient heterogeneities of in vivo Photofrin concentration are observed. PDT doses delivered to 22 sites in the pleural cavity of 8 patients were different by 2.9 times intra-patient and 8.3 times inter-patient.

Norepinephrine kinetics and dynamics in septic shock and trauma patients.

PubMed

Beloeil, H; Mazoit, J-X; Benhamou, D; Duranteau, J

2005-12-01

There is considerable variability in the inter-patient response to norepinephrine. Pharmacokinetic studies of dopamine infusion in volunteers and in patients have also shown large variability. The purpose of this study was to define the pharmacokinetics of norepinephrine in septic shock and trauma patients. After Ethical Committee approval and written informed family consent, 12 patients with septic shock and 11 trauma patients requiring norepinephrine infusion were studied. Norepinephrine dose was increased in three successive steps of 0.1 mg kg(-1) min(-1) at 15-min intervals (20% maximum allowed increase in arterial pressure). Arterial blood was sampled before and at 0.5, 13, and 15 min after each infusion rate change and 30 s, 1, 2, 5, 10, and 15 min after return to baseline dosing. Norepinephrine was assayed by HPLC. The pharmacokinetics were modelled using NONMEM (one-compartment model). The effects of group, body weight (BW), gender and SAPS II (Simplified Acute Physiology Score II) [Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. J Am Med Assoc 1993; 270: 2957-63] patients score on clearance (CL) and volume of distribution (V) were tested. Group, gender, and BW did not influence CL or V. CL was negatively related to SAPS II. CL and T(1/2) varied from 3 litre min(-1) and 2 min, respectively, when SAPS II=20 to 0.9 litre min(-1) and 6.8 min when SAPS II=60. In trauma patients and in septic shock patients, norepinephrine clearance is negatively related to SAPS II.

Patient awareness, knowledge and use of colchicine: an exploratory qualitative study in the Counties Manukau region, Auckland, New Zealand.

PubMed

Rebello, Caraliese; Thomson, Maree; Bassett-Clarke, Deborah; Martini, Nataly

2016-06-01

INTRODUCTION Treatment of gout, specifically with colchicine, varies globally. Colchicine can be fatal due to its narrow therapeutic index and potential for interactions. In New Zealand, cases of intentional and unintentional colchicine overdose have been documented. AIMS To explore patients' knowledge on the use of gout medicines, and in particular their awareness of the maximum dose of colchicine, the dangers of colchicine overdose, and their opinions on restricting colchicine dispensing. The study also investigates where patients receive gout information. METHODS Thirty people with gout presenting to their regular gout clinic in Auckland currently or previously taking colchicine were invited to participate in a 30-min semi-structured interview. Data were analysed using a general inductive thematic approach. FINDINGS Overall, participants had a lack of knowledge regarding colchicine and used variable doses during an acute gout attack. Participants were unsure of the maximum dose of colchicine and several took more than prescribed. The prophylactic use of colchicine and allopurinol varied from 3 weeks to 15 years. Mixed views were reported on restricting colchicine supply. Most participants received gout information from their general practitioner (GP). CONCLUSION Poor understanding of colchicine contributed to inappropriate use and highlights the need for targeted patient education. Considerable inter-patient variability exists in the use of colchicine for acute gout, suggesting the efficacy of low dose regimens be explored. The length of adjunctive colchicine use, as part of a prophylaxis regimen, needs to be regularly reviewed and tailored to each patient. Further research is required on limiting the amount of colchicine dispensed.

Precancerous esophageal epithelia are associated with significantly increased scattering coefficients

PubMed Central

Su, Jing-Wei; Lin, Yang-Hsien; Chiang, Chun-Ping; Lee, Jang-Ming; Hsieh, Chao-Mao; Hsieh, Min-Shu; Yang, Pei-Wen; Wang, Chen-Ping; Tseng, Ping-Huei; Lee, Yi-Chia; Sung, Kung-Bin

2015-01-01

The progression of epithelial precancers into cancer is accompanied by changes of tissue and cellular structures in the epithelium. Correlations between the structural changes and scattering coefficients of esophageal epithelia were investigated using quantitative phase images and the scattering-phase theorem. An ex vivo study of 14 patients demonstrated that the average scattering coefficient of precancerous epithelia was 37.8% higher than that of normal epithelia from the same patient. The scattering coefficients were highly correlated with morphological features including the cell density and the nuclear-to-cytoplasmic ratio. A high interpatient variability in scattering coefficients was observed and suggests identifying precancerous lesions based on the relative change in scattering coefficients. PMID:26504630

CAP waveform estimation from the measured electrical bioimpedance values: Patient's heart rate variability analysis.

PubMed

Krivoshei, A; Uuetoa, H; Min, M; Annus, P; Uuetoa, T; Lamp, J

2015-08-01

The paper presents analysis of the generic transfer function (TF) between Electrical Bioimpedance (EBI) measured non-invasively on the wrist and Central Aortic Pressure (CAP) invasively measured at the aortic root. Influence of the Heart Rate (HR) variations on the generic TF and on reconstructed CAP waveforms is investigated. The HR variation analysis is provided on a single patient data to exclude inter-patient influences at the current research stage. A new approach for the generic TF estimating from a data ensemble is presented as well. Moreover, an influence of the cardiac period beginning point selection is analyzed and empirically optimal solution for its selection is proposed.

Molecular Targets in Advanced Therapeutics of Cancers: The Role of Pharmacogenetics.

PubMed

Abubakar, Murtala B; Gan, Siew Hua

2016-01-01

The advent of advanced molecular targeted therapy has resulted in improved prognoses for patients with advanced malignancies. However, despite the significant success and specificity of this advocated targeted therapy, significant on- and off-target adverse effects and inter-individual variability in treatment responses have been reported. The interpatient variability in drug response has been suggested to be partly due to variations in patient genomes. Therefore, the identification of genetic biomarkers by conducting pharmacogenetics studies can help predict patient responses to targeted therapy and may serve as a basis for individualized treatment. In this review, both clinically established and potential molecular targets are highlighted. Overall, current literature suggests that individualization of targeted therapy is promising; however, integrating the clinical benefits of identified biomarkers into clinical practice for personalized medicine remains a major challenge, and further studies to validate these markers and identify novel therapeutic approaches are needed. © 2016 S. Karger AG, Basel.

Clinical Pharmacogenetics Implementation Consortium Guidelines for CYP2C9 and VKORC1 Genotypes and Warfarin Dosing

PubMed Central

Johnson, JA; Gong, L; Whirl-Carrillo, M; Gage, BF; Scott, SA; Stein, CM; Anderson, JL; Kimmel, SE; Lee, MTM; Pirmohamed, M; Wadelius, M; Klein, TE; Altman, RB

2011-01-01

Warfarin is a widely used anticoagulant with a narrow therapeutic index and large interpatient variability in the dose required to achieve target anticoagulation. Common genetic variants in the cytochrome P450-2C9 (CYP2C9) and vitamin K–epoxide reductase complex (VKORC1) enzymes, in addition to known nongenetic factors, account for ~50% of warfarin dose variability. The purpose of this article is to assist in the interpretation and use of CYP2C9 and VKORC1 geno-type data for estimating therapeutic warfarin dose to achieve an INR of 2–3, should genotype results be available to the clinician. The Clinical Pharmacogenetics Implementation Consortium (CPIC) of the National Institutes of Health Pharmacogenomics Research Network develops peer-reviewed gene–drug guidelines that are published and updated periodically on http://www.pharmgkb.org based on new developments in the field.1 PMID:21900891

High-order sliding-mode control for blood glucose regulation in the presence of uncertain dynamics.

PubMed

Hernández, Ana Gabriela Gallardo; Fridman, Leonid; Leder, Ron; Andrade, Sergio Islas; Monsalve, Cristina Revilla; Shtessel, Yuri; Levant, Arie

2011-01-01

The success of blood glucose automatic regulation depends on the robustness of the control algorithm used. It is a difficult task to perform due to the complexity of the glucose-insulin regulation system. The variety of model existing reflects the great amount of phenomena involved in the process, and the inter-patient variability of the parameters represent another challenge. In this research a High-Order Sliding-Mode Control is proposed. It is applied to two well known models, Bergman Minimal Model, and Sorensen Model, to test its robustness with respect to uncertain dynamics, and patients' parameter variability. The controller designed based on the simulations is tested with the specific Bergman Minimal Model of a diabetic patient whose parameters were identified from an in vivo assay. To minimize the insulin infusion rate, and avoid the hypoglycemia risk, the glucose target is a dynamical profile.

Impact of single nucleotide polymorphisms of cytarabine metabolic genes on drug toxicity in childhood acute lymphoblastic leukemia.

PubMed

Gabor, Krisztina Mita; Schermann, Geza; Lautner-Csorba, Orsolya; Rarosi, Ferenc; Erdelyi, Daniel J; Endreffy, Emoke; Berek, Krisztina; Bartyik, Katalin; Bereczki, Csaba; Szalai, Csaba; Semsei, Agnes F

2015-04-01

Cytarabine (cytosine arabinoside, ara-C) is a chemotherapeutical agent used in the treatment of pediatric acute lymphoblastic leukemia (ALL). Adverse drug reactions, such as interpatient variability in sensitivity to ara-C, are considerable and may cause difficulties during chemotherapy. Single nucleotide polymorphisms (SNPs) can play a significant role in modifying nucleoside-drug pharmacokinetics and pharmacodynamics and thus the development of adverse effects. Our aim was to determine whether polymorphisms in genes encoding transporters and enzymes responsible for the metabolism of ara-C are associated with toxicity and clinical outcome in a patient population with childhood ALL. We studied 8 SNPs in the CDA, DCK, DCTD, SLC28A3, and SLC29A1 genes in 144 patients with childhood acute lymphoblastic leukemia treated according to ALLIC BFM 1990, 1995 and 2002 protocols. DCK rs12648166 and DCK rs4694362 SNPs were associated with hematologic toxicity (OR = 2.63, CI 95% = 1.37-5.04, P = 0.0036 and OR = 2.53, CI 95% = 1.34-4.80, P = 0.0044, respectively). Our results indicate that DCK polymorphisms might be important genetic risk factors for hematologic toxicity during ALL treatment with ara-C. Individualized chemotherapy based on genetic profiling may help to optimize ara-C dosing, leading to improvements in clinical outcome and reduced toxicity. © 2015 Wiley Periodicals, Inc.

WE-FG-202-12: Investigation of Longitudinal Salivary Gland DCE-MRI Changes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ger, R; Howell, R; Li, H

Purpose: To determine the correlation between dose and changes through treatment in dynamic contrast enhanced (DCE) MRI voxel parameters (Ktrans, kep, Ve, and Vp) within salivary glands of head and neck oropharyngeal squamous cell carcinoma (HNSCC) patients. Methods: 17 HNSCC patients treated with definitive radiation therapy completed DCE-MRI scans on a 3T scanner at pre-treatment, mid-treatment, and post-treatment time points. Mid-treatment and post-treatment DCE images were deformably registered to pre-treatment DCE images (Velocity software package). Pharmacokinetic analysis of the DCE images used a modified Tofts model to produce parameter maps with an arterial input function selected from each patient’s perivertebralmore » space on the image (NordicICE software package). In-house software was developed for voxel-by-voxel longitudinal analysis of the salivary glands within the registered images. The planning CT was rigidly registered to the pre-treatment DCE image to obtain dose values in each voxel. Voxels within the lower and upper dose quartiles for each gland were averaged for each patient, then an average of the patients’ means for the two quartiles were compared. Dose-relationships were also assessed by Spearman correlations between dose and voxel parameter changes for each patient’s gland. Results: Changes in parameters’ means between time points were observed, but inter-patient variability was high. Ve of the parotid was the only parameter that had a consistently significant longitudinal difference between dose quartiles. The highest Spearman correlation was Vp of the sublingual gland for the change in the pre-treatment to mid-treatment values with only a ρ=0.29. Conclusion: In this preliminary study, there was large inter-patient variability in the changes of DCE voxel parameters with no clear relationship with dose. Additional patients may reduce the uncertainties and allow for the determination of the existence of parameter and dose relationships.« less

Event-Based control of depth of hypnosis in anesthesia.

PubMed

Merigo, Luca; Beschi, Manuel; Padula, Fabrizio; Latronico, Nicola; Paltenghi, Massimiliano; Visioli, Antonio

2017-08-01

In this paper, we propose the use of an event-based control strategy for the closed-loop control of the depth of hypnosis in anesthesia by using propofol administration and the bispectral index as a controlled variable. A new event generator with high noise-filtering properties is employed in addition to a PIDPlus controller. The tuning of the parameters is performed off-line by using genetic algorithms by considering a given data set of patients. The effectiveness and robustness of the method is verified in simulation by implementing a Monte Carlo method to address the intra-patient and inter-patient variability. A comparison with a standard PID control structure shows that the event-based control system achieves a reduction of the total variation of the manipulated variable of 93% in the induction phase and of 95% in the maintenance phase. The use of event based automatic control in anesthesia yields a fast induction phase with bounded overshoot and an acceptable disturbance rejection. A comparison with a standard PID control structure shows that the technique effectively mimics the behavior of the anesthesiologist by providing a significant decrement of the total variation of the manipulated variable. Copyright © 2017 Elsevier B.V. All rights reserved.

Detection of inter-patient left and right bundle branch block heartbeats in ECG using ensemble classifiers

PubMed Central

2014-01-01

Background Left bundle branch block (LBBB) and right bundle branch block (RBBB) not only mask electrocardiogram (ECG) changes that reflect diseases but also indicate important underlying pathology. The timely detection of LBBB and RBBB is critical in the treatment of cardiac diseases. Inter-patient heartbeat classification is based on independent training and testing sets to construct and evaluate a heartbeat classification system. Therefore, a heartbeat classification system with a high performance evaluation possesses a strong predictive capability for unknown data. The aim of this study was to propose a method for inter-patient classification of heartbeats to accurately detect LBBB and RBBB from the normal beat (NORM). Methods This study proposed a heartbeat classification method through a combination of three different types of classifiers: a minimum distance classifier constructed between NORM and LBBB; a weighted linear discriminant classifier between NORM and RBBB based on Bayesian decision making using posterior probabilities; and a linear support vector machine (SVM) between LBBB and RBBB. Each classifier was used with matching features to obtain better classification performance. The final types of the test heartbeats were determined using a majority voting strategy through the combination of class labels from the three classifiers. The optimal parameters for the classifiers were selected using cross-validation on the training set. The effects of different lead configurations on the classification results were assessed, and the performance of these three classifiers was compared for the detection of each pair of heartbeat types. Results The study results showed that a two-lead configuration exhibited better classification results compared with a single-lead configuration. The construction of a classifier with good performance between each pair of heartbeat types significantly improved the heartbeat classification performance. The results showed a sensitivity of 91.4% and a positive predictive value of 37.3% for LBBB and a sensitivity of 92.8% and a positive predictive value of 88.8% for RBBB. Conclusions A multi-classifier ensemble method was proposed based on inter-patient data and demonstrated a satisfactory classification performance. This approach has the potential for application in clinical practice to distinguish LBBB and RBBB from NORM of unknown patients. PMID:24903422

Detection of inter-patient left and right bundle branch block heartbeats in ECG using ensemble classifiers.

PubMed

Huang, Huifang; Liu, Jie; Zhu, Qiang; Wang, Ruiping; Hu, Guangshu

2014-06-05

Left bundle branch block (LBBB) and right bundle branch block (RBBB) not only mask electrocardiogram (ECG) changes that reflect diseases but also indicate important underlying pathology. The timely detection of LBBB and RBBB is critical in the treatment of cardiac diseases. Inter-patient heartbeat classification is based on independent training and testing sets to construct and evaluate a heartbeat classification system. Therefore, a heartbeat classification system with a high performance evaluation possesses a strong predictive capability for unknown data. The aim of this study was to propose a method for inter-patient classification of heartbeats to accurately detect LBBB and RBBB from the normal beat (NORM). This study proposed a heartbeat classification method through a combination of three different types of classifiers: a minimum distance classifier constructed between NORM and LBBB; a weighted linear discriminant classifier between NORM and RBBB based on Bayesian decision making using posterior probabilities; and a linear support vector machine (SVM) between LBBB and RBBB. Each classifier was used with matching features to obtain better classification performance. The final types of the test heartbeats were determined using a majority voting strategy through the combination of class labels from the three classifiers. The optimal parameters for the classifiers were selected using cross-validation on the training set. The effects of different lead configurations on the classification results were assessed, and the performance of these three classifiers was compared for the detection of each pair of heartbeat types. The study results showed that a two-lead configuration exhibited better classification results compared with a single-lead configuration. The construction of a classifier with good performance between each pair of heartbeat types significantly improved the heartbeat classification performance. The results showed a sensitivity of 91.4% and a positive predictive value of 37.3% for LBBB and a sensitivity of 92.8% and a positive predictive value of 88.8% for RBBB. A multi-classifier ensemble method was proposed based on inter-patient data and demonstrated a satisfactory classification performance. This approach has the potential for application in clinical practice to distinguish LBBB and RBBB from NORM of unknown patients.

PubMed-supported clinical term weighting approach for improving inter-patient similarity measure in diagnosis prediction.

PubMed

Chan, Lawrence Wc; Liu, Ying; Chan, Tao; Law, Helen Kw; Wong, S C Cesar; Yeung, Andy Ph; Lo, K F; Yeung, S W; Kwok, K Y; Chan, William Yl; Lau, Thomas Yh; Shyu, Chi-Ren

2015-06-02

Similarity-based retrieval of Electronic Health Records (EHRs) from large clinical information systems provides physicians the evidence support in making diagnoses or referring examinations for the suspected cases. Clinical Terms in EHRs represent high-level conceptual information and the similarity measure established based on these terms reflects the chance of inter-patient disease co-occurrence. The assumption that clinical terms are equally relevant to a disease is unrealistic, reducing the prediction accuracy. Here we propose a term weighting approach supported by PubMed search engine to address this issue. We collected and studied 112 abdominal computed tomography imaging examination reports from four hospitals in Hong Kong. Clinical terms, which are the image findings related to hepatocellular carcinoma (HCC), were extracted from the reports. Through two systematic PubMed search methods, the generic and specific term weightings were established by estimating the conditional probabilities of clinical terms given HCC. Each report was characterized by an ontological feature vector and there were totally 6216 vector pairs. We optimized the modified direction cosine (mDC) with respect to a regularization constant embedded into the feature vector. Equal, generic and specific term weighting approaches were applied to measure the similarity of each pair and their performances for predicting inter-patient co-occurrence of HCC diagnoses were compared by using Receiver Operating Characteristics (ROC) analysis. The Areas under the curves (AUROCs) of similarity scores based on equal, generic and specific term weighting approaches were 0.735, 0.728 and 0.743 respectively (p < 0.01). In comparison with equal term weighting, the performance was significantly improved by specific term weighting (p < 0.01) but not by generic term weighting. The clinical terms "Dysplastic nodule", "nodule of liver" and "equal density (isodense) lesion" were found the top three image findings associated with HCC in PubMed. Our findings suggest that the optimized similarity measure with specific term weighting to EHRs can improve significantly the accuracy for predicting the inter-patient co-occurrence of diagnosis when compared with equal and generic term weighting approaches.

Active appearance model and deep learning for more accurate prostate segmentation on MRI

NASA Astrophysics Data System (ADS)

Cheng, Ruida; Roth, Holger R.; Lu, Le; Wang, Shijun; Turkbey, Baris; Gandler, William; McCreedy, Evan S.; Agarwal, Harsh K.; Choyke, Peter; Summers, Ronald M.; McAuliffe, Matthew J.

2016-03-01

Prostate segmentation on 3D MR images is a challenging task due to image artifacts, large inter-patient prostate shape and texture variability, and lack of a clear prostate boundary specifically at apex and base levels. We propose a supervised machine learning model that combines atlas based Active Appearance Model (AAM) with a Deep Learning model to segment the prostate on MR images. The performance of the segmentation method is evaluated on 20 unseen MR image datasets. The proposed method combining AAM and Deep Learning achieves a mean Dice Similarity Coefficient (DSC) of 0.925 for whole 3D MR images of the prostate using axial cross-sections. The proposed model utilizes the adaptive atlas-based AAM model and Deep Learning to achieve significant segmentation accuracy.

Warfarin-acetaminophen drug interaction revisited.

PubMed

Shek, K L; Chan, L N; Nutescu, E

1999-10-01

Physicians and pharmacists routinely advise patients receiving warfarin to take acetaminophen for pain or fever because of its relative safety; however, a recent study questioned the safety of such practice. A comprehensive search of MEDLINE and IPA for human studies and case reports from 1966-1999 revealed evidence that acetaminophen may potentiate the effect of warfarin by a mechanism that has yet to be elucidated. Due to lack of a safer alternative, acetaminophen still should be the analgesic and antipyretic of choice in patients taking warfarin, as long as excessive amounts and prolonged administration (> 1.3 g acetaminophen/day for > 2 wks) are avoided. With the high degree of interpatient variability and the unpredictability of various drug-drug interactions with warfarin, close and frequent monitoring of international normalized ratios is the key for safe oral anticoagulation therapy.

Comparing human peritoneal fluid and phosphate-buffered saline for drug delivery: do we need bio-relevant media?

PubMed

Bhusal, Prabhat; Rahiri, Jamie Lee; Sua, Bruce; McDonald, Jessica E; Bansal, Mahima; Hanning, Sara; Sharma, Manisha; Chandramouli, Kaushik; Harrison, Jeff; Procter, Georgina; Andrews, Gavin; Jones, David S; Hill, Andrew G; Svirskis, Darren

2018-06-01

An understanding of biological fluids at the site of administration is important to predict the fate of drug delivery systems in vivo. Little is known about peritoneal fluid; therefore, we have investigated this biological fluid and compared it to phosphate-buffered saline, a synthetic media commonly used for in vitro evaluation of intraperitoneal drug delivery systems. Human peritoneal fluid samples were analysed for electrolyte, protein and lipid levels. In addition, physicochemical properties were measured alongside rheological parameters. Significant inter-patient variations were observed with regard to pH (p < 0.001), buffer capacity (p < 0.05), osmolality (p < 0.001) and surface tension (p < 0.05). All the investigated physicochemical properties of peritoneal fluid differed from phosphate-buffered saline (p < 0.001). Rheological examination of peritoneal fluid demonstrated non-Newtonian shear thinning behaviour and predominantly exhibited the characteristics of an entangled network. Inter-patient and inter-day variability in the viscosity of peritoneal fluid was observed. The solubility of the local anaesthetic lidocaine in peritoneal fluid was significantly higher (p < 0.05) when compared to phosphate-buffered saline. Interestingly, the dissolution rate of lidocaine was not significantly different between the synthetic and biological media. Importantly, and with relevance to intraperitoneal drug delivery systems, the sustained release of lidocaine from a thermosensitive gel formulation occurred at a significantly faster rate into peritoneal fluid. Collectively, these data demonstrate the variation between commonly used synthetic media and human peritoneal fluid. The differences in drug release rates observed illustrate the need for bio-relevant media, which ultimately would improve in vitro-in vivo correlation.

Population pharmacokinetics of intravenous busulfan in patients undergoing hematopoietic stem cell transplantation.

PubMed

Takama, H; Tanaka, H; Nakashima, D; Ueda, R; Takaue, Y

2006-02-01

A population pharmacokinetic analysis was performed in 30 patients who received an intravenous busulfan and cyclophosphamide regimen before hematopoietic stem cell transplantation. Each patient received 0.8 mg/kg as a 2 h infusion every 6 h for 16 doses. A total of 690 concentration measurements were analyzed using the nonlinear mixed effect model (NONMEM) program. A one-compartment model with an additive error model as an intraindividual variability including an interoccasion variability (IOV) in clearance (CL) was sufficient to describe the concentration-time profile of busulfan. Actual body weight (ABW) was found to be the determinant for CL and the volume of distribution (V) according to NONMEM analysis. In this limited study, the age (range 7-53 years old; median, 30 years old) had no significant effect on busulfan pharmacokinetics. For a patient weighting 60 kg, the typical CL and V were estimated to be 8.87 l/h and 33.8 l, respectively. The interindividual variability of CL and V were 13.6 and 6.3%, respectively. The IOV (6.6%) in CL was estimated to be less than the intraindividual variability. These results indicate high interpatient and intrapatient consistency of busulfan pharmacokinetics after intravenous administration, which may eliminate the requirement for pharmacokinetic monitoring.

Patient-specific model of a scoliotic torso for surgical planning

NASA Astrophysics Data System (ADS)

Harmouche, Rola; Cheriet, Farida; Labelle, Hubert; Dansereau, Jean

2013-03-01

A method for the construction of a patient-specific model of a scoliotic torso for surgical planning via inter-patient registration is presented. Magnetic Resonance Images (MRI) of a generic model are registered to surface topography (TP) and X-ray data of a test patient. A partial model is first obtained via thin-plate spline registration between TP and X-ray data of the test patient. The MRIs from the generic model are then fit into the test patient using articulated model registration between the vertebrae of the generic model's MRIs in prone position and the test patient's X-rays in standing position. A non-rigid deformation of the soft tissues is performed using a modified thin-plate spline constrained to maintain bone rigidity and to fit in the space between the vertebrae and the surface of the torso. Results show average Dice values of 0:975 +/- 0:012 between the MRIs following inter-patient registration and the surface topography of the test patient, which is comparable to the average value of 0:976 +/- 0:009 previously obtained following intra-patient registration. The results also show a significant improvement compared to rigid inter-patient registration. Future work includes validating the method on a larger cohort of patients and incorporating soft tissue stiffness constraints. The method developed can be used to obtain a geometric model of a patient including bone structures, soft tissues and the surface of the torso which can be incorporated in a surgical simulator in order to better predict the outcome of scoliosis surgery, even if MRI data cannot be acquired for the patient.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Moore, B; Yin, F; Cai, J

Purpose: To determine the variation in tumor contrast between different MRI sequences and between patients for the purpose of MRI-based treatment planning. Methods: Multiple MRI scans of 11 patients with cancer(s) in the liver were included in this IRB-approved study. Imaging sequences consisted of T1W MRI, Contrast-Enhanced T1W MRI, T2W MRI, and T2*/T1W MRI. MRI images were acquired on a 1.5T GE Signa scanner with a four-channel torso coil. We calculated the tumor-to-tissue contrast to noise ratio (CNR) for each MR sequence by contouring the tumor and a region of interest (ROI) in a homogeneous region of the liver usingmore » the Eclipse treatment planning software. CNR was calculated (I-Tum-I-ROI)/SD-ROI, where I-Tum and I-ROI are the mean values of the tumor and the ROI respectively, and SD-ROI is the standard deviation of the ROI. The same tumor and ROI structures were used in all measurements for different MR sequences. Inter-patient Coefficient of variation (CV), and inter-sequence CV was determined. In addition, mean and standard deviation of CNR were calculated and compared between different MR sequences. Results: Our preliminary results showed large inter-patient CV (range: 37.7% to 88%) and inter-sequence CV (range 5.3% to 104.9%) of liver tumor CNR, indicating great variations in tumor CNR between MR sequences and between patients. Tumor CNR was found to be largest in CE-T1W (8.5±7.5), followed by T2W (4.2±2.4), T1W (3.4±2.2), and T2*/T1W (1.7±0.6) MR scans. The inter-patient CV of tumor CNR was also the largest in CE-T1W (88%), followed by T1W (64.3%), T1W (56.2%), and T2*/T1W (37.7) MR scans. Conclusion: Large inter-sequence and inter-patient variations were observed in liver tumor CNR. CE-T1W MR images on average provided the best tumor CNR. Efforts are needed to optimize tumor contrast and its consistency for MRI-based treatment planning of cancer in the liver. This project is supported by NIH grant: 1R21CA165384.« less

A systematic review of the risk factors for clinical response to opioids for all-age patients with cancer-related pain and presentation of the paediatric STOP pain study.

PubMed

Lucenteforte, Ersilia; Vagnoli, Laura; Pugi, Alessandra; Crescioli, Giada; Lombardi, Niccolò; Bonaiuti, Roberto; Aricò, Maurizio; Giglio, Sabrina; Messeri, Andrea; Mugelli, Alessandro; Vannacci, Alfredo; Maggini, Valentina

2018-05-18

Inter-patient variability in response to opioids is well known but a comprehensive definition of its pathophysiological mechanism is still lacking and, more importantly, no studies have focused on children. The STOP Pain project aimed to evaluate the risk factors that contribute to clinical response and adverse drug reactions to opioids by means of a systematic review and a clinical investigation on paediatric oncological patients. We conducted a systematic literature search in EMBASE and PubMed up to the 24th of November 2016 following Cochrane Handbook and PRISMA guidelines. Two independent reviewers screened titles and abstracts along with full-text papers; disagreements were resolved by discussion with two other independent reviewers. We used a data extraction form to provide details of the included studies, and conducted quality assessment using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Young age, lung or gastrointestinal cancer, neuropathic or breakthrough pain and anxiety or sleep disturbance were associated to a worse response to opioid analgesia. No clear association was identified in literature regarding gender, ethnicity, weight, presence of metastases, biochemical or hematological factors. Studies in children were lacking. Between June 2011 and April 2014, the Italian STOP Pain project enrolled 87 paediatric cancer patients under treatment with opioids (morphine, codeine, oxycodone, fentanyl and tramadol). Future studies on cancer pain should be designed with consideration for the highlighted factors to enhance our understanding of opioid non-response and safety. Studies in children are mandatory. CRD42017057740 .

Stochastic targeted (STAR) glycemic control: design, safety, and performance.

PubMed

Evans, Alicia; Le Compte, Aaron; Tan, Chia-Siong; Ward, Logan; Steel, James; Pretty, Christopher G; Penning, Sophie; Suhaimi, Fatanah; Shaw, Geoffrey M; Desaive, Thomas; Chase, J Geoffrey

2012-01-01

Tight glycemic control (TGC) has shown benefits but has been difficult to achieve consistently. STAR (Stochastic TARgeted) is a flexible, model-based TGC approach that directly accounts for intra- and interpatient variability with a stochastically derived maximum 5% risk of blood glucose (BG) below 72 mg/dl. This research assesses the safety, efficacy, and clinical burden of a STAR TGC controller modulating both insulin and nutrition inputs in virtual and clinical pilot trials. Clinically validated virtual trials using data from 370 patients in the SPRINT (Specialized Relative Insulin and Nutrition Titration) study were used to design the STAR protocol and test its safety, performance, and required clinical effort prior to clinical pilot trials. Insulin and nutrition interventions were given every 1-3 h as chosen by the nurse to allow them to manage workload. Interventions were designed to maximize the overlap of the model-predicted (5-95(th) percentile) range of BG outcomes with the 72-117 mg/dl band and thus provide a maximum 5% risk of BG <72 mg/dl. Interventions were calculated using clinically validated computer models of human metabolism and its variability in critical illness. Carbohydrate intake (all sources) was selected to maximize intake up to 100% of the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) goal (25 kg/kcal/h). Insulin doses were limited (8 U/h maximum), with limited increases based on current rate (0.5-2.0 U/h). Initial clinical pilot trials involved 3 patients covering ~450 h. Approval was granted by the Upper South A Regional Ethics Committee. Virtual trials indicate that STAR provides similar glycemic control performance to SPRINT with 2-3 h (maximum) measurement intervals. Time in the 72-126 mg/dl and 72-145 mg/dl bands was equivalent for all controllers, indicating that glycemic outcome differences between protocols were only shifted in this range. Safety from hypoglycemia was improved. Importantly, STAR using 2-3 h (maximum) intervention intervals reduced clinical burden up to 30%, which is clinically very significant. Initial clinical trials showed glycemic performance, safety, and management of inter- and intrapatient variability that matched or exceeded the virtual trial results. In virtual trials, STAR TGC provided tight control that maximized the likelihood of BG in a clinically specified glycemic band and reduced hypoglycemia with a maximum 5% (or lower) expected risk of light hypoglycemia (BG <72 mg/dl) via model-based management of intra- and interpatient variability. Clinical workload was self-managed and reduced up to 30% compared with SPRINT. Initial pilot clinical trials matched or exceeded these virtual results. © 2012 Diabetes Technology Society.

The National Clinical Trials Network: Conducting Successful Clinical Trials of New Therapies for Rare Cancers

PubMed Central

Schott, Anne F.; Welch, John J.; Verschraegen, Claire F.; Kurzrock, Razelle

2015-01-01

Rare cancers account for 27% of neoplasms diagnosed each year, and 25% of cancer-related deaths in the United States. However, rare cancers show some of the highest response rates to targeted therapies, probably due to identification of oncogenic drivers with little inter-patient variability. Although the low incidence of rare cancers make large scale randomized trials involving single histologies difficult to perform, drugs have been successfully developed in rare cancers utilizing clinical trial designs that combine microscopic anatomies. Such trials are being pursued within the National Clinical Trials Network (NCTN), which possesses unique qualifications to perform widespread molecular screening of tumors for patient enrollment onto therapeutic clinical trials. When larger clinical trials are needed to determine optimum treatment strategies in rare cancers, the NCTN's broad reach in North America and internationally, and ability to partner with both US-based and international research organizations, can make these challenging studies feasible. PMID:26433554

Computational Motion Phantoms and Statistical Models of Respiratory Motion

NASA Astrophysics Data System (ADS)

Ehrhardt, Jan; Klinder, Tobias; Lorenz, Cristian

Breathing motion is not a robust and 100 % reproducible process, and inter- and intra-fractional motion variations form an important problem in radiotherapy of the thorax and upper abdomen. A widespread consensus nowadays exists that it would be useful to use prior knowledge about respiratory organ motion and its variability to improve radiotherapy planning and treatment delivery. This chapter discusses two different approaches to model the variability of respiratory motion. In the first part, we review computational motion phantoms, i.e. computerized anatomical and physiological models. Computational phantoms are excellent tools to simulate and investigate the effects of organ motion in radiation therapy and to gain insight into methods for motion management. The second part of this chapter discusses statistical modeling techniques to describe the breathing motion and its variability in a population of 4D images. Population-based models can be generated from repeatedly acquired 4D images of the same patient (intra-patient models) and from 4D images of different patients (inter-patient models). The generation of those models is explained and possible applications of those models for motion prediction in radiotherapy are exemplified. Computational models of respiratory motion and motion variability have numerous applications in radiation therapy, e.g. to understand motion effects in simulation studies, to develop and evaluate treatment strategies or to introduce prior knowledge into the patient-specific treatment planning.

In vivo wide-field multispectral dosimeter for use in ALA-PpIX based photodynamic therapy of skin

NASA Astrophysics Data System (ADS)

LaRochelle, Ethan P. M.; Davis, Scott C.; de Souza, Ana Luiza Ribeiro; Pogue, Brian W.

2017-02-01

Photodynamic therapy (PDT) for Actinic Kertoses (AK) using aminoluvelinic acid (ALA) is an FDA-approved treatment, which is generally effective, yet response rates vary. The origin of the variability is not well characterized, but may be related to inter-patient variability in the production of protoporphyrin IX (PpIX). While fiber-based point probe systems provide a method for measuring PpIX production, these measurements have demonstrated large spatial and inter-operator variability. Thus, in an effort to improve patient-specific dosimetry and treatment it is important to develop a robust system that accounts for spatial variability and reduces the chance of operator errors. To address this need, a wide-field multispectral imaging system was developed that is capable of quantifying maps of PpIX in both liquid phantoms and in vivo experiments, focusing on high sensitivity light signals. The system uses both red and blue excitation to elicit a fluorescent response at varying skin depths. A ten-position filter wheel with bandpass filters ranging from 635nm to 710nm are used to capture images along the emission band. A linear least-square spectral fitting algorithm provides the ability to decouple background autofluorescence from PpIX fluorescence, which has improved the system sensitivity by an order of magnitude, detecting nanomolar PpIX concentrations in liquid phantoms in the presence of 2% whole blood and 2% intralipid.

Control Law Design for Propofol Infusion to Regulate Depth of Hypnosis: A Nonlinear Control Strategy

PubMed Central

Khaqan, Ali; Bilal, Muhammad; Ilyas, Muhammad; Ijaz, Bilal; Ali Riaz, Raja

2016-01-01

Maintaining the depth of hypnosis (DOH) during surgery is one of the major objectives of anesthesia infusion system. Continuous administration of Propofol infusion during surgical procedures is essential but increases the undue load of an anesthetist in operating room working in a multitasking setup. Manual and target controlled infusion (TCI) systems are not good at handling instabilities like blood pressure changes and heart rate variability arising due to interpatient variability. Patient safety, large interindividual variability, and less postoperative effects are the main factors to motivate automation in anesthesia. The idea of automated system for Propofol infusion excites the control engineers to come up with a more sophisticated and safe system that handles optimum delivery of drug during surgery and avoids postoperative effects. In contrast to most of the investigations with linear control strategies, the originality of this research work lies in employing a nonlinear control technique, backstepping, to track the desired hypnosis level of patients during surgery. This effort is envisioned to unleash the true capabilities of this nonlinear control technique for anesthesia systems used today in biomedical field. The working of the designed controller is studied on the real dataset of five patients undergoing surgery. The controller tracks the desired hypnosis level within the acceptable range for surgery. PMID:27293475

Control Law Design for Propofol Infusion to Regulate Depth of Hypnosis: A Nonlinear Control Strategy.

PubMed

Khaqan, Ali; Bilal, Muhammad; Ilyas, Muhammad; Ijaz, Bilal; Ali Riaz, Raja

2015-01-01

Maintaining the depth of hypnosis (DOH) during surgery is one of the major objectives of anesthesia infusion system. Continuous administration of Propofol infusion during surgical procedures is essential but increases the undue load of an anesthetist in operating room working in a multitasking setup. Manual and target controlled infusion (TCI) systems are not good at handling instabilities like blood pressure changes and heart rate variability arising due to interpatient variability. Patient safety, large interindividual variability, and less postoperative effects are the main factors to motivate automation in anesthesia. The idea of automated system for Propofol infusion excites the control engineers to come up with a more sophisticated and safe system that handles optimum delivery of drug during surgery and avoids postoperative effects. In contrast to most of the investigations with linear control strategies, the originality of this research work lies in employing a nonlinear control technique, backstepping, to track the desired hypnosis level of patients during surgery. This effort is envisioned to unleash the true capabilities of this nonlinear control technique for anesthesia systems used today in biomedical field. The working of the designed controller is studied on the real dataset of five patients undergoing surgery. The controller tracks the desired hypnosis level within the acceptable range for surgery.

Quantitative image feature variability amongst CT scanners with a controlled scan protocol

NASA Astrophysics Data System (ADS)

Ger, Rachel B.; Zhou, Shouhao; Chi, Pai-Chun Melinda; Goff, David L.; Zhang, Lifei; Lee, Hannah J.; Fuller, Clifton D.; Howell, Rebecca M.; Li, Heng; Stafford, R. Jason; Court, Laurence E.; Mackin, Dennis S.

2018-02-01

Radiomics studies often analyze patient computed tomography (CT) images acquired from different CT scanners. This may result in differences in imaging parameters, e.g. different manufacturers, different acquisition protocols, etc. However, quantifiable differences in radiomics features can occur based on acquisition parameters. A controlled protocol may allow for minimization of these effects, thus allowing for larger patient cohorts from many different CT scanners. In order to test radiomics feature variability across different CT scanners a radiomics phantom was developed with six different cartridges encased in high density polystyrene. A harmonized protocol was developed to control for tube voltage, tube current, scan type, pitch, CTDIvol, convolution kernel, display field of view, and slice thickness across different manufacturers. The radiomics phantom was imaged on 18 scanners using the control protocol. A linear mixed effects model was created to assess the impact of inter-scanner variability with decomposition of feature variation between scanners and cartridge materials. The inter-scanner variability was compared to the residual variability (the unexplained variability) and to the inter-patient variability using two different patient cohorts. The patient cohorts consisted of 20 non-small cell lung cancer (NSCLC) and 30 head and neck squamous cell carcinoma (HNSCC) patients. The inter-scanner standard deviation was at least half of the residual standard deviation for 36 of 49 quantitative image features. The ratio of inter-scanner to patient coefficient of variation was above 0.2 for 22 and 28 of the 49 features for NSCLC and HNSCC patients, respectively. Inter-scanner variability was a significant factor compared to patient variation in this small study for many of the features. Further analysis with a larger cohort will allow more thorough analysis with additional variables in the model to truly isolate the interscanner difference.

Clinical brain MR imaging prescriptions in Talairach space: technologist- and computer-driven methods.

PubMed

Weiss, Kenneth L; Pan, Hai; Storrs, Judd; Strub, William; Weiss, Jane L; Jia, Li; Eldevik, O Petter

2003-05-01

Variability in patient head positioning may yield substantial interstudy image variance in the clinical setting. We describe and test three-step technologist and computer-automated algorithms designed to image the brain in a standard reference system and reduce variance. Triple oblique axial images obtained parallel to the Talairach anterior commissure (AC)-posterior commissure (PC) plane were reviewed in a prospective analysis of 126 consecutive patients. Requisite roll, yaw, and pitch correction, as three authors determined independently and subsequently by consensus, were compared with the technologists' actual graphical prescriptions and those generated by a novel computer automated three-step (CATS) program. Automated pitch determinations generated with Statistical Parametric Mapping '99 (SPM'99) were also compared. Requisite pitch correction (15.2 degrees +/- 10.2 degrees ) far exceeded that for roll (-0.6 degrees +/- 3.7 degrees ) and yaw (-0.9 degrees +/- 4.7 degrees ) in terms of magnitude and variance (P <.001). Technologist and computer-generated prescriptions substantially reduced interpatient image variance with regard to roll (3.4 degrees and 3.9 degrees vs 13.5 degrees ), yaw (0.6 degrees and 2.5 degrees vs 22.3 degrees ), and pitch (28.6 degrees, 18.5 degrees with CATS, and 59.3 degrees with SPM'99 vs 104 degrees ). CATS performed worse than the technologists in yaw prescription, and it was equivalent in roll and pitch prescriptions. Talairach prescriptions better approximated standard CT canthomeatal angulations (9 degrees vs 24 degrees ) and provided more efficient brain coverage than that of routine axial imaging. Brain MR prescriptions corrected for direct roll, yaw, and Talairach AC-PC pitch can be readily achieved by trained technologists or automated computer algorithms. This ability will substantially reduce interpatient variance, allow better approximation of standard CT angulation, and yield more efficient brain coverage than that of routine clinical axial imaging.

Pharmacokinetics and pharmacodynamics of carboplatin administered in a high-dose combination regimen with thiotepa, cyclophosphamide and peripheral stem cell support.

PubMed Central

van Warmerdam, L. J.; Rodenhuis, S.; van der Wall, E.; Maes, R. A.; Beijnen, J. H.

1996-01-01

The aim of this pharmacokinetic/pharmacodynamic study was to define the relationships of the carboplatin exposure with the toxicity in patients treated with high dose carboplatin (400 mg m-2 day-1), cyclophosphamide (1500 mg m-2 day-1) and thiotepa (120 mg m-2 day-1) for four consecutive days, followed by peripheral stem cell transplantation. Exposure to carboplatin was studied in 200 treatment days by measuring the area under the carboplatin plasma ultrafiltrate (pUF) concentration vs time curve (AUC). The AUC was obtained by using a previously validated limited sampling model. A total of 31 patients was studied who received one, two or three courses of this high-dose chemotherapy regimen. The unbound, plasma ultrafiltrate carboplatin was almost completely cleared from the body before each next treatment day in a course; the day-to-day AUC variation was 3.3%. The mean cumulative AUC over 4 days was 19.6 (range 14.1-27.2) mg ml-1 min-1. In 97 treatment days the carboplatin dose was calculated using the Calvert formula with the creatinine clearance as the measure for the glomerular filtration rate (GFR). For these courses, the inter-patient variability in pharmacokinetics was significantly reduced from 21% to 15% (P = 0.007) in comparison with the schemes where it was given as a fixed dose of 400 mg m-2. There were no relationships found between toxicity and the AUC of carboplatin, which may be due to the influence of overlapping toxicities of cyclophosphamide and thiotepa. However, the ototoxicity was strongly related to the cumulative carboplatin AUC. This toxicity was dose limiting for carboplatin in this schedule. It appeared that the carboplatin pharmacokinetics in these regimens were similar to those reported at conventional dosages. To reduce the inter-patient variation, the carboplatin dose can be calculated using the Calvert-formula with the creatinine clearance as the measure for the GFR. PMID:8611435

Stochastic optimization of intensity modulated radiotherapy to account for uncertainties in patient sensitivity

NASA Astrophysics Data System (ADS)

Kåver, Gereon; Lind, Bengt K.; Löf, Johan; Liander, Anders; Brahme, Anders

1999-12-01

The aim of the present work is to better account for the known uncertainties in radiobiological response parameters when optimizing radiation therapy. The radiation sensitivity of a specific patient is usually unknown beyond the expectation value and possibly the standard deviation that may be derived from studies on groups of patients. Instead of trying to find the treatment with the highest possible probability of a desirable outcome for a patient of average sensitivity, it is more desirable to maximize the expectation value of the probability for the desirable outcome over the possible range of variation of the radiation sensitivity of the patient. Such a stochastic optimization will also have to consider the distribution function of the radiation sensitivity and the larger steepness of the response for the individual patient. The results of stochastic optimization are also compared with simpler methods such as using biological response `margins' to account for the range of sensitivity variation. By using stochastic optimization, the absolute gain will typically be of the order of a few per cent and the relative improvement compared with non-stochastic optimization is generally less than about 10 per cent. The extent of this gain varies with the level of interpatient variability as well as with the difficulty and complexity of the case studied. Although the dose changes are rather small (<5 Gy) there is a strong desire to make treatment plans more robust, and tolerant of the likely range of variation of the radiation sensitivity of each individual patient. When more accurate predictive assays of the radiation sensitivity for each patient become available, the need to consider the range of variations can be reduced considerably.

Prediction of individual response to anticancer therapy: historical and future perspectives.

PubMed

Unger, Florian T; Witte, Irene; David, Kerstin A

2015-02-01

Since the introduction of chemotherapy for cancer treatment in the early 20th century considerable efforts have been made to maximize drug efficiency and at the same time minimize side effects. As there is a great interpatient variability in response to chemotherapy, the development of predictive biomarkers is an ambitious aim for the rapidly growing research area of personalized molecular medicine. The individual prediction of response will improve treatment and thus increase survival and life quality of patients. In the past, cell cultures were used as in vitro models to predict in vivo response to chemotherapy. Several in vitro chemosensitivity assays served as tools to measure miscellaneous endpoints such as DNA damage, apoptosis and cytotoxicity or growth inhibition. Twenty years ago, the development of high-throughput technologies, e.g. cDNA microarrays enabled a more detailed analysis of drug responses. Thousands of genes were screened and expression levels were correlated to drug responses. In addition, mutation analysis became more and more important for the prediction of therapeutic success. Today, as research enters the area of -omics technologies, identification of signaling pathways is a tool to understand molecular mechanism underlying drug resistance. Combining new tissue models, e.g. 3D organoid cultures with modern technologies for biomarker discovery will offer new opportunities to identify new drug targets and in parallel predict individual responses to anticancer therapy. In this review, we present different currently used chemosensitivity assays including 2D and 3D cell culture models and several -omics approaches for the discovery of predictive biomarkers. Furthermore, we discuss the potential of these assays and biomarkers to predict the clinical outcome of individual patients and future perspectives.

Non-steroidal anti-inflammatory drugs. Current status and rational therapeutic use.

PubMed

Hart, F D; Huskisson, E C

1984-03-01

Aspirin (acetylsalicylic acid), the first of the NSAIDs (introduced in 1899), was initially never referred to as an anti-inflammatory agent. It was the advent of cortisone in 1949 that demonstrated dramatically that corticosteroids had anti-inflammatory properties and the term 'non-steroidal anti-inflammatory drug' was first used when phenylbutazone was introduced 3 years later. Since then, the NSAIDs have proliferated. There is to date no good evidence that they halt progression of rheumatoid disease, but by easing pain and diminishing swelling they make life much easier in osteoarthrosis, rheumatoid arthritis and many other types of arthritis, and are the drugs of first choice in acute gout. Their mode (or modes) of action are obscure and though inhibition of cyclo-oxygenase (prostaglandin synthetase) is clearly important, other mechanisms are also involved. The assessment of the anti-inflammatory action of these agents has received considerable attention in clinical trials because, whatever their action may be in experimental animal models, their action in inflamed joints in human patients must be ascertained, since there may be little parallel between the two. Different experimental animal models give different results with various agents and often bear little relation to their therapeutic action in man. No attempt has been made here to review in depth all the NSAIDs that have appeared since 1952. All have anti-inflammatory and analgesic activity and all can cause gastrointestinal side effects, though effectiveness and toxicity vary from drug to drug and patient to patient, there being very great interpatient variability. Non-reactors, patients who apparently fail to respond to certain agents, need further study, for it seems that these subjects may metabolise these agents differently from others. Considerable ingenuity has been shown not only in evolving new NSAIDs but in finding new ways of administering them. The number and variety of NSAIDs in their various forms varies greatly from country to country, depending largely on the regulatory bodies of those countries. In the meantime, the search for a better, less toxic compound continues with the hope that one may be found which has a deeper and more basic action on the underlying disease process.

Modeling and segmentation of intra-cochlear anatomy in conventional CT

NASA Astrophysics Data System (ADS)

Noble, Jack H.; Rutherford, Robert B.; Labadie, Robert F.; Majdani, Omid; Dawant, Benoit M.

2010-03-01

Cochlear implant surgery is a procedure performed to treat profound hearing loss. Since the cochlea is not visible in surgery, the physician uses anatomical landmarks to estimate the pose of the cochlea. Research has indicated that implanting the electrode in a particular cavity of the cochlea, the scala tympani, results in better hearing restoration. The success of the scala tympani implantation is largely dependent on the point of entry and angle of electrode insertion. Errors can occur due to the imprecise nature of landmark-based, manual navigation as well as inter-patient variations between scala tympani and the anatomical landmarks. In this work, we use point distribution models of the intra-cochlear anatomy to study the inter-patient variations between the cochlea and the typical anatomic landmarks, and we implement an active shape model technique to automatically localize intra-cochlear anatomy in conventional CT images, where intra-cochlear structures are not visible. This fully automatic segmentation could aid the surgeon to choose the point of entry and angle of approach to maximize the likelihood of scala tympani insertion, resulting in more substantial hearing restoration.

[Population pharmacokinetics applied to optimising cisplatin doses in cancer patients].

PubMed

Ramón-López, A; Escudero-Ortiz, V; Carbonell, V; Pérez-Ruixo, J J; Valenzuela, B

2012-01-01

To develop and internally validate a population pharmacokinetics model for cisplatin and assess its prediction capacity for personalising doses in cancer patients. Cisplatin plasma concentrations in forty-six cancer patients were used to determine the pharmacokinetic parameters of a two-compartment pharmacokinetic model implemented in NONMEN VI software. Pharmacokinetic parameter identification capacity was assessed using the parametric bootstrap method and the model was validated using the nonparametric bootstrap method and standardised visual and numerical predictive checks. The final model's prediction capacity was evaluated in terms of accuracy and precision during the first (a priori) and second (a posteriori) chemotherapy cycles. Mean population cisplatin clearance is 1.03 L/h with an interpatient variability of 78.0%. Estimated distribution volume at steady state was 48.3 L, with inter- and intrapatient variabilities of 31,3% and 11,7%, respectively. Internal validation confirmed that the population pharmacokinetics model is appropriate to describe changes over time in cisplatin plasma concentrations, as well as its variability in the study population. The accuracy and precision of a posteriori prediction of cisplatin concentrations improved by 21% and 54% compared to a priori prediction. The population pharmacokinetic model developed adequately described the changes in cisplatin plasma concentrations in cancer patients and can be used to optimise cisplatin dosing regimes accurately and precisely. Copyright © 2011 SEFH. Published by Elsevier Espana. All rights reserved.

Comparative analysis of semantic localization accuracies between adult and pediatric DICOM CT images

NASA Astrophysics Data System (ADS)

Robertson, Duncan; Pathak, Sayan D.; Criminisi, Antonio; White, Steve; Haynor, David; Chen, Oliver; Siddiqui, Khan

2012-02-01

Existing literature describes a variety of techniques for semantic annotation of DICOM CT images, i.e. the automatic detection and localization of anatomical structures. Semantic annotation facilitates enhanced image navigation, linkage of DICOM image content and non-image clinical data, content-based image retrieval, and image registration. A key challenge for semantic annotation algorithms is inter-patient variability. However, while the algorithms described in published literature have been shown to cope adequately with the variability in test sets comprising adult CT scans, the problem presented by the even greater variability in pediatric anatomy has received very little attention. Most existing semantic annotation algorithms can only be extended to work on scans of both adult and pediatric patients by adapting parameters heuristically in light of patient size. In contrast, our approach, which uses random regression forests ('RRF'), learns an implicit model of scale variation automatically using training data. In consequence, anatomical structures can be localized accurately in both adult and pediatric CT studies without the need for parameter adaptation or additional information about patient scale. We show how the RRF algorithm is able to learn scale invariance from a combined training set containing a mixture of pediatric and adult scans. Resulting localization accuracy for both adult and pediatric data remains comparable with that obtained using RRFs trained and tested using only adult data.

Phase I and pharmacokinetic evaluation of floxuridine/leucovorin given on the Roswell Park weekly regimen.

PubMed

Creaven, P J; Rustum, Y M; Petrelli, N J; Meropol, N J; Raghavan, D; Rodriguez-Bigas, M; Levine, E G; Frank, C; Udvary-Nagy, S; Proefrock, A

1994-01-01

A phase I and pharmacokinetics study was carried out of floxuridine (FdUrd) modulated by leucovorin (LV) given on the Roswell Park regimen (LV given at 500 mg/m2 by 2-h infusion and FdUrd given by i.v. push at 1 h after the start of LV infusion, treatment being given weekly x 6). The dose-limiting toxicity was diarrhea; the MTD and recommended dose for phase II studies was 1,650 mg/m2 per week of FdUrd. The dose-response curve was steep, with 3/3 patients treated at a dose of 1,750 mg/m2 developing grade IV diarrhea. With this schedule there was no significant mucositis. Pharmacokinetic parameters showed very wide interpatient variability. Plasma decay was biphasic with a t1/2 beta of approximately 2 h. Plasma clearance was high (> 200 1 h-1). No correlation between pharmacokinetic parameters and toxicity could be identified.

A Raman spectroscopy bio-sensor for tissue discrimination in surgical robotics.

PubMed

Ashok, Praveen C; Giardini, Mario E; Dholakia, Kishan; Sibbett, Wilson

2014-01-01

We report the development of a fiber-based Raman sensor to be used in tumour margin identification during endoluminal robotic surgery. Although this is a generic platform, the sensor we describe was adapted for the ARAKNES (Array of Robots Augmenting the KiNematics of Endoluminal Surgery) robotic platform. On such a platform, the Raman sensor is intended to identify ambiguous tissue margins during robot-assisted surgeries. To maintain sterility of the probe during surgical intervention, a disposable sleeve was specially designed. A straightforward user-compatible interface was implemented where a supervised multivariate classification algorithm was used to classify different tissue types based on specific Raman fingerprints so that it could be used without prior knowledge of spectroscopic data analysis. The protocol avoids inter-patient variability in data and the sensor system is not restricted for use in the classification of a particular tissue type. Representative tissue classification assessments were performed using this system on excised tissue. Copyright © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Pulmonary function at diagnosis of amyotrophic lateral sclerosis. Rate of deterioration.

PubMed

Schiffman, P L; Belsh, J M

1993-02-01

The purpose of this study was to determine the degree of respiratory muscle impairment in patients with newly diagnosed amyotrophic lateral sclerosis (ALS) and the subsequent rate of decline of respiratory function. Thirty-one of 36 patients had respiratory muscle weakness at presentation, although only 7 complained of any respiratory symptoms. Vital capacity (percent predicted) was significantly lower in the symptomatic group (55.9 +/- 20.3) compared with the asymptomatic group (76.4 +/- 21.0). Respiratory muscle impairment as measured by vital capacity (percent predicted) was related to stage of disease at presentation. Rate of decline of respiratory muscle strength as measured by VC (-3.5 percent/month), negative inspiratory pressure (NIF) (+2.9 cm H2O/month), and positive expiratory pressure (PEP) (-3.4 cm H2O/month) tended to be linear with a great deal of interpatient variability. It is concluded that early measurement of respiratory muscle strength in ALS with subsequent follow-up studies may be useful in determining overall prognosis and in decision making.

Rare platelet GPCR variants: what can we learn?

PubMed

Nisar, S P; Jones, M L; Cunningham, M R; Mumford, A D; Mundell, S J

2015-07-01

Platelet-expressed GPCRs are critical regulators of platelet function. Pharmacological blockade of these receptors forms a powerful therapeutic tool in the treatment and prevention of arterial thrombosis associated with coronary atherosclerosis and ischaemic stroke. However, anti-thrombotic drug therapy is associated with high inter-patient variability in therapeutic response and adverse bleeding side effects. In order to optimize the use of existing anti-platelet drugs and to develop new therapies, more detailed knowledge is required relating to the molecular mechanisms that regulate GPCR and therefore platelet function. One approach has been to identify rare, function-disrupting mutations within key platelet proteins in patients with bleeding disorders. In this review, we describe how an integrated functional genomics strategy has contributed important structure-function information about platelet GPCRs with specific emphasis upon purinergic and thromboxane A2 receptors. We also discuss the potential implications these findings have for pharmacotherapy and for understanding the molecular basis of mild bleeding disorders. © 2014 The British Pharmacological Society.

Therapeutic drug monitoring in patients with inflammatory bowel disease

PubMed Central

Yarur, Andres J; Abreu, Maria T; Deshpande, Amar R; Kerman, David H; Sussman, Daniel A

2014-01-01

Thiopurine analogs and anti-tumor necrosis factor (TNF) agents have dramatically changed the therapeutics of inflammatory bowel diseases (IBD), improving short and long-term outcomes. Unfortunately some patients do not respond to therapy and others lose response over time. The pharmacokinetic properties of these drugs are complex, with high inter-patient variability. Thiopurine analogs are metabolized through a series of pathways, which vary according to the patients’ pharmacogenetic profile. This profile largely determines the ratios of metabolites, which are in turn associated with likelihoods of clinical efficacy and/or toxicity. Understanding these mechanisms allows for manipulation of drug dose, aiming to reduce the development of toxicity while improving the efficacy of treatment. The efficacy of anti-TNF drugs is influenced by many pharmacodynamic variables. Several factors may alter drug clearance, including the concomitant use of immunomodulators (thiopurine analogs and methotrexate), systemic inflammation, the presence of anti-drug antibodies, and body mass. The treatment of IBD has evolved with the understanding of the pharmacologic profiles of immunomodulating and TNF-inhibiting medications, with good evidence for improvement in patient outcomes observed when measuring metabolic pathway indices. The role of routine measurement of metabolite/drug levels and antibodies warrants further prospective studies as we enter the era of personalized IBD care. PMID:24707130

[Medical Image Registration Method Based on a Semantic Model with Directional Visual Words].

PubMed

Jin, Yufei; Ma, Meng; Yang, Xin

2016-04-01

Medical image registration is very challenging due to the various imaging modality,image quality,wide inter-patients variability,and intra-patient variability with disease progressing of medical images,with strict requirement for robustness.Inspired by semantic model,especially the recent tremendous progress in computer vision tasks under bag-of-visual-word framework,we set up a novel semantic model to match medical images.Since most of medical images have poor contrast,small dynamic range,and involving only intensities and so on,the traditional visual word models do not perform very well.To benefit from the advantages from the relative works,we proposed a novel visual word model named directional visual words,which performs better on medical images.Then we applied this model to do medical registration.In our experiment,the critical anatomical structures were first manually specified by experts.Then we adopted the directional visual word,the strategy of spatial pyramid searching from coarse to fine,and the k-means algorithm to help us locating the positions of the key structures accurately.Sequentially,we shall register corresponding images by the areas around these positions.The results of the experiments which were performed on real cardiac images showed that our method could achieve high registration accuracy in some specific areas.

Population pharmacokinetic and pharmacogenetic analysis of 6-mercaptopurine in paediatric patients with acute lymphoblastic leukaemia

PubMed Central

Hawwa, Ahmed F; Collier, Paul S; Millership, Jeff S; McCarthy, Anthony; Dempsey, Sid; Cairns, Carole; McElnay, James C

2008-01-01

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECTThe cytotoxic effects of 6-mercaptopurine (6-MP) were found to be due to drug-derived intracellular metabolites (mainly 6-thioguanine nucleotides and to some extent 6-methylmercaptopurine nucleotides) rather than the drug itself.Current empirical dosing methods for oral 6-MP result in highly variable drug and metabolite concentrations and hence variability in treatment outcome. WHAT THIS STUDY ADDSThe first population pharmacokinetic model has been developed for 6-MP active metabolites in paediatric patients with acute lymphoblastic leukaemia and the potential demographic and genetically controlled factors that could lead to interpatient pharmacokinetic variability among this population have been assessed.The model shows a large reduction in interindividual variability of pharmacokinetic parameters when body surface area and thiopurine methyltransferase polymorphism are incorporated into the model as covariates.The developed model offers a more rational dosing approach for 6-MP than the traditional empirical method (based on body surface area) through combining it with pharmacogenetically guided dosing based on thiopurine methyltransferase genotype. AIMS To investigate the population pharmacokinetics of 6-mercaptopurine (6-MP) active metabolites in paediatric patients with acute lymphoblastic leukaemia (ALL) and examine the effects of various genetic polymorphisms on the disposition of these metabolites. METHODS Data were collected prospectively from 19 paediatric patients with ALL (n = 75 samples, 150 concentrations) who received 6-MP maintenance chemotherapy (titrated to a target dose of 75 mg m−2 day−1). All patients were genotyped for polymorphisms in three enzymes involved in 6-MP metabolism. Population pharmacokinetic analysis was performed with the nonlinear mixed effects modelling program (nonmem) to determine the population mean parameter estimate of clearance for the active metabolites. RESULTS The developed model revealed considerable interindividual variability (IIV) in the clearance of 6-MP active metabolites [6-thioguanine nucleotides (6-TGNs) and 6-methylmercaptopurine nucleotides (6-mMPNs)]. Body surface area explained a significant part of 6-TGNs clearance IIV when incorporated in the model (IIV reduced from 69.9 to 29.3%). The most influential covariate examined, however, was thiopurine methyltransferase (TPMT) genotype, which resulted in the greatest reduction in the model's objective function (P < 0.005) when incorporated as a covariate affecting the fractional metabolic transformation of 6-MP into 6-TGNs. The other genetic covariates tested were not statistically significant and therefore were not included in the final model. CONCLUSIONS The developed pharmacokinetic model (if successful at external validation) would offer a more rational dosing approach for 6-MP than the traditional empirical method since it combines the current practice of using body surface area in 6-MP dosing with a pharmacogenetically guided dosing based on TPMT genotype. PMID:18823306

Ten problems and solutions when predicting individual outcome from lesion site after stroke.

PubMed

Price, Cathy J; Hope, Thomas M; Seghier, Mohamed L

2017-01-15

In this paper, we consider solutions to ten of the challenges faced when trying to predict an individual's functional outcome after stroke on the basis of lesion site. A primary goal is to find lesion-outcome associations that are consistently observed in large populations of stroke patients because consistent associations maximise confidence in future individualised predictions. To understand and control multiple sources of inter-patient variability, we need to systematically investigate each contributing factor and how each factor depends on other factors. This requires very large cohorts of patients, who differ from one another in typical and measurable ways, including lesion site, lesion size, functional outcome and time post stroke (weeks to decades). These multivariate investigations are complex, particularly when the contributions of different variables interact with one another. Machine learning algorithms can help to identify the most influential variables and indicate dependencies between different factors. Multivariate lesion analyses are needed to understand how the effect of damage to one brain region depends on damage or preservation in other brain regions. Such data-led investigations can reveal predictive relationships between lesion site and outcome. However, to understand and improve the predictions we need explanatory models of the neural networks and degenerate pathways that support functions of interest. This will entail integrating the results of lesion analyses with those from functional imaging (fMRI, MEG), transcranial magnetic stimulation (TMS) and diffusor tensor imaging (DTI) studies of healthy participants and patients. Copyright © 2016 Elsevier Inc. All rights reserved.

Ten problems and solutions when predicting individual outcome from lesion site after stroke

PubMed Central

Price, Cathy J.; Hope, Thomas M.; Seghier, Mohamed L.

2016-01-01

In this paper, we consider solutions to ten of the challenges faced when trying to predict an individual’s functional outcome after stroke on the basis of lesion site. A primary goal is to find lesion-outcome associations that are consistently observed in large populations of stroke patients because consistent associations maximise confidence in future individualised predictions. To understand and control multiple sources of inter-patient variability, we need to systematically investigate each contributing factor and how each factor depends on other factors. This requires very large cohorts of patients, who differ from one another in typical and measurable ways, including lesion site, lesion size, functional outcome and time post stroke (weeks to decades). These multivariate investigations are complex, particularly when the contributions of different variables interact with one another. Machine learning algorithms can help to identify the most influential variables and indicate dependencies between different factors. Multivariate lesion analyses are needed to understand how the effect of damage to one brain region depends on damage or preservation in other brain regions. Such data-led investigations can reveal predictive relationships between lesion site and outcome. However, to understand and improve predictions we need explanatory models of the neural networks and degenerate pathways that support functions of interest. This will entail integrating the results of lesion analyses with those from functional imaging (fMRI, MEG), transcranial magnetic stimulation (TMS) and diffusor tensor imaging (DTI) studies of healthy participants and patients. PMID:27502048

Molecular and Cellular Determinants of Malignant Transformation in Pulmonary Premalignancy

DTIC Science & Technology

2017-07-01

AWARD NUMBER: W81XWH-16-1-0194 TITLE: Molecular and Cellular Determinants of Malignant Transformation in Pulmonary Premalignancy PRINCIPAL...2017 4. TITLE AND SUBTITLE Molecular and Cellular Determinants of Malignant Transformation in Pulmonary Premalignancy 5a. CONTRACT NUMBER 5b. GRANT...Sequenced Regions Figure 2. Intra- and inter-patient genetic heterogeneity of pulmonary lesions. A) Distribution of Jaccard indices comparing n.s

Advancements in automated tissue segmentation pipeline for contrast-enhanced CT scans of adult and pediatric patients

NASA Astrophysics Data System (ADS)

Somasundaram, Elanchezhian; Kaufman, Robert; Brady, Samuel

2017-03-01

The development of a random forests machine learning technique is presented for fully-automated neck, chest, abdomen, and pelvis tissue segmentation of CT images using Trainable WEKA (Waikato Environment for Knowledge Analysis) Segmentation (TWS) plugin of FIJI (ImageJ, NIH). The use of a single classifier model to segment six tissue classes (lung, fat, muscle, solid organ, blood/contrast agent, bone) in the CT images is studied. An automated unbiased scheme to sample pixels from the training images and generate a balanced training dataset over the seven classes is also developed. Two independent training datasets are generated from a pool of 4 adult (>55 kg) and 3 pediatric patients (<=55 kg) with 7 manually contoured slices for each patient. Classifier training investigated 28 image filters comprising a total of 272 features. Highly correlated and insignificant features are eliminated using Correlated Feature Subset (CFS) selection with Best First Search (BFS) algorithms in WEKA. The 2 training models (from the 2 training datasets) had 74 and 71 input training features, respectively. The study also investigated the effect of varying the number of trees (25, 50, 100, and 200) in the random forest algorithm. The performance of the 2 classifier models are evaluated on inter-patient intra-slice, intrapatient inter-slice and inter-patient inter-slice test datasets. The Dice similarity coefficients (DSC) and confusion matrices are used to understand the performance of the classifiers across the tissue segments. The effect of number of features in the training input on the performance of the classifiers for tissue classes with less than optimal DSC values is also studied. The average DSC values for the two training models on the inter-patient intra-slice test data are: 0.98, 0.89, 0.87, 0.79, 0.68, and 0.84, for lung, fat, muscle, solid organ, blood/contrast agent, and bone, respectively. The study demonstrated that a robust segmentation accuracy for lung, muscle and fat tissue classes. For solid-organ, blood/contrast and bone, the performance of the segmentation pipeline improved significantly by using the advanced capabilities of WEKA. However, further improvements are needed to reduce the noise in the segmentation.

Pharmacokinetic variability, efficacy and tolerability of eslicarbazepine acetate-A national approach to the evaluation of therapeutic drug monitoring data and clinical outcome.

PubMed

Svendsen, Torleiv; Brodtkorb, Eylert; Reimers, Arne; Molden, Espen; Sætre, Erik; Johannessen, Svein I; Johannessen Landmark, Cecilie

2017-01-01

Eslicarbazepine acetate (ESL) is a new antiepileptic drug (AED), still insufficiently studied regarding pharmacokinetic variability, efficacy and tolerability. The purpose of this study was to evaluate therapeutic drug monitoring (TDM) data in Norway and relate pharmacokinetic variability to clinical efficacy and tolerability in a long-term clinical setting in patients with refractory epilepsy. This retrospective observational study included TDM-data from the main laboratories and population data from the Norwegian Prescription Database in Norway, in addition to clinical data from medical records of adult patients using ESL for up to three years, whenever possible. TDM-data from 168 patients were utilized for assessment of pharmacokinetic variability, consisting of 71% of the total number of patients in Norway using ESL, 2011-14. Median daily dose of ESL was 800mg (range 400-1600mg), and median serum concentration of ESL was 53μmol/L (range 13-132μmol/L). Inter-patient variability of ESL was extensive, with 25-fold variability in concentration/dose ratios. Additional clinical data were available from 104 adult patients out of the 168, all with drug resistant focal epilepsy. After 1, 2 and 3 years follow-up, the retention rate of ESL was 83%, 72% and 64%, respectively. ESL was generally well tolerated as add-on treatment, but sedation, cognitive impairment and hyponatremia were reported. Hyponatremia (sodium <137mmol/L) was present in 36% of the patients, and lead to discontinuation in three. Pharmacokinetic variability of ESL was extensive and the demonstration of usefulness of TDM requires further studies. In patients with drug resistant focal Epilepsy, the high retention rate indicated good efficacy and tolerability. Hyponatremia was observed in one third of the patients. The present results point to a need for individualization of treatment and TDM may be useful. Copyright © 2016 Elsevier B.V. All rights reserved.

Quantification of cellular autofluorescence of human skin using multiphoton tomography and fluorescence lifetime imaging in two spectral detection channels

PubMed Central

Patalay, Rakesh; Talbot, Clifford; Alexandrov, Yuriy; Munro, Ian; Neil, Mark A. A.; König, Karsten; French, Paul M. W.; Chu, Anthony; Stamp, Gordon W.; Dunsby, Chris

2011-01-01

We explore the diagnostic potential of imaging endogenous fluorophores using two photon microscopy and fluorescence lifetime imaging (FLIM) in human skin with two spectral detection channels. Freshly excised benign dysplastic nevi (DN) and malignant nodular Basal Cell Carcinomas (nBCCs) were excited at 760 nm. The resulting fluorescence signal was binned manually on a cell by cell basis. This improved the reliability of fitting using a double exponential decay model and allowed the fluorescence signatures from different cell populations within the tissue to be identified and studied. We also performed a direct comparison between different diagnostic groups. A statistically significant difference between the median mean fluorescence lifetime of 2.79 ns versus 2.52 ns (blue channel, 300-500 nm) and 2.08 ns versus 1.33 ns (green channel, 500-640 nm) was found between nBCCs and DN respectively, using the Mann-Whitney U test (p < 0.01). Further differences in the distribution of fluorescence lifetime parameters and inter-patient variability are also discussed. PMID:22162820

Using reconstructed IVUS images for coronary plaque classification.

PubMed

Caballero, Karla L; Barajas, Joel; Pujol, Oriol; Rodriguez, Oriol; Radeva, Petia

2007-01-01

Coronary plaque rupture is one of the principal causes of sudden death in western societies. Reliable diagnostic of the different plaque types are of great interest for the medical community the predicting their evolution and applying an effective treatment. To achieve this, a tissue classification must be performed. Intravascular Ultrasound (IVUS) represents a technique to explore the vessel walls and to observe its histological properties. In this paper, a method to reconstruct IVUS images from the raw Radio Frequency (RF) data coming from ultrasound catheter is proposed. This framework offers a normalization scheme to compare accurately different patient studies. The automatic tissue classification is based on texture analysis and Adapting Boosting (Adaboost) learning technique combined with Error Correcting Output Codes (ECOC). In this study, 9 in-vivo cases are reconstructed with 7 different parameter set. This method improves the classification rate based on images, yielding a 91% of well-detected tissue using the best parameter set. It also reduces the inter-patient variability compared with the analysis of DICOM images, which are obtained from the commercial equipment.

Challenges and opportunities in patient-specific, motion-managed and PET/CT-guided radiation therapy of lung cancer: review and perspective

PubMed Central

2012-01-01

The increasing interest in combined positron emission tomography (PET) and computed tomography (CT) to guide lung cancer radiation therapy planning has been well documented. Motion management strategies during treatment simulation PET/CT imaging and treatment delivery have been proposed to improve the precision and accuracy of radiotherapy. In light of these research advances, why has translation of motion-managed PET/CT to clinical radiotherapy been slow and infrequent? Solutions to this problem are as complex as they are numerous, driven by large inter-patient variability in tumor motion trajectories across a highly heterogeneous population. Such variation dictates a comprehensive and patient-specific incorporation of motion management strategies into PET/CT-guided radiotherapy rather than a one-size-fits-all tactic. This review summarizes challenges and opportunities for clinical translation of advances in PET/CT-guided radiotherapy, as well as in respiratory motion-managed radiotherapy of lung cancer. These two concepts are then integrated into proposed patient-specific workflows that span classification schemes, PET/CT image formation, treatment planning, and adaptive image-guided radiotherapy delivery techniques. PMID:23369522

Pharmacokinetics of 13-cis-retinoic acid in patients with advanced cancer.

PubMed

Goodman, G E; Einspahr, J G; Alberts, D S; Davis, T P; Leigh, S A; Chen, H S; Meyskens, F L

1982-05-01

13-cis-Retinoic acid (13-CRA) is a synthetic analog of vitamin A effective reversing preneoplastic lesions in both humans and animals. To study its physiochemical properties and disposition kinetics, we developed a rapid, sensitive, and precise high-performance liquid chromatography assay for 13-CRA in biological samples. This assay system resulted in a clear separation of 13-CRA from all-trans-retinoic acid and retinol and had a detection limit of 20 ng/ml plasma. Recovery was 89 +/- 6% (S.D.) at equivalent physiological concentrations with a precision of 8%. To study the disposition kinetics in humans, 13 patients received a p.o. bolus of 13-CRA and had blood samples collected at timed intervals. For the 10 patients studied on the first day of 13-CRA administration, the mean time to peak plasma concentration was 222 +/- 102 min. Interpatient peak 13-CRA plasma concentrations were found to be variable, suggesting irregular gastrointestinal absorption. Beta-Phase t 1/2 was approximately 25 hr. The prolonged terminal-phase plasma half-life may represent biliary excretion and enterohepatic circulation.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sorensen, J; Duran, C; Stingo, F

Purpose: To characterize the effect of virtual monochromatic reconstructions on several commonly used texture analysis features in DECT of the chest. Further, to assess the effect of monochromatic energy levels on the ability of these textural features to identify tissue types. Methods: 20 consecutive patients underwent chest CTs for evaluation of lung nodules using Siemens Somatom Definition Flash DECT. Virtual monochromatic images were constructed at 10keV intervals from 40–190keV. For each patient, an ROI delineated the lesion under investigation, and cylindrical ROI’s were placed within 5 different healthy tissues (blood, fat, muscle, lung, and liver). Several histogram- and Grey Levelmore » Cooccurrence Matrix (GLCM)-based texture features were then evaluated in each ROI at each energy level. As a means of validation, these feature values were then used in a random forest classifier to attempt to identify the tissue types present within each ROI. Their predictive accuracy at each energy level was recorded. Results: All textural features changed considerably with virtual monochromatic energy, particularly below 70keV. Most features exhibited a global minimum or maximum around 80keV, and while feature values changed with energy above this, patient ranking was generally unaffected. As expected, blood demonstrated the lowest inter-patient variability, for all features, while lung lesions (encompassing many different pathologies) exhibited the highest. The accuracy of these features in identifying tissues (76% accuracy) was highest at 80keV, but no clear relationship between energy and classification accuracy was found. Two common misclassifications (blood vs liver and muscle vs fat) accounted for the majority (24 of the 28) errors observed. Conclusion: All textural features were highly dependent on virtual monochromatic energy level, especially below 80keV, and were more stable above this energy. However, in a random forest model, these commonly used features were able to reliably differentiate between most tissues types regardless of energy level. Dr Godoy has received a dual-energy CT research grant from Siemens Healthcare. That grant did not directly fund this research.« less

Quantitative Analysis of Signaling Networks across Differentially Embedded Tumors Highlights Interpatient Heterogeneity in Human Glioblastoma

PubMed Central

2015-01-01

Glioblastoma multiforme (GBM) is the most aggressive malignant primary brain tumor, with a dismal mean survival even with the current standard of care. Although in vitro cell systems can provide mechanistic insight into the regulatory networks governing GBM cell proliferation and migration, clinical samples provide a more physiologically relevant view of oncogenic signaling networks. However, clinical samples are not widely available and may be embedded for histopathologic analysis. With the goal of accurately identifying activated signaling networks in GBM tumor samples, we investigated the impact of embedding in optimal cutting temperature (OCT) compound followed by flash freezing in LN2 vs immediate flash freezing (iFF) in LN2 on protein expression and phosphorylation-mediated signaling networks. Quantitative proteomic and phosphoproteomic analysis of 8 pairs of tumor specimens revealed minimal impact of the different sample processing strategies and highlighted the large interpatient heterogeneity present in these tumors. Correlation analyses of the differentially processed tumor sections identified activated signaling networks present in selected tumors and revealed the differential expression of transcription, translation, and degradation associated proteins. This study demonstrates the capability of quantitative mass spectrometry for identification of in vivo oncogenic signaling networks from human tumor specimens that were either OCT-embedded or immediately flash-frozen. PMID:24927040

Evolution of the Pseudomonas aeruginosa mutational resistome in an international Cystic Fibrosis clone.

PubMed

López-Causapé, Carla; Sommer, Lea Mette; Cabot, Gabriel; Rubio, Rosa; Ocampo-Sosa, Alain A; Johansen, Helle Krogh; Figuerola, Joan; Cantón, Rafael; Kidd, Timothy J; Molin, Soeren; Oliver, Antonio

2017-07-17

Emergence of epidemic clones and antibiotic resistance development compromises the management of Pseudomonas aeruginosa cystic fibrosis (CF) chronic respiratory infections. Whole genome sequencing (WGS) was used to decipher the phylogeny, interpatient dissemination, WGS mutator genotypes (mutome) and resistome of a widespread clone (CC274), in isolates from two highly-distant countries, Australia and Spain, covering an 18-year period. The coexistence of two divergent CC274 clonal lineages was revealed, but without evident geographical barrier; phylogenetic reconstructions and mutational resistome demonstrated the interpatient transmission of mutators. The extraordinary capacity of P. aeruginosa to develop resistance was evidenced by the emergence of mutations in >100 genes related to antibiotic resistance during the evolution of CC274, catalyzed by mutator phenotypes. While the presence of classical mutational resistance mechanisms was confirmed and correlated with resistance phenotypes, results also showed a major role of unexpected mutations. Among them, PBP3 mutations, shaping up β-lactam resistance, were noteworthy. A high selective pressure for mexZ mutations was evidenced, but we showed for the first time that high-level aminoglycoside resistance in CF is likely driven by mutations in fusA1/fusA2, coding for elongation factor G. Altogether, our results provide valuable information for understanding the evolution of the mutational resistome of CF P. aeruginosa.

Variation of fluorescence spectroscopy during the menstrual cycle

NASA Astrophysics Data System (ADS)

Macaulay, Calum; Richards-Kortum, Rebecca; Utzinger, Urs; Fedyk, Amanda; Neely Atkinson, E.; Cox, Dennis; Follen, Michele

2002-06-01

Cervical autofluorescence has been demonstrated to have potential for real-time diagnosis. Inter-patient and intra-patient variations in fluorescence intensity have been measured. Inter-patient measurements may vary by a factor of ten, while intra-patient measurements may vary by a factor of two. Age and menopausal status have been demonstrated to account for some of the variations, while race and smoking have not. In order to explore in detail the role of the menstrual cycle in intra-patient variation, a study was designed to measure fluorescence excitation emission matrices (EEMs) in patients daily throughout one cycle. Ten patients with a history of normal menstrual cycles and normal Papanicolaou smears underwent daily measurements of fluorescence EEMs from three colposcopically normal sites throughout one menstrual cycle. Changes in signals from porphyrin, NADH, and FAD fluorescence and blood absorption were noted when the data was viewed in a graphical format. Visually interpreted features of the EEMs in this graphical format did not appear to correlate with the day of the menstrual cycle with the exception that blood absorption features were more prominent during the menstrual phase (during which bleeding occurs), suggesting that measurements during the menstrual phase should be avoided. Variations in cycle date likely do not account for inter- or intra-patient variations.

A phase I and pharmacokinetic study of the quinoxaline antitumour Agent R(+)XK469 in patients with advanced solid tumours

PubMed Central

Undevia, Samir D.; Innocenti, Federico; Ramirez, Jacqueline; House, Larry; Desai, Apurva A.; Skoog, Linda A.; Singh, Deepti A.; Karrison, Theodore; Kindler, Hedy L.; Ratain, Mark J.

2009-01-01

Purpose To investigate the safety and pharmacokinetics of R(+)XK469, a quinoxaline analogue, in patients with advanced refractory solid tumours. Preclinical studies suggested that efficacy was independent of schedule but that toxicity was decreased by dividing the dose. Methods R(+)XK469 was initially administered as a 30 min intravenous infusion on days 1–5 of a 21-d cycle. Based on the demonstration of a long half-life, the dosing schedule was subsequently amended to infusion on days 1, 3 and 5 of a 21-d cycle. An alternate single-dose schedule of once every 21 d was also explored. Blood samples were collected for pharmaco-kinetic studies. Results Dose-limiting toxicity (DLT) was neutropaenia. There was significant interindividual variability in clearance as evidenced by a coefficient of variation of 46%. A flat-dosing scheme (not based on body surface area) was justified by the absence of correlation between clearance and body surface area. A partial response was observed in a patient with nasopharyngeal carcinoma. Conclusions The recommended phase II doses are 850–1100 mg/d on days 1, 3 and 5 of a 21-d cycle and 2500 mg on day 1 of a 21-d cycle. The observed interpatient pharmacokinetic variability should prompt investigation into the presence of genetic polymorphism in relevant metabolizing enzymes. PMID:18650079

Tympanic ear thermometer assessment of body temperature among patients with cognitive disturbances. An acceptable and ethically desirable alternative?

PubMed

Aadal, Lena; Fog, Lisbet; Pedersen, Asger Roer

2016-12-01

Investigation of a possible relation between body temperature measurements by the current generation of tympanic ear and rectal thermometers. In Denmark, a national guideline recommends the rectal measurement. Subsequently, the rectal thermometers and tympanic ear devices are the most frequently used and first choice in Danish hospital wards. Cognitive changes constitute challenges with cooperating in rectal temperature assessments. With regard to diagnosing, ethics, safety and the patients' dignity, the tympanic ear thermometer might comprise a desirable alternative to rectal noninvasive measurement of body temperature during in-hospital-based neurorehabilitation. A prospective, descriptive cohort study. Consecutive inclusion of 27 patients. Linear regression models were used to analyse 284 simultaneous temperature measurements. Ethical approval for this study was granted by the Danish Data Protection Agency, and the study was completed in accordance with the Helsinki Declaration 2008. About 284 simultaneous rectal and ear temperature measurements on 27 patients were analysed. The patient-wise variability of measured temperatures was significantly higher for the ear measurements. Patient-wise linear regressions for the 25 patients with at least three pairs of simultaneous ear and rectal temperature measurements showed large interpatient variability of the association. A linear relationship between the rectal body temperature assessment and the temperature assessment employing the tympanic thermometer is weak. Both measuring methods reflect variance in temperature, but ear measurements showed larger variation. © 2016 Nordic College of Caring Science.

High Intrapatient Variability of Tacrolimus Exposure in the Early Period After Liver Transplantation Is Associated With Poorer Outcomes.

PubMed

Rayar, Michel; Tron, Camille; Jézéquel, Caroline; Beaurepaire, Jean Marie; Petitcollin, Antoine; Houssel-Debry, Pauline; Camus, Christophe; Verdier, Marie Clémence; Dehlawi, Ammar; Lakéhal, Mohamed; Desfourneaux, Véronique; Meunier, Bernard; Sulpice, Laurent; Bellissant, Eric; Boudjema, Karim; Lemaitre, Florian

2018-03-01

Tacrolimus (TAC) is the cornerstone of immunosuppressive regimen in liver transplantation (LT). Its pharmacokinetics is characterized by a high interpatient and intrapatient variability (IPV) leading to an unpredictable dose-response relationship. The aim of our study was to evaluate the impact of TAC IPV (IPV) on graft and patient outcomes after LT. We retrospectively analyzed 812 LT recipients treated with TAC. The IPV of TAC concentrations was estimated by calculating the coefficient of variation (CV) of whole blood trough concentrations. Patients were categorized in 2 groups: low IPV (CV < 40%) and high IPV (CV ≥ 40%). There were significantly more neurologic complications (31.2% vs 16.6%, P < 0.001), cardiovascular complications (19.7% vs 9.7%, P < 0.001), and acute renal failure requiring dialysis (8.5% vs 2.2%, P < 0.001) in the high CV group than in the low CV group. Moreover, graft survival was significantly poorer in the high CV group (hazard ratio, 1.42; 95% confidence interval, 1.04-1.95; P = 0.03). A pretransplantation elevated Model for End-Stage Liver Disease score (P < 0.001) and Child-Pugh grade (P < 0.001) were identified as risk factors for presenting a high CV. A high CV of TAC concentrations was found to be predictive of TAC-related toxicity and poorer survival.

Comparison of the In Vivo Pharmacokinetics and In Vitro Dissolution of Raltegravir in HIV Patients Receiving the Drug by Swallowing or by Chewing

PubMed Central

Baldelli, Sara; Cerea, Matteo; Landonio, Simona; Meraviglia, Paola; Simioni, Emanuela; Cozzi, Valeria; Fucile, Serena; Gazzaniga, Andrea; Clementi, Emilio; Galli, Massimo; Rizzardini, Giuliano; Gervasoni, Cristina

2012-01-01

The pharmacokinetics of raltegravir (RAL) in HIV patients is characterized by high interpatient/intrapatient variability. We investigated the potential contribution of the drug pharmaceutical formulation to RAL pharmacokinetics. We first compared in vivo the pharmacokinetics of RAL for 67 patients to whom the drug was administered by swallowing the intact tablet with those obtained from 13 HIV-infected patients who chewed the RAL tablet due to swallowing difficulties. Subsequently, we evaluated in vitro the dissolution of RAL tablets under different conditions. In the in vivo study, we found that patients given RAL by chewing the tablets presented pharmacokinetic profiles characterized by significantly higher RAL absorption than did patients receiving the drug by swallowing. The in vitro studies showed that when the whole tablets were exposed to an acidic medium, the release of RAL was very low, whereas when the tablets were crushed, the profiles presented significantly higher concentrations of RAL. Crushed tablets tested in water or in a pH 6.8 buffer exhibited prompt and complete dissolution of RAL. HIV-infected patients receiving RAL by chewing the tablet showed higher drug absorption and reduced pharmacokinetic variability compared with patients swallowing the intact tablet. This is related to problems in tablet disintegration and to erratic drug absorption. The amelioration of the RAL pharmaceutical formulation could improve drug pharmacokinetics. PMID:22964253

Chaperones in Polyglutamine Aggregation: Beyond the Q-Stretch

PubMed Central

Kuiper, E. F. E.; de Mattos, Eduardo P.; Jardim, Laura B.; Kampinga, Harm H.; Bergink, Steven

2017-01-01

Expanded polyglutamine (polyQ) stretches in at least nine unrelated proteins lead to inherited neuronal dysfunction and degeneration. The expansion size in all diseases correlates with age at onset (AO) of disease and with polyQ protein aggregation, indicating that the expanded polyQ stretch is the main driving force for the disease onset. Interestingly, there is marked interpatient variability in expansion thresholds for a given disease. Between different polyQ diseases the repeat length vs. AO also indicates the existence of modulatory effects on aggregation of the upstream and downstream amino acid sequences flanking the Q expansion. This can be either due to intrinsic modulation of aggregation by the flanking regions, or due to differential interaction with other proteins, such as the components of the cellular protein quality control network. Indeed, several lines of evidence suggest that molecular chaperones have impact on the handling of different polyQ proteins. Here, we review factors differentially influencing polyQ aggregation: the Q-stretch itself, modulatory flanking sequences, interaction partners, cleavage of polyQ-containing proteins, and post-translational modifications, with a special focus on the role of molecular chaperones. By discussing typical examples of how these factors influence aggregation, we provide more insight on the variability of AO between different diseases as well as within the same polyQ disorder, on the molecular level. PMID:28386214

Plasma concentrations of 5-fluorouracil and its metabolites in colon cancer patients.

PubMed

Casale, Federico; Canaparo, Roberto; Serpe, Loredana; Muntoni, Elisabetta; Pepa, Carlo Della; Costa, Mario; Mairone, Lorenza; Zara, Gian Paolo; Fornari, Gianni; Eandi, Mario

2004-08-01

5-Fluorouracil (5-FU) is a common anticancer agent used in the treatment of solid tumours, with a reported variability in the pharmacokinetic profile and inter-patient differences in efficacy and toxicity. Since 5-FU is intracellularly metabolised to active cytotoxic fluoronucleotides, some authors suggested it would be useful to determine the plasma levels of its main metabolites 5-fluoro-5,6-dihydrouracil (5-FUH2), 5-fluorouridine (5-FUrd) and 5-fluoro-2'-deoxyuridine (5-FdUrd), in order to better characterise population pharmacokinetics-pharmacodynamics (PK-PD) of this drug. We developed and validated an HPLC method to simultaneously determine plasma concentrations of 5-FU and the three main metabolites, and we analysed the plasma concentration-time curves of the first dose of 18 colon cancer patients treated with folinic acid and 5-FU 400 mg m(-2) by intra-venous bolus injection as adjuvant chemotherapy. Non-compartmental PK analysis has been applied to 5-FU and 5-FUH2 concentrations, estimating the following parameters (median values): Cmax 55.44 and 6.23 microg ml(-1), respectively, AUC(0-2 h) 11.59 and 5.94 hx microg ml(-1), CLTB 30.64 and 51.81 lh(-1) m(-2), 5-FUH2/5-FU AUC ratio 0.47 (range 0.29-1.12). We verified the patient covariables which could influence the inter-patient variability in the area under the time-concentration curves, and we observed that age, sex, weight, body surface area, cycle of therapy, toxicity development and 5-FUrd or 5-FdUrd detectability did not have statistical influence on 5-FUH2/5-FU AUC ratio. In eight subjects, we compared the PK data of the first and the fifth day of dose administration, and we found stable 5-FU values, but the 5-FUH2 disposition decreased with lower AUC(0-2 h) (7.90 hx microg ml(-1) versus 5.99 hx microg ml(-1)) and, particularly, Cmax (8.38 microg ml(-1) versus 5.50 microg ml(-1)) at day 5. This fact, evident in almost every patient, could suggest a possible reduction in the catabolic pathway of 5-FU leading to 5-FUH2, with a possible increase of the therapeutic pathway. For this reason, we tried to detect 5-FUrd and 5-FdUrd and, in fact, in our patients these metabolites were detected only in few samples, but most of them at day 5. In conclusion, our study confirms the relevance of pharmacokinetic analysis of 5-FU main metabolites and especially 5-FUH2, to better understand the metabolism and to improve the therapeutic efficacy. Copyright 2004 Elsevier Ltd.

Population pharmacokinetic and pharmacogenetic analysis of tacrolimus in paediatric liver transplant patients

PubMed Central

Abdel Jalil, Mariam H; Hawwa, Ahmed F; McKiernan, Patrick J; Shields, Michael D; McElnay, James C

2014-01-01

Aims To build a population pharmacokinetic model that describes the apparent clearance of tacrolimus and the potential demographic, clinical and genetically controlled factors that could lead to inter-patient pharmacokinetic variability within children following liver transplantation. Methods The present study retrospectively examined tacrolimus whole blood pre-dose concentrations (n = 628) of 43 children during their first year post-liver transplantation. Population pharmacokinetic analysis was performed using the non-linear mixed effects modelling program (nonmem) to determine the population mean parameter estimate of clearance and influential covariates. Results The final model identified time post-transplantation and CYP3A5*1 allele as influential covariates on tacrolimus apparent clearance according to the following equation: where TVCL is the typical value for apparent clearance, TPT is time post-transplantation in days and the CYP3A5 is 1 where *1 allele is present and 0 otherwise. The population estimate and inter-individual variability (%CV) of tacrolimus apparent clearance were found to be 0.977 l h−1 kg−1 (95% CI 0.958, 0.996) and 40.0%, respectively, while the residual variability between the observed and predicted concentrations was 35.4%. Conclusion Tacrolimus apparent clearance was influenced by time post-transplantation and CYP3A5 genotypes. The results of this study, once confirmed by a large scale prospective study, can be used in conjunction with therapeutic drug monitoring to recommend tacrolimus dose adjustments that take into account not only body weight but also genetic and time-related changes in tacrolimus clearance. PMID:23738951

Emergence of Resistance to Atovaquone-Proguanil in Malaria Parasites: Insights from Computational Modeling and Clinical Case Reports

PubMed Central

Musset, Lise; Hubert, Véronique; Le Bras, Jacques

2014-01-01

The usefulness of atovaquone-proguanil (AP) as an antimalarial treatment is compromised by the emergence of atovaquone resistance during therapy. However, the origin of the parasite mitochondrial DNA (mtDNA) mutation conferring atovaquone resistance remains elusive. Here, we report a patient-based stochastic model that tracks the intrahost emergence of mutations in the multicopy mtDNA during the first erythrocytic parasite cycles leading to the malaria febrile episode. The effect of mtDNA copy number, mutation rate, mutation cost, and total parasite load on the mutant parasite load per patient was evaluated. Computer simulations showed that almost any infected patient carried, after four to seven erythrocytic cycles, de novo mutant parasites at low frequency, with varied frequencies of parasites carrying varied numbers of mutant mtDNA copies. A large interpatient variability in the size of this mutant reservoir was found; this variability was due to the different parameters tested but also to the relaxed replication and partitioning of mtDNA copies during mitosis. We also report seven clinical cases in which AP-resistant infections were treated by AP. These provided evidence that parasiticidal drug concentrations against AP-resistant parasites were transiently obtained within days after treatment initiation. Altogether, these results suggest that each patient carries new mtDNA mutant parasites that emerge before treatment but are killed by high starting drug concentrations. However, because the size of this mutant reservoir is highly variable from patient to patient, we propose that some patients fail to eliminate all of the mutant parasites, repeatedly producing de novo AP treatment failures. PMID:24867967

Monte Carlo treatment planning for molecular targeted radiotherapy within the MINERVA system

NASA Astrophysics Data System (ADS)

Lehmann, Joerg; Hartmann Siantar, Christine; Wessol, Daniel E.; Wemple, Charles A.; Nigg, David; Cogliati, Josh; Daly, Tom; Descalle, Marie-Anne; Flickinger, Terry; Pletcher, David; DeNardo, Gerald

2005-03-01

The aim of this project is to extend accurate and patient-specific treatment planning to new treatment modalities, such as molecular targeted radiation therapy, incorporating previously crafted and proven Monte Carlo and deterministic computation methods. A flexible software environment is being created that allows planning radiation treatment for these new modalities and combining different forms of radiation treatment with consideration of biological effects. The system uses common input interfaces, medical image sets for definition of patient geometry and dose reporting protocols. Previously, the Idaho National Engineering and Environmental Laboratory (INEEL), Montana State University (MSU) and Lawrence Livermore National Laboratory (LLNL) had accrued experience in the development and application of Monte Carlo based, three-dimensional, computational dosimetry and treatment planning tools for radiotherapy in several specialized areas. In particular, INEEL and MSU have developed computational dosimetry systems for neutron radiotherapy and neutron capture therapy, while LLNL has developed the PEREGRINE computational system for external beam photon-electron therapy. Building on that experience, the INEEL and MSU are developing the MINERVA (modality inclusive environment for radiotherapeutic variable analysis) software system as a general framework for computational dosimetry and treatment planning for a variety of emerging forms of radiotherapy. In collaboration with this development, LLNL has extended its PEREGRINE code to accommodate internal sources for molecular targeted radiotherapy (MTR), and has interfaced it with the plugin architecture of MINERVA. Results from the extended PEREGRINE code have been compared to published data from other codes, and found to be in general agreement (EGS4—2%, MCNP—10%) (Descalle et al 2003 Cancer Biother. Radiopharm. 18 71-9). The code is currently being benchmarked against experimental data. The interpatient variability of the drug pharmacokinetics in MTR can only be properly accounted for by image-based, patient-specific treatment planning, as has been common in external beam radiation therapy for many years. MINERVA offers 3D Monte Carlo-based MTR treatment planning as its first integrated operational capability. The new MINERVA system will ultimately incorporate capabilities for a comprehensive list of radiation therapies. In progress are modules for external beam photon-electron therapy and boron neutron capture therapy (BNCT). Brachytherapy and proton therapy are planned. Through the open application programming interface (API), other groups can add their own modules and share them with the community.

Molecular evolution of HIV-1 integrase during the 20 years prior to the first approval of integrase inhibitors.

PubMed

Meixenberger, Karolin; Yousef, Kaveh Pouran; Smith, Maureen Rebecca; Somogyi, Sybille; Fiedler, Stefan; Bartmeyer, Barbara; Hamouda, Osamah; Bannert, Norbert; von Kleist, Max; Kücherer, Claudia

2017-11-14

Detailed knowledge of the evolutionary potential of polymorphic sites in a viral protein is important for understanding the development of drug resistance in the presence of an inhibitor. We therefore set out to analyse the molecular evolution of the HIV-1 subtype B integrase at the inter-patient level in Germany during a 20-year period prior to the first introduction of integrase strand inhibitors (INSTIs). We determined 337 HIV-1 integrase subtype B sequences (amino acids 1-278) from stored plasma samples of antiretroviral treatment-naïve individuals newly diagnosed with HIV-1 between 1986 and 2006. Shannon entropy was calculated to determine the variability at each amino acid position. Time trends in the frequency of amino acid variants were identified by linear regression. Direct coupling analysis was applied to detect covarying sites. Twenty-two time trends in the frequency of amino acid variants demonstrated either single amino acid exchanges or variation in the degree of polymorphy. Covariation was observed for 17 amino acid variants with a temporal trend. Some minor INSTI resistance mutations (T124A, V151I, K156 N, T206S, S230 N) and some INSTI-selected mutations (M50I, L101I, T122I, T124 N, T125A, M154I, G193E, V201I) were identified at overall frequencies >5%. Among these, the frequencies of L101I, T122I, and V201I increased over time, whereas the frequency of M154I decreased. Moreover, L101I, T122I, T124A, T125A, M154I, and V201I covaried with non-resistance-associated variants. Time-trending, covarying polymorphisms indicate that long-term evolutionary changes of the HIV-1 integrase involve defined clusters of possibly structurally or functionally associated sites independent of selective pressure through INSTIs at the inter-patient level. Linkage between polymorphic resistance- and non-resistance-associated sites can impact the selection of INSTI resistance mutations in complex ways. Identification of these sites can help in improving genotypic resistance assays, resistance prediction algorithms, and the development of new integrase inhibitors.

Robust linear parameter-varying control of blood pressure using vasoactive drugs

NASA Astrophysics Data System (ADS)

Luspay, Tamas; Grigoriadis, Karolos

2015-10-01

Resuscitation of emergency care patients requires fast restoration of blood pressure to a target value to achieve hemodynamic stability and vital organ perfusion. A robust control design methodology is presented in this paper for regulating the blood pressure of hypotensive patients by means of the closed-loop administration of vasoactive drugs. To this end, a dynamic first-order delay model is utilised to describe the vasoactive drug response with varying parameters that represent intra-patient and inter-patient variability. The proposed framework consists of two components: first, an online model parameter estimation is carried out using a multiple-model extended Kalman-filter. Second, the estimated model parameters are used for continuously scheduling a robust linear parameter-varying (LPV) controller. The closed-loop behaviour is characterised by parameter-varying dynamic weights designed to regulate the mean arterial pressure to a target value. Experimental data of blood pressure response of anesthetised pigs to phenylephrine injection are used for validating the LPV blood pressure models. Simulation studies are provided to validate the online model estimation and the LPV blood pressure control using phenylephrine drug injection models representing patients showing sensitive, nominal and insensitive response to the drug.

Modelling catheter-vein biomechanical interactions during an intravenous procedure.

PubMed

Weiss, Dar; Gefen, Amit; Einav, Shmuel

2016-02-01

A reliable intravenous (IV) access into the upper extremity veins requires the insertion of a temporary short peripheral catheter (SPC). This so common procedure is, however, associated with a risk of developing short peripheral catheter thrombophlebitis (SPCT) which causes distress and potentially prolongs patient hospitalization. We have developed and studied a biomechanical SPC-vein computational model during an IV procedure, and explored the biomechanical effects of repeated IV episodes on onset and reoccurrences of SPCT. The model was used to determine the effects of different insertion techniques as well as inter-patient biological variability on the catheter-vein wall contact pressures and wall deformations. We found that the maximal pressure exerted upon the vein wall was inhomogeneously distributed, and that the bending region was exposed to significantly greater pressures and deformations. The maximal exerted contact pressure on the inner vein's wall was 2938 Pa. The maximal extent of the SPC penetration into the vein wall reached 3.6 μm, which corresponds to approximately 100% of the average height of the inner layer, suggesting local squashing of endothelial cells at the contact site. The modelling describes a potential biomechanical damage pathway that can explain the reoccurrence of SPCT.

Disposition of epirubicin after intraarterial administration in Lipiodol to patients with hepatocellular carcinoma.

PubMed

Dodds, H M; Walpole, E T; Rivory, L P; Strong, R W; Pond, S M

1996-10-01

Delivering emulsions of anthracycline drugs in Lipiodol, an iodinated poppy-seed oil, via the hepatic artery for the treatment of hepatocellular carcinoma (HCC) has become increasingly popular. However, investigations to determine the extent to which the Lipiodol sequesters the anthracycline in the liver have been limited. Concern has been expressed that such emulsions are not stable and that the anthracycline is, therefore, released rapidly into the circulation. We studied the pharmacokinetics of epirubicin (50 mg m-2) in five patients with nonresectable primary hepatocellular carcinoma after infusion of an epirubicin/Lipiodol emulsion via the hepatic artery. We used a reliable and specific high-performance liquid chromatography assay that allows quantitation of plasma concentrations of epirubicin, epirubicinol, epirubicin glucuronide, and epirubicin aglycone. Although a large interpatient variability in pharmacokinetics was observed, our results were similar to historical data after epirubicin intravenous therapy. Only the results from one patient provided evidence of significant retention of the drug in the liver. It would appear that more stable formulations of epirubicin/Lipiodol are required to increase the efficacy of this form of treatment. We suggest that pharmacokinetic studies should accompany clinical evaluation of emulsions of epirubicin/Lipiodol for the treatment of HCC.

Patient phenotyping in clinical trials of chronic pain treatments: IMMPACT recommendations

PubMed Central

Edwards, Robert R.; Dworkin, Robert H.; Turk, Dennis C.; Angst, Martin S.; Dionne, Raymond; Freeman, Roy; Hansson, Per; Haroutounian, Simon; Arendt-Nielsen, Lars; Attal, Nadine; Baron, Ralf; Brell, Joanna; Bujanover, Shay; Burke, Laurie B.; Carr, Daniel; Chappell, Amy S.; Cowan, Penney; Etropolski, Mila; Fillingim, Roger B.; Gewandter, Jennifer S.; Katz, Nathaniel P.; Kopecky, Ernest A.; Markman, John D.; Nomikos, George; Porter, Linda; Rappaport, Bob A.; Rice, Andrew S.C.; Scavone, Joseph M.; Scholz, Joachim; Simon, Lee S.; Smith, Shannon M.; Tobias, Jeffrey; Tockarshewsky, Tina; Veasley, Christine; Versavel, Mark; Wasan, Ajay D.; Wen, Warren; Yarnitsky, David

2018-01-01

There is tremendous inter-patient variability in the response to analgesic therapy (even for efficacious treatments), which can be the source of great frustration in clinical practice. This has led to calls for “precision medicine”, or personalized pain therapeutics (i.e., empirically-based algorithms that determine the optimal treatments, or treatment combinations, for individual patients) that would presumably improve both the clinical care of patients with pain, and the success rates for putative analgesic drugs in Phase 2 and 3 clinical trials. However, before implementing this approach, the characteristics of individual patients or subgroups of patients that increase or decrease the response to a specific treatment need to be identified. The challenge is to identify the measurable phenotypic characteristics of patients that are most predictive of individual variation in analgesic treatment outcomes, and the measurement tools that are best suited to evaluate these characteristics. In this article, we present evidence on the most promising of these phenotypic characteristics for use in future research, including psychosocial factors, symptom characteristics, sleep patterns, responses to noxious stimulation, endogenous pain-modulatory processes, and response to pharmacologic challenge. We provide evidence-based recommendations for core phenotyping domains and recommend measures of each domain. PMID:27152687

Clinical Pharmacogenetics Implementation Consortium Guidelines for CYP2C9 and HLA‐B Genotypes and Phenytoin Dosing

PubMed Central

Rettie, A E; Whirl‐Carrillo, M; Smith, L H; Mintzer, S; Lee, M T M; Klein, T E; Callaghan, J T

2014-01-01

Phenytoin is a widely used antiepileptic drug with a narrow therapeutic index and large interpatient variability, partly due to genetic variations in the gene encoding cytochrome P450 (CYP)2C9 (CYP2C9). Furthermore, the variant allele HLA‐B*15:02, encoding human leukocyte antigen, is associated with an increased risk of Stevens–Johnson syndrome and toxic epidermal necrolysis in response to phenytoin treatment. We summarize evidence from the published literature supporting these associations and provide recommendations for the use of phenytoin based on CYP2C9 and/or HLA‐B genotype (also available on PharmGKB: http://www.pharmgkb.org). The purpose of this guideline is to provide information for the interpretation of HLA‐B and/or CYP2C9 genotype tests so that the results can guide dosing and/or use of phenytoin. Detailed guidelines for the use of phenytoin as well as analyses of cost‐effectiveness are out of scope. Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines are periodically updated at http://www.pharmgkb.org. Clinical Pharmacology & Therapeutics (2014); 96 5, 542–548. doi:10.1038/clpt.2014.159 PMID:25099164

Variability of Sorafenib Toxicity and Exposure over Time: A Pharmacokinetic/Pharmacodynamic Analysis

PubMed Central

Ropert, Stanislas; Mir, Olivier; Coriat, Romain; Billemont, Bertrand; Tod, Michel; Cabanes, Laure; Franck, Nathalie; Blanchet, Benoit; Goldwasser, François

2012-01-01

Background. Sorafenib displays major interpatient pharmacokinetic variability. It is unknown whether the pharmacokinetics of sorafenib influence its toxicity. Methods. We analyzed the severity and kinetics of sorafenib-induced toxicities in unselected consecutive patients with cancer, as well as their relationship with biological, clinical, and pharmacokinetic parameters. Toxicity was recorded bimonthly. Sorafenib plasma concentrations were assessed by liquid chromatography. Results. For 83 patients (median age, 62 years; range, 21–84 years), median sorafenib 12-hour area under the curve (AUC0–12) was 52.8 mg · h/L (range: 11.8–199.6). A total of 51 patients (61%) experienced grade 3–4 toxicities, including hand-foot skin reactions (23%), asthenia (18%), and diarrhea (11%). Sorafenib AUC0–12 preceding grade 3–4 toxicities was significantly higher than that observed in the remaining population (61.9 mg · h/L vs. 53 mg · h/L). In 25 patients treated with fixed doses of sorafenib for the first 4 months, median dose-normalized AUC0–12 on day 120 was significantly lower than on day 15 (63 vs. 102 mg · h/L). The incidence of hypertension and hand-foot skin reactions significantly decreased over time. Conclusion. Sorafenib AUC0–12 decreases over time, similarly to the incidence of hypertension and hand-foot skin reactions. Monitoring of sorafenib plasma concentrations may help to prevent acute severe toxicities and detect patients with suboptimal exposure at disease progression. PMID:22752067

Benzoate treatment and the glycine index in nonketotic hyperglycinaemia.

PubMed

Van Hove, J L K; Vande Kerckhove, K; Hennermann, J B; Mahieu, V; Declercq, P; Mertens, S; De Becker, M; Kishnani, P S; Jaeken, J

2005-01-01

High-dose benzoate treatment aimed at reducing plasma glycine levels to normal reduces seizures and increases wakefulness in patients with nonketotic hyperglycinaemia (NKH). Since benzoate metabolism is dependent on the available glycine pool, and since the glycine pool is variably affected by the deficiency in the glycine cleavage enzyme system, we examined the importance of interpatient variability in benzoate requirement. To correct for the dietary glycine contribution, the glycine index was introduced as the molar requirement of benzoate dose necessary to normalize plasma glycine levels and subtracting from that the dietary glycine intake, both corrected for weight. The glycine index varied between 3.62 and 4.87 mmol/kg per day in five patients with a poor neurodevelopmental outcome and between 0.92 and 1.90 mmol/kg per day in four patients with a better neurodevelopmental outcome, and was 2.54 mmol/kg per day in a single patient with an intermediate outcome. The glycine index was stable over time within each patient. Exceeding the balance by either increasing food glycine intake or decreasing the benzoate dose resulted in increased glycine levels. Exceeding the glycine tolerance by increasing benzoate resulted in elevated and toxic levels of benzoate. The glycine index is a stable, individually specific parameter in patients with NKH. It has clinical consequences for the dose of benzoate required and the role of dietary management. Through its correlation with neurodevelopmental outcome, the glycine index points to potential genetic factors that could contribute to the psychomotor retardation in NKH.

Investigation of Slow-wave Activity Saturation during Surgical Anesthesia Reveals a Signature of Neural Inertia in Humans.

PubMed

Warnaby, Catherine E; Sleigh, Jamie W; Hight, Darren; Jbabdi, Saad; Tracey, Irene

2017-10-01

Previously, we showed experimentally that saturation of slow-wave activity provides a potentially individualized neurophysiologic endpoint for perception loss during anesthesia. Furthermore, it is clear that induction and emergence from anesthesia are not symmetrically reversible processes. The observed hysteresis is potentially underpinned by a neural inertia mechanism as proposed in animal studies. In an advanced secondary analysis of 393 individual electroencephalographic data sets, we used slow-wave activity dose-response relationships to parameterize slow-wave activity saturation during induction and emergence from surgical anesthesia. We determined whether neural inertia exists in humans by comparing slow-wave activity dose responses on induction and emergence. Slow-wave activity saturation occurs for different anesthetics and when opioids and muscle relaxants are used during surgery. There was wide interpatient variability in the hypnotic concentrations required to achieve slow-wave activity saturation. Age negatively correlated with power at slow-wave activity saturation. On emergence, we observed abrupt decreases in slow-wave activity dose responses coincident with recovery of behavioral responsiveness in ~33% individuals. These patients are more likely to have lower power at slow-wave activity saturation, be older, and suffer from short-term confusion on emergence. Slow-wave activity saturation during surgical anesthesia implies that large variability in dosing is required to achieve a targeted potential loss of perception in individual patients. A signature for neural inertia in humans is the maintenance of slow-wave activity even in the presence of very-low hypnotic concentrations during emergence from anesthesia.

High interpatient variability of treosulfan exposure is associated with early toxicity in paediatric HSCT: a prospective multicentre study.

PubMed

van der Stoep, M Y Eileen C; Bertaina, Alice; Ten Brink, Marloes H; Bredius, Robbert G; Smiers, Frans J; Wanders, Dominique C M; Moes, Dirk Jan A R; Locatelli, Franco; Guchelaar, Henk-Jan; Zwaveling, Juliëtte; Lankester, Arjan C

2017-12-01

Treosulfan-based conditioning is increasingly employed in paediatric haematopoietic stem cell transplantation (HSCT). Data on treosulfan pharmacokinetics in children are scarce, and the relationship between treosulfan exposure, toxicity and clinical outcome is unresolved. In this multicentre prospective observational study, we studied treosulfan pharmacokinetics and the drug's relationship with regimen-related toxicity and early clinical outcome in 77 paediatric patients. Treosulfan dose was 30 g/m 2 , administered over 3 consecutive days in infants <1 year old (n = 12) and 42 g/m 2 in children ≥1 year old (n = 65). Mean day 1 treosulfan exposure was 1744 ± 795 mg*h/l (10 g/m 2 ) and 1561 ± 511 mg*h/l (14 g/m 2 ), with an inter-individual variability of 56 and 33% in the respective groups. High treosulfan exposure (>1650 mg*h/l) was associated with an increased risk of mucosal [Odds ratio (OR) 4·40; 95% confidence interval (CI) 1·19-16·28, P = 0·026] and skin toxicity (OR 4·51; 95% CI 1·07-18·93, P = 0·040). No correlation was found between treosulfan exposure and the early clinical outcome parameters: engraftment, acute graft-versus-host disease and donor chimerism. Our study provides the first evidence in a large cohort of paediatric patients of high variability in treosulfan pharmacokinetics and an association between treosulfan exposure and early toxicity. Ongoing studies will reveal whether treosulfan exposure is related to long-term disease-specific outcome and late treatment-related toxicity. © 2017 John Wiley & Sons Ltd.

Principal component analysis-based pattern analysis of dose-volume histograms and influence on rectal toxicity.

PubMed

Söhn, Matthias; Alber, Markus; Yan, Di

2007-09-01

The variability of dose-volume histogram (DVH) shapes in a patient population can be quantified using principal component analysis (PCA). We applied this to rectal DVHs of prostate cancer patients and investigated the correlation of the PCA parameters with late bleeding. PCA was applied to the rectal wall DVHs of 262 patients, who had been treated with a four-field box, conformal adaptive radiotherapy technique. The correlated changes in the DVH pattern were revealed as "eigenmodes," which were ordered by their importance to represent data set variability. Each DVH is uniquely characterized by its principal components (PCs). The correlation of the first three PCs and chronic rectal bleeding of Grade 2 or greater was investigated with uni- and multivariate logistic regression analyses. Rectal wall DVHs in four-field conformal RT can primarily be represented by the first two or three PCs, which describe approximately 94% or 96% of the DVH shape variability, respectively. The first eigenmode models the total irradiated rectal volume; thus, PC1 correlates to the mean dose. Mode 2 describes the interpatient differences of the relative rectal volume in the two- or four-field overlap region. Mode 3 reveals correlations of volumes with intermediate doses ( approximately 40-45 Gy) and volumes with doses >70 Gy; thus, PC3 is associated with the maximal dose. According to univariate logistic regression analysis, only PC2 correlated significantly with toxicity. However, multivariate logistic regression analysis with the first two or three PCs revealed an increased probability of bleeding for DVHs with more than one large PC. PCA can reveal the correlation structure of DVHs for a patient population as imposed by the treatment technique and provide information about its relationship to toxicity. It proves useful for augmenting normal tissue complication probability modeling approaches.

Considerations in choosing a primary endpoint that measures durability of virological suppression in an antiretroviral trial.

PubMed

Gilbert, P B; Ribaudo, H J; Greenberg, L; Yu, G; Bosch, R J; Tierney, C; Kuritzkes, D R

2000-09-08

At present, many clinical trials of anti-HIV-1 therapies compare treatments by a primary endpoint that measures the durability of suppression of HIV-1 replication. Several durability endpoints are compared. Endpoints are compared by their implicit assumptions regarding surrogacy for clinical outcomes, sample size requirements, and accommodations for inter-patient differences in baseline plasma HIV-1-RNA levels and in initial treatment response. Virological failure is defined by the non-suppression of virus levels at a prespecified follow-up time T(early virological failure), or by relapse. A binary virological failure endpoint is compared with three time-to-virological failure endpoints: time from (i) randomization that assigns early failures a failure time of T weeks; (ii) randomization that extends the early failure time T for slowly responding subjects; and (iii) virological response that assigns non-responders a failure time of 0 weeks. Endpoint differences are illustrated with Agouron's trial 511. In comparing high with low-dose nelfinavir (NFV) regimens in Agouron 511, the difference in Kaplan-Meier estimates of the proportion not failing by 24 weeks is 16.7% (P = 0.048), 6.5% (P = 0.29) and 22.9% (P = 0.0030) for endpoints (i), (ii) and (iii), respectively. The results differ because NFV suppresses virus more quickly at the higher dose, and the endpoints weigh this treatment difference differently. This illustrates that careful consideration needs to be given to choosing a primary endpoint that will detect treatment differences of interest. A time from randomization endpoint is usually recommended because of its advantages in flexibility and sample size, especially at interim analyses, and for its interpretation for patient management.

[Personalized drug therapy-directed clinical pharmacology research based on genetic polymorphisms and pharmacokinetics analysis].

PubMed

Hayashi, Hideki

2013-01-01

In this decade, the field of pharmacogenomics (PGx), which is related to pharmacokinetics (PK) or pharmacodynamics (PD), has attracted much attention because it may provide a possible explanation for individual differences in the clinical efficacy of drugs. For the development of personalized drug therapy, it is important to accumulate evidence from PK/PD/PGx analysis in clinical trials. Warfarin (WF) is one of the most widely prescribed anticoagulants for the prevention and treatment of venous and arterial thromboembolism. However, large interindividual and interethnic differences have been observed in the WF dose required to elicit the anticoagulant effect. We investigated the factors influencing the WF maintenance dose in Japanese patients. Our study confirmed a large interindividual variability in the WF maintenance dose that was due to a VKORC1 1639 G>A polymorphism and differences in body weight, age, and serum albumin. In addition, we found that the CYP4F2 genotype affects the plasma concentration of menaquinone-4, and that this finding was correlated with the WF sensitivity index in Japanese pediatric patients. Methotrexate (MTX) is an antifolate that is widely used to treat rheumatoid arthritis (RA) and cancer. The response to low-dose MTX demonstrated wide interpatient variability; however, the contributing factors remain unclear. We found that the frequency of the RFC1 80A allele was higher in RA patients treated with MTX alone compared with patients who received biological disease-modifying antirheumatic drugs (bDMARDs). This finding may support the combined use of bDMARDs and MTX. Further large-scale prospective clinical trials are required to confirm these findings.

Dextromethorphan as a phenotyping test to predict endoxifen exposure in patients on tamoxifen treatment.

PubMed

de Graan, Anne-Joy M; Teunissen, Sebastiaan F; de Vos, Filip Y F L; Loos, Walter J; van Schaik, Ron H N; de Jongh, Felix E; de Vos, Aad I; van Alphen, Robbert J; van der Holt, Bronno; Verweij, Jaap; Seynaeve, Caroline; Beijnen, Jos H; Mathijssen, Ron H J

2011-08-20

Tamoxifen, a widely used agent for the prevention and treatment of breast cancer, is mainly metabolized by CYP2D6 and CYP3A to form its most abundant active metabolite, endoxifen. Interpatient variability in toxicity and efficacy of tamoxifen is substantial. Contradictory results on the value of CYP2D6 genotyping to reduce the variable efficacy have been reported. In this pharmacokinetic study, we investigated the value of dextromethorphan, a known probe drug for both CYP2D6 and CYP3A enzymatic activity, as a potential phenotyping probe for tamoxifen pharmacokinetics. In this prospective study, 40 women using tamoxifen for invasive breast cancer received a single dose of dextromethorphan 2 hours after tamoxifen intake. Dextromethorphan, tamoxifen, and their respective metabolites were quantified. Exposure parameters of all compounds were estimated, log transformed, and subsequently correlated. A strong and highly significant correlation (r = -0.72; P < .001) was found between the exposures of dextromethorphan (0 to 6 hours) and endoxifen (0 to 24 hours). Also, the area under the plasma concentration-time curve of dextromethorphan (0 to 6 hours) and daily trough endoxifen concentration was strongly correlated (r = -0.70; P < .001). In a single patient using the potent CYP2D6 inhibitor paroxetine, the low endoxifen concentration was accurately predicted by dextromethorphan exposure. Dextromethorphan exposure after a single administration adequately predicted endoxifen exposure in individual patients with breast cancer taking tamoxifen. This test could contribute to the personalization and optimization of tamoxifen treatment, but it needs additional validation and simplification before being applicable in future dosing strategies.

[Measurement of CO diffusion capacity (II): Standardization and quality criteria].

PubMed

Salcedo Posadas, A; Villa Asensi, J R; de Mir Messa, I; Sardón Prado, O; Larramona, H

2015-08-01

The diffusion capacity is the technique that measures the ability of the respiratory system for gas exchange, thus allowing a diagnosis of the malfunction of the alveolar-capillary unit. The most important parameter to assess is the CO diffusion capacity (DLCO). New methods are currently being used to measure the diffusion using nitric oxide (NO). There are other methods for measuring diffusion, although in this article the single breath technique is mainly referred to, as it is the most widely used and best standardized. Its complexity, its reference equations, differences in equipment, inter-patient variability and conditions in which the DLCO is performed, lead to a wide inter-laboratory variability, although its standardization makes this a more reliable and reproductive method. The practical aspects of the technique are analyzed, by specifying the recommendations to carry out a suitable procedure, the calibration routine, calculations and adjustments. Clinical applications are also discussed. An increase in the transfer of CO occurs in diseases in which there is an increased volume of blood in the pulmonary capillaries, such as in the polycythemia and pulmonary hemorrhage. There is a decrease in DLCO in patients with alveolar volume reduction or diffusion defects, either by altered alveolar-capillary membrane (interstitial diseases) or decreased volume of blood in the pulmonary capillaries (pulmonary embolism or primary pulmonary hypertension). Other causes of decreased or increased DLCO are also highlighted. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

Hemodynamic Evaluation of a Biological and Mechanical Aortic Valve Prosthesis Using Patient-Specific MRI-Based CFD.

PubMed

Hellmeier, Florian; Nordmeyer, Sarah; Yevtushenko, Pavlo; Bruening, Jan; Berger, Felix; Kuehne, Titus; Goubergrits, Leonid; Kelm, Marcus

2018-01-01

Modeling different treatment options before a procedure is performed is a promising approach for surgical decision making and patient care in heart valve disease. This study investigated the hemodynamic impact of different prostheses through patient-specific MRI-based CFD simulations. Ten time-resolved MRI data sets with and without velocity encoding were obtained to reconstruct the aorta and set hemodynamic boundary conditions for simulations. Aortic hemodynamics after virtual valve replacement with a biological and mechanical valve prosthesis were investigated. Wall shear stress (WSS), secondary flow degree (SFD), transvalvular pressure drop (TPD), turbulent kinetic energy (TKE), and normalized flow displacement (NFD) were evaluated to characterize valve-induced hemodynamics. The biological prostheses induced significantly higher WSS (medians: 9.3 vs. 8.6 Pa, P = 0.027) and SFD (means: 0.78 vs. 0.49, P = 0.002) in the ascending aorta, TPD (medians: 11.4 vs. 2.7 mm Hg, P = 0.002), TKE (means: 400 vs. 283 cm 2 /s 2 , P = 0.037), and NFD (means: 0.0994 vs. 0.0607, P = 0.020) than the mechanical prostheses. The differences between the prosthesis types showed great inter-patient variability, however. Given this variability, a patient-specific evaluation is warranted. In conclusion, MRI-based CFD offers an opportunity to assess the interactions between prosthesis and patient-specific boundary conditions, which may help in optimizing surgical decision making and providing additional guidance to clinicians. © 2017 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

Two complementary strategies to improve cell engraftment in mesenchymal stem cell-based therapy: Increasing transplanted cell resistance and increasing tissue receptivity.

PubMed

Ezquer, Fernando E; Ezquer, Marcelo E; Vicencio, Jose M; Calligaris, Sebastián D

2017-01-02

Over the past 2 decades, therapies based on mesenchymal stem cells (MSC) have been tested to treat several types of diseases in clinical studies, due to their potential for tissue repair and regeneration. Currently, MSC-based therapy is considered a biologically safe procedure, with the therapeutic results being very promising. However, the benefits of these therapies are not stable in the long term, and the final outcomes manifest with high inter-patient variability. The major cause of these therapeutic limitations results from the poor engraftment of the transplanted cells. Researchers have developed separate strategies to improve MSC engraftment. One strategy aims at increasing the survival of the transplanted MSCs in the recipient tissue, rendering them more resistant to the hostile microenvironment (cell-preconditioning). Another strategy aims at making the damaged tissue more receptive to the transplanted cells, favoring their interactions (tissue-preconditioning). In this review, we summarize several approaches using these strategies, providing an integral and updated view of the recent developments in MSC-based therapies. In addition, we propose that the combined use of these different conditioning strategies could accelerate the process to translate experimental evidences from pre-clinic studies to the daily clinical practice.

Automatic segmentation of the facial nerve and chorda tympani using image registration and statistical priors

NASA Astrophysics Data System (ADS)

Noble, Jack H.; Warren, Frank M.; Labadie, Robert F.; Dawant, Benoit M.

2008-03-01

In cochlear implant surgery, an electrode array is permanently implanted in the cochlea to stimulate the auditory nerve and allow deaf people to hear. A minimally invasive surgical technique has recently been proposed--percutaneous cochlear access--in which a single hole is drilled from the skull surface to the cochlea. For the method to be feasible, a safe and effective drilling trajectory must be determined using a pre-operative CT. Segmentation of the structures of the ear would improve trajectory planning safety and efficiency and enable the possibility of automated planning. Two important structures of the ear, the facial nerve and chorda tympani, present difficulties in intensity based segmentation due to their diameter (as small as 1.0 and 0.4 mm) and adjacent inter-patient variable structures of similar intensity in CT imagery. A multipart, model-based segmentation algorithm is presented in this paper that accomplishes automatic segmentation of the facial nerve and chorda tympani. Segmentation results are presented for 14 test ears and are compared to manually segmented surfaces. The results show that mean error in structure wall localization is 0.2 and 0.3 mm for the facial nerve and chorda, proving the method we propose is robust and accurate.

Prodrug and nanomedicine approaches for the delivery of the camptothecin analogue SN38.

PubMed

Bala, Vaskor; Rao, Shasha; Boyd, Ben J; Prestidge, Clive A

2013-11-28

SN38 (7-ethyl-10-hydroxy camptothecin) is a prominent and efficacious anticancer agent. It is poorly soluble in both water and pharmaceutically approved solvents; therefore, the direct formulation of SN38 in solution form is limited. Currently, the water soluble prodrug of SN38, irinotecan (CPT-11), is formulated as a low pH solution and is approved for chemotherapy. However, CPT-11, along with most other water-soluble prodrugs shows unpredictable inter-patient conversion to SN38 in vivo, instability in the physiological environment and variable dose-related toxicities. More recently, macromolecular prodrugs (i.e. EZN-2208, IMMU-130) and nanomedicine formulations (i.e. nanoemulsions, polymeric micelles, lipid nanocapsule/nanoparticle, and liposomes) of SN38 have been investigated for improved delivery to cancer cells and tissues. Specifically, these carriers can take advantage of the EPR effect to direct drug preferentially to tumour tissues, thereby substantially improving efficacy and minimising side effects. Furthermore, oral delivery has been shown to be possible in preclinical results using nanomedicine formulations (i.e. dendrimers, lipid nanocapsules, polymeric micelles). This review summarizes the recent advances for the delivery of SN38 with a focus on macromolecular prodrugs and nanomedicines. © 2013 Elsevier B.V. All rights reserved.

High-content screening identifies kinase inhibitors that overcome venetoclax resistance in activated CLL cells.

PubMed

Oppermann, Sina; Ylanko, Jarkko; Shi, Yonghong; Hariharan, Santosh; Oakes, Christopher C; Brauer, Patrick M; Zúñiga-Pflücker, Juan C; Leber, Brian; Spaner, David E; Andrews, David W

2016-08-18

Novel agents such as the Bcl-2 inhibitor venetoclax (ABT-199) are changing treatment paradigms for chronic lymphocytic leukemia (CLL) but important problems remain. Although some patients exhibit deep and durable responses to venetoclax as a single agent, other patients harbor subpopulations of resistant leukemia cells that mediate disease recurrence. One hypothesis for the origin of resistance to venetoclax is by kinase-mediated survival signals encountered in proliferation centers that may be unique for individual patients. An in vitro microenvironment model was developed with primary CLL cells that could be incorporated into an automated high-content microscopy-based screen of kinase inhibitors (KIs) to identify agents that may improve venetoclax therapy in a personalized manner. Marked interpatient variability was noted for which KIs were effective; nevertheless, sunitinib was identified as the most common clinically available KI effective in overcoming venetoclax resistance. Examination of the underlying mechanisms indicated that venetoclax resistance may be induced by microenvironmental signals that upregulate antiapoptotic Bcl-xl, Mcl-1, and A1, which can be counteracted more efficiently by sunitinib than by ibrutinib or idelalisib. Although patient-specific drug responses are common, for many patients, combination therapy with sunitinib may significantly improve the therapeutic efficacy of venetoclax. © 2016 by The American Society of Hematology.

High-content screening identifies kinase inhibitors that overcome venetoclax resistance in activated CLL cells

PubMed Central

Oppermann, Sina; Ylanko, Jarkko; Shi, Yonghong; Hariharan, Santosh; Oakes, Christopher C.; Brauer, Patrick M.; Zúñiga-Pflücker, Juan C.; Leber, Brian; Spaner, David E.

2016-01-01

Novel agents such as the Bcl-2 inhibitor venetoclax (ABT-199) are changing treatment paradigms for chronic lymphocytic leukemia (CLL) but important problems remain. Although some patients exhibit deep and durable responses to venetoclax as a single agent, other patients harbor subpopulations of resistant leukemia cells that mediate disease recurrence. One hypothesis for the origin of resistance to venetoclax is by kinase-mediated survival signals encountered in proliferation centers that may be unique for individual patients. An in vitro microenvironment model was developed with primary CLL cells that could be incorporated into an automated high-content microscopy-based screen of kinase inhibitors (KIs) to identify agents that may improve venetoclax therapy in a personalized manner. Marked interpatient variability was noted for which KIs were effective; nevertheless, sunitinib was identified as the most common clinically available KI effective in overcoming venetoclax resistance. Examination of the underlying mechanisms indicated that venetoclax resistance may be induced by microenvironmental signals that upregulate antiapoptotic Bcl-xl, Mcl-1, and A1, which can be counteracted more efficiently by sunitinib than by ibrutinib or idelalisib. Although patient-specific drug responses are common, for many patients, combination therapy with sunitinib may significantly improve the therapeutic efficacy of venetoclax. PMID:27297795

Plasma Letrozole Concentrations in Postmenopausal Women With Breast Cancer Are Associated With CYP2A6 Genetic Variants, Body Mass Index, and Age

PubMed Central

Desta, Z; Kreutz, Y; Nguyen, AT; Li, L; Skaar, T; Kamdem, LK; Henry, NL; Hayes, DF; Storniolo, AM; Stearns, V; Hoffmann, E; Tyndale, RF; Flockhart, DA

2013-01-01

The associations between plasma letrozole concentrations and CYP2A6 and CYP3A5 genetic variants were tested in the Exemestane and Letrozole Pharmacogenomics (ELPH) trial. ELPH is a multicenter, open-label prospective clinical trial in women randomly assigned (n ≈ 250 in each arm) to receive 2 years of treatment with either oral letrozole (2.5 mg/day) or oral exemestane (25 mg/day). CYP2A6 and CYP3A showed effects on letrozole metabolism in vitro. DNA samples were genotyped for variants in the CYP2A6 and CYP3A5 genes. plasma letrozole concentrations showed high interpatient variability (>10-fold) and were associated significantly with CYP2A6 genotypes (P < 0.0001), body mass index (BMI) (P < 0.0001), and age (P = 0.0035). However, CYP3A5 genotypes showed no association with plasma letrozole concentrations. These data suggest that CYP2A6 is the principal clearance mechanism for letrozole in vivo. CYP2A6 metabolic status, along with BMI and age, may serve as a biomarker of the efficacy of letrozole treatment or a predictor of adverse effects. PMID:21975350

Diffusion Tensor Imaging Based Thalamic Segmentation in Deep Brain Stimulation for Chronic Pain Conditions

PubMed Central

Kim, Won; Chivukula, Srinivas; Hauptman, Jason; Pouratian, Nader

2016-01-01

Background/Aims Thalamic deep brain stimulation (DBS) for the treatment of medically refractory pain has largely been abandoned on account of its inconsistent and oftentimes poor efficacy. Our aim here was to use diffusion tensor imaging (DTI)-based segmentation to assess the internal thalamic nuclei of patients who have undergone thalamic DBS for intractable pain and retrospectively correlate lead position with clinical outcome. Methods DTI-based segmentation was performed on 5 patients who underwent sensory thalamus DBS for chronic pain. Postoperative computed tomography (CT) images obtained for electrode placement were fused with preoperative MRIs that had undergone DTI-based thalamic segmentation. Sensory thalamus maps of 4 patients were analyzed for lead positioning and interpatient variability. Results Four patients who experienced significant pain relief following DBS demonstrated contact positions within the DTI-determined sensory thalamus or in its vicinity, whereas one who did not respond to stimulation did not. Only four voxels (2%) within the sensory thalamus were mutually shared among patients; 108 voxels (58%) were uniquely represented. Conclusions DTI-based segmentation of the thalamus can be used to confirm thalamic lead placement relative to the sensory thalamus, and may serve as a useful tool to guide thalamic DBS electrode implantation in the future. PMID:27537848

Adenovirus infection and cytotoxicity of primary mantle cell lymphoma cells.

PubMed

Medina, Daniel J; Sheay, Wendy; Osman, Mona; Goodell, Lauri; Martin, John; Rabson, Arnold B; Strair, Roger K

2005-11-01

Mantle cell lymphoma (MCL) is a distinct form of non-Hodgkin's lymphoma (NHL) derived from CD5+ B cells. MCL cells overexpress cyclin D1 as a consequence of translocation of the gene into the immunoglobulin heavy-chain gene locus. MCL is an aggressive form of NHL with frequent relapses after standard-dose chemotherapy. In this context, a variety of novel therapies for patients with MCL have been investigated. In this study, we use an expanded panel of attenuated adenoviruses to study adenovirus-mediated cytotoxicity of MCL cells. Our results demonstrate: 1) adenovirus infection of MCL cells despite the absence of receptor/coreceptor molecules known to be important for adenovirus infection of other cells types; 2) cytotoxicity of MCL cells after infection with specific adenovirus mutants; 3) a high degree of cytotoxicity after infection of some patient samples with viruses lacking the E1B 19k "antiapoptotic" gene; and 4) cytotoxicity after infection with viruses containing mutations in E1A pRb or p300 binding. The extent of cytotoxicity with the panel of viruses demonstrated interpatient variability, but 100% cytotoxicity, as determined by molecular analysis, was detected in some samples. These studies provide the foundation for: 1) the development of adenoviruses as cytotoxic agents for MCL and 2) analyses of key regulatory pathways operative in MCL cells.

Sample size calculations for comparative clinical trials with over-dispersed Poisson process data.

PubMed

Matsui, Shigeyuki

2005-05-15

This paper develops a new formula for sample size calculations for comparative clinical trials with Poisson or over-dispersed Poisson process data. The criteria for sample size calculations is developed on the basis of asymptotic approximations for a two-sample non-parametric test to compare the empirical event rate function between treatment groups. This formula can accommodate time heterogeneity, inter-patient heterogeneity in event rate, and also, time-varying treatment effects. An application of the formula to a trial for chronic granulomatous disease is provided. Copyright 2004 John Wiley & Sons, Ltd.

Sci—Thur AM: YIS - 02: Radiogenomic Modeling of Normal Tissue Toxicities in Prostate Cancer Patients Receiving Hypofractionated Radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Coates, J; Jeyaseelan, K; Ybarra, N

2014-08-15

Inter-patient radiation sensitivity variability has recently been shown to have a genetic component. This genetic component may play a key role in explaining the fluctuating rates of radiation-induced toxicities (RITs). Single nucleotide polymorphisms (SNPs) have thus far yielded inconsistent results in delineating RITs while copy number variations (CNVs) have not yet been investigated for such purposes. We explore a radiogenomic modeling approach to investigate the association of CNVs and SNPs, along with clinical and dosimetric variables, in radiation induced rectal bleeding (RB) and erectile dysfunction (ED) in prostate cancer patients treated with curative hypofractionated irradiation. A cohort of 62 prostatemore » cancer patients who underwent hypofractionated radiotherapy (66 Gy in 22 fractions) between 2002 to 2010 were retrospectively genotyped for CNV and SNP rs5489 in the xrcc1 DNA repair gene. Late toxicity rates for RB grade 2 and 3 and grade 3 alone were 29.0% and 12.9%, respectively. ED toxicity was found to be 62.9%. Radiogenomic model performance was evaluated using receiver operating characteristic area under the curve (AUC) and resampling by cross-validation. Binary variables were evaluated using Chi-squared contingency table analysis and multivariate models by Spearman's rank correlation coefficient (rs). Ten patients were found to have three copies of xrcc1 CNV (RB: χ{sup 2}=14.6, p<0.001 and ED: χ{sup 2}=4.88, p=0.0272) and twelve had heterozygous rs25489 SNP (RB: χ{sup 2}=0.278, p=0.599 and ED: χ{sup 2}=0.112, p=0.732). Radiogenomic modeling yielded significant, cross-validated NTCP models for RB (AUC=0.665) and ED (AUC=0.754). These results indicate that CNVs may be potential predictive biomarkers of both late ED and RB.« less

Cystic fibrosis and bacterial colonization define the sputum N-glycosylation phenotype.

PubMed

Venkatakrishnan, Vignesh; Thaysen-Andersen, Morten; Chen, Sharon C A; Nevalainen, Helena; Packer, Nicolle H

2015-01-01

Although mucin O-glycosylation of sputum from individuals suffering from cystic fibrosis (CF) is known to be altered relative to their unaffected counterparts, protein N-glycosylation of CF sputum remains structurally and functionally under-characterized. We report the first N-glycome of soluble proteins in sputum derived from five CF patients, two pathogen-free and two pathogen-infected/colonized non-CF individuals suffering from other pulmonary conditions. N-Glycans were profiled using porous graphitized carbon-liquid chromatography-negative ion-tandem mass spectrometry following enzymatic release from sputum proteins. The composition, topology and linkage isomers of 68 N-glycans were characterized and relatively quantified. Recurring structural features in all sputum N-glycomes were terminal α2,6-sialylation, α1,6-core fucosylation, β1,4-bisecting GlcNAcylation and compositions indicating paucimannosylation. Despite covering different genotypes, age, gender and microbial flora, the sputum N-glycomes showed little interpatient and longitudinal variation within CF patients. Comparative N-glycome analysis between inter-patient group revealed that lung infection/colonization, in general, extensively enriches the CF sputum N-glycosylation phenotype with paucimannose with simultaneous over-sialylation/fucosylation and under-bisecting GlcNAcylation of complex/hybrid N-glycans. In contrast, the sputum from CF patients had only slightly increased abundance of paucimannose N-glycans relative to pathogen-infected/colonized non-CF individuals. Similar to mucin O-glycosylation, protein N-glycosylation appears to be regulated primarily as a secondary effect of bacterial infection and inflammation rather than the CF pathogenesis in sputum. This study provides new structural N-glycan information to help understand the complex cellular and molecular environment of the CF affected respiratory tract. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Subjective cognitive impairment: Towards early identification of Alzheimer disease.

PubMed

Garcia-Ptacek, S; Eriksdotter, M; Jelic, V; Porta-Etessam, J; Kåreholt, I; Manzano Palomo, S

2016-10-01

Neurodegeneration in Alzheimer disease (AD) begins decades before dementia and patients with mild cognitive impairment (MCI) already demonstrate significant lesion loads. Lack of information about the early pathophysiology in AD complicates the search for therapeutic strategies.Subjective cognitive impairment is the description given to subjects who have memory-related complaints without pathological results on neuropsychological tests. There is no consensus regarding this heterogeneous syndrome, but at least some of these patients may represent the earliest stage in AD. We reviewed available literature in order to summarise current knowledge on subjective cognitive impairment. Although they may not present detectable signs of disease, SCI patients as a group score lower on neuropsychological tests than the general population does, and they also have a higher incidence of future cognitive decline. Depression and psychiatric co-morbidity play a role but cannot account for all cognitive complaints. Magnetic resonance imaging studies in these patients reveal a pattern of hippocampal atrophy similar to that of amnestic mild cognitive impairment and functional MRI shows increased activation during cognitive tasks which might indicate compensation for loss of function. Prevalence of an AD-like pattern of beta-amyloid (Aβ42) and tau proteins in cerebrospinal fluid is higher in SCI patients than in the general population. Memory complaints are relevant symptoms and may predict AD. Interpatient variability and methodological differences between clinical studies make it difficult to assign a definition to this syndrome. In the future, having a standard definition and longitudinal studies with sufficient follow-up times and an emphasis on quantifiable variables may clarify aspects of early AD. Copyright © 2012 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

Role of Pharmacogenomics in the Management of Traditional and Novel Oral Anticoagulants

PubMed Central

Cavallari, Larisa H.; Shin, Jaekyu; Perera, Minoli A.

2013-01-01

Warfarin is the most commonly prescribed oral anticoagulant. However, it remains a difficult drug to manage mostly because of its narrow therapeutic index and wide interpatient variability in anticoagulant effects. Over the past decade, there has been substantial progress in our understanding of genetic contributions to variable warfarin response, particularly with regard to warfarin dose requirements. The genes encoding for cytochrome P450 (CYP) 2C9 (CYP2C9) and vitamin K epoxide reductase complex subunit 1 (VKORC1) are the major genetic determinants of warfarin pharmacokinetics and pharmacodynamics, respectively. Numerous studies have demonstrated significant contributions of these genes to warfarin dose requirements. The CYP2C9 gene has also been associated with bleeding risk with warfarin. The CYP4F2 gene influences vitamin K availability and makes minor contributions to warfarin dose requirements. Less is known about genes influencing warfarin response in African-American patients compared with other racial groups, but this is the focus of ongoing research. Several warfarin pharmacogenetic dosing algorithms and United States Food and Drug Administration–cleared genotyping tests are available for clinical use. Clinical trials are ongoing to determine the clinical utility and cost-effectiveness of genotype-guided warfarin dosing. Results from these trials will likely influence clinical uptake and third party payer reimbursement for genotype-guided warfarin therapy. There is still a lack of pharmacogenetic data for the newly approved oral anticoagulants, dabigatran and rivaroxaban, and with other oral anticoagulants in the research and development pipeline. These data, once known, could be of great importance as routine monitoring parameters for these agents are not available. PMID:22122181

Pharmacokinetics and pharmacodynamics of multiple doses of BG00010, a neurotrophic factor with anti-hyperalgesic effects, in patients with sciatica.

PubMed

Okkerse, Pieter; Hay, Justin L; Versage, Eve; Tang, Yongqiang; Galluppi, Gerald; Ravina, Bernard; Verma, Ajay; Williams, Leslie; Aycardi, Ernesto; Groeneveld, Geert Jan

2016-07-01

BG00010 is a protein in the glial cell line-derived neurotrophic factor (GDNF) family. It is a selective ligand for the GDNF family receptor alpha-3 (GFRα3) co-receptor that normalizes cellular changes resulting from damage or disease, and potentially alleviates neuropathic pain. The main objectives of this study were to evaluate the pharmacokinetic and safety profiles and to determine the effects on pain of ascending doses of intravenous injections of BG00010 in patients with sciatica. This was a randomized, blinded, placebo-controlled multiple-dose study in subjects with sciatica. In Part I (16 patients), four IV dose levels were examined (50, 150, 400, 800 μg kg(-1) ) and in Part II (12 patients), three dose levels were examined (400, 600 and 1200 μg kg(-1) ). Safety and efficacy assessments were used as endpoints. The BG00010 concentration-time data indicated relatively low inter-patient variability and there was a dose-dependent (not dose-proportional) increase in serum exposure from 150 to 1200 μg kg(-1) . The effective half-life was between 40 and 60 h. The most frequently occurring adverse events (AEs) reported by patients receiving BG00010 were headache (67-83%), feeling hot (50-100%), and pruritus (42-67%). Most AEs were mild; no serious AEs or AEs leading to discontinuation occurred. Higher dose regimens of BG00010 resulted in greater pain reduction than placebo or lower dose regimens, although a clear dose-response relationship was not seen. The pharmacokinetic profile of BG00010 was characterized by low intra-patient variability. These data from a small sample suggest that BG00010 may have a benefit for patients with sciatica. © 2016 The British Pharmacological Society.

Angiotensin-converting enzyme 2 is subject to post-transcriptional regulation by miR-421.

PubMed

Lambert, Daniel W; Lambert, Louise A; Clarke, Nicola E; Hooper, Nigel M; Porter, Karen E; Turner, Anthony J

2014-08-01

ACE2 (angiotensin converting enzyme 2) plays a critical role in the local tissue RAS (renin-angiotensin system) by hydrolysing the potent hypertensive and mitogenic peptide AngII (angiotensin II). Changes in the levels of ACE2 have been observed in a number of pathologies, including cardiovascular disease, but little is known of the mechanisms regulating its expression. In the present study, therefore, the potential role of miRNAs in the regulation of ACE2 expression in primary human cardiac myofibroblasts was examined. Putative miRNA-binding sites were identified in the 3'-UTR of the ACE2 transcript using online prediction algorithms. Two of these, miR-200b and miR-421, were selected for further analysis. A reporter system using the 3'-UTR of ACE2 fused to the coding region of firefly luciferase was used to determine the functionality of the identified binding sites in vitro. This identified miR-421, but not miR-200b, as a potential regulator of ACE2. The ability of miR-421, an miRNA implicated in the development of thrombosis, to down-regulate ACE2 expression was subsequently confirmed by Western blot analysis of both primary cardiac myofibroblasts and transformed cells transfected with a synthetic miR-421 precursor. Real-time PCR analysis of miR-421 revealed widespread expression in human tissues. miR-421 levels in cardiac myofibroblasts showed significant inter-patient variability, in keeping with the variability of ACE2 expression we have observed previously. In conclusion, the present study is the first to demonstrate that ACE2 may be subject to post-transcriptional regulation and reveals a novel potential therapeutic target, miR-421, which could be exploited to modulate ACE2 expression in disease.

Sensitivity of reentrant driver localization to electrophysiological parameter variability in image-based computational models of persistent atrial fibrillation sustained by a fibrotic substrate

NASA Astrophysics Data System (ADS)

Deng, Dongdong; Murphy, Michael J.; Hakim, Joe B.; Franceschi, William H.; Zahid, Sohail; Pashakhanloo, Farhad; Trayanova, Natalia A.; Boyle, Patrick M.

2017-09-01

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, causing morbidity and mortality in millions worldwide. The atria of patients with persistent AF (PsAF) are characterized by the presence of extensive and distributed atrial fibrosis, which facilitates the formation of persistent reentrant drivers (RDs, i.e., spiral waves), which promote fibrillatory activity. Targeted catheter ablation of RD-harboring tissues has shown promise as a clinical treatment for PsAF, but the outcomes remain sub-par. Personalized computational modeling has been proposed as a means of non-invasively predicting optimal ablation targets in individual PsAF patients, but it remains unclear how RD localization dynamics are influenced by inter-patient variability in the spatial distribution of atrial fibrosis, action potential duration (APD), and conduction velocity (CV). Here, we conduct simulations in computational models of fibrotic atria derived from the clinical imaging of PsAF patients to characterize the sensitivity of RD locations to these three factors. We show that RDs consistently anchor to boundaries between fibrotic and non-fibrotic tissues, as delineated by late gadolinium-enhanced magnetic resonance imaging, but those changes in APD/CV can enhance or attenuate the likelihood that an RD will anchor to a specific site. These findings show that the level of uncertainty present in patient-specific atrial models reconstructed without any invasive measurements (i.e., incorporating each individual's unique distribution of fibrotic tissue from medical imaging alongside an average representation of AF-remodeled electrophysiology) is sufficiently high that a personalized ablation strategy based on targeting simulation-predicted RD trajectories alone may not produce the desired result.

Measurement of Induced Cytokines in AIDS Clinical Trials Using Whole Blood: A Preliminary Report

PubMed Central

Wallis, Robert S.; Lederman, Howard M.; Spritzler, John; Devers, Jennifer L.; Georges, Daniel; Weinberg, Adriana; Stehn, Susan; Lederman, Michael M.; Group, the Actg Inducible Cytokines Focus

1998-01-01

Measures of immune function have become increasingly important as endpoints in AIDS clinical trials, with respect to both modulation and reconstitution of immunity by experimental therapies. Measurement of immune function in this setting requires the development of robust analytic approaches suitable for the clinical laboratory. Experiments were performed to evaluate the suitability of using cultured heparinized (“whole”) blood for induction of tumor necrosis factor alpha (TNF-α) and gamma interferon (IFN-γ), two cytokines critical in AIDS pathogenesis. TNF-α expression ranged from 229 to 769 pg/ml in lipopolysaccharide (LPS)-stimulated cultures and was not detected in unstimulated cultures. IFN-γ expression ranged from 0 to 112,000 pg/ml in phytohemagglutinin A (PHA)-stimulated cultures and from 0 to 789 pg/ml in antigen-stimulated cultures. The mean coefficient of variation observed in three weekly determinations was 0.47 for TNF-α and ranged from 0.12 to 1.73 for IFN-γ. These values indicate that sample sizes of 8, 24, and 29 subjects would be sufficient to detect twofold changes in LPS-induced TNF-α and in PHA- and antigen-induced IFN-γ, respectively, if two baseline and two treatment determinations were obtained, and if the interpatient variability of changes in true levels from baseline to follow-up is negligible compared to the variability in the three weekly measurements. Measurement of LPS-induced TNF-α and mitogen- or antigen-induced IFN-γ can be performed simply and reproducibly in human immunodeficiency virus-infected persons by the whole-blood culture method. Further studies are warranted to determine the effect of overnight shipping on assay reproducibility and to determine the extent to which responses can be reliably detected in subjects with low CD4 cell numbers. PMID:9665966

Integrating artificial intelligence with real-time intracranial EEG monitoring to automate interictal identification of seizure onset zones in focal epilepsy.

PubMed

Varatharajah, Yogatheesan; Berry, Brent; Cimbalnik, Jan; Kremen, Vaclav; Van Gompel, Jamie; Stead, Matt; Brinkmann, Benjamin; Iyer, Ravishankar; Worrell, Gregory

2018-08-01

An ability to map seizure-generating brain tissue, i.e. the seizure onset zone (SOZ), without recording actual seizures could reduce the duration of invasive EEG monitoring for patients with drug-resistant epilepsy. A widely-adopted practice in the literature is to compare the incidence (events/time) of putative pathological electrophysiological biomarkers associated with epileptic brain tissue with the SOZ determined from spontaneous seizures recorded with intracranial EEG, primarily using a single biomarker. Clinical translation of the previous efforts suffers from their inability to generalize across multiple patients because of (a) the inter-patient variability and (b) the temporal variability in the epileptogenic activity. Here, we report an artificial intelligence-based approach for combining multiple interictal electrophysiological biomarkers and their temporal characteristics as a way of accounting for the above barriers and show that it can reliably identify seizure onset zones in a study cohort of 82 patients who underwent evaluation for drug-resistant epilepsy. Our investigation provides evidence that utilizing the complementary information provided by multiple electrophysiological biomarkers and their temporal characteristics can significantly improve the localization potential compared to previously published single-biomarker incidence-based approaches, resulting in an average area under ROC curve (AUC) value of 0.73 in a cohort of 82 patients. Our results also suggest that recording durations between 90 min and 2 h are sufficient to localize SOZs with accuracies that may prove clinically relevant. The successful validation of our approach on a large cohort of 82 patients warrants future investigation on the feasibility of utilizing intra-operative EEG monitoring and artificial intelligence to localize epileptogenic brain tissue. Broadly, our study demonstrates the use of artificial intelligence coupled with careful feature engineering in augmenting clinical decision making.

Predicting location of recurrence using FDG, FLT, and Cu-ATSM PET in canine sinonasal tumors treated with radiotherapy

NASA Astrophysics Data System (ADS)

Bradshaw, Tyler; Fu, Rau; Bowen, Stephen; Zhu, Jun; Forrest, Lisa; Jeraj, Robert

2015-07-01

Dose painting relies on the ability of functional imaging to identify resistant tumor subvolumes to be targeted for additional boosting. This work assessed the ability of FDG, FLT, and Cu-ATSM PET imaging to predict the locations of residual FDG PET in canine tumors following radiotherapy. Nineteen canines with spontaneous sinonasal tumors underwent PET/CT imaging with radiotracers FDG, FLT, and Cu-ATSM prior to hypofractionated radiotherapy. Therapy consisted of 10 fractions of 4.2 Gy to the sinonasal cavity with or without an integrated boost of 0.8 Gy to the GTV. Patients had an additional FLT PET/CT scan after fraction 2, a Cu-ATSM PET/CT scan after fraction 3, and follow-up FDG PET/CT scans after radiotherapy. Following image registration, simple and multiple linear and logistic voxel regressions were performed to assess how well pre- and mid-treatment PET imaging predicted post-treatment FDG uptake. R2 and pseudo R2 were used to assess the goodness of fits. For simple linear regression models, regression coefficients for all pre- and mid-treatment PET images were significantly positive across the population (P < 0.05). However, there was large variability among patients in goodness of fits: R2 ranged from 0.00 to 0.85, with a median of 0.12. Results for logistic regression models were similar. Multiple linear regression models resulted in better fits (median R2 = 0.31), but there was still large variability between patients in R2. The R2 from regression models for different predictor variables were highly correlated across patients (R ≈ 0.8), indicating tumors that were poorly predicted with one tracer were also poorly predicted by other tracers. In conclusion, the high inter-patient variability in goodness of fits indicates that PET was able to predict locations of residual tumor in some patients, but not others. This suggests not all patients would be good candidates for dose painting based on a single biological target.

Predicting location of recurrence using FDG, FLT, and Cu-ATSM PET in canine sinonasal tumors treated with radiotherapy.

PubMed

Bradshaw, Tyler; Fu, Rau; Bowen, Stephen; Zhu, Jun; Forrest, Lisa; Jeraj, Robert

2015-07-07

Dose painting relies on the ability of functional imaging to identify resistant tumor subvolumes to be targeted for additional boosting. This work assessed the ability of FDG, FLT, and Cu-ATSM PET imaging to predict the locations of residual FDG PET in canine tumors following radiotherapy. Nineteen canines with spontaneous sinonasal tumors underwent PET/CT imaging with radiotracers FDG, FLT, and Cu-ATSM prior to hypofractionated radiotherapy. Therapy consisted of 10 fractions of 4.2 Gy to the sinonasal cavity with or without an integrated boost of 0.8 Gy to the GTV. Patients had an additional FLT PET/CT scan after fraction 2, a Cu-ATSM PET/CT scan after fraction 3, and follow-up FDG PET/CT scans after radiotherapy. Following image registration, simple and multiple linear and logistic voxel regressions were performed to assess how well pre- and mid-treatment PET imaging predicted post-treatment FDG uptake. R(2) and pseudo R(2) were used to assess the goodness of fits. For simple linear regression models, regression coefficients for all pre- and mid-treatment PET images were significantly positive across the population (P < 0.05). However, there was large variability among patients in goodness of fits: R(2) ranged from 0.00 to 0.85, with a median of 0.12. Results for logistic regression models were similar. Multiple linear regression models resulted in better fits (median R(2) = 0.31), but there was still large variability between patients in R(2). The R(2) from regression models for different predictor variables were highly correlated across patients (R ≈ 0.8), indicating tumors that were poorly predicted with one tracer were also poorly predicted by other tracers. In conclusion, the high inter-patient variability in goodness of fits indicates that PET was able to predict locations of residual tumor in some patients, but not others. This suggests not all patients would be good candidates for dose painting based on a single biological target.

SEGMENTING CT PROSTATE IMAGES USING POPULATION AND PATIENT-SPECIFIC STATISTICS FOR RADIOTHERAPY.

PubMed

Feng, Qianjin; Foskey, Mark; Tang, Songyuan; Chen, Wufan; Shen, Dinggang

2009-08-07

This paper presents a new deformable model using both population and patient-specific statistics to segment the prostate from CT images. There are two novelties in the proposed method. First, a modified scale invariant feature transform (SIFT) local descriptor, which is more distinctive than general intensity and gradient features, is used to characterize the image features. Second, an online training approach is used to build the shape statistics for accurately capturing intra-patient variation, which is more important than inter-patient variation for prostate segmentation in clinical radiotherapy. Experimental results show that the proposed method is robust and accurate, suitable for clinical application.

SEGMENTING CT PROSTATE IMAGES USING POPULATION AND PATIENT-SPECIFIC STATISTICS FOR RADIOTHERAPY

PubMed Central

Feng, Qianjin; Foskey, Mark; Tang, Songyuan; Chen, Wufan; Shen, Dinggang

2010-01-01

This paper presents a new deformable model using both population and patient-specific statistics to segment the prostate from CT images. There are two novelties in the proposed method. First, a modified scale invariant feature transform (SIFT) local descriptor, which is more distinctive than general intensity and gradient features, is used to characterize the image features. Second, an online training approach is used to build the shape statistics for accurately capturing intra-patient variation, which is more important than inter-patient variation for prostate segmentation in clinical radiotherapy. Experimental results show that the proposed method is robust and accurate, suitable for clinical application. PMID:21197416

Investigation of MR scanning, image registration, and image processing techniques to visualize cortical veins for neurosurgery

NASA Astrophysics Data System (ADS)

Noordmans, Herke J.; Rutten, G. J. M.; Willems, Peter W. A.; Hoogduin, J.; Viergever, Max A.

2001-01-01

The visualization of brain vessels on the cortex helps the neurosurgeon in two ways: To avoid blood vessels when specifying the trepanation entry, and to overcome errors in the surgical navigation system due to brain shift. We compared 3D T1 MR, 3D T1 MR with gadolinium contrast, MR venography and MR phase contrast angiography as scanning techniques, mutual information as registration technique, and thresholding and multi-vessel enhancement as image processing techniques. We evaluated the volume rendered results based on their quality and correspondence with photos took during surgery. It appears that with 3D T1 MR scans, gadolinium is required to show cortical veins. The visibility of small cortical veins is strongly enhanced by subtracting a 3D T1 MR baseline scan, which should be registered to the scan with gadolinium contrast, even when the scans are made during the same session. Multi-vessel enhancement helps to clarify the view on small vessels by reducing the noise level, but strikingly does not reveal more. MR venography does show intracerebral veins with high detail, but is, as is, unsuited to show cortical veins due to the low contrast with CSF. MR phase contrast angiography can perform equally well as the subtraction technique, but its quality seems to show more inter-patient variability.

Multi-atlas pancreas segmentation: Atlas selection based on vessel structure.

PubMed

Karasawa, Ken'ichi; Oda, Masahiro; Kitasaka, Takayuki; Misawa, Kazunari; Fujiwara, Michitaka; Chu, Chengwen; Zheng, Guoyan; Rueckert, Daniel; Mori, Kensaku

2017-07-01

Automated organ segmentation from medical images is an indispensable component for clinical applications such as computer-aided diagnosis (CAD) and computer-assisted surgery (CAS). We utilize a multi-atlas segmentation scheme, which has recently been used in different approaches in the literature to achieve more accurate and robust segmentation of anatomical structures in computed tomography (CT) volume data. Among abdominal organs, the pancreas has large inter-patient variability in its position, size and shape. Moreover, the CT intensity of the pancreas closely resembles adjacent tissues, rendering its segmentation a challenging task. Due to this, conventional intensity-based atlas selection for pancreas segmentation often fails to select atlases that are similar in pancreas position and shape to those of the unlabeled target volume. In this paper, we propose a new atlas selection strategy based on vessel structure around the pancreatic tissue and demonstrate its application to a multi-atlas pancreas segmentation. Our method utilizes vessel structure around the pancreas to select atlases with high pancreatic resemblance to the unlabeled volume. Also, we investigate two types of applications of the vessel structure information to the atlas selection. Our segmentations were evaluated on 150 abdominal contrast-enhanced CT volumes. The experimental results showed that our approach can segment the pancreas with an average Jaccard index of 66.3% and an average Dice overlap coefficient of 78.5%. Copyright © 2017 Elsevier B.V. All rights reserved.

[Regulation of hypnosis in Propofol anesthesia administration based on non-linear control strategy].

PubMed

Ilyas, Muhammad; Khaqan, Ali; Iqbal, Jamshed; Riaz, Raja Ali

Continuous adjustment of Propofol in manual delivery of anesthesia for conducting a surgical procedure overburdens the workload of an anesthetist who is working in a multi-tasking scenario. Going beyond manual administration and Target Controlled Infusion, closed-loop control of Propofol infusion has the potential to offer several benefits in terms of handling perturbations and reducing the effect of inter-patient variability. This paper proposes a closed-loop automated drug administration approach to control Depth Of Hypnosis in anesthesia. In contrast with most of the existing research on anesthesia control which makes use of linear control strategies or their improved variants, the novelty of the present research lies in applying robust control strategy i.e. Sliding Mode Control to accurately control drug infusion. Based on the derived patient's model, the designed controller uses measurements from EEG to regulate DOH on Bispectral Index by controlling infusion rate of Propofol. The performance of the controller is investigated and characterized with real dataset of 8 patients undergoing surgery. Results of this in silico study indicate that for all the patients, with 0% overshoot observed, the steady state error lies in between ±5. Clinically, this implies that in all the cases, without any overdose, the controller maintains the desired DOH level for smooth conduction of surgical procedures. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

Regulation of hypnosis in Propofol anesthesia administration based on non-linear control strategy.

PubMed

Ilyas, Muhammad; Khaqan, Ali; Iqbal, Jamshed; Riaz, Raja Ali

Continuous adjustment of Propofol in manual delivery of anesthesia for conducting a surgical procedure overburdens the workload of an anesthetist who is working in a multi-tasking scenario. Going beyond manual administration and Target Controlled Infusion, closed-loop control of Propofol infusion has the potential to offer several benefits in terms of handling perturbations and reducing the effect of inter-patient variability. This paper proposes a closed-loop automated drug administration approach to control Depth Of Hypnosis in anesthesia. In contrast with most of the existing research on anesthesia control which makes use of linear control strategies or their improved variants, the novelty of the present research lies in applying robust control strategy i.e. Sliding Mode Control to accurately control drug infusion. Based on the derived patient's model, the designed controller uses measurements from EEG to regulate DOH on Bispectral Index by controlling infusion rate of Propofol. The performance of the controller is investigated and characterized with real dataset of 8 patients undergoing surgery. Results of this in silico study indicate that for all the patients, with 0% overshoot observed, the steady state error lies in between ±5. Clinically, this implies that in all the cases, without any overdose, the controller maintains the desired DOH level for smooth conduction of surgical procedures. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

A novel somatic JAK2 kinase-domain mutation in pediatric acute lymphoblastic leukemia with rapid on-treatment development of LOH.

PubMed

Sadras, Teresa; Heatley, Susan L; Kok, Chung H; McClure, Barbara J; Yeung, David; Hughes, Timothy P; Sutton, Rosemary; Ziegler, David S; White, Deborah L

2017-10-01

We report a novel somatic mutation in the kinase domain of JAK2 (R938Q) in a high-risk pediatric case of B-cell acute lymphoblastic leukemia (ALL). The patient developed on-therapy relapse at 12 months, and interestingly, the JAK2 locus acquired loss of heterozygosity during treatment resulting in 100% mutation load. Furthermore, we show that primary ALL mononuclear cells harboring the JAK2 R938Q mutation display reduced sensitivity to the JAK1/2 ATP-competitive inhibitor ruxolitinib in vitro, compared to ALL cells that carry a more common JAK2 pseudokinase domain mutation. Our findings are in line with previous reports that demonstrate that mutations within the kinase domain of JAK2 are associated with resistance to type I JAK inhibitors. Importantly, given the recent inclusion of ruxolitinib in trial protocols for children with JAK pathway alterations, we predict that inter-patient genetic variability may result in suboptimal responses to JAK inhibitor therapy in a subset of cases. The need for alternate targeted and/or combination therapies for patients who display inherent or developed resistance to JAK inhibitor therapy will be warranted, and we propose that kinase-mutants less sensitive to type I JAK inhibitors may present a currently unexplored platform for investigation of improved therapies. Copyright © 2017. Published by Elsevier Inc.

Anticoagulants for secondary prevention after acute myocardial infarction: lessons from the past decade

PubMed Central

Atar, Dan; Bode, Christoph; Stuerzenbecher, André; Verheugt, Freek W A

2014-01-01

The impact of an acute coronary syndrome (ACS) event, such as an acute myocardial infarction (MI), is not limited to the acute management phase; patients face an elevated risk of residual atherothrombotic events that commonly requires chronic management for months or even years. Significant advances have been made in both the acute and chronic management of patients with acute MI over the past decade, resulting in improved prognoses. One of the hallmarks of modern treatment strategies is more aggressive antiplatelet treatment regimens. However, the risks of further ACS events, stroke and premature death remain elevated in these patients, and addressing this residual risk is challenging owing to interpatient variability, differences in management strategies between centres and countries, incomplete understanding of the specific pathophysiology of post-ACS thrombosis and limitations of current therapeutic approaches. The recent approval in Europe of the direct oral anticoagulant rivaroxaban for use in this setting in combination with clopidogrel and acetylsalicylic acid offers another strategy to consider in the management of these patients, and clinical strategies in this area continue to evolve. In this review, we chart the progress made over the past decade in reducing the burden of secondary thromboembolic events after acute MI and discuss the current position of and future perspectives on the inclusion of oral anticoagulants into care pathways in this setting. PMID:24494730

Engine design considerations for 2nd generation supersonic transports

NASA Technical Reports Server (NTRS)

Howlett, R. A.

1975-01-01

The environmental and economic goals projected for advanced supersonic transports will require revolutionary improvements in propulsion systems. Variable cycle engine concepts that incorporate unique components and advanced technologies show promise in meeting these goals. Pratt & Whitney Aircraft is conducting conceptual design studies of variable cycle engine concepts under NASA sponsorship. This paper reviews some of the design considerations for these engine concepts. Emphasis is placed on jet noise abatement, reduction of emissions, performance improvements, installation considerations, hot-section characteristics and control system requirements. Two representative variable cycle engine concepts that incorporate these basic design considerations are described.

Pharmacodynamic, pharmacokinetic and pharmacogenetic aspects of drugs used in the treatment of Alzheimer's disease.

PubMed

Noetzli, Muriel; Eap, Chin B

2013-04-01

With the aging population and its rapidly increasing prevalence, dementia has become an important public health concern in developed and developing countries. To date, the pharmacological treatment is symptomatic and based on the observed neurotransmitter disturbances. The four most commonly used drugs are donepezil, galantamine, rivastigmine and memantine. Donepezil, galantamine and rivastigmine are acetylcholinesterase inhibitors with different pharmacodynamic and pharmacokinetic profiles. Donepezil inhibits selectively the acetylcholinesterase and has a long elimination half-life (t(1/2)) of 70 h. Galantamine is also a selective acetylcholinesterase inhibitor, but also modulates presynaptic nicotinic receptors. It has a t(1/2) of 6-8 h. Donepezil and galantamine are mainly metabolised by cytochrome P450 (CYP) 2D6 and CYP3A4 in the liver. Rivastigmine is a so-called 'pseudo-irreversible' inhibitor of acetylcholinesterase and butyrylcholinesterase. The t(1/2) of the drug is very short (1-2 h), but the duration of action is longer as the enzymes are blocked for around 8.5 and 3.5 h, respectively. Rivastigmine is metabolised by esterases in liver and intestine. Memantine is a non-competitive low-affinity antagonist of the NMDA receptor with a t(1/2) of 70 h. Its major route of elimination is unchanged via the kidneys. Addressing the issue of inter-patient variability in treatment response might be of special importance for the vulnerable population taking anti-dementia drugs. Pharmacogenetic considerations might help to avoid multiple medication changes due to non-response and/or adverse events. Some pharmacogenetic studies conducted on donepezil and galantamine reported an influence of the CYP2D6 genotype on the pharmacokinetics of the drugs and/or on the response to treatment. Moreover, polymorphisms in genes of the cholinergic markers acetylcholinesterase, butyrylcholinesterase, choline acetyltransferase and paraoxonase were found to be associated with better clinical response to acetylcholinesterase inhibitors. However, confirmation studies in larger populations are necessary to establish evidence of which subgroups of patients will most likely benefit from anti-dementia drugs. The aim of this review is to summarize the pharmacodynamics and pharmacokinetics of the four commonly used anti-dementia drugs and to give an overview on the current knowledge of pharmacogenetics in this field.

SU-E-T-580: On the Significance of Model Based Dosimetry for Breast and Head and Neck 192Ir HDR Brachytherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Peppa, V; Pappas, E; Pantelis, E

2015-06-15

Purpose: To assess the dosimetric and radiobiological differences between TG43-based and model-based dosimetry in the treatment planning of {sup 192}Ir HDR brachytherapy for breast and head and neck cancer. Methods: Two cohorts of 57 Accelerated Partial Breast Irradiation (APBI) and 22 head and neck (H&N) patients with oral cavity carcinoma were studied. Dosimetry for the treatment plans was performed using the TG43 algorithm of the Oncentra Brachy v4.4 treatment planning system (TPS). Corresponding Monte Carlo (MC) simulations were performed using MCNP6 with input files automatically prepared by the BrachyGuide software tool from DICOM RT plan data. TG43 and MC datamore » were compared in terms of % dose differences, Dose Volume Histograms (DVHs) and related indices of clinical interest for the Planning Target Volume (PTV) and the Organs-At-Risk (OARs). A radiobiological analysis was also performed using the Equivalent Uniform Dose (EUD), mean survival fraction (S) and Tumor Control Probability (TCP) for the PTV, and the Normal Tissue Control Probability (N TCP) and the generalized EUD (gEUD) for the OARs. Significance testing of the observed differences performed using the Wilcoxon paired sample test. Results: Differences between TG43 and MC DVH indices, associated with the increased corresponding local % dose differences observed, were statistically significant. This is mainly attributed to their consistency however, since TG43 agrees closely with MC for the majority of DVH and radiobiological parameters in both patient cohorts. Differences varied considerably among patients only for the ipsilateral lung and ribs in the APBI cohort, with a strong correlation to target location. Conclusion: While the consistency and magnitude of differences in the majority of clinically relevant DVH indices imply that no change is needed in the treatment planning practice, individualized dosimetry improves accuracy and addresses instances of inter-patient variability observed. Research co-financed by the ESF and Greek funds through the Operational Program Education and Lifelong Learning Investing in Knowledge Society of the NSRF. Research Funding Program Aristeia. Nucletron, an Elekta company (Veenendaal, The Netherlands) is gratefully acknowledged for providing Oncentra Brachy v4.4 for research purposes.« less

WE-D-BRE-02: BEST IN PHYSICS (THERAPY) - Radiogenomic Modeling of Normal Tissue Toxicities in Prostate Cancer Patients Receiving Hypofractionated Radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Coates, J; Jeyaseelan, K; Ybarra, N

2014-06-15

Purpose: It has been realized that inter-patient radiation sensitivity variability is a multifactorial process involving dosimetric, clinical, and genetic factors. Therefore, we explore a new framework to integrate physical, clinical, and biological data denoted as radiogenomic modeling. In demonstrating the feasibility of this work, we investigate the association of genetic variants (copy number variations [CNVs] and single nucleotide polymorphisms [SNPs]) with radiation induced rectal bleeding (RB) and erectile dysfunction (ED) while taking into account dosimetric and clinical variables in prostate cancer patients treated with curative irradiation. Methods: A cohort of 62 prostate cancer patients who underwent hypofractionated radiotherapy (66 Gymore » in 22 fractions) was retrospectively genotyped for CNV and SNP rs25489 in the xrcc1 DNA repair gene. Dosevolume metrics were extracted from treatment plans of 54 patients who had complete dosimetric profiles. Treatment outcomes were considered to be a Result of functional mapping of radiogenomic input variables according to a logit transformation. Model orders were estimated using resampling by leave-one out cross-validation (LOO-CV). Radiogenomic model performance was evaluated using area under the ROC curve (AUC) and LOO-CV. For continuous univariate dosimetric and clinical variables, Spearmans rank coefficients were calculated and p-values reported accordingly. In the case of binary variables, Chi-squared statistics and contingency table calculations were used. Results: Ten patients were found to have three copies of xrcc1 CNV (RB: χ2=14.6 [p<0.001] and ED: χ2=4.88[p=0.0272]) and twelve had heterozygous rs25489 SNP (RB: χ2=0.278[p=0.599] and ED: χ2=0.112[p=0.732]). LOO-CV identified penile bulb D60 as the only significant QUANTEC predictor (rs=0.312 [p=0.0145]) for ED. Radiogenomic modeling yielded statistically significant, cross-validated NTCP models for RB (rs=0.243[p=0.0443], AUC=0.665) and ED (rs=0.276[p=0.0217], AUC=0.754). Conclusion: The radiogenomic modeling approach presented herein has been shown to identify NTCP models which have increased predictive power. Furthermore, CNVs appears to be useful genetic variants when added to dosimetric NTCP models. This work was partially supported by CIHR grant MOP-114910.« less

Secondary Students' Considerations of Variability in Measurement Activities Based on Authentic Practices

ERIC Educational Resources Information Center

Dierdorp, Adri; Bakker, Arthur; Ben-Zvi, Dani; Makar, Katie

2017-01-01

Measurement activities were designed in this study on the basis of authentic professional practices in which linear regression is used, to study considerations of variability by students in Grade 12 (aged 17-18). The question addressed in this article is: In what ways do secondary students consider variability within these measurement activities?…

Busulfan pharmacokinetics following intravenous and oral dosing regimens in children receiving high-dose myeloablative chemotherapy for high-risk neuroblastoma as part of the HR-NBL-1/SIOPEN trial.

PubMed

Veal, G J; Nguyen, L; Paci, A; Riggi, M; Amiel, M; Valteau-Couanet, D; Brock, P; Ladenstein, R; Vassal, G

2012-11-01

Busulfan is widely used in a neuroblastoma setting, with several studies reporting marked inter-patient variability in busulfan pharmacokinetics and pharmacodynamics. The current study reports on the pharmacokinetics of oral versus intravenous (IV) busulfan in high-risk neuroblastoma patients treated on the European HR-NBL-1/SIOPEN study. Busulfan was administered four times daily for 4 days to children aged 0.7-13.1 years, either orally (1.45-1.55 mg/kg) or by the IV route (0.8-1.2mg/kg according to body weight strata). Blood samples were obtained prior to administration, 2, 4, and 6h after the start of administration on dose 1. Busulfan analysis was carried out by gas chromatography-mass spectrometry and data analysed using a NONMEM population pharmacokinetic approach. Busulfan plasma concentrations obtained from 38 patients receiving IV busulfan and 25 patients receiving oral busulfan, were fitted simultaneously using a one-compartment pharmacokinetic model. Lower variability in drug exposure was observed following IV administration, with a mean busulfan area under the plasma concentration versus time curve (AUC) of 1146 ± 187 μM.min (range 838-1622), as compared to 953 ± 290 μM.min (range 434-1427) following oral busulfan. A total of 87% of children treated with IV busulfan achieved AUC values within the target of 900-1500 μM.min versus 56% of patients following oral busulfan. Busulfan AUC values were significantly higher in HR-NBL-1/SIOPEN trial patients who experienced hepatic toxicity or veno-occlusive disease (VOD) (1177 ± 189 μM.min versus 913 ± 256 μM.min; p=0.0086). Further stratification based on route of administration suggested that the incidence of hepatic toxicity was related to both high busulfan AUC and oral drug administration. The reduced pharmacokinetic variability and improved control of busulfan AUC observed following IV administration support its utility within the ongoing HR-NBL-1/SIOPEN trial. Copyright © 2012 Elsevier Ltd. All rights reserved.

Next-generation clinical trials: Novel strategies to address the challenge of tumor molecular heterogeneity.

PubMed

Catenacci, Daniel V T

2015-05-01

The promise of 'personalized cancer care' with therapies toward specific molecular aberrations has potential to improve outcomes. However, there is recognized heterogeneity within any given tumor-type from patient to patient (inter-patient heterogeneity), and within an individual (intra-patient heterogeneity) as demonstrated by molecular evolution through space (primary tumor to metastasis) and time (after therapy). These issues have become hurdles to advancing cancer treatment outcomes with novel molecularly targeted agents. Classic trial design paradigms are challenged by heterogeneity, as they are unable to test targeted therapeutics against low frequency genomic 'oncogenic driver' aberrations with adequate power. Usual accrual difficulties to clinical trials are exacerbated by low frequencies of any given molecular driver. To address these challenges, there is need for innovative clinical trial designs and strategies implementing novel diagnostic biomarker technologies to account for inter-patient molecular diversity and scarce tissue for analysis. Importantly, there is also need for pre-defined treatment priority algorithms given numerous aberrations commonly observed within any one individual sample. Access to multiple available therapeutic agents simultaneously is crucial. Finally intra-patient heterogeneity through time may be addressed by serial biomarker assessment at the time of tumor progression. This report discusses various 'next-generation' biomarker-driven trial designs and their potentials and limitations to tackle these recognized molecular heterogeneity challenges. Regulatory hurdles, with respect to drug and companion diagnostic development and approval, are considered. Focus is on the 'Expansion Platform Design Types I and II', the latter demonstrated with a first example, 'PANGEA: Personalized Anti-Neoplastics for Gastro-Esophageal Adenocarcinoma'. Applying integral medium-throughput genomic and proteomic assays along with a practical biomarker assessment and treatment algorithm, 'PANGEA' attempts to address the problem of heterogeneity towards successful implementation of molecularly targeted therapies. Copyright © 2014 The Author. Published by Elsevier B.V. All rights reserved.

Targeting CD157 in AML using a novel, Fc-engineered antibody construct

PubMed Central

Krupka, Christina; Lichtenegger, Felix S.; Köhnke, Thomas; Bögeholz, Jan; Bücklein, Veit; Roiss, Michael; Altmann, Torben; Do, To Uyen; Dusek, Rachel; Wilson, Keith; Bisht, Arnima; Terrett, Jon; Aud, Dee; Pombo-Villar, Esteban; Rohlff, Christian; Hiddemann, Wolfgang; Subklewe, Marion

2017-01-01

Antibody-based immunotherapy represents a promising strategy to eliminate chemorefractory leukemic cells in acute myeloid leukemia (AML). In this study, we evaluated a novel Fc-engineered antibody against CD157 (MEN1112) for its suitability as immunotherapy in AML. CD157 was expressed in 97% of primary AML patient samples. A significant, albeit lower expression level of CD157 was observed within the compartment of leukemia-initiating cells, which are supposed to be the major source of relapse. In healthy donor bone marrow, CD157 was expressed on CD34+ cells. In ex vivo assays, MEN1112 triggered natural killer (NK) cell-mediated cytotoxicity against AML cell lines and primary AML cells. Compared to its parental analogue, the Fc-engineered antibody exhibited higher antibody dependent cellular cytotoxicity responses. Using NK cells from AML patients, we observed heterogeneous MEN1112-mediated cytotoxicity against AML cells, most likely due to well-documented defects in AML-NK cells and corresponding inter-patient variations in NK cell function. Cytotoxicity could not be correlated to the time after completion of chemotherapy. In summary, we could demonstrate that CD157 is strongly expressed in AML. MEN1112 is a promising antibody construct that showed high cytotoxicity against AML cells and warrants further clinical testing. Due to variability in NK-cell function of AML patients, the time of application during the course of the disease as well as combinatorial strategies might influence treatment results. PMID:28415689

Pharmacokinetics of temozolomide given three times a day in pediatric and adult patients.

PubMed

Riccardi, Anna; Mazzarella, Giorgio; Cefalo, Graziella; Garrè, Maria Luisa; Massimino, Maura; Barone, Carlo; Sandri, Alessandro; Ridola, Vita; Ruggiero, Antonio; Mastrangelo, Stefano; Lazzareschi, Ilaria; Caldarelli, Massimo; Maira, Giulio; Madon, Enrico; Riccardi, Riccardo

2003-12-01

To characterize and compare pharmacokinetic parameters in children and adults treated with temozolomide (TMZ) administered for 5 days in three doses daily, and to evaluate the possible relationship between AUC values and hematologic toxicity. TMZ pharmacokinetic parameters were characterized in pediatric and adult patients with primary central nervous system tumors treated with doses ranging from 120 to 200 mg/m2 per day, divided into three doses daily for 5 days. Plasma levels were measured over 8 h following oral administration in a fasting state. A total of 40 courses were studied in 22 children (mean age 10 years, range 3-16 years) and in 8 adults (mean age 30 years, range 19-54 years). In all patients, a linear relationship was found between systemic exposure (AUC) and increasing doses of TMZ. Time to peak concentration, elimination half-life, apparent clearance and volume of distribution were not related to TMZ dose. No differences were seen among TMZ C(max), t(1/2), V(d) or CL/F in children compared with adults. Intra- and interpatient variability of systemic exposure were limited in both children and adults. No statistically significant differences were found between the AUCs of children who experienced grade 4 hematologic toxicity and children who did not. No difference appears to exist between pharmacokinetic parameters in adults and children when TMZ is administered in three doses daily. Hematologic toxicity was not related to TMZ AUC. AUC measurement does not appear to be of any use in optimizing TMZ treatment.

Genetic factors contribute to bleeding after cardiac surgery.

PubMed

Welsby, I J; Podgoreanu, M V; Phillips-Bute, B; Mathew, J P; Smith, P K; Newman, M F; Schwinn, D A; Stafford-Smith, M

2005-06-01

Postoperative bleeding remains a common, serious problem for cardiac surgery patients, with striking inter-patient variability poorly explained by clinical, procedural, and biological markers. We tested the hypothesis that genetic polymorphisms of coagulation proteins and platelet glycoproteins are associated with bleeding after cardiac surgery. Seven hundred and eighty patients undergoing aortocoronary surgery with cardiopulmonary bypass were studied. Clinical covariates previously associated with bleeding were recorded and DNA isolated from preoperative blood. Matrix Assisted Laser Desorption/Ionization, Time-Of-Flight (MALDI-TOF) mass spectroscopy or polymerase chain reaction were used for genotype analysis. Multivariable linear regression modeling, including all genetic main effects and two-way gene-gene interactions, related clinical and genetic predictors to bleeding from the thorax and mediastinum. Nineteen candidate polymorphisms were assessed; seven [GPIaIIa-52C>T and 807C>T, GPIb alpha 524C>T, tissue factor-603A>G, prothrombin 20210G>A, tissue factor pathway inhibitor-399C>T, and angiotensin converting enzyme (ACE) deletion/insertion] demonstrate significant association with bleeding (P < 0.01). Adding genetic to clinical predictors results improves the model, doubling overall ability to predict bleeding (P < 0.01). We identified seven genetic polymorphisms associated with bleeding after cardiac surgery. Genetic factors appear primarily independent of, and explain at least as much variation in bleeding as clinical covariates; combining genetic and clinical factors double our ability to predict bleeding after cardiac surgery. Accounting for genotype may be necessary when stratifying risk of bleeding after cardiac surgery.

Systems Chronotherapeutics

PubMed Central

Innominato, Pasquale F.; Dallmann, Robert; Rand, David A.; Lévi, Francis A.

2017-01-01

Chronotherapeutics aim at treating illnesses according to the endogenous biologic rhythms, which moderate xenobiotic metabolism and cellular drug response. The molecular clocks present in individual cells involve approximately fifteen clock genes interconnected in regulatory feedback loops. They are coordinated by the suprachiasmatic nuclei, a hypothalamic pacemaker, which also adjusts the circadian rhythms to environmental cycles. As a result, many mechanisms of diseases and drug effects are controlled by the circadian timing system. Thus, the tolerability of nearly 500 medications varies by up to fivefold according to circadian scheduling, both in experimental models and/or patients. Moreover, treatment itself disrupted, maintained, or improved the circadian timing system as a function of drug timing. Improved patient outcomes on circadian-based treatments (chronotherapy) have been demonstrated in randomized clinical trials, especially for cancer and inflammatory diseases. However, recent technological advances have highlighted large interpatient differences in circadian functions resulting in significant variability in chronotherapy response. Such findings advocate for the advancement of personalized chronotherapeutics through interdisciplinary systems approaches. Thus, the combination of mathematical, statistical, technological, experimental, and clinical expertise is now shaping the development of dedicated devices and diagnostic and delivery algorithms enabling treatment individualization. In particular, multiscale systems chronopharmacology approaches currently combine mathematical modeling based on cellular and whole-body physiology to preclinical and clinical investigations toward the design of patient-tailored chronotherapies. We review recent systems research works aiming to the individualization of disease treatment, with emphasis on both cancer management and circadian timing system–resetting strategies for improving chronic disease control and patient outcomes. PMID:28351863

Myeloma Cell Dynamics in Response to Treatment Supports a Model of Hierarchical Differentiation and Clonal Evolution.

PubMed

Tang, Min; Zhao, Rui; van de Velde, Helgi; Tross, Jennifer G; Mitsiades, Constantine; Viselli, Suzanne; Neuwirth, Rachel; Esseltine, Dixie-Lee; Anderson, Kenneth; Ghobrial, Irene M; San Miguel, Jesús F; Richardson, Paul G; Tomasson, Michael H; Michor, Franziska

2016-08-15

Since the pioneering work of Salmon and Durie, quantitative measures of tumor burden in multiple myeloma have been used to make clinical predictions and model tumor growth. However, such quantitative analyses have not yet been performed on large datasets from trials using modern chemotherapy regimens. We analyzed a large set of tumor response data from three randomized controlled trials of bortezomib-based chemotherapy regimens (total sample size n = 1,469 patients) to establish and validate a novel mathematical model of multiple myeloma cell dynamics. Treatment dynamics in newly diagnosed patients were most consistent with a model postulating two tumor cell subpopulations, "progenitor cells" and "differentiated cells." Differential treatment responses were observed with significant tumoricidal effects on differentiated cells and less clear effects on progenitor cells. We validated this model using a second trial of newly diagnosed patients and a third trial of refractory patients. When applying our model to data of relapsed patients, we found that a hybrid model incorporating both a differentiation hierarchy and clonal evolution best explains the response patterns. The clinical data, together with mathematical modeling, suggest that bortezomib-based therapy exerts a selection pressure on myeloma cells that can shape the disease phenotype, thereby generating further inter-patient variability. This model may be a useful tool for improving our understanding of disease biology and the response to chemotherapy regimens. Clin Cancer Res; 22(16); 4206-14. ©2016 AACR. ©2016 American Association for Cancer Research.

Anticoagulants for secondary prevention after acute myocardial infarction: lessons from the past decade.

PubMed

Atar, Dan; Bode, Christoph; Stuerzenbecher, André; Verheugt, Freek W A

2014-08-01

The impact of an acute coronary syndrome (ACS) event, such as an acute myocardial infarction (MI), is not limited to the acute management phase; patients face an elevated risk of residual atherothrombotic events that commonly requires chronic management for months or even years. Significant advances have been made in both the acute and chronic management of patients with acute MI over the past decade, resulting in improved prognoses. One of the hallmarks of modern treatment strategies is more aggressive antiplatelet treatment regimens. However, the risks of further ACS events, stroke and premature death remain elevated in these patients, and addressing this residual risk is challenging owing to interpatient variability, differences in management strategies between centres and countries, incomplete understanding of the specific pathophysiology of post-ACS thrombosis and limitations of current therapeutic approaches. The recent approval in Europe of the direct oral anticoagulant rivaroxaban for use in this setting in combination with clopidogrel and acetylsalicylic acid offers another strategy to consider in the management of these patients, and clinical strategies in this area continue to evolve. In this review, we chart the progress made over the past decade in reducing the burden of secondary thromboembolic events after acute MI and discuss the current position of and future perspectives on the inclusion of oral anticoagulants into care pathways in this setting. © 2014 The Authors. Fundamental & Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of Société Française de Pharmacologie et de Thérapeutique.

Systems Chronotherapeutics.

PubMed

Ballesta, Annabelle; Innominato, Pasquale F; Dallmann, Robert; Rand, David A; Lévi, Francis A

2017-04-01

Chronotherapeutics aim at treating illnesses according to the endogenous biologic rhythms, which moderate xenobiotic metabolism and cellular drug response. The molecular clocks present in individual cells involve approximately fifteen clock genes interconnected in regulatory feedback loops. They are coordinated by the suprachiasmatic nuclei, a hypothalamic pacemaker, which also adjusts the circadian rhythms to environmental cycles. As a result, many mechanisms of diseases and drug effects are controlled by the circadian timing system. Thus, the tolerability of nearly 500 medications varies by up to fivefold according to circadian scheduling, both in experimental models and/or patients. Moreover, treatment itself disrupted, maintained, or improved the circadian timing system as a function of drug timing. Improved patient outcomes on circadian-based treatments (chronotherapy) have been demonstrated in randomized clinical trials, especially for cancer and inflammatory diseases. However, recent technological advances have highlighted large interpatient differences in circadian functions resulting in significant variability in chronotherapy response. Such findings advocate for the advancement of personalized chronotherapeutics through interdisciplinary systems approaches. Thus, the combination of mathematical, statistical, technological, experimental, and clinical expertise is now shaping the development of dedicated devices and diagnostic and delivery algorithms enabling treatment individualization. In particular, multiscale systems chronopharmacology approaches currently combine mathematical modeling based on cellular and whole-body physiology to preclinical and clinical investigations toward the design of patient-tailored chronotherapies. We review recent systems research works aiming to the individualization of disease treatment, with emphasis on both cancer management and circadian timing system-resetting strategies for improving chronic disease control and patient outcomes. Copyright © 2017 by The Author(s).

Optimization of agricultural field workability predictions for improved risk management

USDA-ARS?s Scientific Manuscript database

Risks introduced by weather variability are key considerations in agricultural production. The sensitivity of agriculture to weather variability is of special concern in the face of climate change. In particular, the availability of workable days is an important consideration in agricultural practic...

Neighborhood graph and learning discriminative distance functions for clinical decision support.

PubMed

Tsymbal, Alexey; Zhou, Shaohua Kevin; Huber, Martin

2009-01-01

There are two essential reasons for the slow progress in the acceptance of clinical case retrieval and similarity search-based decision support systems; the especial complexity of clinical data making it difficult to define a meaningful and effective distance function on them and the lack of transparency and explanation ability in many existing clinical case retrieval decision support systems. In this paper, we try to address these two problems by introducing a novel technique for visualizing inter-patient similarity based on a node-link representation with neighborhood graphs and by considering two techniques for learning discriminative distance function that help to combine the power of strong "black box" learners with the transparency of case retrieval and nearest neighbor classification.

A semi-automatic method for positioning a femoral bone reconstruction for strict view generation.

PubMed

Milano, Federico; Ritacco, Lucas; Gomez, Adrian; Gonzalez Bernaldo de Quiros, Fernan; Risk, Marcelo

2010-01-01

In this paper we present a semi-automatic method for femoral bone positioning after 3D image reconstruction from Computed Tomography images. This serves as grounding for the definition of strict axial, longitudinal and anterior-posterior views, overcoming the problem of patient positioning biases in 2D femoral bone measuring methods. After the bone reconstruction is aligned to a standard reference frame, new tomographic slices can be generated, on which unbiased measures may be taken. This could allow not only accurate inter-patient comparisons but also intra-patient comparisons, i.e., comparisons of images of the same patient taken at different times. This method could enable medical doctors to diagnose and follow up several bone deformities more easily.

Thyroid Hormones Are Transport Substrates and Transcriptional Regulators of Organic Anion Transporting Polypeptide 2B1.

PubMed

Meyer Zu Schwabedissen, Henriette E; Ferreira, Celio; Schaefer, Anima M; Oufir, Mouhssin; Seibert, Isabell; Hamburger, Matthias; Tirona, Rommel G

2018-07-01

Levothyroxine replacement therapy forms the cornerstone of hypothyroidism management. Variability in levothyroxine oral absorption may contribute to the well-recognized large interpatient differences in required dose. Moreover, levothyroxine-drug pharmacokinetic interactions are thought to be caused by altered oral bioavailability. Interestingly, little is known regarding the mechanisms contributing to levothyroxine absorption in the gastrointestinal tract. Here, we aimed to determine whether the intestinal drug uptake transporter organic anion transporting polypeptide 2B1 (OATP2B1) may be involved in facilitating intestinal absorption of thyroid hormones. We also explored whether thyroid hormones regulate OATP2B1 gene expression. In cultured Madin-Darby Canine Kidney II/OATP2B1 cells and in OATP2B1-transfected Caco-2 cells, thyroid hormones were found to inhibit OATP2B1-mediated uptake of estrone-3-sulfate. Competitive counter-flow experiments evaluating the influence on the cellular accumulation of estrone-3-sulfate in the steady state indicated that thyroid hormones were substrates of OATP2B1. Additional evidence that thyroid hormones were OATP2B1 substrates was provided by OATP2B1-dependent stimulation of thyroid hormone receptor activation in cell-based reporter assays. Bidirectional transport studies in intestinal Caco-2 cells showed net absorptive flux of thyroid hormones, which was attenuated by the presence of the OATP2B1 inhibitor, atorvastatin. In intestinal Caco-2 and LS180 cells, but not in liver Huh-7 or HepG2 cells, OATP2B1 expression was induced by treatment with thyroid hormones. Reporter gene assays revealed thyroid hormone receptor α -mediated transactivation of the SLCO2B1 1b and the SLCO2B1 1e promoters. We conclude that thyroid hormones are substrates and transcriptional regulators of OATP2B1. These insights provide a potential mechanistic basis for oral levothyroxine dose variability and drug interactions. Copyright © 2018 by The American Society for Pharmacology and Experimental Therapeutics.

Quantitative Evaluation of Segmentation- and Atlas-Based Attenuation Correction for PET/MR on Pediatric Patients.

PubMed

Bezrukov, Ilja; Schmidt, Holger; Gatidis, Sergios; Mantlik, Frédéric; Schäfer, Jürgen F; Schwenzer, Nina; Pichler, Bernd J

2015-07-01

Pediatric imaging is regarded as a key application for combined PET/MR imaging systems. Because existing MR-based attenuation-correction methods were not designed specifically for pediatric patients, we assessed the impact of 2 potentially influential factors: inter- and intrapatient variability of attenuation coefficients and anatomic variability. Furthermore, we evaluated the quantification accuracy of 3 methods for MR-based attenuation correction without (SEGbase) and with bone prediction using an adult and a pediatric atlas (SEGwBONEad and SEGwBONEpe, respectively) on PET data of pediatric patients. The variability of attenuation coefficients between and within pediatric (5-17 y, n = 17) and adult (27-66 y, n = 16) patient collectives was assessed on volumes of interest (VOIs) in CT datasets for different tissue types. Anatomic variability was assessed on SEGwBONEad/pe attenuation maps by computing mean differences to CT-based attenuation maps for regions of bone tissue, lungs, and soft tissue. PET quantification was evaluated on VOIs with physiologic uptake and on 80% isocontour VOIs with elevated uptake in the thorax and abdomen/pelvis. Inter- and intrapatient variability of the bias was assessed for each VOI group and method. Statistically significant differences in mean VOI Hounsfield unit values and linear attenuation coefficients between adult and pediatric collectives were found in the lungs and femur. The prediction of attenuation maps using the pediatric atlas showed a reduced error in bone tissue and better delineation of bone structure. Evaluation of PET quantification accuracy showed statistically significant mean errors in mean standardized uptake values of -14% ± 5% and -23% ± 6% in bone marrow and femur-adjacent VOIs with physiologic uptake for SEGbase, which could be reduced to 0% ± 4% and -1% ± 5% using SEGwBONEpe attenuation maps. Bias in soft-tissue VOIs was less than 5% for all methods. Lung VOIs showed high SDs in the range of 15% for all methods. For VOIs with elevated uptake, mean and SD were less than 5% except in the thorax. The use of a dedicated atlas for the pediatric patient collective resulted in improved attenuation map prediction in osseous regions and reduced interpatient bias variation in femur-adjacent VOIs. For the lungs, in which intrapatient variation was higher for the pediatric collective, a patient- or group-specific attenuation coefficient might improve attenuation map accuracy. Mean errors of -14% and -23% in bone marrow and femur-adjacent VOIs can affect PET quantification in these regions when bone tissue is ignored. © 2015 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

Fluorescent marker-based and marker-free discrimination between healthy and cancerous human tissues using hyper-spectral imaging

NASA Astrophysics Data System (ADS)

Arnold, Thomas; De Biasio, Martin; Leitner, Raimund

2015-06-01

Two problems are addressed in this paper (i) the fluorescent marker-based and the (ii) marker-free discrimination between healthy and cancerous human tissues. For both applications the performance of hyper-spectral methods are quantified. Fluorescent marker-based tissue classification uses a number of fluorescent markers to dye specific parts of a human cell. The challenge is that the emission spectra of the fluorescent dyes overlap considerably. They are, furthermore disturbed by the inherent auto-fluorescence of human tissue. This results in ambiguities and decreased image contrast causing difficulties for the treatment decision. The higher spectral resolution introduced by tunable-filter-based spectral imaging in combination with spectral unmixing techniques results in an improvement of the image contrast and therefore more reliable information for the physician to choose the treatment decision. Marker-free tissue classification is based solely on the subtle spectral features of human tissue without the use of artificial markers. The challenge in this case is that the spectral differences between healthy and cancerous tissues are subtle and embedded in intra- and inter-patient variations of these features. The contributions of this paper are (i) the evaluation of hyper-spectral imaging in combination with spectral unmixing techniques for fluorescence marker-based tissue classification, (ii) the evaluation of spectral imaging for marker-free intra surgery tissue classification. Within this paper, we consider real hyper-spectral fluorescence and endoscopy data sets to emphasize the practical capability of the proposed methods. It is shown that the combination of spectral imaging with multivariate statistical methods can improve the sensitivity and specificity of the detection and the staging of cancerous tissues compared to standard procedures.

Determinants of Awareness, Consideration, and Choice Set Size in University Choice.

ERIC Educational Resources Information Center

Dawes, Philip L.; Brown, Jennifer

2002-01-01

Developed and tested a model of students' university "brand" choice using five individual-level variables (ethnic group, age, gender, number of parents going to university, and academic ability) and one situational variable (duration of search) to explain variation in the sizes of awareness, consideration, and choice decision sets. (EV)

Early Childhood Development Cultural Considerations--Commonalities, Variables, and Local Community Determinants for Program Modules.

ERIC Educational Resources Information Center

Taylor, Anne P.; Warren, Dave

The paper discusses cultural commonality and variability considerations of the Native American populations served by the Federation of Rocky Mountain States Educational Technical Development (ETD) Project. Section I explores important factors to consider when setting up an Early Childhood Development program module for Indian people, such as…

Early Epstein-Barr Virus Genomic Diversity and Convergence toward the B95.8 Genome in Primary Infection.

PubMed

Weiss, Eric R; Lamers, Susanna L; Henderson, Jennifer L; Melnikov, Alexandre; Somasundaran, Mohan; Garber, Manuel; Selin, Liisa; Nusbaum, Chad; Luzuriaga, Katherine

2018-01-15

Over 90% of the world's population is persistently infected with Epstein-Barr virus. While EBV does not cause disease in most individuals, it is the common cause of acute infectious mononucleosis (AIM) and has been associated with several cancers and autoimmune diseases, highlighting a need for a preventive vaccine. At present, very few primary, circulating EBV genomes have been sequenced directly from infected individuals. While low levels of diversity and low viral evolution rates have been predicted for double-stranded DNA (dsDNA) viruses, recent studies have demonstrated appreciable diversity in common dsDNA pathogens (e.g., cytomegalovirus). Here, we report 40 full-length EBV genome sequences obtained from matched oral wash and B cell fractions from a cohort of 10 AIM patients. Both intra- and interpatient diversity were observed across the length of the entire viral genome. Diversity was most pronounced in viral genes required for establishing latent infection and persistence, with appreciable levels of diversity also detected in structural genes, including envelope glycoproteins. Interestingly, intrapatient diversity declined significantly over time ( P < 0.01), and this was particularly evident on comparison of viral genomes sequenced from B cell fractions in early primary infection and convalescence ( P < 0.001). B cell-associated viral genomes were observed to converge, becoming nearly identical to the B95.8 reference genome over time (Spearman rank-order correlation test; r = -0.5589, P = 0.0264). The reduction in diversity was most marked in the EBV latency genes. In summary, our data suggest independent convergence of diverse viral genome sequences toward a reference-like strain within a relatively short period following primary EBV infection. IMPORTANCE Identification of viral proteins with low variability and high immunogenicity is important for the development of a protective vaccine. Knowledge of genome diversity within circulating viral populations is a key step in this process, as is the expansion of intrahost genomic variation during infection. We report full-length EBV genomes sequenced from the blood and oral wash of 10 individuals early in primary infection and during convalescence. Our data demonstrate considerable diversity within the pool of circulating EBV strains, as well as within individual patients. Overall viral diversity decreased from early to persistent infection, particularly in latently infected B cells, which serve as the viral reservoir. Reduction in B cell-associated viral genome diversity coincided with a convergence toward a reference-like EBV genotype. Greater convergence positively correlated with time after infection, suggesting that the reference-like genome is the result of selection. Copyright © 2018 American Society for Microbiology.

Fully automatic segmentation of the femur from 3D-CT images using primitive shape recognition and statistical shape models.

PubMed

Ben Younes, Lassad; Nakajima, Yoshikazu; Saito, Toki

2014-03-01

Femur segmentation is well established and widely used in computer-assisted orthopedic surgery. However, most of the robust segmentation methods such as statistical shape models (SSM) require human intervention to provide an initial position for the SSM. In this paper, we propose to overcome this problem and provide a fully automatic femur segmentation method for CT images based on primitive shape recognition and SSM. Femur segmentation in CT scans was performed using primitive shape recognition based on a robust algorithm such as the Hough transform and RANdom SAmple Consensus. The proposed method is divided into 3 steps: (1) detection of the femoral head as sphere and the femoral shaft as cylinder in the SSM and the CT images, (2) rigid registration between primitives of SSM and CT image to initialize the SSM into the CT image, and (3) fitting of the SSM to the CT image edge using an affine transformation followed by a nonlinear fitting. The automated method provided good results even with a high number of outliers. The difference of segmentation error between the proposed automatic initialization method and a manual initialization method is less than 1 mm. The proposed method detects primitive shape position to initialize the SSM into the target image. Based on primitive shapes, this method overcomes the problem of inter-patient variability. Moreover, the results demonstrate that our method of primitive shape recognition can be used for 3D SSM initialization to achieve fully automatic segmentation of the femur.

Pharmacokinetically guided phase I trial of topotecan and etoposide phosphate in recurrent ovarian cancer.

PubMed

Levitt, N C; Propper, D J; Madhusudan, S; Braybrooke, J P; Echeta, C; Te Poele, R; Davies, S L; Flanagan, E; Hickson, I D; Joel, S; Ganesan, T S

2005-07-11

A pharmacokinetically guided phase I study of topotecan and etoposide phosphate was conducted in recurrent ovarian cancer. The scheduling of the topoisomerase I and II inhibitors was determined using in vitro activity data. All patients had recurrent disease following prior platinum-containing chemotherapy. Patients had a World Health Organisation performance status of 0-2 and adequate bone marrow, renal and hepatic function. Treatment was with topotecan intravenously for 5 days followed immediately by a 5-day intravenous infusion of etoposide phosphate (EP), with pharmacokinetically guided dose adjustment. Plasma etoposide levels were measured on days 2 and 4 of the infusion. A total of 21 patients entered the study. In all, 48% were platinum resistant and 71% had received prior paclitaxel. The main toxicities were haematological, short lived and reversible. A total of 29% of patients experienced grade 4 thrombocytopenia and 66% grade 4 neutropenia after the first cycle. Neutropenia and thrombocytopenia was dose limiting. The maximum-tolerated dose was topotecan 0.85 mg m(-2) day(-1) days 1-5 followed immediately by a 5-day infusion of EP at a plasma concentration of 1 mug ml(-1). The response rate (RR) was 28% in 18 evaluable patients. There was marked interpatient variability in topoisomerase IIalpha levels measured from peripheral lymphocytes, with no observed increase following topotecan. This regimen of topotecan followed by EP demonstrated good activity in recurrent ovarian cancer and was noncrossresistant with paclitaxel. Both the toxicity and RR was higher than would be expected from the single agent data, in keeping with synergy of action.

Topotecan lacks third space sequestration.

PubMed

Gelderblom, H; Loos, W J; Verweij, J; de Jonge, M J; Sparreboom, A

2000-04-01

The objective of this study was to determine the influence of pleural and ascitic fluid on the pharmacokinetics of the antitumor camptothecin derivative topotecan. Four patients with histological proof of malignant solid tumor received topotecan (0.45 or 1.5 mg/m2) p.o. on several occasions in both the presence and absence of third space volumes. Serial plasma and pleural or ascitic fluid samples were collected during each dosing and analyzed by high-performance liquid chromatography for both the intact lactone form of topotecan and its ring-opened carboxylate form. The apparent topotecan clearance demonstrated substantial interpatient variability but remained unchanged within the same patient in the presence [110 +/- 55.6 liters/ h/m2 (mean +/- SD of eight courses)] or absence of pleural and ascitic fluid [118 +/- 31.1 liters/h/m2 (mean +/- SD of seven courses)]. Similarly, terminal half-lives and area under the concentration-time curve ratios of lactone:total drug in plasma were similar between courses within each patient. Topotecan penetration into pleural and ascitic fluid demonstrated a mean lag time of 1.61 h (range, 1.37-1.86 h), and ratios with plasma concentration increased with time after dosing in all patients. The mean ratio of third space topotecan total drug area under the concentration-time curve to that in plasma was 0.55 (range, 0.26-0.87). These data indicate that topotecan can be safely administered to patients with pleural effusions or ascites and that there is substantial penetration of topotecan into these third spaces, which may prove beneficial for local antitumor effects.

Texture analysis of apparent diffusion coefficient maps for treatment response assessment in prostate cancer bone metastases-A pilot study.

PubMed

Reischauer, Carolin; Patzwahl, René; Koh, Dow-Mu; Froehlich, Johannes M; Gutzeit, Andreas

2018-04-01

To evaluate whole-lesion volumetric texture analysis of apparent diffusion coefficient (ADC) maps for assessing treatment response in prostate cancer bone metastases. Texture analysis is performed in 12 treatment-naïve patients with 34 metastases before treatment and at one, two, and three months after the initiation of androgen deprivation therapy. Four first-order and 19 second-order statistical texture features are computed on the ADC maps in each lesion at every time point. Repeatability, inter-patient variability, and changes in the feature values under therapy are investigated. Spearman rank's correlation coefficients are calculated across time to demonstrate the relationship between the texture features and the serum prostate specific antigen (PSA) levels. With few exceptions, the texture features exhibited moderate to high precision. At the same time, Friedman's tests revealed that all first-order and second-order statistical texture features changed significantly in response to therapy. Thereby, the majority of texture features showed significant changes in their values at all post-treatment time points relative to baseline. Bivariate analysis detected significant correlations between the great majority of texture features and the serum PSA levels. Thereby, three first-order and six second-order statistical features showed strong correlations with the serum PSA levels across time. The findings in the present work indicate that whole-tumor volumetric texture analysis may be utilized for response assessment in prostate cancer bone metastases. The approach may be used as a complementary measure for treatment monitoring in conjunction with averaged ADC values. Copyright © 2018 Elsevier B.V. All rights reserved.

Impact of nonsynonymous mutations of factor X on the functions of factor X and anticoagulant activity of edoxaban.

PubMed

Noguchi, Kengo; Morishima, Yoshiyuki; Takahashi, Shinichi; Ishihara, Hiroaki; Shibano, Toshiro; Murata, Mitsuru

2015-03-01

Edoxaban is an oral direct factor Xa (FXa) inhibitor and its efficacy as an oral anticoagulant is less subject to drug-food and drug-drug interaction than existing vitamin K antagonists. Although this profile of edoxaban suggests it is well suited for clinical use, it is not clear whether genetic variations of factor X influence the activity of edoxaban. Our aim was to investigate a possible impact of single-nucleotide polymorphisms (SNPs) in the factor X gene on the functions of factor X and the activity of edoxaban. Two nonsynonymous SNPs within mature factor X, Ala152Thr and Gly192Arg, were selected as possible candidates that might affect the functions of FXa and the activity of edoxaban. We measured catalytic activities of wild type and mutant FXas in a chromogenic assay using S-2222 and coagulation times including prothrombin time (PT) and activated partial thrombin time (aPTT) of plasma-containing recombinant FXs in the presence and absence of edoxaban. Michaelis-Menten kinetic parameters of FXas, Km and Vmax values, PT and aPTT were not influenced by either mutation indicating these mutations do not affect the FXa catalytic and coagulation activities. The Ki values of edoxaban for the FXas and the concentrations of edoxaban required to double PT and aPTT were not different between wild type and mutated FXas indicating that both mutations have little impact on the activity of edoxaban. In conclusion, these data suggest that edoxaban has little interpatient variability stemming from SNPs in the factor X gene.

Learning-based stochastic object models for characterizing anatomical variations

NASA Astrophysics Data System (ADS)

Dolly, Steven R.; Lou, Yang; Anastasio, Mark A.; Li, Hua

2018-03-01

It is widely known that the optimization of imaging systems based on objective, task-based measures of image quality via computer-simulation requires the use of a stochastic object model (SOM). However, the development of computationally tractable SOMs that can accurately model the statistical variations in human anatomy within a specified ensemble of patients remains a challenging task. Previously reported numerical anatomic models lack the ability to accurately model inter-patient and inter-organ variations in human anatomy among a broad patient population, mainly because they are established on image data corresponding to a few of patients and individual anatomic organs. This may introduce phantom-specific bias into computer-simulation studies, where the study result is heavily dependent on which phantom is used. In certain applications, however, databases of high-quality volumetric images and organ contours are available that can facilitate this SOM development. In this work, a novel and tractable methodology for learning a SOM and generating numerical phantoms from a set of volumetric training images is developed. The proposed methodology learns geometric attribute distributions (GAD) of human anatomic organs from a broad patient population, which characterize both centroid relationships between neighboring organs and anatomic shape similarity of individual organs among patients. By randomly sampling the learned centroid and shape GADs with the constraints of the respective principal attribute variations learned from the training data, an ensemble of stochastic objects can be created. The randomness in organ shape and position reflects the learned variability of human anatomy. To demonstrate the methodology, a SOM of an adult male pelvis is computed and examples of corresponding numerical phantoms are created.

Use of a statistical model of the whole femur in a large scale, multi-model study of femoral neck fracture risk.

PubMed

Bryan, Rebecca; Nair, Prasanth B; Taylor, Mark

2009-09-18

Interpatient variability is often overlooked in orthopaedic computational studies due to the substantial challenges involved in sourcing and generating large numbers of bone models. A statistical model of the whole femur incorporating both geometric and material property variation was developed as a potential solution to this problem. The statistical model was constructed using principal component analysis, applied to 21 individual computer tomography scans. To test the ability of the statistical model to generate realistic, unique, finite element (FE) femur models it was used as a source of 1000 femurs to drive a study on femoral neck fracture risk. The study simulated the impact of an oblique fall to the side, a scenario known to account for a large proportion of hip fractures in the elderly and have a lower fracture load than alternative loading approaches. FE model generation, application of subject specific loading and boundary conditions, FE processing and post processing of the solutions were completed automatically. The generated models were within the bounds of the training data used to create the statistical model with a high mesh quality, able to be used directly by the FE solver without remeshing. The results indicated that 28 of the 1000 femurs were at highest risk of fracture. Closer analysis revealed the percentage of cortical bone in the proximal femur to be a crucial differentiator between the failed and non-failed groups. The likely fracture location was indicated to be intertrochantic. Comparison to previous computational, clinical and experimental work revealed support for these findings.

Colorectal cancer detection by hyperspectral imaging using fluorescence excitation scanning

NASA Astrophysics Data System (ADS)

Leavesley, Silas J.; Deal, Joshua; Hill, Shante; Martin, Will A.; Lall, Malvika; Lopez, Carmen; Rider, Paul F.; Rich, Thomas C.; Boudreaux, Carole W.

2018-02-01

Hyperspectral imaging technologies have shown great promise for biomedical applications. These techniques have been especially useful for detection of molecular events and characterization of cell, tissue, and biomaterial composition. Unfortunately, hyperspectral imaging technologies have been slow to translate to clinical devices - likely due to increased cost and complexity of the technology as well as long acquisition times often required to sample a spectral image. We have demonstrated that hyperspectral imaging approaches which scan the fluorescence excitation spectrum can provide increased signal strength and faster imaging, compared to traditional emission-scanning approaches. We have also demonstrated that excitation-scanning approaches may be able to detect spectral differences between colonic adenomas and adenocarcinomas and normal mucosa in flash-frozen tissues. Here, we report feasibility results from using excitation-scanning hyperspectral imaging to screen pairs of fresh tumoral and nontumoral colorectal tissues. Tissues were imaged using a novel hyperspectral imaging fluorescence excitation scanning microscope, sampling a wavelength range of 360-550 nm, at 5 nm increments. Image data were corrected to achieve a NIST-traceable flat spectral response. Image data were then analyzed using a range of supervised and unsupervised classification approaches within ENVI software (Harris Geospatial Solutions). Supervised classification resulted in >99% accuracy for single-patient image data, but only 64% accuracy for multi-patient classification (n=9 to date), with the drop in accuracy due to increased false-positive detection rates. Hence, initial data indicate that this approach may be a viable detection approach, but that larger patient sample sizes need to be evaluated and the effects of inter-patient variability studied.

Altered mitochondrial genome content signals worse pathology and prognosis in prostate cancer.

PubMed

Kalsbeek, Anton M F; Chan, Eva K F; Grogan, Judith; Petersen, Desiree C; Jaratlerdsiri, Weerachai; Gupta, Ruta; Lyons, Ruth J; Haynes, Anne-Maree; Horvath, Lisa G; Kench, James G; Stricker, Phillip D; Hayes, Vanessa M

2018-01-01

Mitochondrial genome (mtDNA) content is depleted in many cancers. In prostate cancer, there is intra-glandular as well as inter-patient mtDNA copy number variation. In this study, we determine if mtDNA content can be used as a predictor for prostate cancer staging and outcomes. Fresh prostate cancer biopsies from 115 patients were obtained at time of surgery. All cores underwent pathological review, followed by isolation of cancer and normal tissue. DNA was extracted and qPCR performed to quantify the total amount of mtDNA as a ratio to genomic DNA. Differences in mtDNA content were compared for prostate cancer pathology features and disease outcomes. We showed a significantly reduced mtDNA content in prostate cancer compared with normal adjacent prostate tissue (mean difference 1.73-fold, P-value <0.001). Prostate cancer with increased mtDNA content showed unfavorable pathologic characteristics including, higher disease stage (PT2 vs PT3 P-value = 0.018), extracapsular extension (P-value = 0.02) and a trend toward an increased Gleason score (P-value = 0.064). No significant association was observed between changes in mtDNA content and biochemical recurrence (median follow up of 107 months). Contrary to other cancer types, prostate cancer tissue shows no universally depleted mtDNA content. Rather, the change in mtDNA content is highly variable, mirroring known prostate cancer genome heterogeneity. Patients with high mtDNA content have an unfavorable pathology, while a high mtDNA content in normal adjacent prostate tissue is associated with worse prognosis. © 2017 Wiley Periodicals, Inc.

Phase I study of obinutuzumab (GA101) in Japanese patients with relapsed or refractory B-cell non-Hodgkin lymphoma.

PubMed

Ogura, Michinori; Tobinai, Kensei; Hatake, Kiyohiko; Uchida, Toshiki; Suzuki, Tatsuya; Kobayashi, Yukio; Mori, Masakazu; Terui, Yasuhito; Yokoyama, Masahiro; Hotta, Tomomitsu

2013-01-01

As CD20 has become an established target for treating B-cell malignancies, there is interest in developing anti-CD20 antibodies with different functional activity from rituximab that might translate into improved efficacy. Obinutuzumab (GA101) is a glycoengineered, humanized type II anti-CD20 monoclonal antibody that has demonstrated superior activity to type I antibodies in preclinical studies and is currently being investigated in phase III trials. In this phase I dose-escalating study in Japanese patients with relapsed/refractory B-cell non-Hodgkin lymphoma, the primary endpoint was to characterize the safety of GA101; secondary endpoints were efficacy, pharmacokinetics and pharmacodynamics. Patients received up to nine doses of GA101 with up to 52 weeks' follow up. Most adverse events were grade 1 or 2 infusion-related reactions, and 10 grade 3/4 adverse events occurred. No dose-limiting toxicities were observed and the maximum tolerated dose was not identified. Out of 12 patients, 7 responded (end-of-treatment response rate 58%), with 2 complete responses and 5 partial responses. Responses were observed from low to high doses, and no dose-efficacy relationship was observed. B-cell depletion occurred in all patients after the first infusion and was maintained for the duration of treatment. Serum levels of GA101 increased in a dose-dependent fashion, although there was inter-patient variability. This phase I study demonstrated that GA101 has an acceptable safety profile and offers encouraging activity to Japanese patients with relapsed/refractory B-cell non-Hodgkin lymphoma. © 2012 Japanese Cancer Association.

The role of impulse parameters in force variability

NASA Technical Reports Server (NTRS)

Carlton, L. G.; Newell, K. M.

1986-01-01

One of the principle limitations of the human motor system is the ability to produce consistent motor responses. When asked to repeatedly make the same movement, performance outcomes are characterized by a considerable amount of variability. This occurs whether variability is expressed in terms of kinetics or kinematics. Variability in performance is of considerable importance because for tasks requiring accuracy it is a critical variable in determining the skill of the performer. What has long been sought is a description of the parameter or parameters that determine the degree of variability. Two general experimental protocals were used. One protocal is to use dynamic actions and record variability in kinematic parameters such as spatial or temporal error. A second strategy was to use isometric actions and record kinetic variables such as peak force produced. What might be the important force related factors affecting variability is examined and an experimental approach to examine the influence of each of these variables is provided.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chen, H; Dolly, S; Anastasio, M

Purpose: Head and neck (H&N) internal organ motion has previously been determined with low frequency and temporary nature based on population-based pre- and post-treatment studies. Using immobilization masks and adding a 4–6 mm planning-tumor-volume margin, geometric uncertainties of patients are routinely considered clinically inconsequential in H&N radiotherapy. Using the first commercially-available MR-IGRT system, we conducted the first quantitative study on inter-patient, intra- and inter-fractional H&N internal motion patterns to evaluate the necessity of individualized asymmetric internal margins. Methods: Ninety cine sagittal MR image sequences were acquired during the entire treatment course (6–7 weeks) of three H&N cancer patients using themore » ViewRay™ MR-IGRT system. The images were 5 mm thick and acquired at 4 frames/per second. One of the patients had a tracheostomy tube. The cross-sectional H&N airway (nasopharynx, oropharynx, and laryngopharynx portions) movement was analyzed comprehensively using in-house developed motion detection software. Results: Large inter-patient variations of swallowing frequency (0–1 times/per fraction), swallowing duration (1–3 seconds), and pharyngeal cross-sectional area (238–2516 mm2) were observed. Extensive pharyngeal motion occurred during swallowing, while nonzero and periodic change of airway geometry was observed in resting. For patient 1 with tracheostomy tube replacement, 30.3%, 30.0%, 48.7% and 0.3% of total frames showed ≥ 4 mm displacements in the anterior, posterior, inferior, and superior airway boundaries, respectively; similarly, (5.7%, 0.0%, 0.0%, 0.3%) and (23.3%, 0.0%, 35.7%, 1.7%) occurred for patients 2 and 3. Area overlapping coefficients with respect to the first frame were 76.3+/−6.4%, 90.3+/−0.6%, and 92.3+/−1.2% for the three patients, respectively. Conclusion: Both the resting and swallowing motions varied in frequency and amplitude among the patients and across fractions of a patient’s treatment. Patients receiving surgery that alters their respiratory and swallowing behavior can have significant intra-fractional internal motion. Patient-specific organ/tumor motion analysis may yield individualized asymmetric internal margins and improve the therapeutic ratio.« less

Proton therapy versus intensity modulated x-ray therapy in the treatment of prostate cancer: Estimating secondary cancer risks

NASA Astrophysics Data System (ADS)

Fontenot, Jonas David

External beam radiation therapy is used to treat nearly half of the more than 200,000 new cases of prostate cancer diagnosed in the United States each year. During a radiation therapy treatment, healthy tissues in the path of the therapeutic beam are exposed to high doses. In addition, the whole body is exposed to a low-dose bath of unwanted scatter radiation from the pelvis and leakage radiation from the treatment unit. As a result, survivors of radiation therapy for prostate cancer face an elevated risk of developing a radiogenic second cancer. Recently, proton therapy has been shown to reduce the dose delivered by the therapeutic beam to normal tissues during treatment compared to intensity modulated x-ray therapy (IMXT, the current standard of care). However, the magnitude of stray radiation doses from proton therapy, and their impact on this incidence of radiogenic second cancers, was not known. The risk of a radiogenic second cancer following proton therapy for prostate cancer relative to IMXT was determined for 3 patients of large, median, and small anatomical stature. Doses delivered to healthy tissues from the therapeutic beam were obtained from treatment planning system calculations. Stray doses from IMXT were taken from the literature, while stray doses from proton therapy were simulated using a Monte Carlo model of a passive scattering treatment unit and an anthropomorphic phantom. Baseline risk models were taken from the Biological Effects of Ionizing Radiation VII report. A sensitivity analysis was conducted to characterize the uncertainty of risk calculations to uncertainties in the risk model, the relative biological effectiveness (RBE) of neutrons for carcinogenesis, and inter-patient anatomical variations. The risk projections revealed that proton therapy carries a lower risk for radiogenic second cancer incidence following prostate irradiation compared to IMXT. The sensitivity analysis revealed that the results of the risk analysis depended only weakly on uncertainties in the risk model and inter-patient variations. Second cancer risks were sensitive to changes in the RBE of neutrons. However, the findings of the study were qualitatively consistent for all patient sizes and risk models considered, and for all neutron RBE values less than 100.

Integrated analysis of genetic variation and gene expression reveals novel variant for increased warfarin dose requirement in African Americans.

PubMed

Hernandez, W; Gamazon, E R; Aquino-Michaels, K; Smithberger, E; O'Brien, T J; Harralson, A F; Tuck, M; Barbour, A; Cavallari, L H; Perera, M A

2017-04-01

Essentials Genetic variants controlling gene regulation have not been explored in pharmacogenomics. We tested liver expression quantitative trait loci for association with warfarin dose response. A novel predictor for increased warfarin dose response in African Americans was identified. Precision medicine must take into account population-specific variation in gene regulation. Background Warfarin is commonly used to control and prevent thromboembolic disorders. However, because of warfarin's complex dose-requirement relationship, safe and effective use is challenging. Pharmacogenomics-guided warfarin dosing algorithms that include the well-established VKORC1 and CYP2C9 polymorphisms explain only a small proportion of inter-individual variability in African Americans (AAs). Objectives We aimed to assess whether transcriptomic analyses could be used to identify regulatory variants associated with warfarin dose response in AAs. Patients/Methods We identified a total of 56 expression quantitative trait loci (eQTLs) for CYP2C9, VKORC1 and CALU derived from human livers and evaluated their association with warfarin dose response in two independent AA warfarin patient cohorts. Results We found that rs4889606, a strong cis-eQTL for VKORC1 (log 10 Bayes Factor = 12.02), is significantly associated with increased warfarin daily dose requirement (β = 1.1; 95% confidence interval [CI] 0.46 to 1.8) in the discovery cohort (n = 305) and in the replication cohort (β = 1.04; 95% CI 0.33 -1.7; n = 141) after conditioning on relevant covariates and the VKORC1 -1639G>A (rs9923231) variant. Inclusion of rs4889606 genotypes, along with CYP2C9 alleles, rs9923231 genotypes and clinical variables, explained 31% of the inter-patient variability in warfarin dose requirement. We demonstrate different linkage disequilibrium patterns in the region encompassing rs4889606 and rs9923231 between AAs and European Americans, which may explain the increased dose requirement found in AAs. Conclusion Our approach of interrogating eQTLs identified in liver has revealed a novel predictor of warfarin dose response in AAs. Our work highlights the utility of leveraging information from regulatory variants mapped in the liver to uncover novel variants associated with drug response and the importance of population-specific research. © 2017 International Society on Thrombosis and Haemostasis.

Technical Note: Introduction of variance component analysis to setup error analysis in radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Matsuo, Yukinori, E-mail: ymatsuo@kuhp.kyoto-u.ac.

Purpose: The purpose of this technical note is to introduce variance component analysis to the estimation of systematic and random components in setup error of radiotherapy. Methods: Balanced data according to the one-factor random effect model were assumed. Results: Analysis-of-variance (ANOVA)-based computation was applied to estimate the values and their confidence intervals (CIs) for systematic and random errors and the population mean of setup errors. The conventional method overestimates systematic error, especially in hypofractionated settings. The CI for systematic error becomes much wider than that for random error. The ANOVA-based estimation can be extended to a multifactor model considering multiplemore » causes of setup errors (e.g., interpatient, interfraction, and intrafraction). Conclusions: Variance component analysis may lead to novel applications to setup error analysis in radiotherapy.« less

Social and cultural sustainability: criteria, indicators, verifier variables for measurement and maps for visualization to support planning.

PubMed

Axelsson, Robert; Angelstam, Per; Degerman, Erik; Teitelbaum, Sara; Andersson, Kjell; Elbakidze, Marine; Drotz, Marcus K

2013-03-01

Policies on economic use of natural resources require considerations to social and cultural values. In order to make those concrete in a planning context, this paper aims to interpret social and cultural criteria, identify indicators, match these with verifier variables and visualize them on maps. Indicators were selected from a review of scholarly work and natural resource policies, and then matched with verifier variables available for Sweden's 290 municipalities. Maps of the spatial distribution of four social and four cultural verifier variables were then produced. Consideration of social and cultural values in the studied natural resource use sectors was limited. The spatial distribution of the verifier variables exhibited a general divide between northwest and south Sweden, and regional rural and urban areas. We conclude that it is possible to identify indicators and match them with verifier variables to support inclusion of social and cultural values in planning.

31 CFR Appendix C to Part 356 - Investment Considerations

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance:Treasury 2 2011-07-01 2011-07-01 false Investment Considerations C Appendix C..., App. C Appendix C to Part 356—Investment Considerations I. Inflation-Protected Securities A. Principal and Interest Variability An investment in securities with principal or interest determined by...

Tumor Uptake of 64Cu-DOTA-Trastuzumab in Patients with Metastatic Breast Cancer.

PubMed

Mortimer, Joanne E; Bading, James R; Park, Jinha M; Frankel, Paul H; Carroll, Mary I; Tran, Tri T; Poku, Erasmus K; Rockne, Russell C; Raubitschek, Andrew A; Shively, John E; Colcher, David M

2018-01-01

The goal of this study was to characterize the relationship between tumor uptake of 64 Cu-DOTA-trastuzumab as measured by PET/CT and standard, immunohistochemistry (IHC)-based, histopathologic classification of human epidermal growth factor receptor 2 (HER2) status in women with metastatic breast cancer (MBC). Methods: Women with biopsy-confirmed MBC and not given trastuzumab for 2 mo or more underwent complete staging, including 18 F-FDG PET/CT. Patients were classified as HER2-positive (HER2+) or -negative (HER2-) based on fluorescence in situ hybridization (FISH)-supplemented immunohistochemistry of biopsied tumor tissue. Eighteen patients underwent 64 Cu-DOTA-trastuzumab injection, preceded in 16 cases by trastuzumab infusion (45 mg). PET/CT was performed 21-25 (day 1) and 47-49 (day 2) h after 64 Cu-DOTA-trastuzumab injection. Radiolabel uptake in prominent lesions was measured as SUV max Average intrapatient SUV max ( pt ) was compared between HER2+ and HER2- patients. Results: Eleven women were HER2+ (8 immunohistochemistry 3+; 3 immunohistochemistry 2+/FISH amplified), whereas 7 were HER2- (3 immunohistochemistry 2+/FISH nonamplified; 4 immunohistochemistry 1+). Median pt for day 1 and day 2 was 6.6 and 6.8 g/mL for HER 2+ and 3.7 and 4.3 g/mL for HER2- patients ( P < 0.005 either day). The distributions of pt overlapped between the 2 groups, and interpatient variability was greater for HER2+ than HER2- disease ( P < 0.005 and 0.001, respectively, on days 1 and 2). Conclusion: By 1 d after injection, uptake of 64 Cu-DOTA-trastuzumab in MBC is strongly associated with patient HER2 status and is indicative of binding to HER2. The variability within and among HER2+ patients, as well as the overlap between the HER2+ and HER2- groups, suggests a role for 64 Cu-DOTA-trastuzumab PET/CT in optimizing treatments that include trastuzumab. © 2018 by the Society of Nuclear Medicine and Molecular Imaging.

Computational modeling of radiofrequency ablation: evaluation on ex vivo data using ultrasound monitoring

NASA Astrophysics Data System (ADS)

Audigier, Chloé; Kim, Younsu; Dillow, Austin; Boctor, Emad M.

2017-03-01

Radiofrequency ablation (RFA) is the most widely used minimally invasive ablative therapy for liver cancer, but it is challenged by a lack of patient-specific monitoring. Inter-patient tissue variability and the presence of blood vessels make the prediction of the RFA difficult. A monitoring tool which can be personalized for a given patient during the intervention would be helpful to achieve a complete tumor ablation. However, the clinicians do not have access to such a tool, which results in incomplete treatment and a large number of recurrences. Computational models can simulate the phenomena and mechanisms governing this therapy. The temperature evolution as well as the resulted ablation can be modeled. When combined together with intraoperative measurements, computational modeling becomes an accurate and powerful tool to gain quantitative understanding and to enable improvements in the ongoing clinical settings. This paper shows how computational models of RFA can be evaluated using intra-operative measurements. First, simulations are used to demonstrate the feasibility of the method, which is then evaluated on two ex vivo datasets. RFA is simulated on a simplified geometry to generate realistic longitudinal temperature maps and the resulted necrosis. Computed temperatures are compared with the temperature evolution recorded using thermometers, and with temperatures monitored by ultrasound (US) in a 2D plane containing the ablation tip. Two ablations are performed on two cadaveric bovine livers, and we achieve error of 2.2 °C on average between the computed and the thermistors temperature and 1.4 °C and 2.7 °C on average between the temperature computed and monitored by US during the ablation at two different time points (t = 240 s and t = 900 s).

Lack of Obvious Influence of PLLA Nanofibers on the Gene Expression of BMP-2 and VEGF during Growth and Differentiation of Human Mesenchymal Stem Cells

PubMed Central

Schofer, Markus D.; Fuchs-Winkelmann, S.; Wack, C.; Rudisile, M.; Dersch, R.; Leifeld, I.; Wendorff, J.; Greiner, A.; Paletta, J. R. J.; Boudriot, U.

2009-01-01

Growth factors like bone morphogenetic protein 2 (BMP-2) and vascular endothelial growth factor (VEGF) play an important role in bone remodeling and fracture repair. Therefore, with respect to tissue engineering, an artificial graft should have no negative impact on the expression of these factors. In this context, the aim of this study was to analyze the impact of poly(L-lactic acid) (PLLA) nanofibers on VEGF and BMP-2 gene expression during the time course of human mesenchymal stem cell (hMSC) differentiation towards osteoblasts. PLLA matrices were seeded with hMSCs and cultivated over a period of 22 days under growth and osteoinductive conditions, and analyzed during the course of culture, with respect to gene expression of VEGF and BMP-2. Furthermore, BMP-2–enwoven PLLA nanofibers were used in order to elucidate whether initial down-regulation of growth factor expression could be compensated. Although there was a great interpatient variability with respect to the expression of VEGF and BMP-2, PLLA nanofibers tend to result in a down-regulation in BMP-2 expression during the early phase of cultivation. This effect was diminished in the case of VEGF gene expression. The initial down-regulation was overcome when BMP-2 was directly incorporated into the PLLA nanofibers by electrospinning. Furthermore, the incorporation of BMP-2 into the PLLA nanofibers resulted in an increase in VEGF gene expression. Summarized, the results indicate that the PLLA nanofibers have little effect on growth factor production. An enhancement in gene expression of BMP-2 and VEGF can be achieved by an incorporation of BMP-2 into the PLLA nanofibers. PMID:19412560

Determination of enoxaparin with rotational thrombelastometry using the prothrombinase-induced clotting time reagent.

PubMed

Schaden, Eva; Schober, Andreas; Hacker, Stefan; Spiss, Christian; Chiari, Astrid; Kozek-Langenecker, Sibylle

2010-04-01

Drug monitoring of low molecular weight heparin is generally not recommended, but could be reasonable in critically ill patients, whose risk for bleeding or thrombosis shows a high interpatient variability. Anti-Xa assays are not available around the clock even in central hospitals, whereas rotational thrombelastometry (ROTEM) becomes increasingly used at the bedside. Prothrombinase-induced clotting time (PiCT) reagent allows determination of factor Xa-inhibition in plasma. The aim of our study was to evaluate enoxaparin determination in whole blood with the ROTEM using specific test modifications, including PiCT. After ethics committee's approval, citrated whole blood obtained from overall 16 healthy volunteers was incubated with enoxaparin at 16 different anti-Xa concentrations. Main endpoint was the clotting time (CT) in ROTEM representing initial activation of clot formation. CT was determined in the new PiCT-ROTEM test, in a low-tissue factor-activated modification (LowTF-ROTEM) as well as in the commercially available heparin-sensitive ROTEM assays (HEPTEM and INTEM). In the absence of enoxaparin, CT values were 168.6 +/- 6.1 s (PiCT-ROTEM), 247.3 +/- 18.6 s (LowTF-ROTEM), and -6.2 +/- 7.9 s (INTEM-HEPTEM). A linear dependency (P < 0.01) between anti-Xa concentration and CT was found for PiCT-ROTEM, LowTF-ROTEM, and for INTEM-HEPTEM with correlation coefficients of 0.93 for PiCT-ROTEM, 0.94 for LowTF-ROTEM, and 0.81 for INTEM-HEPTEM. This in-vitro experiment demonstrates a strong correlation between enoxaparin anti-Xa concentrations and specific ROTEM tests. These promising assays should be further evaluated for monitoring anticoagulation in high-risk patients in clinical studies.

Sorafenib in advanced melanoma: a critical role for pharmacokinetics?

PubMed Central

Pécuchet, N; Lebbe, C; Mir, O; Billemont, B; Blanchet, B; Franck, N; Viguier, M; Coriat, R; Tod, M; Avril, M-F; Goldwasser, F

2012-01-01

Background: Inter-patient pharmacokinetic variability can lead to suboptimal drug exposure, and therefore might impact the efficacy of sorafenib. This study reports long-term pharmacokinetic monitoring of patients treated with sorafenib and a retrospective pharmacodynamic/pharmacokinetic analysis in melanoma patients. Patients and methods: Heavily pretreated patients with stage IV melanoma were started on sorafenib 400 mg twice daily (bid). In the absence of limiting toxicity, dose escalation of 200 mg bid levels was done every 2 weeks. Plasma sorafenib measurement was performed at each visit, allowing a retrospective pharmacodynamic/pharmacokinetic analysis for safety and efficacy. Results: In all, 19 of 30 patients underwent dose escalation over 400 mg bid, and 28 were evaluable for response. The overall disease control rate was 61% (95% confidence interval (CI): 42.6–78.8), including three confirmed responses (12%). Disease control rate and progression-free survival (PFS) were improved in patients with high vs low exposure (80% vs 32%, P=0.02, and 5.25 vs 2.5 months, P=0.005, hazard ratio (HR)=0.28 (95% CI: 0.11–0.73)). In contrast, drug dosing had no effect on PFS. In multivariate analysis, drug exposure was the only factor associated with PFS (HR=0.36 (95% CI: 0.13–0.99)). Diarrhoea and anorexia were correlated with drug dosing, while hypertension and hand–foot skin reaction were correlated with drug exposure. Conclusions: Although sorafenib had modest efficacy in melanoma, these results suggest a correlation between exposure and efficacy of sorafenib. Therefore, dose optimisation in patients with low exposure at standard doses should be evaluated in validated indications. PMID:22767146

Levofloxacin Pharmacokinetics and Pharmacodynamics in Patients with Severe Burn Injury

PubMed Central

Kiser, Tyree H.; Hoody, Dorie W.; Obritsch, Marilee D.; Wegzyn, Colleen O.; Bauling, Paulus C.; Fish, Douglas N.

2006-01-01

Levofloxacin pharmacokinetics were studied in 11 patients with severe burn injuries. Patients (values are means ± standard deviations; age, 41 ± 17 years; weight, 81 ± 12 kg; creatinine clearance, 114 ± 40 ml/min) received intravenous levofloxacin at 750 mg (n = 10 patients) or 500 mg (n = one patient) once daily. Blood samples were collected on day 1 of levofloxacin therapy; eight patients were studied again on days 4 to 6. The pharmacodynamic probability of target attainment (PTA) was evaluated by Monte Carlo simulation. Mean systemic clearance, half-life, and area under the concentration-time curve over 24 h after levofloxacin at 750 mg were 9.0 ± 3.2 liters/h, 7.8 ± 1.6 h, and 93 ± 31 mg · h/liter, respectively. There were no differences in pharmacokinetic parameters between day 1 and day 4; however, large intrapatient and interpatient variability was observed. Levofloxacin pharmacokinetics in burned patients were similar to those reported in other critically ill populations. Levofloxacin at 750 mg achieved >90% PTA for gram-negative and gram-positive pathogens with MICs of ≤0.5 μg/ml and MICs of ≤1 μg/ml, respectively. However, satisfactory PTA was not obtained with less-susceptible gram-negative organisms with MICs of 1 μg/ml or any organism with a MIC of ≥2 μg/ml. The results of this study indicate that levofloxacin should be administered at 750 mg/day for treatment of systemic infections in severely burned patients. However, even 750 mg/day may be inadequate for gram-negative organisms with MICs of 1 to 2 μg/ml even though they are defined as susceptible. Alternative antibiotics or treatment strategies should be considered for infections due to these pathogens. PMID:16723549

Levofloxacin pharmacokinetics and pharmacodynamics in patients with severe burn injury.

PubMed

Kiser, Tyree H; Hoody, Dorie W; Obritsch, Marilee D; Wegzyn, Colleen O; Bauling, Paulus C; Fish, Douglas N

2006-06-01

Levofloxacin pharmacokinetics were studied in 11 patients with severe burn injuries. Patients (values are means +/- standard deviations; age, 41 +/- 17 years; weight, 81 +/- 12 kg; creatinine clearance, 114 +/- 40 ml/min) received intravenous levofloxacin at 750 mg (n = 10 patients) or 500 mg (n = one patient) once daily. Blood samples were collected on day 1 of levofloxacin therapy; eight patients were studied again on days 4 to 6. The pharmacodynamic probability of target attainment (PTA) was evaluated by Monte Carlo simulation. Mean systemic clearance, half-life, and area under the concentration-time curve over 24 h after levofloxacin at 750 mg were 9.0 +/- 3.2 liters/h, 7.8 +/- 1.6 h, and 93 +/- 31 mg . h/liter, respectively. There were no differences in pharmacokinetic parameters between day 1 and day 4; however, large intrapatient and interpatient variability was observed. Levofloxacin pharmacokinetics in burned patients were similar to those reported in other critically ill populations. Levofloxacin at 750 mg achieved >90% PTA for gram-negative and gram-positive pathogens with MICs of < or =0.5 microg/ml and MICs of < or =1 microg/ml, respectively. However, satisfactory PTA was not obtained with less-susceptible gram-negative organisms with MICs of 1 microg/ml or any organism with a MIC of > or =2 microg/ml. The results of this study indicate that levofloxacin should be administered at 750 mg/day for treatment of systemic infections in severely burned patients. However, even 750 mg/day may be inadequate for gram-negative organisms with MICs of 1 to 2 microg/ml even though they are defined as susceptible. Alternative antibiotics or treatment strategies should be considered for infections due to these pathogens.

Investigating the impact of oxygen concentration and blood flow variation on photodynamic therapy

NASA Astrophysics Data System (ADS)

Penjweini, Rozhin; Kim, Michele M.; Finlay, Jarod C.; Zhu, Timothy C.

2016-03-01

Type II photodynamic therapy (PDT) is used for cancer treatment based on the combined action of a photosensitizer, a special wavelength of light, oxygen (3O2) and generation of singlet oxygen (1O2). Intra-patient and inter-patient variability of oxygen concentration ([3O2]) before and after the treatment as well as photosensitizer concentration and hemodynamic parameters such as blood flow during PDT has been reported. Simulation of these variations is valuable, as it would be a means for the rapid assessment of treatment effect. A mathematical model has been previously developed to incorporate the diffusion equation for light transport in tissue and the macroscopic kinetic equations for simulation of [3O2], photosensitizers in ground and triplet states and concentration of the reacted singlet oxygen ([1O₂]rx) during PDT. In this study, the finite-element based calculation of the macroscopic kinetic equations is done for 2-(1- Hexyloxyethyl)-2-devinyl pyropheophorbide (HPPH)-mediated PDT by incorporating the information of the photosensitizer photochemical parameters as well as the tissue optical properties, photosensitizer concentration, initial oxygen concentration ([3O2]0), blood flow changes and Φ that have been measured in mice bearing radiation-induced fibrosarcoma (RIF) tumors. Then, [1O2]rx calculated by using the measured [3O2] during the PDT is compared with [1O2]rx calculated based on the simulated [3O₂]; both calculations showed a reasonably good agreement. Moreover, the impacts of the blood flow changes and [3O2]0 on [1O2]rx have been investigated, which showed no pronounced effect of the blood flow changes on the long-term 1O2 generation. When [3O2]0 becomes limiting, small changes in [3O₂] have large effects on [1O2]rx.

Pharmacokinetically guided phase I trial of topotecan and etoposide phosphate in recurrent ovarian cancer

PubMed Central

Levitt, N C; Propper, D J; Madhusudan, S; Braybrooke, J P; Echeta, C; te Poele, R; Davies, S L; Flanagan, E; Hickson, I D; Joel, S; Ganesan, T S

2005-01-01

A pharmacokinetically guided phase I study of topotecan and etoposide phosphate was conducted in recurrent ovarian cancer. The scheduling of the topoisomerase I and II inhibitors was determined using in vitro activity data. All patients had recurrent disease following prior platinum-containing chemotherapy. Patients had a World Health Organisation performance status of 0–2 and adequate bone marrow, renal and hepatic function. Treatment was with topotecan intravenously for 5 days followed immediately by a 5-day intravenous infusion of etoposide phosphate (EP), with pharmacokinetically guided dose adjustment. Plasma etoposide levels were measured on days 2 and 4 of the infusion. A total of 21 patients entered the study. In all, 48% were platinum resistant and 71% had received prior paclitaxel. The main toxicities were haematological, short lived and reversible. A total of 29% of patients experienced grade 4 thrombocytopenia and 66% grade 4 neutropenia after the first cycle. Neutropenia and thrombocytopenia was dose limiting. The maximum-tolerated dose was topotecan 0.85 mg m−2 day−1 days 1–5 followed immediately by a 5-day infusion of EP at a plasma concentration of 1 μg ml−1. The response rate (RR) was 28% in 18 evaluable patients. There was marked interpatient variability in topoisomerase IIα levels measured from peripheral lymphocytes, with no observed increase following topotecan. This regimen of topotecan followed by EP demonstrated good activity in recurrent ovarian cancer and was noncrossresistant with paclitaxel. Both the toxicity and RR was higher than would be expected from the single agent data, in keeping with synergy of action. PMID:15956976

Preclinical discovery of candidate genes to guide pharmacogenetics during phase I development: the example of the novel anticancer agent ABT-751

PubMed Central

Innocenti, Federico; Ramírez, Jacqueline; Obel, Jennifer; Xiong, Julia; Mirkov, Snezana; Chiu, Yi-Lin; Katz, David A.; Carr, Robert A.; Zhang, Wei; Das, Soma; Adjei, Araba; Moyer, Ann M.; Chen, Pei Xian; Krivoshik, Andrew; Medina, Diane; Gordon, Gary B.; Ratain, Mark J.; Sahelijo, Leonardo; Weinshilboum, Richard M.; Fleming, Gini F.; Bhathena, Anahita

2013-01-01

Objective ABT-751, a novel orally available antitubulin agent, is mainly eliminated as inactive glucuronide (ABT-751G) and sulfate (ABT-751S) conjugates. We performed a pharmacogenetic investigation of ABT-751 pharmacokinetics using in-vitro data to guide the selection of genes for genotyping in a phase I trial of ABT-751. Methods UDP-glucuronosyltransferase (UGT) and sulfotransferase (SULT) enzymes were screened for ABT-751 metabolite formation in vitro. Forty-seven cancer patients treated with ABT-751 were genotyped for 21 variants in these genes. Results UGT1A1, UGT1A4, UGT1A8, UGT2B7, and SULT1A1 were found to be involved in the formation of inactive ABT-751 glucuronide (ABT-751G) and sulfate (ABT-751S). SULT1A1 copy number (> 2) was associated with an average 34% increase in ABT-751 clearance (P= 0.044), an 18% reduction in ABT-751 AUC (P = 0.045), and a 50% increase in sulfation metabolic ratios (P=0.025). UGT1A8 rs6431558 was associated with a 28% increase in glucuronidation metabolic ratios (P =0.022), and UGT1A4*2 was associated with a 65% decrease in ABT-751 Ctrough (P = 0.009). Conclusion These results might represent the first example of a clinical pharmacokinetic effect of the SULT1A1 copy number variant on the clearance of a SULT1A1 substrate. A-priori selection of candidate genes guided by in-vitro metabolic screening enhanced our ability to identify genetic determinants of interpatient pharmacokinetic variability. PMID:23670235

Transcellular movement of hydroxyurea is mediated by specific solute carrier transporters

PubMed Central

Walker, Aisha L.; Franke, Ryan M.; Sparreboom, Alex; Ware, Russell E.

2015-01-01

Objective Hydroxyurea has proven laboratory and clinical therapeutic benefits for sickle cell anemia (SCA) and other diseases, yet many questions remain regarding its in vivo pharmacokinetic and pharmacodynamic profiles. Previous reports suggest that hydroxyurea passively diffuses across cells, but its observed rapid absorption and distribution are more consistent with facilitated or active transport. We investigated the potential role of solute carrier (SLC) transporters in cellular uptake and accumulation of hydroxyurea. Materials and Methods Passive diffusion of hydroxyurea across cell membranes was determined using the parallel artificial membrane permeability assay. SLC transporter screens were conducted using in vitro intracellular drug accumulation and transcellular transport assays in cell lines and oocytes overexpressing SLC transporters. Gene expression of SLC transporters was measured by real-time PCR in human tissues and cell lines. Results Hydroxyurea had minimal diffusion across a lipid bilayer but was a substrate for 5 different SLC transporters belonging to the OCTN and OATP families of transporters and urea transporters A and B. Further characterization of hydroxyurea transport revealed that cellular uptake by OATP1B3 is time and temperature dependent and inhibited by known substrates of OATP1B3. Urea transporters A and B are expressed differentially in human tissues and erythroid cells, and transport hydroxyurea bidirectionally via facilitated diffusion. Conclusions These studies provide new insight into drug transport proteins that may be involved in the in vivo absorption, cellular distribution, and elimination of hydroxyurea. Elucidation of hydroxyurea transcellular movement should improve our understanding of its pharmacokinetics and pharmacodynamics, and may help explain some of the inter-patient drug variability observed in patients with SCA. PMID:21256917

Sci—Thur AM: YIS - 03: irtGPUMCD: a new GPU-calculated dosimetry code for {sup 177}Lu-octreotate radionuclide therapy of neuroendocrine tumors

DOE Office of Scientific and Technical Information (OSTI.GOV)

Montégiani, Jean-François; Gaudin, Émilie; Després, Philippe

2014-08-15

In peptide receptor radionuclide therapy (PRRT), huge inter-patient variability in absorbed radiation doses per administered activity mandates the utilization of individualized dosimetry to evaluate therapeutic efficacy and toxicity. We created a reliable GPU-calculated dosimetry code (irtGPUMCD) and assessed {sup 177}Lu-octreotate renal dosimetry in eight patients (4 cycles of approximately 7.4 GBq). irtGPUMCD was derived from a brachytherapy dosimetry code (bGPUMCD), which was adapted to {sup 177}Lu PRRT dosimetry. Serial quantitative single-photon emission computed tomography (SPECT) images were obtained from three SPECT/CT acquisitions performed at 4, 24 and 72 hours after {sup 177}Lu-octreotate administration, and registered with non-rigid deformation of CTmore » volumes, to obtain {sup 177}Lu-octreotate 4D quantitative biodistribution. Local energy deposition from the β disintegrations was assumed. Using Monte Carlo gamma photon transportation, irtGPUMCD computed dose rate at each time point. Average kidney absorbed dose was obtained from 1-cm{sup 3} VOI dose rate samples on each cortex, subjected to a biexponential curve fit. Integration of the latter time-dose rate curve yielded the renal absorbed dose. The mean renal dose per administered activity was 0.48 ± 0.13 Gy/GBq (range: 0.30–0.71 Gy/GBq). Comparison to another PRRT dosimetry code (VRAK: Voxelized Registration and Kinetics) showed fair accordance with irtGPUMCD (11.4 ± 6.8 %, range: 3.3–26.2%). These results suggest the possibility to use the irtGPUMCD code in order to personalize administered activity in PRRT. This could allow improving clinical outcomes by maximizing per-cycle tumor doses, without exceeding the tolerable renal dose.« less

Association of genetic polymorphisms with risk of renal injury after coronary bypass graft surgery.

PubMed

Stafford-Smith, Mark; Podgoreanu, Mihai; Swaminathan, Madhav; Phillips-Bute, Barbara; Mathew, Joseph P; Hauser, Elizabeth H; Winn, Michelle P; Milano, Carmelo; Nielsen, Dahlia M; Smith, Mike; Morris, Richard; Newman, Mark F; Schwinn, Debra A

2005-03-01

Post-cardiac surgery renal dysfunction is a common, serious, multifactorial disorder, with interpatient variability predicted poorly by preoperative clinical, procedural, and biological markers. Therefore, we tested the hypothesis that selected gene variants are associated with acute renal injury, reflected by a serum creatinine level increase after cardiac surgery. One thousand six hundred seventy-one patients undergoing aortocoronary surgery were studied. Clinical covariates were recorded. DNA was isolated from preoperative blood; mass spectrometry was used for genotype analysis. A model was developed relating clinical and genetic factors to postoperative acute renal injury. A race effect was found; therefore, Caucasians and African Americans were analyzed separately. Overall, clinical factors alone account poorly for postoperative renal injury, although more so in African Americans than Caucasians. When 12 candidate polymorphisms were assessed, 2 alleles (interleukin 6 -572C and angiotensinogen 842C) showed a strong association with renal injury in Caucasians (P < 0.0001; >50% decrease in renal filtration when they present together). Using less stringent criteria for significance (0.01 > P > 0.001), 4 additional polymorphisms are identified (apolipoproteinE 448C [4], angiotensin receptor1 1166C, and endothelial nitric oxide synthase [eNOS] 894T in Caucasians; eNOS 894T and angiotensin-converting enzyme deletion and insertion in African Americans). Adding genetic to clinical factors resulted in the best model, with overall ability to explain renal injury increasing approximately 4-fold in Caucasians and doubling in African Americans (P < 0.0005). In this study, we identify genetic polymorphisms that collectively provide 2- to 4-fold improvement over preoperative clinical factors alone in explaining post-cardiac surgery renal dysfunction. From a mechanistic perspective, most identified genetic variants are associated with increased renal inflammatory and/or vasoconstrictor responses.

Association of the 98T ELAM-1 polymorphism with increased bleeding after cardiac surgery.

PubMed

Welsby, Ian J; Podgoreanu, Mihai V; Phillips-Bute, Barbara; Morris, Richard; Mathew, Joseph P; Smith, Peter K; Newman, Mark F; Schwinn, Debra A; Stafford-Smith, Mark

2010-06-01

Hemorrhage continues to be a major problem after cardiac surgery despite the routine use of antifibrinolytic drugs, with striking inter-patient variability poorly explained by already known risk factors. The authors tested the hypothesis that genetic polymorphisms of inflammatory mediators and cellular adhesion molecules are associated with bleeding after cardiac surgery. Prospective, observational study. Single, tertiary referral university heart center. Adult patients undergoing aortocoronary surgery with cardiopulmonary bypass. Patients (n = 759) had 10 mL of blood drawn preoperatively and genomic DNA isolated then genotyped for 17 polymorphisms in 7 candidate genes: tumor necrosis factor, interleukins 1beta and 6, interleukin 1 receptor antagonist, intercellular adhesion molecule-1 (ICAM-1), P-selectin and endothelial leucocyte adhesion molecule-1 (E-selectin). Multivariate analyses were used to relate clinical and genetic factors to bleeding and transfusion. The 98G/T polymorphism of the E-selectin gene was independently associated with bleeding after cardiac surgery (p = 0.002), after adjusting for significant clinical predictors (patient size and baseline hemoglobin concentration). There was a gene dose effect according to the number of minor alleles in the genotype; carriers of the minor allele bled 17% (GT) and 54% (TT) more than wild type (GG) genotypes, respectively (p = 0.01). Carriers of the minor allele also had longer activated partial thromboplastin times (p = 0.0023) and increased fresh frozen plasma transfusion (p = 0.03) compared with wild type. The authors found a dose-related association between the 98T E-selectin polymorphism and bleeding after cardiac surgery, independent of and additive to standard clinical risk factors. Copyright 2010 Elsevier Inc. All rights reserved.

Inflammatory gene polymorphisms and risk of postoperative myocardial infarction after cardiac surgery.

PubMed

Podgoreanu, M V; White, W D; Morris, R W; Mathew, J P; Stafford-Smith, M; Welsby, I J; Grocott, H P; Milano, C A; Newman, M F; Schwinn, D A

2006-07-04

The inflammatory response triggered by cardiac surgery with cardiopulmonary bypass (CPB) is a primary mechanism in the pathogenesis of postoperative myocardial infarction (PMI), a multifactorial disorder with significant inter-patient variability poorly predicted by clinical and procedural factors. We tested the hypothesis that candidate gene polymorphisms in inflammatory pathways contribute to risk of PMI after cardiac surgery. We genotyped 48 polymorphisms from 23 candidate genes in a prospective cohort of 434 patients undergoing elective cardiac surgery with CPB. PMI was defined as creatine kinase-MB isoenzyme level > or = 10x upper limit of normal at 24 hours postoperatively. A 2-step analysis strategy was used: marker selection, followed by model building. To minimize false-positive associations, we adjusted for multiple testing by permutation analysis, Bonferroni correction, and controlling the false discovery rate; 52 patients (12%) experienced PMI. After adjusting for multiple comparisons and clinical risk factors, 3 polymorphisms were found to be independent predictors of PMI (adjusted P<0.05; false discovery rate <10%). These gene variants encode the proinflammatory cytokine interleukin 6 (IL6 -572G>C; odds ratio [OR], 2.47), and 2 adhesion molecules: intercellular adhesion molecule-1 (ICAM1 Lys469Glu; OR, 1.88), and E-selectin (SELE 98G>T; OR, 0.16). The inclusion of genotypic information from these polymorphisms improved prediction models for PMI based on traditional risk factors alone (C-statistic 0.764 versus 0.703). Functional genetic variants in cytokine and leukocyte-endothelial interaction pathways are independently associated with severity of myonecrosis after cardiac surgery. This may aid in preoperative identification of high-risk cardiac surgical patients and development of novel cardioprotective strategies.

The effectiveness and safety of amisulpride in Chinese patients with schizophrenia who switch from risperidone or olanzapine: a subgroup analysis of the ESCAPE study

PubMed Central

Liang, Ying; Yu, Xin

2017-01-01

Introduction Second-generation antipsychotics show significant interpatient variability in treatment response and side-effect profiles, and the majority of patients with schizophrenia require multiple treatment changes. This subgroup analysis of the ESCAPE study evaluated the efficacy and safety of amisulpride in Chinese patients with schizophrenia who switched from risperidone or olanzapine. Methods ESCAPE was a prospective, open-label, multicenter, single-arm Phase IV study in which Chinese patients with an ICD-10 diagnosis of schizophrenia received amisulpride for 8 weeks. This analysis included 109 patients who switched to amisulpride from risperidone (n=68) or olanzapine (n=41) and 59 treatment-naïve patients for reference. The primary effectiveness outcome was a ≥50% decrease in Positive and Negative Syndrome Scale (PANSS) Total score from Baseline to Week 8. The study was registered at ClinicalTrials.gov (NCT01795183). Results Of the patients who switched from risperidone and olanzapine, 77.9% and 56.1% achieved ≥50% reduction in PANSS Total score from Baseline to Week 8 and 57.4% and 46.3% achieved ≥20% reduction in PANSS score from Baseline to Week 2, respectively; these end points were achieved by 66.1% and 61.0% of treatment-naïve patients, respectively. No unexpected adverse events (AEs) were reported. Of the most common AEs, extrapyramidal side effects occurred in 32.4% and 14.6%, blood prolactin increase in 32.4% and 39.0%, and ≥7% increase in body weight in 4.4% and 12% of patients switching from risperidone and olanzapine, respectively. Conclusion The results of this subgroup analysis suggest that switching to amisulpride from risperidone and olanzapine is effective and generally well tolerated in Chinese patients with schizophrenia. PMID:28461752

90Yttrium Ibritumomab Tiuxetan Therapy in Allogeneic Transplantation in B-cell Lymphoma with Extensive Marrow involvement and Chronic Lymphocytic Leukemia: Utility of Pre-transplantation Biodistribution

PubMed Central

Matesan, Manuela; Rajendran, Joseph; Press, Oliver W.; Maloney, David G.; Storb, Rainer F.; Cassaday, Ryan D.; Pagel, John M.; Oliveira, George; Gopal, Ajay K.

2014-01-01

Biodistribution data to-date using 111In- ibritumomab tiuxetan has been initially obtained in patients with <25% lymphomatous bone marrow involvement and adequate hematopoietic synthetic function. In this article we present the results of an analysis of the biodistribution data obtained from a cohort of patients with extensive bone marrow involvement, baseline cytopenias, and chronic lymphocytic leukemia (CLL). Thirty nine patients with diagnosis of B-cell lymphoma or CLL expressing the CD20 antigen, who had failed at least one prior regimen, and had evidence of persistent disease were included in this analysis, however only 38 of these completed the treatment. Semiquantitative analysis of the biodistribution was performed using regions of interest (ROI) over the liver, lungs, kidneys, spleen and sacrum. The observed interpatient variability including higher liver uptake in 4 patients is discussed. No severe solid organs toxicity was observed at the maximum administered activity of 1184 MBq (32 mCi) 90Yibritumomab tiuxetan. After accounting for differences in marrow involvement, patients with CLL exhibit comparable biodistributions to those with B-NHL. We found that the estimated sacral marrow uptake on 48 hour images in patients with bone marrow involvement may be an indicator of bone marrow involvement. There was no correlation between tumor visualization and response to treatment. These data suggest that the imaging step is not critical when the administered activity is below 1184 MBq (32 mCi). However our analysis confirms that the semiquantitative imaging data can be used to identify patients at risk for liver toxicity when higher doses of 90Y- ibritumomab tiuxetan are used. Patients with CLL can have excellent targeting of disease by 111Inibritumomab tiuxetan, indicating potential efficacy in this patient population. PMID:25076159

The Bad Berka dose protocol: comparative results of dosimetry in peptide receptor radionuclide therapy using (177)Lu-DOTATATE, (177)Lu-DOTANOC, and (177)Lu-DOTATOC.

PubMed

Schuchardt, Christiane; Kulkarni, Harshad R; Prasad, Vikas; Zachert, Carolin; Müller, Dirk; Baum, Richard P

2013-01-01

The objective of this study is to analyze the in vivo behavior of the (177)Lu-labeled peptides DOTATATE, DOTANOC, and DOTATOC used for peptide receptor radionuclide therapy (PRRNT) of neuroendocrine tumors (NETs), by measuring organ and tumor kinetics and by performing dosimetric calculations. Two hundred fifty-three patients (group 1) with metastasized NET who underwent PRRNT were examined. Out of these, 185 patients received (177)Lu-DOTATATE, 9 were treated with (177)Lu-DOTANOC, and 59 with (177)Lu-DOTATOC. Additionally, 25 patients receiving, in consecutive PRRNT cycles, DOTATATE followed by DOTATOC (group 2) and 3 patients receiving DOTATATE and DOTANOC (group 3) were analyzed. Dosimetric calculations (according to MIRD scheme) were performed using OLINDA software. In group 1, DOTATOC exhibited the lowest and DOTANOC the highest uptake and therefore mean absorbed dose in normal organs (whole body, kidney, and spleen). In group 2, there was a significant difference between DOTATATE and DOTATOC concerning kinetics and normal organ doses. (177)Lu-DOTATOC had the lowest uptake/dose delivered to normal organs and highest tumor-to-kidney ratio. There were no significant differences between the three peptides concerning tumor kinetics and mean absorbed tumor dose. The study demonstrates a correlation between high affinity of DOTANOC in vitro and high uptake in normal organs/whole body in vivo, resulting in a higher whole-body dose. DOTATOC exhibited the lowest uptake and dose delivered to normal tissues and the best tumor-to-kidney ratio. Due to large interpatient variability, individual dosimetry should be performed for each therapy cycle.

Pergolide: multiple-dose pharmacokinetics in patients with mild to moderate Parkinson disease.

PubMed

Thalamas, Claire; Rajman, Iris; Kulisevsky, Jaime; Lledó, Alberto; Mackie, Alison E; Blin, Olivier; Gillespie, Todd A; Seger, Mary; Rascol, Olivier

2005-01-01

The primary objective of this study was to describe the pharmacokinetics of oral pergolide in patients with mild to moderate Parkinson disease using a new high-performance liquid chromatography-tandem mass spectrometry assay. A secondary objective was to investigate the relationship between plasma concentrations and efficacy. Fourteen patients with a diagnosis of Parkinson disease completed this multicenter, open-label, dose-escalating study. Pergolide was administered for 58 days, using increasing daily doses from 0.05 mg daily up to 1 mg three times daily and then tapering the dose. The steady-state pharmacokinetic profile and motor score were determined at dose levels of 0.25, 0.5, and 1 mg three times a day and during elimination after the last dose. Pergolide was absorbed with a median time to maximum concentration of 2 to 3 hours across the dose range. Systemic exposure appeared to increase proportionally with dose over the range of 0.25 to 1 mg three times daily within a patient, but there was a large variability in exposures between patients (interpatient coefficients of variation were 56.4% for the area under the curve). Pergolide was widely distributed (volume of distribution, approximately 14,000 L) and was eliminated with a mean half-life of 21 hours. Motor scores improved as both peak plasma pergolide concentrations and exposure increased. No unexpected safety concerns were identified. Pergolide is absorbed relatively quickly into the systemic circulation, has a large apparent volume of distribution, and has a relatively long half-life (mean, 21 hours). This prolonged half-life is of particular interest, given the current hypothesis that more continuous dopaminergic receptor stimulation may reduce motor complications in patients with Parkinson disease.

Review article: relationship between the metabolism and efficacy of proton pump inhibitors--focus on rabeprazole.

PubMed

Horn, J

2004-11-01

Proton pump inhibitors are now considered the mainstay of treatment for acid-related disease. Although all proton pump inhibitors are highly effective, the antisecretory effects of different drugs in this class are not completely consistent across patients. One reason for this is the acid-suppressing effect of Helicobacter pylori infection, which may augment the actions of proton pump inhibitors. A second important reason for interpatient variability of the effects of proton pump inhibitors on acid secretion involves genetically determined differences in the metabolism of these drugs. This article focuses on the impact of genetic polymorphism of cytochrome P450 (CYP)2C19 on the pharmacokinetics and pharmacodynamics of proton pump inhibitors, particularly rabeprazole. Results reviewed indicate that the metabolism and pharmacokinetics of rabeprazole differ significantly from those of other proton pump inhibitors. Most importantly, the clearance of rabeprazole is largely nonenzymatic and less dependent on CYP2C19 than other drugs in its class. This results in greater consistency of pharmacokinetics for rabeprazole across a wide range of patients with acid-related disease, particularly those with different CYP2C19 genotypes. The pharmacodynamic profile for rabeprazole is also characterized by more rapid suppression of gastric acid secretion than with other proton pump inhibitors, which is also independent of CYP2C19 genotype. The favourable pharmacokinetic/pharmacodynamic profile for rabeprazole has been shown to result in high eradication rates for H. pylori in both normal and poor metabolizers. Pharmacodynamic results have also suggested that rabeprazole may be better suited than omeprazole as on-demand therapy for symptomatic gastro-oesophageal reflux disease. Finally, the use of rabeprazole is not complicated by clinically significant drug-drug interactions of the type that have been reported for omeprazole.

[New-generation proton pump inhibitors: progress in the treatment of peptic acid diseases?].

PubMed

de Korwin, Jean-Dominique; Ducrotté, Philippe; Vallot, Thierry

2004-06-19

EFFECTS AND INCONVENIENCIES OF THE OLDER PRODUCTS: The proton pump inhibitors (PPIs) are now universally considered the treatment of choice for management of gastric-acid-related diseases, mainly gastro-oesophageal reflux disease (GERD). These drugs share similar properties: general structure, acid-activation step, covalent binding to the proton pump of the gastric parietal cell via the production of covalent disulphide bonds, relatively stable inhibition of H+,K+-ATPase. However, the older PPIs (omeprazole, lansoprazole et pantoprazole) have notable limitations. These drugs exhibit substantial interpatient variability and may have significant interactions with other drugs. These first-generation PPIs also do not achieve a rapid and sustained suppression of gastric acid, leading to the development of new acid-pump antagonists. The new-generation PPIs, esomeprazole and rabeprazole, offer several pharmacokinetic advantages: lower oxidative hepatic metabolism rate via the CYP 2C19 reducing the activity variations due to genetic polymorphisms and decreasing the risk of significant drug-drug interactions (advantages mainly for rabeprazole), lower metabolic clearance of esomeprazole (S-enantiomer of omeprazole) increasing plasma concentrations and acid suppression of this new PPI, higher accumulation of rabeprazole in the parietal cell due to its higher pKa. Gastric pH studies and therapeutic trials have demonstrated significant advantages of esomeprazole and rabeprazole compared with the older PPIs, which omeprazole is the prototype: a greater inhibition of acid secretion, a more rapid onset of action to provide reflux symptoms relief over 24 hours with lower GERD-related cost for rabeprazole, a sustained acid suppression, cost-effectiveness advantages for esomeprazole in the healing and maintenance of erosive esophagitis compared with lansoprazole, reduced potential for clinically significant drug-drug interactions with rabeprazole compared with omeprazole and esomeprazole. Due to their properties, esomeprazole and rabeprazole are the best candidates for "on demand" treatment of GERD.

Assessment of genotoxicity associated with hydroxyurea therapy in children with sickle cell anemia

PubMed Central

Flanagan, Jonathan M.; Howard, Thad A.; Mortier, Nicole; Avlasevich, Svetlana L.; Smeltzer, Matthew P.; Wu, Song; Dertinger, Stephen D.; Ware, Russell E.

2018-01-01

Hydroxyurea induces fetal hemoglobin, improves laboratory parameters, and ameliorates clinical complications of sickle cell anemia (SCA), but its long-term efficacy and safety in this patient population remain incompletely defined. Although generally considered non-DNA reactive, an important safety concern is that hydroxyurea may indirectly cause genotoxic damage. To better address this safety issue of hydroxyurea in patients with SCA, we measured the production of micronuclei (MN) in red blood cells (RBC) as a marker of genotoxicity. Blood samples were collected from children with SCA enrolled in the Hydroxyurea Study of Long-term Effects (ClinicalTrials.gov NCT00305175). Flow cytometry quantified circulating MN-containing erythrocyte sub-populations before and during hydroxyurea exposure. The frequency of micronucleated reticulocytes (MN-CD71+) and micronucleated mature erythrocytes (MN-RBC) were then tested for associations with laboratory and clinical data. In cross-sectional analysis of 293 blood samples from 105 children with SCA and a median of 2 years of hydroxyurea therapy, exposure to hydroxyurea was associated with significantly increased frequencies of MN-CD71+ and MN-RBC compared to baseline. The increases were evident by 3 months of therapy, and did not escalate further with up to 12 years of continuous drug exposure. In prospective longitudinal analysis, substantial inter-individual variation in the effect of hydroxyurea on %MN-CD71+ was observed that was associated with the expected laboratory effects of hydroxyurea. In conclusion, clinically relevant exposure to hydroxyurea is associated with increased MN production consistent with erythroblast genotoxicity but with substantial inter-patient variability. Associations between increased %MN-CD71+ and laboratory benefits suggest that hydroxyurea effects on MN production may be related to individual patient sensitivity to hydroxyurea within the bone marrow. PMID:20230905

Organic anion transporting polypeptide 1B transporters modulate hydroxyurea pharmacokinetics.

PubMed

Walker, Aisha L; Lancaster, Cynthia S; Finkelstein, David; Ware, Russell E; Sparreboom, Alex

2013-12-15

Hydroxyurea is currently the only FDA-approved drug that ameliorates the pathophysiology of sickle cell anemia. Unfortunately, substantial interpatient variability in the pharmacokinetics (PK) of hydroxyurea may result in variation of the drug's efficacy. However, little is known about mechanisms that modulate hydroxyurea PK. Recent in vitro studies identifying hydroxyurea as a substrate for organic anion transporting polypeptide (OATP1B) transporters prompted the current investigation assessing the role of OATP1B transporters in modulating hydroxyurea PK. Using wild-type and Oatp1b knockout (Oatp1b(-/-)) mice, hydroxyurea PK was analyzed in vivo by measuring [(14)C]hydroxyurea distribution in plasma, kidney, liver, urine, or the exhaled (14)CO2 metabolite. Plasma levels were significantly reduced by 20% in Oatp1b(-/-) mice compared with wild-type (area under the curve of 38.64 or 48.45 μg·h(-1)·ml(-1), respectively) after oral administration, whereas no difference was observed between groups following intravenous administration. Accumulation in the kidney was significantly decreased by twofold in Oatp1b(-/-) mice (356.9 vs. 748.1 pmol/g), which correlated with a significant decrease in urinary excretion. Hydroxyurea accumulation in the liver was also decreased (136.6 vs. 107.3 pmol/g in wild-type or Oatp1b(-/-) mice, respectively) correlating with a decrease in exhaled (14)CO2. These findings illustrate that deficiency of Oatp1b transporters alters the absorption, distribution, and elimination of hydroxyurea thus providing the first in vivo evidence that cell membrane transporters may play a significant role in modulating hydroxyurea PK. Future studies to investigate other transporters and their role in hydroxyurea disposition are warranted for understanding the sources of variation in hydroxyurea's PK.

Organic anion transporting polypeptide 1B transporters modulate hydroxyurea pharmacokinetics

PubMed Central

Lancaster, Cynthia S.; Finkelstein, David; Ware, Russell E.; Sparreboom, Alex

2013-01-01

Hydroxyurea is currently the only FDA-approved drug that ameliorates the pathophysiology of sickle cell anemia. Unfortunately, substantial interpatient variability in the pharmacokinetics (PK) of hydroxyurea may result in variation of the drug's efficacy. However, little is known about mechanisms that modulate hydroxyurea PK. Recent in vitro studies identifying hydroxyurea as a substrate for organic anion transporting polypeptide (OATP1B) transporters prompted the current investigation assessing the role of OATP1B transporters in modulating hydroxyurea PK. Using wild-type and Oatp1b knockout (Oatp1b−/−) mice, hydroxyurea PK was analyzed in vivo by measuring [14C]hydroxyurea distribution in plasma, kidney, liver, urine, or the exhaled 14CO2 metabolite. Plasma levels were significantly reduced by 20% in Oatp1b−/− mice compared with wild-type (area under the curve of 38.64 or 48.45 μg·h−1·ml−1, respectively) after oral administration, whereas no difference was observed between groups following intravenous administration. Accumulation in the kidney was significantly decreased by twofold in Oatp1b−/− mice (356.9 vs. 748.1 pmol/g), which correlated with a significant decrease in urinary excretion. Hydroxyurea accumulation in the liver was also decreased (136.6 vs. 107.3 pmol/g in wild-type or Oatp1b−/− mice, respectively) correlating with a decrease in exhaled 14CO2. These findings illustrate that deficiency of Oatp1b transporters alters the absorption, distribution, and elimination of hydroxyurea thus providing the first in vivo evidence that cell membrane transporters may play a significant role in modulating hydroxyurea PK. Future studies to investigate other transporters and their role in hydroxyurea disposition are warranted for understanding the sources of variation in hydroxyurea's PK. PMID:23986199

Increased peroxisome proliferator-activated receptor γ activity reduces imatinib uptake and efficacy in chronic myeloid leukemia mononuclear cells

PubMed Central

Wang, Jueqiong; Lu, Liu; Kok, Chung H.; Saunders, Verity A.; Goyne, Jarrad M.; Dang, Phuong; Leclercq, Tamara M.; Hughes, Timothy P.; White, Deborah L.

2017-01-01

Imatinib is actively transported by organic cation transporter-1 (OCT-1) influx transporter, and low OCT-1 activity in diagnostic chronic myeloid leukemia blood mononuclear cells is significantly associated with poor molecular response to imatinib. Herein we report that, in diagnostic chronic myeloid leukemia mononuclear cells and BCR-ABL1+ cell lines, peroxisome proliferator-activated receptor γ agonists (GW1929, rosiglitazone, pioglitazone) significantly decrease OCT-1 activity; conversely, peroxisome proliferator-activated receptor γ antagonists (GW9662, T0070907) increase OCT-1 activity. Importantly, these effects can lead to corresponding changes in sensitivity to BCR-ABL kinase inhibition. Results were confirmed in peroxisome proliferator-activated receptor γ-transduced K562 cells. Furthermore, we identified a strong negative correlation between OCT-1 activity and peroxisome proliferator-activated receptor γ transcriptional activity in diagnostic chronic myeloid leukemia patients (n=84; P<0.0001), suggesting that peroxisome proliferator-activated receptor γ activation has a negative impact on the intracellular uptake of imatinib and consequent BCR-ABL kinase inhibition. The inter-patient variability of peroxisome proliferator-activated receptor γ activation likely accounts for the heterogeneity observed in patient OCT-1 activity at diagnosis. Recently, the peroxisome proliferator-activated receptor γ agonist pioglitazone was reported to act synergistically with imatinib, targeting the residual chronic myeloid leukemia stem cell pool. Our findings suggest that peroxisome proliferator-activated receptor γ ligands have differential effects on circulating mononuclear cells compared to stem cells. Since the effect of peroxisome proliferator-activated receptor γ activation on imatinib uptake in mononuclear cells may counteract the clinical benefit of this activation in stem cells, caution should be applied when combining these therapies, especially in patients with high peroxisome proliferator-activated receptor γ transcriptional activity. PMID:28154092

Accuracy of a continuous glucose monitoring system in dogs and cats with diabetic ketoacidosis.

PubMed

Reineke, Erica L; Fletcher, Daniel J; King, Lesley G; Drobatz, Kenneth J

2010-06-01

(1) To determine the ability of a continuous interstitial glucose monitoring system (CGMS) to accurately estimate blood glucose (BG) in dogs and cats with diabetic ketoacidosis. (2) To determine the effect of perfusion, hydration, body condition score, severity of ketosis, and frequency of calibration on the accuracy of the CGMS. Prospective study. University Teaching Hospital. Thirteen dogs and 11 cats diagnosed with diabetic ketoacidosis were enrolled in the study within 24 hours of presentation. Once BG dropped below 22.2 mmol/L (400 mg/dL), a sterile flexible glucose sensor was placed aseptically in the interstitial space and attached to the continuous glucose monitoring device for estimation of the interstitial glucose every 5 minutes. BG measurements were taken with a portable BG meter every 2-4 hours at the discretion of the primary clinician and compared with CGMS glucose measurements. The CGMS estimates of BG and BG measured on the glucometer were strongly associated regardless of calibration frequency (calibration every 8 h: r=0.86, P<0.001; calibration every 12 h: r=0.85, P<0.001). Evaluation of this data using both the Clarke and Consensus error grids showed that 96.7% and 99% of the CGMS readings, respectively, were deemed clinically acceptable (Zones A and B errors). Interpatient variability in the accuracy of the CGMS glucose measurements was found but was not associated with body condition, perfusion, or degree of ketosis. A weak association between hydration status of the patient as assessed with the visual analog scale and absolute percent error (Spearman's rank correlation, rho=-0.079, 95% CI=-0.15 to -0.01, P=0.03) was found, with the device being more accurate in the more hydrated patients. The CGMS provides clinically accurate estimates of BG in patients with diabetic ketoacidosis.

Polymorphisms in methotrexate transporters and their relationship to plasma methotrexate levels, toxicity of high-dose methotrexate, and outcome of pediatric acute lymphoblastic leukemia.

PubMed

Liu, Shu-Guang; Gao, Chao; Zhang, Rui-Dong; Zhao, Xiao-Xi; Cui, Lei; Li, Wei-Jing; Chen, Zhen-Ping; Yue, Zhi-Xia; Zhang, Yuan-Yuan; Wu, Min-Yuan; Wang, Jian-Xiang; Li, Zhi-Gang; Zheng, Hu-Yong

2017-06-06

High-dose methotrexate (HDMTX) plays an important role in the treatment of acute lymphoblastic leukemia (ALL) although there is great inter-patient variability in the efficacy and toxicity of MTX. The relationship between polymorphisms in genes encoding MTX transporters and MTX response is controversial. In the present study, 322 Chinese children with standard- and intermediate-risk ALL were genotyped for 12 polymorphisms. SLCO1B1 rs10841753 showed a significant association with plasma MTX levels at 48 h (P = 0.017). Patients who had the ABCB1 rs1128503 C allele had longer duration of hospitalization than did those with the TT genotype (P = 0.006). No association was found between oral mucositis and any polymorphism. Long-term outcome was worse in patients with the SLCO1B1 rs4149056 CC genotype than in patients with TT or TC (5-year event-free survival [EFS] 33.3 ± 19.2% vs. 90.5 ± 1.7%, P < 0.001), and was worse in patients with the SCL19A1 rs2838958 AA genotype than in patients with AG or GG (5-year EFS 78.5 ± 4.6% vs. 92.2 ± 1.8%, P = 0.008). Multiple Cox regression analyses revealed associations of minimal residual disease (MRD) at day 33 (hazard ratio 3.458; P = 0.002), MRD at day 78 (hazard ratio 6.330; P = 0.001), SLCO1B1 rs4149056 (hazard ratio 12.242; P < 0.001), and SCL19A1 rs2838958 (hazard ratio 2.324; P = 0.019) with EFS. Our findings show that polymorphisms in genes encoding MTX transporters substantially influence the kinetics and response to HDMTX therapy in childhood ALL.

The innate oxygen dependant immune pathway as a sensitive parameter to predict the performance of biological graft materials.

PubMed

Bryan, Nicholas; Ashwin, Helen; Smart, Neil; Bayon, Yves; Scarborough, Nelson; Hunt, John A

2012-09-01

Clinical performance of a biomaterial is decided early after implantation as leukocytes interrogate the graft throughout acute inflammation. High degrees of leukocyte activation lead to poor material/patient compliance, accelerated degeneration and graft rejection. A number reactive oxygen species (ROS) are released by leukocytes throughout their interaction with a material, which can be used as a sensitive measure of leukocyte activation. The aim of this study was to compare leukocyte activation by commercially available biologic surgical materials and define the extent manufacturing variables influence down-stream ROS response. Chemiluminescence assays were performed using modifications to a commercially available kit (Knight Scientific, UK). Whole blood was obtained from 4 healthy human adults at 7 day intervals for 4 weeks, combined with Adjuvant K, Pholasin (a highly sensitive ROS excitable photoprotein) and biomaterial, and incubated for 60 min with continuous chemiluminescent measurements. Leukocyte ROS inducers fMLP and PMA were added as controls. Xeno- and allogeneic dermal and small intestinal submucosal (SIS) derived biomaterials were produced commercially (Surgisis Biodesign™, Alloderm(®), Strattice(®)Firm & Pliable & Permacol™) or fabricated in house to induce variations in decellularisation and cross-linking. Statistics were performed using Waller-Duncan post hoc ranking. Materials demonstrated significant differences in leukocyte activation as a function of decellularisation reagent and tissue origin. The data demonstrated SIS was significantly more pro-inflammatory than dermis. Additionally it was deduced that SDS during decellularisation induced pro-inflammatory changes to dermal materials. Furthermore, it was possible to conclude inter-patient variation in leukocyte response. The in vitro findings were validated in vivo which confirmed the chemiluminescence observations, highlighting the potential for translation of this technique as a routine component of pre-surgical evaluation to maximise foreign body compliance. Copyright © 2012 Elsevier Ltd. All rights reserved.

PET attenuation correction for flexible MRI surface coils in hybrid PET/MRI using a 3D depth camera

NASA Astrophysics Data System (ADS)

Frohwein, Lynn J.; Heß, Mirco; Schlicher, Dominik; Bolwin, Konstantin; Büther, Florian; Jiang, Xiaoyi; Schäfers, Klaus P.

2018-01-01

PET attenuation correction for flexible MRI radio frequency surface coils in hybrid PET/MRI is still a challenging task, as position and shape of these coils conform to large inter-patient variabilities. The purpose of this feasibility study is to develop a novel method for the incorporation of attenuation information about flexible surface coils in PET reconstruction using the Microsoft Kinect V2 depth camera. The depth information is used to determine a dense point cloud of the coil’s surface representing the shape of the coil. From a CT template—acquired once in advance—surface information of the coil is extracted likewise and converted into a point cloud. The two point clouds are then registered using a combination of an iterative-closest-point (ICP) method and a partially rigid registration step. Using the transformation derived through the point clouds, the CT template is warped and thereby adapted to the PET/MRI scan setup. The transformed CT template is converted into an attenuation map from Hounsfield units into linear attenuation coefficients. The resulting fitted attenuation map is then integrated into the MRI-based patient-specific DIXON-based attenuation map of the actual PET/MRI scan. A reconstruction of phantom PET data acquired with the coil present in the field-of-view (FoV), but without the corresponding coil attenuation map, shows large artifacts in regions close to the coil. The overall count loss is determined to be around 13% compared to a PET scan without the coil present in the FoV. A reconstruction using the new μ-map resulted in strongly reduced artifacts as well as increased overall PET intensities with a remaining relative difference of about 1% to a PET scan without the coil in the FoV.

A Phase I and Pharmacokinetic Study of the Oral Histone Deacetylase Inhibitor, MS-275, in Patients with Refractory Solid Tumors and Lymphomas

PubMed Central

Gore, Lia; Rothenberg, Mace L.; O'Bryant, Cindy L.; Schultz, Mary Kay; Sandler, Alan B.; Coffin, Denise; McCoy, Candice; Schott, Astrid; Scholz, Catherine; Eckhardt, S. Gail

2010-01-01

Purpose To evaluate the toxicity profile, pharmacologic, and biological properties of 3-pyridylmethyl N-{4-[(2-aminophenyl)carbamoyl]benzyl}carbamate (MS-275), a histone deacetylase inhibitor, when administered orally on three different dosing schedules. Experimental Design Patients with advanced solid malignancies and lymphomas were treated on three dose schedules: once every other week, twice weekly for 3 weeks every 28 days, and once weekly for 3 weeks every 28 days. First-cycle plasma pharmacokinetics and peripheral blood mononuclear cell histone acetylation were determined. Results Twenty-seven patients received ≥149 courses of treatment. Hypophosphatemia and asthenia were dose limiting on the weekly and twice-weekly dosing schedules; there was no dose-limiting toxicity on the every other week schedule. Pharmacokinetic variables revealed dose-dependent and dose-proportional increases. Two of 27 patients showed partial remissions, including one patient with metastatic melanoma who had a partial response and has remained on study for >5 years. Six patients showed prolonged disease stabilization. Levels of histone H3 and H4 acetylation in peripheral blood mononuclear cells increased qualitatively but with a high degree of interpatient variation. Conclusions MS-275 is well tolerated at doses up to 6 mg/m2 every other week or 4 mg/m2 weekly for 3 weeks followed by 1 week of rest and results in biologically relevant plasma concentrations and antitumor activity. Twice-weekly dosing was not tolerable due to asthenia, and further evaluation of this schedule was halted. The recommended dose for further disease-focused studies is 4 mg/m2 given weekly for 3 weeks every 28 days or 2 to 6 mg/m2 given once every other week. PMID:18579665

Population Pharmacokinetics of Oral Topotecan in Infants and Very Young Children with Brain Tumors Demonstrates a Role of ABCG2 rs4148157 on the Absorption Rate Constant

PubMed Central

Roberts, Jessica K.; Birg, Anna V.; Lin, Tong; Daryani, Vinay M.; Panetta, John C.; Broniscer, Alberto; Robinson, Giles W.; Gajjar, Amar J.

2016-01-01

For infants and very young children with brain tumors, chemotherapy after surgical resection is the main treatment due to neurologic and neuroendocrine adverse effects from whole brain irradiation. Topotecan, an anticancer drug with antitumor activity against pediatric brain tumors, can be given intravenous or orally. However, high interpatient variability in oral drug bioavailability is common in children less than 3 years old. Therefore, this study aimed to determine the population pharmacokinetics of oral topotecan in infants and very young children, specifically evaluating the effects of age and ABCG2 and ABCB1 on the absorption rate constant (Ka), as well as other covariate effects on all pharmacokinetic parameters. A nonlinear mixed effects model was implemented in Monolix 4.3.2 (Lixoft, Orsay, France). A one-compartment model with first-order input and first-order elimination was found to adequately characterize topotecan lactone concentrations with population estimates as [mean (S.E.)]; Ka = 0.61 (0.11) h−1, apparent volume of distribution (V/F) = 40.2 (7.0) l, and apparent clearance (CL/F) = 40.0 (2.9) l/h. After including the body surface area in the V/F and CL/F as a power model centered on the population median, the ABCG2 rs4148157 allele was found to play a significant role in the value of Ka. Patients homozygous or heterozygous for G>A demonstrated a Ka value 2-fold higher than their GG counterparts, complemented with a 2-fold higher maximal concentration as well. These results demonstrate a possible role for the ABCG2 rs4148157 allele in the pharmacokinetics of oral topotecan in infants and very young children, and warrants further investigation. PMID:27052877

"X-Map 2.0" for Edema Signal Enhancement for Acute Ischemic Stroke Using Non-Contrast-Enhanced Dual-Energy Computed Tomography.

PubMed

Taguchi, Katsuyuki; Itoh, Toshihide; Fuld, Matthew K; Fournie, Eric; Lee, Okkyun; Noguchi, Kyo

2018-03-14

A novel imaging technique ("X-map") has been developed to identify acute ischemic lesions for stroke patients using non-contrast-enhanced dual-energy computed tomography (NE-DE-CT). Using the 3-material decomposition technique, the original X-map ("X-map 1.0") eliminates fat and bone from the images, suppresses the gray matter (GM)-white matter (WM) tissue contrast, and makes signals of edema induced by severe ischemia easier to detect. The aim of this study was to address the following 2 problems with the X-map 1.0: (1) biases in CT numbers (or artifacts) near the skull of NE-DE-CT images and (2) large intrapatient and interpatient variations in X-map 1.0 values. We improved both an iterative beam-hardening correction (iBHC) method and the X-map algorithm. The new iBHC (iBHC2) modeled x-ray physics more accurately. The new X-map ("X-map 2.0") estimated regional GM values-thus, maximizing the ability to suppress the GM-WM contrast, make edema signals quantitative, and enhance the edema signals that denote an increased water density for each pixel. We performed a retrospective study of 11 patients (3 men, 8 women; mean age, 76.3 years; range, 68-90 years) who presented to the emergency department with symptoms of acute stroke. Images were reconstructed with the old iBHC (iBHC1) and the iBHC2, and biases in CT numbers near the skull were measured. Both X-map 2.0 maps and X-map 1.0 maps were computed from iBHC2 images, both with and without a material decomposition-based edema signal enhancement (ESE) process. X-map values were measured at 5 to 9 locations on GM without infarct per patient; the mean value was calculated for each patient (we call it the patient-mean X-map value) and subtracted from the measured X-map values to generate zero-mean X-map values. The standard deviation of the patient-mean X-map values over multiple patients denotes the interpatient variation; the standard deviation over multiple zero-mean X-map values denotes the intrapatient variation. The Levene F test was performed to assess the difference in the standard deviations with different algorithms. Using 5 patient data who had diffusion weighted imaging (DWI) within 2 hours of NE-DE-CT, mean values at and near ischemic lesions were measured at 7 to 14 locations per patient with X-map images, CT images (low kV and high kV), and DWI images. The Pearson correlation coefficient was calculated between a normalized increase in DWI signals and either X-map or CT. The bias in CT numbers was lower with iBHC2 than with iBHC1 in both high- and low-kV images (2.5 ± 2.0 HU [95% confidence interval (CI), 1.3-3.8 HU] for iBHC2 vs 6.9 ± 2.3 HU [95% CI, 5.4-8.3 HU] for iBHC1 with high-kV images, P < 0.01; 1.5 ± 3.6 HU [95% CI, -0.8 to 3.7 HU] vs 12.8 ± 3.3 HU [95% CI, 10.7-14.8 HU] with low-kV images, P < 0.01). The interpatient variation was smaller with X-map 2.0 than with X-map 1.0, both with and without ESE (4.3 [95% CI, 3.0-7.6] for X-map 2.0 vs 19.0 [95% CI, 13.3-22.4] for X-map 1.0, both with ESE, P < 0.01; 3.0 [95% CI, 2.1-5.3] vs 12.0 [95% CI, 8.4-21.0] without ESE, P < 0.01). The intrapatient variation was also smaller with X-map 2.0 than with X-map 1.0 (6.2 [95% CI, 5.3-7.3] vs 8.5 [95% CI, 7.3-10.1] with ESE, P = 0.0122; 4.1 [95% CI, 3.6-4.9] vs 6.3 [95% CI, 5.5-7.6] without ESE, P < 0.01). The best 3 correlation coefficients (R) with DWI signals were -0.733 (95% CI, -0.845 to -0.560, P < 0.001) for X-map 2.0 with ESE, -0.642 (95% CI, -0.787 to -0.429, P < 0.001) for high-kV CT, and -0.609 (95% CI, -0.766 to -0.384, P < 0.001) for X-map 1.0 with ESE. Both of the 2 problems outlined in the objectives have been addressed by improving both iBHC and X-map algorithm. The iBHC2 improved the bias in CT numbers and the visibility of GM-WM contrast throughout the brain space. The combination of iBHC2 and X-map 2.0 with ESE decreased both intrapatient and interpatient variations of edema signals significantly and had a strong correlation with DWI signals in terms of the strength of edema signals.

On X-Ray Variability in Seyfert Galaxies

NASA Technical Reports Server (NTRS)

Turner, T. J.; George, I. M.; Nandra, K.; Turcan, D.

1999-01-01

This paper presents a quantification of the X-ray variability amplitude for 79 ASCA observations of 36 Seyfert 1 galaxies. We find that consideration of sources with the narrowest permitted lines in the optical band introduces scatter into the established correlation between X-ray variability and nuclear luminosity. Consideration of the X-ray spectral index and variability properties together shows distinct groupings in parameter space for broad and narrow-line Seyfert 1 galaxies, confirming previous studies. A strong correlation is found between hard X-ray variability and FWHM Hbeta. A range of nuclear mass and accretion rate across the Seyfert population can explain the differences observed in X-ray and optical properties. An attractive alternative model, which does not depend on any systematic difference in central mass, is that the circumnuclear gas of NLSy1s is different to BLSy1s in temperature, optical depth, density or geometry.

Variables related to romanticism and self-esteem in pregnant teenagers.

PubMed

Medora, N P; Goldstein, A; von der Hellen, C

1993-01-01

In this study, the Dean Romanticism Scale and the Bachman Self-esteem Scale were administered to 121 teenagers between the ages of 12 and 19 in Southern California to investigate their degree of romanticism and self-esteem. The study also explored whether there was any relationship between the dependent variables of romanticism and self-esteem and ten independent variables--age, race, place of residence during pregnancy, age when first sexual intercourse occurred, age when pregnancy occurred, incidence of sexual abuse, incidence of abortion, adoption considerations, whether the subject was currently sexually active, and whether the teenager planned to have a child with the father of the baby. The results indicated that two variables were significantly related to feelings of romanticism--adoption considerations and whether the adolescent planned to have a child with the baby's father. In addition, two variables were significantly related to self-esteem--the incidence of sexual abuse and the incidence of abortion.

HIV-1 sequence variation between isolates from mother-infant transmission pairs

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wike, C.M.; Daniels, M.R.; Furtado, M.

1991-12-31

To examine the sequence diversity of human immunodeficiency virus type 1 (HIV-1) between known transmission sets, sequences from the V3 and V4-V5 region of the env gene from 4 mother-infant pairs were analyzed. The mean interpatient sequence variation between isolates from linked mother-infant pairs was comparable to the sequence diversity found between isolates from other close contacts. The mean intrapatient variation was significantly less in the infants` isolates then the isolates from both their mothers and other characterized intrapatient sequence sets. In addition, a distinct and characteristic difference in the glycosylation pattern preceding the V3 loop was found between eachmore » linked transmission pair. These findings indicate that selection of specific genotypic variants, which may play a role in some direct transmission sets, and the duration of infection are important factors in the degree of diversity seen between the sequence sets.« less

The nuclear 18S ribosomal RNA gene as a source of phylogenetic information in the genus Taenia.

PubMed

Yan, Hongbin; Lou, Zhongzi; Li, Li; Ni, Xingwei; Guo, Aijiang; Li, Hongmin; Zheng, Yadong; Dyachenko, Viktor; Jia, Wanzhong

2013-03-01

Most species of the genus Taenia are of considerable medical and veterinary significance. In this study, complete nuclear 18S rRNA gene sequences were obtained from seven members of genus Taenia [Taenia multiceps, Taenia saginata, Taenia asiatica, Taenia solium, Taenia pisiformis, Taenia hydatigena, and Taenia taeniaeformis] and a phylogeny inferred using these sequences. Most of the variable sites fall within the variable regions, V1-V5. We show that sequences from the nuclear 18S ribosomal RNA gene have considerable promise as sources of phylogenetic information within the genus Taenia. Furthermore, given that almost all the variable sites lie within defined variable portions of that gene, it will be appropriate and economical to sequence only those regions for additional species of Taenia.

Socioeconomic and Cultural Correlates of Diet Quality in the Canadian Arctic: Results from the 2007-2008 Inuit Health Survey.

PubMed

Galloway, Tracey; Johnson-Down, Louise; Egeland, Grace M

2015-09-01

We examined the impact of socioeconomic and cultural factors on dietary quality in adult Inuit living in the Canadian Arctic. Interviews and a 24-h dietary recall were administered to 805 men and 1292 women from Inuit regions in the Canadian Arctic. We examined the effect of age, sex, education, income, employment, and cultural variables on respondents' energy, macronutrient intake, sodium/potassium ratio, and healthy eating index. Logistic regression was used to assess the impact of socioeconomic status (SES) on diet quality indicators. Age was positively associated with traditional food (TF) consumption and greater energy from protein but negatively associated with total energy and fibre intake. Associations between SES and diet quality differed considerably between men and women and there was considerable regional variability in diet quality measures. Age and cultural variables were significant predictors of diet quality in logistic regression. Increased age and use of the Inuit language in the home were the most significant predictors of TF consumption. Our findings are consistent with studies reporting a nutrition transition in circumpolar Inuit. We found considerable variability in diet quality and complex interaction between SES and cultural variables producing mixed effects that differ by age and gender.

Operant Variability: Procedures and Processes

ERIC Educational Resources Information Center

Machado, Armando; Tonneau, Francois

2012-01-01

Barba's (2012) article deftly weaves three main themes in one argument about operant variability. From general theoretical considerations on operant behavior (Catania, 1973), Barba derives methodological guidelines about response differentiation and applies them to the study of operant variability. In the process, he uncovers unnoticed features of…

Short-term favorable weather conditions are an important control of interannual variability in carbon and water fluxes

Treesearch

Jakob Zscheischler; Simone Fatichi; Sebastian Wolf; Peter D. Blanken; Gil Bohrer; Ken Clark; Ankur R. Desai; David Hollinger; Trevor Keenan; Kimberly A. Novick; Sonia I. Seneviratne

2016-01-01

Ecosystem models often perform poorly in reproducing interannual variability in carbon and water fluxes, resulting in considerable uncertainty when estimating the land-carbon sink. While many aggregated variables (growing season length, seasonal precipitation, or temperature) have been suggested as predictors for interannual variability in carbon fluxes, their...

A theoretical stochastic control framework for adapting radiotherapy to hypoxia

NASA Astrophysics Data System (ADS)

Saberian, Fatemeh; Ghate, Archis; Kim, Minsun

2016-10-01

Hypoxia, that is, insufficient oxygen partial pressure, is a known cause of reduced radiosensitivity in solid tumors, and especially in head-and-neck tumors. It is thus believed to adversely affect the outcome of fractionated radiotherapy. Oxygen partial pressure varies spatially and temporally over the treatment course and exhibits inter-patient and intra-tumor variation. Emerging advances in non-invasive functional imaging offer the future possibility of adapting radiotherapy plans to this uncertain spatiotemporal evolution of hypoxia over the treatment course. We study the potential benefits of such adaptive planning via a theoretical stochastic control framework using computer-simulated evolution of hypoxia on computer-generated test cases in head-and-neck cancer. The exact solution of the resulting control problem is computationally intractable. We develop an approximation algorithm, called certainty equivalent control, that calls for the solution of a sequence of convex programs over the treatment course; dose-volume constraints are handled using a simple constraint generation method. These convex programs are solved using an interior point algorithm with a logarithmic barrier via Newton’s method and backtracking line search. Convexity of various formulations in this paper is guaranteed by a sufficient condition on radiobiological tumor-response parameters. This condition is expected to hold for head-and-neck tumors and for other similarly responding tumors where the linear dose-response parameter is larger than the quadratic dose-response parameter. We perform numerical experiments on four test cases by using a first-order vector autoregressive process with exponential and rational-quadratic covariance functions from the spatiotemporal statistics literature to simulate the evolution of hypoxia. Our results suggest that dynamic planning could lead to a considerable improvement in the number of tumor cells remaining at the end of the treatment course. Through these simulations, we also gain insights into when and why dynamic planning is likely to yield the largest benefits.

Variables Related to Romanticism and Self-Esteem in Pregnant Teenagers.

ERIC Educational Resources Information Center

Medora, Nilufer P.; And Others

1993-01-01

Administered Dean Romanticism Scale and Bachman Self-Esteem Scale to 121 pregnant adolescents (ages 12-21). Found that two variables were significantly related to feelings of romanticism: adoption considerations and whether adolescent planned to have child with the baby's father. Two variables were significantly related to self-esteem: incidence…

Ergonomics: The Forgotten Variable.

ERIC Educational Resources Information Center

Fitterman, L. Jeffrey

This paper describes ergonomics and the need to adapt worksites and technologies for individuals with physical or sensory disabilities. It provides suggestions for how to design an appropriate setup, design considerations, environmental considerations, chairs, monitor height, ambient noise, light, and electricity. Recommendations include: (1)…

Screening variability and change of soil moisture under wide-ranging climate conditions: Snow dynamics effects.

PubMed

Verrot, Lucile; Destouni, Georgia

2015-01-01

Soil moisture influences and is influenced by water, climate, and ecosystem conditions, affecting associated ecosystem services in the landscape. This paper couples snow storage-melting dynamics with an analytical modeling approach to screening basin-scale, long-term soil moisture variability and change in a changing climate. This coupling enables assessment of both spatial differences and temporal changes across a wide range of hydro-climatic conditions. Model application is exemplified for two major Swedish hydrological basins, Norrström and Piteälven. These are located along a steep temperature gradient and have experienced different hydro-climatic changes over the time period of study, 1950-2009. Spatially, average intra-annual variability of soil moisture differs considerably between the basins due to their temperature-related differences in snow dynamics. With regard to temporal change, the long-term average state and intra-annual variability of soil moisture have not changed much, while inter-annual variability has changed considerably in response to hydro-climatic changes experienced so far in each basin.

The Potential for Differential Findings among Invariance Testing Strategies for Multisample Measured Variable Path Models

ERIC Educational Resources Information Center

Mann, Heather M.; Rutstein, Daisy W.; Hancock, Gregory R.

2009-01-01

Multisample measured variable path analysis is used to test whether causal/structural relations among measured variables differ across populations. Several invariance testing approaches are available for assessing cross-group equality of such relations, but the associated test statistics may vary considerably across methods. This study is a…

TECHNOLOGICAL CONSIDERATIONS FOR PLANNING THE GLOBAL CARBON FUTURE

EPA Science Inventory

The atmospheric level of carbon dioxide (CO2) is the dominant variable in the anthropogenic influence of future global climate change. Thus, it is critical to understand the long-term factors affecting its level, especially the longer-range technological considerations. Most rece...

Romanticism and self-esteem among teen mothers.

PubMed

Medora, N P; von der Hellen, C

1997-01-01

This study examined teen mothers' romanticism and self-esteem. The Dean Romanticism Scale and the Bachman Self-esteem Scale were administered to 94 mothers between the ages of 13 and 18 in Southern California. The study also investigated the relationship between the dependent variables--romanticism and self-esteem--and ten independent variables--age, age of mother when first child was born, incidence of sexual abuse, incidence of abortion, current sexual activity, adoption considerations, current use of birth control, whether paternity was denied by the baby's father, whether the mother's parents were living together, and the quality of the relationship between the mother's parents. Results indicated that five variables were significantly related to romanticism--whether the teenager had a previous abortion, adoption considerations, current sexual activity, whether the parents were living together, and the quality of the relationship between the parents. Two variables were significantly related to self-esteem--age and current use of birth control.

On FIA Variables For Ecological Use

Treesearch

David C. Chojnacky

2001-01-01

The Forest Inventory and Analysis (FIA) program collects or calculates over 300 variables for its national network of permanent forest plots. However, considerable ecological analysis can be done with only a few key variables. Two examples--Mexican spotted owl habitat in New Mexico and down deadwood in Maine--are used to illustrate the potential of FIA data for...

Ergonomic Considerations for the Human Environment: Color Treatment, Lighting, and Furniture Selection.

ERIC Educational Resources Information Center

Robertson, Michelle M.

1992-01-01

Discusses ergonomic design considerations for library media centers. Specific design variables, including temperature and humidity, noise, illumination, color, and windows are discussed; and computer workstation design requirements are presented that address furniture and keyboard design, monitor and display features, software issues, and…

Cultural and Cognitive Considerations in the Prevention of American Indian Adolescent Suicide.

ERIC Educational Resources Information Center

La Framboise, Teresa D.; Big Foot, Delores Subia

1988-01-01

Describes cultural considerations associated with American Indian adolescents coping within a transactional, cognitive-phenomenological framework. Discusses select cultural values and beliefs of American Indians associated with death in terms of person variables and situational demand characteristics that interplay in coping process. Suggests…

Some Considerations Necessary for a Viable Theory of Human Memory.

ERIC Educational Resources Information Center

Sietsema, Douglas J.

Empirical research is reviewed in the area of cognitive psychology pertaining to models of human memory. Research evidence and theoretical considerations are combined to develop guidelines for future theory development related to the human memory. The following theoretical constructs and variables are discussed: (1) storage versus process…

X-Ray Variability of BL Lac Objects

NASA Astrophysics Data System (ADS)

McHardy, Ian

I present an overview of the X-ray temporal and spectral variability of BL Lacs on both short and long timescales. The previously observed behaviour of short (~days) flares superimposed on a relatively steady `quiescent' level is still broadly correct. However, for the brighter BL Lacs, the well sampled lightcurves from the RXTE ASM show that the `quiescent' level also varies considerably on timescales of ~100 days in a manner similar to that seen in Optically Violently Variable Quasars (OVVs) such as 3C279 and 3C273. Possible reasons for this behaviour are discussed. For the large majority of BL Lacs the soft and medium energy X-ray bands are dominated by synchrotron emission and, unlike the case of OVVs, the emission mechanism is not in doubt. Most interest then centres on the structure of the emitting region, and the electron acceleration processes, particularly during outbursts. That structure, and the acceleration processes, can be investigated by consideration of the spectral variability during flares, which is not simple. I review the observations of spectral variability and consider the evidence for and against homogeneous models. I also briefly compare the X-ray spectral variability of BL Lacs with that of OVVs such as 3C273.

Small-scale temporal and spatial variability in the abundance of plastic pellets on sandy beaches: Methodological considerations for estimating the input of microplastics.

PubMed

Moreira, Fabiana Tavares; Prantoni, Alessandro Lívio; Martini, Bruno; de Abreu, Michelle Alves; Stoiev, Sérgio Biato; Turra, Alexander

2016-01-15

Microplastics such as pellets have been reported for many years on sandy beaches around the globe. Nevertheless, high variability is observed in their estimates and distribution patterns across the beach environment are still to be unravelled. Here, we investigate the small-scale temporal and spatial variability in the abundance of pellets in the intertidal zone of a sandy beach and evaluate factors that can increase the variability in data sets. The abundance of pellets was estimated during twelve consecutive tidal cycles, identifying the position of the high tide between cycles and sampling drift-lines across the intertidal zone. We demonstrate that beach dynamic processes such as the overlap of strandlines and artefacts of the methods can increase the small-scale variability. The results obtained are discussed in terms of the methodological considerations needed to understand the distribution of pellets in the beach environment, with special implications for studies focused on patterns of input. Copyright © 2015 Elsevier Ltd. All rights reserved.

Trigger learning and ECG parameter customization for remote cardiac clinical care information system.

PubMed

Bashir, Mohamed Ezzeldin A; Lee, Dong Gyu; Li, Meijing; Bae, Jang-Whan; Shon, Ho Sun; Cho, Myung Chan; Ryu, Keun Ho

2012-07-01

Coronary heart disease is being identified as the largest single cause of death along the world. The aim of a cardiac clinical information system is to achieve the best possible diagnosis of cardiac arrhythmias by electronic data processing. Cardiac information system that is designed to offer remote monitoring of patient who needed continues follow up is demanding. However, intra- and interpatient electrocardiogram (ECG) morphological descriptors are varying through the time as well as the computational limits pose significant challenges for practical implementations. The former requires that the classification model be adjusted continuously, and the latter requires a reduction in the number and types of ECG features, and thus, the computational burden, necessary to classify different arrhythmias. We propose the use of adaptive learning to automatically train the classifier on up-to-date ECG data, and employ adaptive feature selection to define unique feature subsets pertinent to different types of arrhythmia. Experimental results show that this hybrid technique outperforms conventional approaches and is, therefore, a promising new intelligent diagnostic tool.

Hemodynamic responses to external counterbalancing of auto-positive end-expiratory pressure in mechanically ventilated patients with chronic obstructive pulmonary disease.

PubMed

Baigorri, F; de Monte, A; Blanch, L; Fernández, R; Vallés, J; Mestre, J; Saura, P; Artigas, A

1994-11-01

To study the effect of positive end-expiratory pressure (PEEP) on right ventricular hemodynamics and ejection fraction in patients with chronic obstructive pulmonary disease and positive alveolar pressure throughout expiration by dynamic hyperinflation (auto-PEEP). Open, prospective, controlled trial. General intensive care unit of a community hospital. Ten patients sedated and paralyzed with an acute exacerbation of chronic obstructive pulmonary disease undergoing mechanical ventilation. Insertion of a pulmonary artery catheter modified with a rapid response thermistor and a radial arterial catheter. PEEP was then increased from 0 (PEEP 0) to auto-PEEP level (PEEP = auto-PEEP) and 5 cm H2O above that (PEEP = auto-PEEP +5). At each level of PEEP, airway pressures, flow and volume, hemodynamic variables (including right ventricular ejection fraction by thermodilution technique), and blood gas analyses were recorded. The mean auto-PEEP was 6.6 +/- 2.8 cm H2O and the total PEEP reached was 12.2 +/- 2.4 cm H2O. The degree of lung inflation induced by PEEP averaged 145 +/- 87 mL with PEEP = auto-PEEP and 495 +/- 133 mL with PEEP = auto-PEEP + 5. The PEEP = auto-PEEP caused a right ventricular end-diastolic pressure increase, but there was no other significant hemodynamic change. With PEEP = auto-PEEP + 5, there was a significant increase in intravascular pressures; this amount of PEEP reduced cardiac output (from 4.40 +/- 1.38 L/min at PEEP 0 to 4.13 +/- 1.48 L/min; p < .05). The cardiac output reduction induced by PEEP = auto-PEEP + 5 was > 10% in only five cases and this group of patients had significantly lower right ventricular volumes than the group with less cardiac output variation (right ventricular end-diastolic volume: 64 +/- 9 vs. 96 +/- 26 mL/m2; right ventricular end-systolic volume: 38 +/- 6 vs. 65 +/- 21 mL/m2; p < .05) without significant difference in the other variables that were measured. Neither right ventricular ejection fraction nor right ventricle volumes changed as PEEP increased, but there were marked interpatient differences and also pronounced changes in volume between stages in individual patients. In the study conditions, PEEP application up to values approaching auto-PEEP did not result in the impairment of right ventricular hemodynamics, while higher levels reduced cardiac output in selected patients.

Energy monitoring in gins

USDA-ARS?s Scientific Manuscript database

Energy costs are the second largest source of variable costs for cotton gins, accounting for 27% of variable costs. Energy use has typically not been a major consideration in gin design, and previous studies of energy use have utilized instantaneous readings or aggregated season-long values. In this...

Consideration of What May Influence Student Outcomes on Alternate Assessment.

ERIC Educational Resources Information Center

Browder, Diane M.; Fallin, Kathy; Davis, Stephanie; Karvonen, Meagan

2003-01-01

This article describes variables that may influence alternate assessment outcomes for students with disabilities and offers recommendations to enhance student achievement. These variables include technical quality, curriculum access, data collection, instructional effectiveness, risk factors, and resources allocated to instruction. Two of four…

Energy Monitoring in Gins - 2011

USDA-ARS?s Scientific Manuscript database

Energy costs are the second largest source of variable costs for gins, accounting for 27% of variable costs. Energy use has typically not been a major consideration in gin design and previous studies of energy use have utilized instantaneous readings or aggregated season-long values. Electricity u...

Electricity use patterns in cotton gins

USDA-ARS?s Scientific Manuscript database

Energy costs are the second largest source of variable costs for cotton gins, with electricity accounting for 18% of variable costs. Energy use has typically not been a major consideration in gin design and previous studies of energy use have utilized instantaneous readings or aggregated season-lon...

Manufacture of threads with variable pitch by using noncircular gears

NASA Astrophysics Data System (ADS)

Slătineanu, L.; Dodun, O.; Coteață, M.; Coman, I.; Nagîț, G.; Beșliu, I.

2016-08-01

There are mechanical equipments in which shafts threaded with variable pitch are included. Such a shaft could be met in the case of worm specific to the double enveloping worm gearing. Over the years, the researchers investigated some possibilities to geometrically define and manufacture the shaft zones characterized by a variable pitch. One of the methods able to facilitate the manufacture of threads with variable pitch is based on the use of noncircular gears in the threading kinematic chain for threading by cutting. In order to design the noncircular gears, the mathematical law of pitch variation has to be known. An analysis of pitch variation based on geometrical considerations was developed in the case of a double enveloping globoid worm. Subsequently, on the bases of a proper situation, a numerical model was determined. In this way, an approximately law of pitch variation was determined and it could be taken into consideration when designing the noncircular gears included in the kinematic chain of the cutting machine tool.

The Semistructured Interview for Consideration of Ethnic Culture in Therapy Scale: Initial Psychometric and Outcome Support

ERIC Educational Resources Information Center

Donohue, Brad; Strada, Marilyn J.; Rosales, Rocio; Taylor-Caldwell, Aundrea; Hise, Dortha; Ahman, Sarah; Lefforge, Noelle L.; Kopof, Monique; Devore, Greg; Soares, Bruno; Radkovich, Ben; Laino, Rowena

2006-01-01

There has been recent pressure for practitioners to consider cultural variables when implementing evidence-based interventions. Therefore, the Semistructured Interview for Consideration of Ethnic Culture in Therapy Scale (SSICECTS) was empirically developed to address this issue. First, psychometric properties of a 6-item scale were evaluated in…

New variables for classical and quantum gravity

NASA Technical Reports Server (NTRS)

Ashtekar, Abhay

1986-01-01

A Hamiltonian formulation of general relativity based on certain spinorial variables is introduced. These variables simplify the constraints of general relativity considerably and enable one to imbed the constraint surface in the phase space of Einstein's theory into that of Yang-Mills theory. The imbedding suggests new ways of attacking a number of problems in both classical and quantum gravity. Some illustrative applications are discussed.

Considerations when using variable frequency drive technology for pond aquculture

USDA-ARS?s Scientific Manuscript database

Some farmers have decided to use variable frequency drives (VFDs) to control pump speed and water flow rate to reduce operational cost and costs associated with repairs and maintenance. Mixed performance issues with VFDs and electric motors have been reported. Examples include frequent drive failure...

Some Methodological Considerations in Researching the Family Career.

ERIC Educational Resources Information Center

White, James

Methodological issues which confront researchers using the concept of the family career include the selection of appropriate dependent variables; the efficacy of historical versus immediate effects; and scaling the family career (a proposed replacement for the "family life cycle"). The issue of which dependent variables should be…

Parameter sensitivity and identifiability for a biogeochemical model of hypoxia in the northern Gulf of Mexico

EPA Science Inventory

Local sensitivity analyses and identifiable parameter subsets were used to describe numerical constraints of a hypoxia model for bottom waters of the northern Gulf of Mexico. The sensitivity of state variables differed considerably with parameter changes, although most variables ...

A UNIFORM VERSUS AN AGGREGATED WATER BALANCE OF A SEMI-ARID WATERSHED. (R824784)

EPA Science Inventory

Hydrologists have long struggled with the problem of how to account for the effects of spatial variability in precipitation, vegetation and soils. This problem is particularly acute in snow-fed, semi-arid watersheds, which typically have considerable variability in snow distribut...

Characterizing Temperature Variability and Associated Large Scale Meteorological Patterns Across South America

NASA Astrophysics Data System (ADS)

Detzer, J.; Loikith, P. C.; Mechoso, C. R.; Barkhordarian, A.; Lee, H.

2017-12-01

South America's climate varies considerably owing to its large geographic range and diverse topographical features. Spanning the tropics to the mid-latitudes and from high peaks to tropical rainforest, the continent experiences an array of climate and weather patterns. Due to this considerable spatial extent, assessing temperature variability at the continent scale is particularly challenging. It is well documented in the literature that temperatures have been increasing across portions of South America in recent decades, and while there have been many studies that have focused on precipitation variability and change, temperature has received less scientific attention. Therefore, a more thorough understanding of the drivers of temperature variability is critical for interpreting future change. First, k-means cluster analysis is used to identify four primary modes of temperature variability across the continent, stratified by season. Next, composites of large scale meteorological patterns (LSMPs) are calculated for months assigned to each cluster. Initial results suggest that LSMPs, defined using meteorological variables such as sea level pressure (SLP), geopotential height, and wind, are able to identify synoptic scale mechanisms important for driving temperature variability at the monthly scale. Some LSMPs indicate a relationship with known recurrent modes of climate variability. For example, composites of geopotential height suggest that the Southern Annular Mode is an important, but not necessarily dominant, component of temperature variability over southern South America. This work will be extended to assess the drivers of temperature extremes across South America.

Rituximab monitoring and redosing in pediatric neuromyelitis optica spectrum disorder

PubMed Central

Nosadini, Margherita; Alper, Gulay; Riney, Catherine J.; Benson, Leslie A.; Mohammad, Shekeeb S.; Ramanathan, Sudarshini; Nolan, Melinda; Appleton, Richard; Leventer, Richard J.; Deiva, Kumaran; Brilot, Fabienne; Gorman, Mark P.; Waldman, Amy T.; Banwell, Brenda

2016-01-01

Objective: To study rituximab in pediatric neuromyelitis optica (NMO)/NMO spectrum disorders (NMOSD) and the relationship between rituximab, B cell repopulation, and relapses in order to improve rituximab monitoring and redosing. Methods: Multicenter retrospective study of 16 children with NMO/NMOSD receiving ≥2 rituximab courses. According to CD19 counts, events during rituximab were categorized as “repopulation,” “depletion,” or “depletion failure” relapses (repopulation threshold CD19 ≥10 × 106 cells/L). Results: The 16 patients (14 girls; mean age 9.6 years, range 1.8–15.3) had a mean of 6.1 events (range 1–11) during a mean follow-up of 6.1 years (range 1.6–13.6) and received a total of 76 rituximab courses (mean 4.7, range 2–9) in 42.6-year cohort treatment. Before rituximab, 62.5% had received azathioprine, mycophenolate mofetil, or cyclophosphamide. Mean time from rituximab to last documented B cell depletion and first repopulation was 4.5 and 6.8 months, respectively, with large interpatient variability. Earliest repopulations occurred with the lowest doses. Significant reduction between pre- and post-rituximab annualized relapse rate (ARR) was observed (p = 0.003). During rituximab, 6 patients were relapse-free, although 21 relapses occurred in 10 patients, including 13 “repopulation,” 3 “depletion,” and 4 “depletion failure” relapses. Of the 13 “repopulation” relapses, 4 had CD19 10–50 × 106 cells/L, 10 had inadequate monitoring (≤1 CD19 in the 4 months before relapses), and 5 had delayed redosing after repopulation detection. Conclusion: Rituximab is effective in relapse prevention, but B cell repopulation creates a risk of relapse. Redosing before B cell repopulation could reduce the relapse risk further. Classification of evidence: This study provides Class IV evidence that rituximab significantly reduces ARR in pediatric NMO/NMOSD. This study also demonstrates a relationship between B cell repopulation and relapses. PMID:26819962

Feedback control methods for drug dosage optimisation. Concepts, classification and clinical application.

PubMed

Vozeh, S; Steimer, J L

1985-01-01

The concept of feedback control methods for drug dosage optimisation is described from the viewpoint of control theory. The control system consists of 5 parts: (a) patient (the controlled process); (b) response (the measured feedback); (c) model (the mathematical description of the process); (d) adaptor (to update the parameters); and (e) controller (to determine optimum dosing strategy). In addition to the conventional distinction between open-loop and closed-loop control systems, a classification is proposed for dosage optimisation techniques which distinguishes between tight-loop and loose-loop methods depending on whether physician's interaction is absent or included as part of the control step. Unlike engineering problems where the process can usually be controlled by fully automated devices, therapeutic situations often require that the physician be included in the decision-making process to determine the 'optimal' dosing strategy. Tight-loop and loose-loop methods can be further divided into adaptive and non-adaptive, depending on the presence of the adaptor. The main application areas of tight-loop feedback control methods are general anaesthesia, control of blood pressure, and insulin delivery devices. Loose-loop feedback methods have been used for oral anticoagulation and in therapeutic drug monitoring. The methodology, advantages and limitations of the different approaches are reviewed. A general feature common to all application areas could be observed: to perform well under routine clinical conditions, which are characterised by large interpatient variability and sometimes also intrapatient changes, control systems should be adaptive. Apart from application in routine drug treatment, feedback control methods represent an important research tool. They can be applied for the investigation of pathophysiological and pharmacodynamic processes. A most promising application is the evaluation of the relationship between an intermediate response (e.g. drug level), which is often used as feedback for dosage adjustment, and the final therapeutic goal.

Differential expression of pro-inflammatory cytokines in intra-epithelial T cells between trachea and bronchi distinguishes severity of COPD.

PubMed

Hodge, Greg; Reynolds, Paul N; Holmes, Mark; Hodge, Sandra

2012-12-01

Measuring T-cell production of intracellular cytokines by flow cytometry enables specific monitoring of airway inflammation and response to therapies in chronic lung diseases including chronic obstructive pulmonary disease (COPD). We have previously shown that T cells in the airways of ex- and current- smoker COPD patients and healthy smokers produce increased T-cell pro-inflammatory cytokines IFNγ and TNFα versus healthy controls. However, we could not differentiate between COPD groups and smokers due to a high degree of inter-patient variability. To address this limitation, we hypothesized that intraepithelial T cells obtained from brushings of trachea may serve as an ideal intra-patient control compared with cells obtained from left and right bronchi. Production of intracellular cytokines by intraepithelial T-cells obtained from trachea and right and left bronchi from 26 individuals with COPD (16 with GOLD I and 10 with GOLD II-III disease), 11 healthy controls and 8 smokers was measured by flow cytometry. There was a significant increase in intraepithelial T-cell IFNγ and TNFα in both right and left bronchi of GOLD II-III COPD patients compared to cells obtained from the trachea. There were no changes in T cell pro-inflammatory cytokines between the bronchi and trachea from control subjects, GOLD I COPD patients or healthy smokers. There was a significant negative correlation between increased intraepithelial IFNγ and TNFα in bronchial brushing T-cells compared with tracheal T-cells, and compared with FEV1. Monitoring intracellular intra-epithelial T-cell cytokine production in bronchial brushings using autologous tracheal brushings as controls provides improves the sensitivity of the technique. Therapeutic targeting of these pro-inflammatory cytokines and assessing the effects of drugs on immune reactivity has the potential to reduce lung inflammation caused by intra-epithelial T cells in COPD. Copyright © 2012 Elsevier Ltd. All rights reserved.

Genetic differences between blood- and brain-derived viral sequences from human immunodeficiency virus type 1-infected patients: evidence of conserved elements in the V3 region of the envelope protein of brain-derived sequences.

PubMed Central

Korber, B T; Kunstman, K J; Patterson, B K; Furtado, M; McEvilly, M M; Levy, R; Wolinsky, S M

1994-01-01

Human immunodeficiency virus type 1 (HIV-1) sequences were generated from blood and from brain tissue obtained by stereotactic biopsy from six patients undergoing a diagnostic neurosurgical procedure. Proviral DNA was directly amplified by nested PCR, and 8 to 36 clones from each sample were sequenced. Phylogenetic analysis of intrapatient envelope V3-V5 region HIV-1 DNA sequence sets revealed that brain viral sequences were clustered relative to the blood viral sequences, suggestive of tissue-specific compartmentalization of the virus in four of the six cases. In the other two cases, the blood and brain virus sequences were intermingled in the phylogenetic analyses, suggesting trafficking of virus between the two tissues. Slide-based PCR-driven in situ hybridization of two of the patients' brain biopsy samples confirmed our interpretation of the intrapatient phylogenetic analyses. Interpatient V3 region brain-derived sequence distances were significantly less than blood-derived sequence distances. Relative to the tip of the loop, the set of brain-derived viral sequences had a tendency towards negative or neutral charge compared with the set of blood-derived viral sequences. Entropy calculations were used as a measure of the variability at each position in alignments of blood and brain viral sequences. A relatively conserved set of positions were found, with a significantly lower entropy in the brain-than in the blood-derived viral sequences. These sites constitute a brain "signature pattern," or a noncontiguous set of amino acids in the V3 region conserved in viral sequences derived from brain tissue. This brain-derived signature pattern was also well preserved among isolates previously characterized in vitro as macrophage tropic. Macrophage-monocyte tropism may be the biological constraint that results in the conservation of the viral brain signature pattern. Images PMID:7933130

TH-AB-209-10: Breast Cancer Identification Through X-Ray Coherent Scatter Spectral Imaging

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kapadia, A; Morris, R; Albanese, K

Purpose: We have previously described the development and testing of a coherent-scatter spectral imaging system for identification of cancer. Our prior evaluations were performed using either tissue surrogate phantoms or formalin-fixed tissue obtained from pathology. Here we present the first results from a scatter imaging study using fresh breast tumor tissues obtained through surgical excision. Methods: A coherent-scatter imaging system was built using a clinical X-ray tube, photon counting detectors, and custom-designed coded-apertures. System performance was characterized using calibration phantoms of biological materials. Fresh breast tumors were obtained from patients undergoing mastectomy and lumpectomy surgeries for breast cancer. Each specimenmore » was vacuum-sealed, scanned using the scatter imaging system, and then sent to pathology for histological workup. Scatter images were generated separately for each tissue specimen and analyzed to identify voxels containing malignant tissue. The images were compared against histological analysis (H&E + pathologist identification of tumors) to assess the match between scatter-based and histological diagnosis. Results: In all specimens scanned, the scatter images showed the location of cancerous regions within the specimen. The detection and classification was performed through automated spectral matching without the need for manual intervention. The scatter spectra corresponding to cancer tissue were found to be in agreement with those reported in literature. Inter-patient variability was found to be within limits reported in literature. The scatter images showed agreement with pathologist-identified regions of cancer. Spatial resolution for this configuration of the scanner was determined to be 2–3 mm, and the total scan time for each specimen was under 15 minutes. Conclusion: This work demonstrates the utility of coherent scatter imaging in identifying cancer based on the scatter properties of the tissue. It presents the first results from coherent scatter imaging of fresh (unfixed) breast tissue using our coded-aperture scatter imaging approach for cancer identification.« less

Neutrophil extracellular trap formation in supragingival biofilms.

PubMed

Hirschfeld, Josefine; Dommisch, Henrik; Skora, Philipp; Horvath, Gabor; Latz, Eicke; Hoerauf, Achim; Waller, Tobias; Kawai, Toshihisa; Jepsen, Søren; Deschner, James; Bekeredjian-Ding, Isabelle

2015-01-01

Oral biofilms are the causative agents of the highly prevalent oral diseases periodontitis and caries. Additionally, the host immune response is thought to play a critical role in disease onset. Neutrophils are known to be a key host response factor to bacterial challenge on host surfaces. Release of neutrophil extracellular traps (NETs) as a novel antimicrobial defense strategy has gained increasing attention in the past years. Here, we investigated the influx of neutrophils into the dental plaque and the ability of oral bacteria to trigger intra-biofilm release of NETs and intracellular proteins. Supragingival biofilms and whole saliva were sampled from systemically healthy subjects participating in an experimental gingivitis study. Biofilms were analysed by immunofluorescence followed by confocal and fluorescence microscopy. Moreover, concentrations of cytokines and immune-associated proteins in biofilm suspensions and saliva were assessed by ELISA. Neutrophils obtained from blood were stimulated with twelve bacterial species isolated from cultured biofilms or with lipopolysaccharide to monitor NET formation. Neutrophils, NETs, neutrophil-associated proteins (myeloperoxidase, elastase-2, cathepsin G, cathelicidin LL-37), interleukin-8, interleukin-1β and tumor necrosis factor were detected within plaque samples and saliva. All tested bacterial species as well as the polymicrobial samples isolated from the plaque of each donor induced release of NETs and interleukin-8. The degree of NET formation varied among different subjects and did not correlate with plaque scores or clinical signs of local inflammation. Our findings indicate that neutrophils are attracted towards dental biofilms, in which they become incorporated and where they are stimulated by microbes to release NETs and immunostimulatory proteins. Thus, neutrophils and NETs may be involved in host biofilm control, although their specific role needs to be further elucidated. Moreover, inter-patient variability suggests NET formation as a potential factor influencing the individual course of disease. Copyright © 2015 Elsevier GmbH. All rights reserved.

Pediatric Phase I Trial and Pharmacokinetic Study of Vorinostat: A Children's Oncology Group Phase I Consortium Report

PubMed Central

Fouladi, Maryam; Park, Julie R.; Stewart, Clinton F.; Gilbertson, Richard J.; Schaiquevich, Paula; Sun, Junfeng; Reid, Joel M.; Ames, Matthew M.; Speights, Roseanne; Ingle, Ashish M.; Zwiebel, James; Blaney, Susan M.; Adamson, Peter C.

2010-01-01

Purpose The purpose of this study was to determine the maximum-tolerated dose (MTD), dose-limiting toxicities (DLT), and pharmacokinetics of vorinostat administered as a single agent and in combination 13-cis retinoic acid (13cRA) in children with refractory solid tumors; to evaluate the tolerability of the solid tumor MTD in children with refractory leukemias; and to characterize the pharmacokinetics of a vorinostat suspension in children. Patients and Methods Vorinostat was administered orally daily starting at 180 mg/m2/d with escalations planned in 30% increments. Pharmacokinetic studies were performed with the initial dose. Acetyl-histone (H3) accumulation was assessed by Western blotting of peripheral blood mononuclear cells (PBMC). Results Sixty-four patients were enrolled on this multipart trial. In patients with solid tumors, the MTD was 230 mg/m2/d with dose-limiting neutropenia, thrombocytopenia, and hypokalemia at 300 mg/m2/d. DLTs observed with the combination of 13cRA and vorinostat included thrombocytopenia, neutropenia, anorexia, and hypertriglyceridemia, resulting in a MTD of vorinostat 180 mg/m2/d 4 times per week and 13cRA 80 mg/m2/dose twice per day, days 1 through 14 every 28 days. Wide interpatient variability was noted in vorinostat disposition, with area under the concentration-time curves at 230 mg/m2/d for the capsule (range, 1,415 to 9,291 ng/mL × hr) and oral suspension (range, 1,186 to 4,780 ng/mL × hr). Significant accumulation of acetylated H3 histone in PBMC was observed after administration of vorinostat, particularly at higher doses. One patient with neuroblastoma experienced a complete response to the combination. Conclusion In children with recurrent solid tumors, vorinostat is well-tolerated at 230 mg/m2/d, with a modest dose reduction being required when combining vorinostat with 13cRA. Drug disposition is similar to that observed in adults. PMID:20606092

Population pharmacokinetics and pharmacodynamics of enoxaparin in unstable angina and non-ST-segment elevation myocardial infarction

PubMed Central

Bruno, René; Baille, Pascale; Retout, Sylvie; Vivier, Nicole; Veyrat-Follet, Christine; Sanderink, Ger-Jan; Becker, Richard; Antman, Elliott M

2003-01-01

Aims A major concern with any antithrombotic therapy is an increase in the risk of haemorrhage. The aim of this study was to analyse population pharmacokinetics and pharmacokinetic/pharmacodynamic (PK/PD) relationships for enoxaparin in patients with unstable angina (UA) and non-ST-segment elevation myocardial infarction (NSTEMI), which may help predict risk of haemorrhage. Methods Anti-factor Xa (anti-Xa) activity was measured as marker of enoxaparin concentration in 448 patients receiving the drug as a single 30-mg intravenous bolus followed by 1.0 or 1.25 mg kg−1 subcutaneously twice a day. A population pharmacokinetic analysis was conducted and individual estimates of enoxaparin clearance and area under the curve were tested as prognostic factors for the occurrence of haemorrhagic episodes. Results Basic population PK parameters were an enoxaparin clearance of 0.733 l h−1[95% confidence interval (CI) 0.698, 0.738], a distribution volume of 5.24 l (95% CI 4.20, 6.28) and an elimination half-life of 5.0 h. Enoxaparin clearance was significantly related to patient weight and creatinine clearance, and was the only independent predictor of experiencing both all (10.7%, P = 0.0013) and major (2.2%, P = 0.0004) haemorrhagic events. A creatinine clearance of 30 ml min−1 was associated with a decrease in enoxaparin clearance of 27% compared with that in a patient with a median creatinine clearance of 88 ml min−1, and was related to a 1.5- and 3.8-fold increase in the risk of ‘all’ and ‘major’ haemorrhagic episodes, respectively. Conclusions Enoxaparin clearance depends on body weight, and, therefore, weight-adjusted dosing is recommended to minimize interpatient variability in drug exposure and the risk of haemorrhage. The importance of an increased risk of haemorrhage with decreasing renal function must be weighed against the benefit of treatment with enoxaparin in patients with UA and NSTEMI. PMID:12968985

Functional diversity of HIV-1 envelope proteins expressed by contemporaneous plasma viruses

PubMed Central

Nora, Tamara; Bouchonnet, Francine; Labrosse, Béatrice; Charpentier, Charlotte; Mammano, Fabrizio; Clavel, François; Hance, Allan J

2008-01-01

Background Numerous studies have shown that viral quasi-species with genetically diverse envelope proteins (Env) replicate simultaneously in patients infected with the human immunodeficiency virus type 1 (HIV-1). Less information is available concerning the extent that envelope sequence diversity translates into a diversity of phenotypic properties, including infectivity and resistance to entry inhibitors. Methods To study these questions, we isolated genetically distinct contemporaneous clonal viral populations from the plasma of 5 HIV-1 infected individuals (n = 70), and evaluated the infectivity of recombinant viruses expressing Env proteins from the clonal viruses in several target cells. The sensitivity to entry inhibitors (enfuvirtide, TAK-799), soluble CD4 and monoclonal antibodies (2G12, 48d, 2F5) was also evaluated for a subset of the recombinant viruses (n = 20). Results Even when comparisons were restricted to viruses with similar tropism, the infectivity for a given target cell of viruses carrying different Env proteins from the same patient varied over an approximately 10-fold range, and differences in their relative ability to infect different target cells were also observed. Variable region haplotypes associated with high and low infectivity could be identified for one patient. In addition, clones carrying unique mutations in V3 often displayed low infectivity. No correlation was observed between viral infectivity and sensitivity to inhibition by any of the six entry inhibitors evaluated, indicating that these properties can be dissociated. Significant inter-patient differences, independent of infectivity, were observed for the sensitivity of Env proteins to several entry inhibitors and their ability to infect different target cells. Conclusion These findings demonstrate the marked functional heterogeneity of HIV-1 Env proteins expressed by contemporaneous circulating viruses, and underscore the advantage of clonal analyses in characterizing the spectrum of functional properties of the genetically diverse viral populations present in a given patient. PMID:18312646

Biliary transport of irinotecan and metabolites in normal and P-glycoprotein-deficient mice.

PubMed

Iyer, Lalitha; Ramírez, Jacqueline; Shepard, Dale R; Bingham, Christopher M; Hossfeld, Dieter-Kurt; Ratain, Mark J; Mayer, Ulrich

2002-04-01

The extensive and unpredictable biliary excretion of CPT-11 and its metabolites, SN-38 and SN-38 glucuronide (SN-38G) may contribute to the wide interpatient variability reported in the disposition and gastrointestinal toxicity of CPT-11. We studied the role of P-glycoprotein (P-gp) in in vivo biliary excretion of CPT-11, SN-38 and SN-38G in mice lacking mdr1-type P-gp [ mdr1a/1b(-/-)] in the presence of the multidrug resistance (MDR) reversal agent, PSC833. Wild-type (Wt) and mdr1a/1b(-/-) mice ( n=3 or 4) were treated intragastrically with PSC833 (50 mg/kg) or vehicle 2 h prior to i.v. CPT-11 dosing (10 mg/kg), and bile samples were collected. P-gp was found to play an important role in CPT-11 biliary excretion, as there was a significant (40%, P<0.05) decrease in its biliary recovery in 90 min in mdr1a/1b(-/-) mice (6.6+/-0.6% dose) compared with Wt mice (11+/-1.2%). This also implied a major role of other undetermined non-P-gp-mediated mechanism(s) for hepatic transport of CPT-11, which was inhibited by PSC833 (1.8+/-0.8% with PSC833, 6.6+/-0.6% without PSC833) in mdr1a/1b(-/-) mice. SN-38 and SN-38G biliary transport was unchanged in mice lacking P-gp after vehicle treatment, indicating a lack of P-gp mediation in their transport. PSC833 significantly reduced (56-89%) SN-38 and SN-38G biliary transport in Wt and mdr1a/1b(-/-) mice, suggesting that PSC833 may be a candidate to modulate biliary excretion of SN-38 with potential use in reducing CPT-11 toxicity.

Quantifying Isoniazid Levels in Small Hair Samples: A Novel Method for Assessing Adherence during the Treatment of Latent and Active Tuberculosis

PubMed Central

Gerona, Roy; Wen, Anita; Chin, Aaron T.; Koss, Catherine A.; Bacchetti, Peter; Metcalfe, John; Gandhi, Monica

2016-01-01

Background Tuberculosis (TB) is the leading cause of death from an infectious pathogen worldwide and the most prevalent opportunistic infection in people living with HIV. Isoniazid preventive therapy (IPT) reduces the incidence of active TB and reduces morbidity and mortality in HIV-infected patients independently of antiretroviral therapy. However, treatment of latent or active TB is lengthy and inter-patient variability in pharmacokinetics and adherence common. Current methods of assessing adherence to TB treatment using drug levels in plasma or urine assess short-term exposure and pose logistical challenges. Drug concentrations in hair assess long-term exposure and have demonstrated pharmacodynamic relevance in HIV. Methods A large hair sample from a patient with active TB was obtained for assay development. Methods to pulverize hair and extract isoniazid were optimized and then the drug detected by liquid chromatography/ tandem mass spectrometry (LC/MS-MS). The method was validated for specificity, accuracy, precision, recovery, linearity and stability to establish the assay’s suitability for therapeutic drug monitoring (TDM). Hair samples from patients on directly-observe isoniazid-based latent or active TB therapy from the San Francisco Department of Public Health TB clinic were then tested. Results Our LC/MS-MS-based assay detected isoniazid in quantities as low as 0.02ng/mg using 10–25 strands hair. Concentrations in spiked samples demonstrated linearity from 0.05–50ng/mg. Assay precision and accuracy for spiked quality-control samples were high, with an overall recovery rate of 79.5%. In 18 patients with latent or active TB on treatment, isoniazid was detected across a wide linear dynamic range. Conclusions An LC-MS/MS-based assay to quantify isoniazid levels in hair with performance characteristics suitable for TDM was developed and validated. Hair concentrations of isoniazid assess long-term exposure and may be useful for monitoring adherence to latent or active TB treatment in the setting of HIV. PMID:27191185

Impact of dual antiplatelet therapy on outcomes among aspirin-resistant patients following coronary artery bypass grafting.

PubMed

Gasparovic, Hrvoje; Petricevic, Mate; Kopjar, Tomislav; Djuric, Zeljko; Svetina, Lucija; Biocina, Bojan

2014-05-15

Coronary artery bypass grafting is pivotal in the contemporary management of complex coronary artery disease. Interpatient variability to antiplatelet agents, however, harbors the potential to compromise the revascularization benefit by increasing the incidence of adverse events. This study was designed to define the impact of dual antiplatelet therapy (dAPT) on clinical outcomes among aspirin-resistant patients who underwent coronary artery surgery. We randomly assigned 219 aspirin-resistant patients according to multiple electrode aggregometry to receive clopidogrel (75 mg) plus aspirin (300 mg) or aspirin-monotherapy (300 mg). The primary end point was a composite outcome of all-cause death, nonfatal myocardial infarction, stroke, or cardiovascular hospitalization assessed at 6 months postoperatively. The primary end point occurred in 6% of patients assigned to dAPT and 10% of patients randomized to aspirin-monotherapy (relative risk 0.61, 95% confidence interval 0.25 to 1.51, p = 0.33). No significant treatment effect was noted in the occurrence of the safety end point. The total incidence of bleeding events was 25% and 19% in the dAPT and aspirin-monotherapy groups, respectively (relative risk 1.34, 95% confidence interval 0.80 to 2.23, p = 0.33). In the subgroup analysis, dAPT led to lower rates of adverse events in patients with a body mass index >30 kg/m(2) (0% vs 18%, p <0.01) and those <65 years (0% vs 10%, p = 0.02). In conclusion, the addition of clopidogrel in patients found to be aspirin resistant after coronary artery bypass grafting did not reduce the incidence of adverse events, nor did it increase the number of recorded bleeding events. dAPT did, however, lower the incidence of the primary end point in obese patients and those <65 years. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Clustering of ABCB1 and CYP2C19 Genetic Variants Predicts Risk of Major Bleeding and Thrombotic Events in Elderly Patients with Acute Coronary Syndrome Receiving Dual Antiplatelet Therapy with Aspirin and Clopidogrel.

PubMed

Galeazzi, Roberta; Olivieri, Fabiola; Spazzafumo, Liana; Rose, Giuseppina; Montesanto, Alberto; Giovagnetti, Simona; Cecchini, Sara; Malatesta, Gelsomina; Di Pillo, Raffaele; Antonicelli, Roberto

2018-06-23

The clinical efficacy of clopidogrel in secondary prevention of vascular events is hampered by marked inter-patient variability in drug response, which partially depends on genetic make-up. The aim of this pilot prospective study was to evaluate 12-month cardiovascular outcomes in elderly patients with acute coronary syndrome (ACS) receiving dual antiplatelet therapy (aspirin and clopidogrel) according to the clustering of CYP2C19 and ABCB1 genetic variants. Participants were 100 consecutive ACS patients who were genotyped for CYP2C19 (G681A and C-806T) and ABCB1 (C3435T) polymorphisms, which affect clopidogrel metabolism and bioavailability, using PCR-restriction fragment length polymorphism. They were then grouped as poor, extensive and ultra-rapid metabolisers based on the combination of CYP2C19 loss-of-function (CYP2C19*2) and gain-of-function (CYP2C19*17) alleles and ABCB1 alleles. The predictive value of each phenotype for acute vascular events was estimated based on 12-month cardiovascular outcomes. The poor metabolisers were at an increased risk of thrombotic events (OR 1.26; 95% CI 1.099-1.45; χ 2  = 5.676; p = 0.027), whereas the ultra-rapid metabolisers had a 1.31-fold increased risk of bleeding events compared with the poor and extensive metabolisers (OR 1.31; 95% CI 1.033-1.67; χ 2  = 5.676; p = 0.048). Logistic regression model, including age, sex, BMI and smoking habit, confirmed the differential risk of major events in low and ultra-rapid metabolisers. Our findings suggest that ACS patients classified as 'poor or ultra-rapid' metabolisers based on CYP2C19 and ABCB1 genotypes should receive alternative antiplatelet therapies to clopidogrel.

Endodontic and Clinical Considerations in the Management of Variable Anatomy in Mandibular Premolars: A Literature Review

PubMed Central

Hammo, Mohammad

2014-01-01

Mandibular premolars are known to have numerous anatomic variations of their roots and root canals, which are a challenge to treat endodontically. The paper reviews literature to detail the various clinically relevant anatomic considerations with detailed techniques and methods to successfully manage these anomalies. An emphasis and detailed description of every step of treatment including preoperative diagnosis, intraoperative identification and management, and surgical endodontic considerations for the successful management of these complex cases have been included. PMID:24895584

Chinese Cultural Collectivism and Work-Related Stress: Implications for Employment Counselors.

ERIC Educational Resources Information Center

Chiu, Randy K.; Kosinski, Frederick A., Jr.

1995-01-01

Employment counselors should take cultural issues into consideration as they provide consultation or counseling services. Stress is influenced by cultural and social variables. Examines the collectivism-individualism construct to measure cultural variables and attempt to explain the differences of some social behaviors between Eastern and Western…

Jury Selection in Child Sex Abuse Trials: A Case Analysis

ERIC Educational Resources Information Center

Cramer, Robert J.; Adams, Desiree D.; Brodsky, Stanley L.

2009-01-01

Child sex abuse cases have been the target of considerable psycho-legal research. The present paper offers an analysis of psychological constructs for jury selection in child sex abuse cases from the defense perspective. The authors specifically delineate general and case-specific jury selection variables. General variables include…

Child Internalizing Symptoms: Contributions of Child Temperament, Maternal Negative Affect, and Family Functioning

ERIC Educational Resources Information Center

Crawford, Nicole A.; Schrock, Matthew; Woodruff-Borden, Janet

2011-01-01

Research has traditionally focused on the role of genetic and environmental variables in the development and maintenance of childhood internalizing disorders. Temperament variables, such as negative affect and effortful control have gained considerable interest within the field of developmental psychopathology. Environmental factors such as…

Counselor-Subject Sex Variables in Systematic Desensitization

ERIC Educational Resources Information Center

Geer, Carol A.; Hurst, James C.

1976-01-01

A Sex of Subject x Sex of Counselor interaction in the desensitization of test anxiety among 44 college students suggested consideration of the sex variable. Results showed significant treatment effects by both male and female counselors and a significant interaction effect by the male counselor with female subjects. (Author)

Within-Class Variability in Student-Teacher Evaluations: Examples and Problems

ERIC Educational Resources Information Center

Clayson, Dennis E.

2005-01-01

Although student evaluation of instruction has been shown to produce reliable results over class averages, considerable within-class variability exists that has not been investigated. This study looked at examples of student evaluations in which students diametrically differed in their evaluation of the same instructor. Patterns were noted. A…

Cortical Action Potential Backpropagation Explains Spike Threshold Variability and Rapid-Onset Kinetics

PubMed Central

Yu, Yuguo; Shu, Yousheng; McCormick, David A.

2008-01-01

Neocortical action potential responses in vivo are characterized by considerable threshold variability, and thus timing and rate variability, even under seemingly identical conditions. This finding suggests that cortical ensembles are required for accurate sensorimotor integration and processing. Intracellularly, trial-to-trial variability results not only from variation in synaptic activities, but also in the transformation of these into patterns of action potentials. Through simultaneous axonal and somatic recordings and computational simulations, we demonstrate that the initiation of action potentials in the axon initial segment followed by backpropagation of these spikes throughout the neuron results in a distortion of the relationship between the timing of synaptic and action potential events. In addition, this backpropagation also results in an unusually high rate of rise of membrane potential at the foot of the action potential. The distortion of the relationship between the amplitude time course of synaptic inputs and action potential output caused by spike back-propagation results in the appearance of high spike threshold variability at the level of the soma. At the point of spike initiation, the axon initial segment, threshold variability is considerably less. Our results indicate that spike generation in cortical neurons is largely as expected by Hodgkin—Huxley theory and is more precise than previously thought. PMID:18632930

How Am I Going to Pay for That?!: First-Generation University Students and Their Financial Concerns

ERIC Educational Resources Information Center

Shultz, Judith J. Andrews

2013-01-01

This study examines first-generation research-university students in relation to their financial considerations. It is driven by the question, What is the relationship between first-generation college-student status and financial considerations among research-university students? It explores the impact of such variables as first-generation student…

Source characteristics and design consideration for an iron-free variable-period/polarizing undulator for the UV/VUV range on SPEAR (abstract)

NASA Astrophysics Data System (ADS)

Tatchyn, Roman

1992-01-01

Insertion devices that are tuned by electrical period variation are particularly suited for the design of flexible polarized-light sources [R. Tatchyn, J. Appl. Phys. 65, 4107 (1989); R. Tatchyn and T. Cremer, IEEE Trans. Mag. 26, 3102 (1990)]. Important advantages vis-a-vis mechanical or hybrid variable field designs include: (1) significantly more rapid modulation of both polarization and energy, (2) an inherently larger set of polarization modulation capabilities and (3) polarization/energy modulation at continuously optimized values of K. In this paper we outline some of the general considerations that enter into the design of hysteresis-free variable-period/polarizing undulator structures and present the parameters of a recently-completed prototype design capable of generating intense levels of UV/VUV photon flux on SPEAR running at 3 GeV.

Prioritizing Wetlands for Waterbirds in a Boom and Bust System: Waterbird Refugia and Breeding in the Murray-Darling Basin.

PubMed

Bino, Gilad; Kingsford, Richard T; Porter, John

2015-01-01

Dryland rivers have considerable flow variability, producing complex ecosystems, processes, and communities of organisms that vary over space and time. They are also among the more vulnerable of the world's ecosystems. A key strategy for conservation of dryland rivers is identifying and maintaining key sites for biodiversity conservation, particularly protecting the quantity and quality of flow and flooding regimes. Extreme variability considerably challenges freshwater conservation planning. We systematically prioritised wetlands for waterbirds (simultaneously for 52 species), across about 13.5% of the Murray-Darling Basin (1,061,469 km2), using a 30-year record of systematic aerial surveys of waterbird populations. Nine key wetlands in this area, primarily lakes, floodplains, and swamps, consistently contributed to a representation target (80%) of total abundances of all 52 waterbird species. The long temporal span of our data included dramatic availability (i.e., booms) and scarcity (i.e., busts) of water, providing a unique opportunity to test prioritisation at extremes of variation. These extremes represented periods when waterbirds were breeding or concentrating on refugia, varying wetland prioritisation. In dry years, important wetlands for waterbirds were riverine and lacustrine (12 wetlands) but this changed in wet years to lacustrine and palustrine (8 wetlands). Such variation in ecosystem condition substantially changes the relative importance of individual wetlands for waterbirds during boom and bust phases. Incorporating this variability is necessary for effective conservation of Murray-Darling Basin waterbirds, with considerable generality for other similarly variable systems around the world.

Ecological Momentary Assessment is a Neglected Methodology in Suicidology.

PubMed

Davidson, Collin L; Anestis, Michael D; Gutierrez, Peter M

2017-01-02

Ecological momentary assessment (EMA) is a group of research methods that collect data frequently, in many contexts, and in real-world settings. EMA has been fairly neglected in suicidology. The current article provides an overview of EMA for suicidologists including definitions, data collection considerations, and different sampling strategies. Next, the benefits of EMA in suicidology (i.e., reduced recall bias, accurate tracking of fluctuating variables, testing assumptions of theories, use in interventions), participant safety considerations, and examples of published research that investigate self-directed violence variables using EMA are discussed. The article concludes with a summary and suggested directions for EMA research in suicidology with the particular aim to spur the increased use of this methodology among suicidologists.

Delphi-Discrepancy Evaluation: A Model for the Quality Control of Federal, State, and Locally Mandated Programs.

ERIC Educational Resources Information Center

Sirois, Herman A.; Iwanick, Edward F.

Legally mandated educational programs often lack specificity and guidelines for such programs are often vague and subject to considerable variability in interpretation. This situation presents perennial problems for evaluators. Few evaluation models have the flexibility for dealing with this ambiguity and variability while at the same time…

Primary School Leadership Practice: How the Subject Matters

ERIC Educational Resources Information Center

Spillane, James P.

2005-01-01

Teaching is a critical consideration in investigations of primary school leadership and not just as an outcome variable. Factoring in instruction as an explanatory variable in scholarship on school leadership involves moving away from views of teaching as a monolithic or unitary practice. When it comes to leadership in primary schools, the subject…

Fluvial processes in Puget Sound rivers and the Pacific Northwest [Chapter 3

Treesearch

John M. Buffington; Richard D. Woodsmith; Derek B. Booth; David R. Montgomery

2003-01-01

The variability of topography, geology, climate; vegetation, and land use in the Pacific Northwest creates considerable spatial and temporal variability of fluvial processes and reach-scale channel type. Here we identify process domains of typical Pacific Northwest watersheds and examine local physiographic and geologic controls on channel processes and response...

Variability in Community Characteristics and Spanish-Speaking Children's Home Language and Literacy Opportunities

ERIC Educational Resources Information Center

Reese, Leslie; Thompson, Sylvia Linan; Goldenberg, Claude

2008-01-01

Drawing on data from 14 communities in California and Texas, this paper examines the variability in language and literacy resources across communities with large numbers of Latino families. Spanish-speaking children live in communities that vary considerably with respect to language use, ethnic composition and education levels. Children's…

Spatio-Temporal Analysis of Surface Soil Moisture in Evaluating Ground Truth Monitoring Sites for Remotely Sensed Observations

USDA-ARS?s Scientific Manuscript database

Soil moisture is an intrinsic state variable that varies considerably in space and time. Although soil moisture is highly variable, repeated measurements of soil moisture at the field or small watershed scale can often reveal certain locations as being temporally stable and representative of the are...

On the Misconception of Multicollinearity in Detection of Moderating Effects: Multicollinearity Is Not Always Detrimental

ERIC Educational Resources Information Center

Shieh, Gwowen

2010-01-01

Due to its extensive applicability and computational ease, moderated multiple regression (MMR) has been widely employed to analyze interaction effects between 2 continuous predictor variables. Accordingly, considerable attention has been drawn toward the supposed multicollinearity problem between predictor variables and their cross-product term.…

The Prevalence of Low Self-Esteem in an Intellectually Disabled Forensic Population

ERIC Educational Resources Information Center

Johnson, P.

2012-01-01

Background: This was a quantitative study to measure the prevalence low self-esteem in an intellectually disabled forensic population. The dependent variables used were the adapted six-item Rosenberg Self-Esteem Scale and the adapted Evaluative Beliefs Scale. It had a repeated measures design with independent variables including consideration of…

An Approach To the Study of Patient Suicide During Psychotherapy.

ERIC Educational Resources Information Center

Selkin, James

The 1977 Denver coroner's report found that 45% of all suicide victims received psychotherapy at some time, and 21% were in treatment at the time of death. The literature on suicide places all responsibility upon the therapist. Four major sources of variance deserving consideration, however, are patient variables, therapist variables, treatment…

Childhood and/or Adolescent Sexual Experiences: Predicting Variability in Subsequent Adjustment.

ERIC Educational Resources Information Center

Seidner, Andrea L.; And Others

There is considerable debate regarding the effects of childhood sexual abuse on an individual's subsequent adjustment. To determine which variables are most useful in predicting subsequent adjustment of individuals who were involved in sexual experiences as children or adolescents, 59 female and 17 male undergraduates who reported having had a…

Considerations in the weathering of wood-plastic composites

Treesearch

Nicole M. Stark

2007-01-01

During weathering, wood-plastic composites (WPCs) can fade and lose stiffness and strength. Weathering variables that induce these changes include exposure to UV light and water. Each variable degrades WPCs independently, but can also act synergistically. Recent efforts have highlighted the need to understand how WPCs weather, and to develop schemes for protection. The...

The role of anthropometry in designing for sustainability.

PubMed

Nadadur, Gopal; Parkinson, Matthew B

2013-01-01

An understanding of human factors and ergonomics facilitates the design of artefacts, tasks and environments that fulfil their users' physical and cognitive requirements. Research in these fields furthers the goal of efficiently accommodating the desired percentage of user populations through enhanced awareness and modelling of human variability. Design for sustainability (DfS) allows for these concepts to be leveraged in the broader context of designing to minimise negative impacts on the environment. This paper focuses on anthropometry and proposes three ways in which its consideration is relevant to DfS: reducing raw material consumption, increasing usage lifetimes and ethical human resource considerations. This is demonstrated through the application of anthropometry synthesis, virtual fitting, and sizing and adjustability allocation methods in the design of an industrial workstation seat for use in five distinct global populations. This work highlights the importance of and opportunities for using ergonomic design principles in DfS efforts. This research demonstrates the relevance of some anthropometry-based ergonomics concepts to the field of design for sustainability. A global design case study leverages human variability considerations in furthering three sustainable design goals: reducing raw material consumption, increasing usage lifetimes and incorporating ethical human resource considerations in design.

Consideration of immediate and future consequences, smoking status, and body mass index.

PubMed

Adams, Jean

2012-03-01

Health-related behaviors often involve immediate costs to achieve long-term benefits. How one considers the future outcomes of present day behaviors (e.g., temporal orientation) may play a role in engagement in healthy behaviors. The Consideration of Future Consequences Scale (CFCS) measures temporal orientation on a unidimensional continuum. Recently, 2 subscales of the CFCS have been reported: immediate (CFC-I) and future (CFC-F) consequences. These support a multidimensional conceptualization of temporal orientation. Confirmatory factor analysis was performed on CFCS data. The associations between 2 health-related variables [smoking and body mass index (BMI)] and each subscale were then explored, controlling for sociodemographic variables. A random sample of 2,000 individuals aged 18 years or over was selected from the edited electoral role for one English city and sent a postal questionnaire, including the CFCS and questions on age, gender, socioeconomic position, and self-reported current smoking status and BMI. Complete data was provided by 800 participants (response rate = 40.0%). The 2-factor model fitted CFCS data better than the 1-factor model. In multiple linear regression, CFC-I was positively associated with BMI, B (95% confidence interval [CI]) = 0.47 (0.06 to 0.88), p = .025; and odds of being a current smoker, odds ratio (95% CI) = 1.28 (1.02 to 1.60), p = .035; CFC-F was not associated with health-related variables. These data support the multidimensional conceptualization of temporal orientation. Consideration of immediate consequences may be a more important determinant of health-related behaviors than consideration of future consequences.

Quantifying Landscape Spatial Pattern: What Is the State of the Art?

Treesearch

Eric J. Gustafson

1998-01-01

Landscape ecology is based on the premise that there are strong links between ecological pattern and ecological function and process. Ecological systems are spatially heterogeneous, exhibiting consid-erable complexity and variability in time and space. This variability is typically represented by categorical maps or by a collection of samples taken at specific spatial...

The Rasch Rating Model and the Disordered Threshold Controversy

ERIC Educational Resources Information Center

Adams, Raymond J.; Wu, Margaret L.; Wilson, Mark

2012-01-01

The Rasch rating (or partial credit) model is a widely applied item response model that is used to model ordinal observed variables that are assumed to collectively reflect a common latent variable. In the application of the model there is considerable controversy surrounding the assessment of fit. This controversy is most notable when the set of…

Expanding Reliability Generalization Methods with KR-21 Estimates: An RG Study of the Coopersmith Self-Esteem Inventory.

ERIC Educational Resources Information Center

Lane, Ginny G.; White, Amy E.; Henson, Robin K.

2002-01-01

Conducted a reliability generalizability study on the Coopersmith Self-Esteem Inventory (CSEI; S. Coopersmith, 1967) to examine the variability of reliability estimates across studies and to identify study characteristics that may predict this variability. Results show that reliability for CSEI scores can vary considerably, especially at the…

Doing Televised Rhetorical Analysis as a Means of Promoting College Awareness in a Target Market.

ERIC Educational Resources Information Center

Schnell, Jim

This paper describes aspects of doing televised rhetorical analysis as they relate to the promotion of college awareness in a particular target market. Considerations in the paper include variables that most professors encounter in their efforts to address the "service" expectations of their employment and how these variables can be…

Psychological Variables as Correlates of Adjustment in Mothers of Children with Intellectual Disabilities: Cross-Sectional and Longitudinal Relationships

ERIC Educational Resources Information Center

Lloyd, Tracey; Hastings, R. P.

2008-01-01

Background: Existing research studies suggest that parenting a child with intellectual disabilities (ID) can be a stressful experience. However, there are few data addressing the question of how or why parents might experience considerable distress. In the present study, psychological variables (acceptance, mindfulness, avoidant coping) are…

Exploration of the Core and Variable Dimensions of Extensive Reading Research and Pedagogy

ERIC Educational Resources Information Center

Waring, Rob; McLean, Stuart

2015-01-01

The Extensive Reading Foundation's bibliography now boasts over 530 articles with "Extensive Reading" in the title. About 35% of this rich and diverse body of papers were published in the past decade. A meta-review of this literature shows it is quite fragmented as evidenced by considerable variability in the conceptualization of…

Adolescent Decision-Making Processes regarding University Entry: A Model Incorporating Cultural Orientation, Motivation and Occupational Variables

ERIC Educational Resources Information Center

Jung, Jae Yup

2013-01-01

This study tested a newly developed model of the cognitive decision-making processes of senior high school students related to university entry. The model incorporated variables derived from motivation theory (i.e. expectancy-value theory and the theory of reasoned action), literature on cultural orientation and occupational considerations. A…

Differences in Affective and Behavioral Health-Related Variables Associated with Age.

ERIC Educational Resources Information Center

Bausell, R. Barker; Soeken, Karen L.

Although considerable data exist linking individual lifestyle variables to health outcomes, little is known about how the elderly differ from younger adults with respect to both their health seeking behavior and their beliefs about health. A national survey contrasted 155 persons aged 65 years of age or older with 1100 younger adults in order to…

Regression and Geostatistical Techniques: Considerations and Observations from Experiences in NE-FIA

Treesearch

Rachel Riemann; Andrew Lister

2005-01-01

Maps of forest variables improve our understanding of the forest resource by allowing us to view and analyze it spatially. The USDA Forest Service's Northeastern Forest Inventory and Analysis unit (NE-FIA) has used geostatistical techniques, particularly stochastic simulation, to produce maps and spatial data sets of FIA variables. That work underscores the...

Variables and Methodological Considerations Associated with Children's Sex Role Preferences.

ERIC Educational Resources Information Center

Cappella, Roseann

Several key variables in the development and assessment of young children's sex role preference are examined in this study. A sample of 257 pre-kindergarten children (mean age, 59 months) and their mothers participated in this study. After obtaining information on each child's age, IQ, and his/her mother's employment status the It Scale for…

Does children's energy intake at one meal influence their intake at subsequent meals? Or do we just think it does?

PubMed

Hanley, James A; Hutcheon, Jennifer A

2010-05-01

It is widely believed that young children are able to adjust their energy intake across successive meals to compensate for higher or lower intakes at a given meal. This conclusion is based on past observations that although children's intake at individual meals is highly variable, total daily intakes are relatively constant. We investigated how much of this reduction in variability could be explained by the statistical phenomenon of the variability of individual components (each meal) always being relatively larger than the variability of their sum (total daily intake), independent of any physiological compensatory mechanism. We calculated, theoretically and by simulation, how variable a child's daily intake would be if there was no correlation between intakes at individual meals. We simulated groups of children with meal/snack intakes and variability in meal/snack intakes based on previously published values. Most importantly, we assumed that there was no correlation between intakes on successive meals. In both approaches, the coefficient of variation of the daily intakes was roughly 15%, considerably less than the 34% for individual meals. Thus, most of the reduction in variability found in past studies was explained without positing strong 'compensation'. Although children's daily energy intakes are indeed considerably less variable than their individual components, this phenomenon was observed even when intakes at each meal were simulated to be totally independent. We conclude that the commonly held belief that young children have a strong physiological compensatory mechanism to adjust intake at one meal based on intake at prior meals is likely to be based on flawed statistical reasoning.

Prioritizing Wetlands for Waterbirds in a Boom and Bust System: Waterbird Refugia and Breeding in the Murray-Darling Basin

PubMed Central

Bino, Gilad; Kingsford, Richard T.; Porter, John

2015-01-01

Dryland rivers have considerable flow variability, producing complex ecosystems, processes, and communities of organisms that vary over space and time. They are also among the more vulnerable of the world’s ecosystems. A key strategy for conservation of dryland rivers is identifying and maintaining key sites for biodiversity conservation, particularly protecting the quantity and quality of flow and flooding regimes. Extreme variability considerably challenges freshwater conservation planning. We systematically prioritised wetlands for waterbirds (simultaneously for 52 species), across about 13.5% of the Murray-Darling Basin (1,061,469 km2), using a 30-year record of systematic aerial surveys of waterbird populations. Nine key wetlands in this area, primarily lakes, floodplains, and swamps, consistently contributed to a representation target (80%) of total abundances of all 52 waterbird species. The long temporal span of our data included dramatic availability (i.e., booms) and scarcity (i.e., busts) of water, providing a unique opportunity to test prioritisation at extremes of variation. These extremes represented periods when waterbirds were breeding or concentrating on refugia, varying wetland prioritisation. In dry years, important wetlands for waterbirds were riverine and lacustrine (12 wetlands) but this changed in wet years to lacustrine and palustrine (8 wetlands). Such variation in ecosystem condition substantially changes the relative importance of individual wetlands for waterbirds during boom and bust phases. Incorporating this variability is necessary for effective conservation of Murray-Darling Basin waterbirds, with considerable generality for other similarly variable systems around the world. PMID:26161652

Ex vivo permeation of tamoxifen and its 4-OH metabolite through rat intestine from lecithin/chitosan nanoparticles.

PubMed

Barbieri, S; Buttini, F; Rossi, A; Bettini, R; Colombo, P; Ponchel, G; Sonvico, F; Colombo, G

2015-08-01

Tamoxifen citrate is an anticancer drug slightly soluble in water. Administered orally, it shows great intra- and inter-patient variations in bioavailability. We developed a nanoformulation based on phospholipid and chitosan able to efficiently load tamoxifen and showing an enzyme triggered release. In this work the permeation of tamoxifen released from lecithin/chitosan nanoparticles across excised rat intestinal wall mounted in an Ussing chamber was investigated. Compared to tamoxifen citrate suspension, the amount of the drug permeated using the nanoformulation was increased from 1.5 to 90 times, in absence or in presence of pancreatin or lipase, respectively. It was also evidenced the formation of an active metabolite of tamoxifen, 4-hydroxy tamoxifen, however, the amount of metabolite permeated remained roughly constant in all experiments. The effect of enzymes on intestinal permeation of tamoxifen was shown only when tamoxifen-loaded nanoparticles were in intimate contact with the mucosal surface. The encapsulation of tamoxifen in lecithin/chitosan nanoparticles improved the non-metabolized drug passing through the rat intestinal tissue via paracellular transport. Copyright © 2015 Elsevier B.V. All rights reserved.

Risk of contamination of nasal sprays in otolaryngologic practice

PubMed Central

Aydin, Erdinc; Hizal, Evren; Akkuzu, Babur; Azap, Ozlem

2007-01-01

Background Reusable nasal-spray devices are frequently used in otolaryngologic examinations, and there is an increasing concern about the risk of cross-contamination from these devices. The aim of our study was to determine, by means of microbiologic analysis, the safety of a positive-displacement or pump-type atomizer after multiple uses. Methods A reusable nasal spray bottle, pump, and tips were used in the nasal physical examination of 282 patients admitted to a tertiary otolaryngology clinic. The effectiveness of 2 different methods of prophylaxis against microbiologic contamination (the use of protective punched caps or rinsing the bottle tip with alcohol) was compared with that of a control procedure. Results Although there was no statistically significant difference in positive culture rates among the types of nasal spray bottles tested, methicillin-resistant coagulase-negative staphylococci were isolated in 4 of 198 cultures. Conclusion Given these findings, we concluded that additional precautions (such as the use of an autoclave between sprays, disposable tips, or disposable devices) are warranted to avoid interpatient cross-contamination from a reusable nasal spray device. PMID:17352835

Optimizing 4-Dimensional Magnetic Resonance Imaging Data Sampling for Respiratory Motion Analysis of Pancreatic Tumors

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stemkens, Bjorn, E-mail: b.stemkens@umcutrecht.nl; Tijssen, Rob H.N.; Senneville, Baudouin D. de

2015-03-01

Purpose: To determine the optimum sampling strategy for retrospective reconstruction of 4-dimensional (4D) MR data for nonrigid motion characterization of tumor and organs at risk for radiation therapy purposes. Methods and Materials: For optimization, we compared 2 surrogate signals (external respiratory bellows and internal MRI navigators) and 2 MR sampling strategies (Cartesian and radial) in terms of image quality and robustness. Using the optimized protocol, 6 pancreatic cancer patients were scanned to calculate the 4D motion. Region of interest analysis was performed to characterize the respiratory-induced motion of the tumor and organs at risk simultaneously. Results: The MRI navigator was foundmore » to be a more reliable surrogate for pancreatic motion than the respiratory bellows signal. Radial sampling is most benign for undersampling artifacts and intraview motion. Motion characterization revealed interorgan and interpatient variation, as well as heterogeneity within the tumor. Conclusions: A robust 4D-MRI method, based on clinically available protocols, is presented and successfully applied to characterize the abdominal motion in a small number of pancreatic cancer patients.« less

The turbulent mean-flow, Reynolds-stress, and heat flux equations in mass-averaged dependent variables

NASA Technical Reports Server (NTRS)

Rubesin, M. W.; Rose, W. C.

1973-01-01

The time-dependent, turbulent mean-flow, Reynolds stress, and heat flux equations in mass-averaged dependent variables are presented. These equations are given in conservative form for both generalized orthogonal and axisymmetric coordinates. For the case of small viscosity and thermal conductivity fluctuations, these equations are considerably simpler than the general Reynolds system of dependent variables for a compressible fluid and permit a more direct extension of low speed turbulence modeling to computer codes describing high speed turbulence fields.

[Environmental and demographic variables associated with psychiatric morbidity in former prisoners of war].

PubMed

Dethienne, F; Donnay, J M

1976-01-01

In this study, present psychiatric morbidity of 100 former prisoners of war is related to 28 environmental and demographic variables grouped in 3 periods: before, during and after WW2. With the exception of the invalidity percentage, all statistically significant relations concern variables of the first two periods. The present results are discussed at the light of former publications by the authors. It appears among others that the age variable has to be taken in consideration in the explanation of psychiatric sequels of captivity, and that the condition "invalid of war" poorly reflects the degree of psychiatric morbidity.

Scheduler Design Criteria: Requirements and Considerations

NASA Technical Reports Server (NTRS)

Lee, Hanbong

2016-01-01

This presentation covers fundamental requirements and considerations for developing schedulers in airport operations. We first introduce performance and functional requirements for airport surface schedulers. Among various optimization problems in airport operations, we focus on airport surface scheduling problem, including runway and taxiway operations. We then describe a basic methodology for airport surface scheduling such as node-link network model and scheduling algorithms previously developed. Next, we explain how to design a mathematical formulation in more details, which consists of objectives, decision variables, and constraints. Lastly, we review other considerations, including optimization tools, computational performance, and performance metrics for evaluation.

The Relationships among Shyness, Shame, and Attachment Style with Respect to College Student Persistence and Grade Point Average

ERIC Educational Resources Information Center

Lamana Finn, Kim

2017-01-01

The purpose of this study was to investigate the relationships between attachment style, shyness, shame, and college persistence and grade point average. While considerable research was conducted to examine these variables in children, less is known about how these variables interact in a college setting. This study used a quantitative,…

Tense Marking in Black English. A Linguistic and Social Analysis. Urban Language Series, No. 8.

ERIC Educational Resources Information Center

Fasold, Ralph W.

In recent years a considerable amount of interest has developed in language variability and in the educational problems connected with it. This volume is a report of linguistic research on the variable language behavior in a community of American English speakers, specifically on some aspects of tense marking in Black English. The following topics…

Topography and climate are more important drivers of long-term, post-fire vegetation assembly than time-since-fire in the Sonoran Desert, US

USGS Publications Warehouse

Shryock, Daniel F.; Esque, Todd C.; Chen, Felicia

2015-01-01

We find substantial evidence that environmental filters, rather than TSF, drive the majority of variability in long-term, post-fire vegetation assembly within the Sonoran Desert. Careful consideration of spatial variability in abiotic conditions may benefit post-fire vegetation modelling, as well as fire management and restoration strategies.

Psychological Well-Being of Mothers of Youth with Fragile X Syndrome: Syndrome Specificity and within-Syndrome Variability

ERIC Educational Resources Information Center

Lewis, P.; Abbeduto, L.; Murphy, M.; Richmond, E.; Giles, N.; Bruno, L.; Schroeder, S.; Anderson, J.; Orsmond, G.

2006-01-01

Background: Research on parental well-being has focused largely on Down syndrome and autism; however, fragile X syndrome is likely to pose different challenges for parents compared with these other diagnostic conditions. Moreover, there is considerable variability among youth with fragile X syndrome; for example, 25% to 33% of affected youth meet…

Heritability of mandibular cephalometric variables in twins with completed craniofacial growth.

PubMed

Šidlauskas, Mantas; Šalomskienė, Loreta; Andriuškevičiūtė, Irena; Šidlauskienė, Monika; Labanauskas, Žygimantas; Vasiliauskas, Arūnas; Kupčinskas, Limas; Juzėnas, Simonas; Šidlauskas, Antanas

2016-10-01

To determine genetic and environmental impact on mandibular morphology using lateral cephalometric analysis of twins with completed mandibular growth and deoxyribonucleic acid (DNA) based zygosity determination. The 39 cephalometric variables of 141 same gender adult pair of twins were analysed. Zygosity was determined using 15 specific DNA markers and cervical vertebral maturation method was used to assess completion of the mandibular growth. A genetic analysis was performed using maximum likelihood genetic structural equation modelling (GSEM). The genetic heritability estimates of angular variables describing horizontal mandibular position in relationship to cranial base and maxilla were considerably higher than in those describing vertical position. The mandibular skeletal cephalometric variables also showed high heritability estimates with angular measurements being considerably higher than linear ones. Results of this study indicate that the angular measurements representing mandibular skeletal morphology (mandibular form) have greater genetic determination than the linear measurements (mandibular size). The shape and sagittal position of the mandible is under stronger genetic control, than is its size and vertical relationship to cranial base. © The Author 2015. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Psychosocial predictors in consideration of cosmetic surgery among women.

PubMed

Nerini, Amanda; Matera, Camilla; Stefanile, Cristina

2014-04-01

This study aimed to analyze the influence of psychosocial factors on the consideration of cosmetic surgery. The authors hypothesized that the internalization of thin ideals and social comparisons mediate the relationship between media pressure, family and peer influence (appearance conversations, perception of teasing, and peer attributions), and the desire to pursue cosmetic surgery. The study participants were 429 Italian women (mean age, 33 years). They completed a questionnaire containing the Appearance Conversations With Friends Scale, the Perception of Teasing Scale for Friends, the Peer Attribution Scale, the "Pressure and Internalization-General" subscales of the Sociocultural Attitudes Towards Appearance Questionnaire-3, the Feedback on Physical Appearance Scale, the Physical Appearance Comparison Scale, and the "Consider" subscale of the Acceptance of Cosmetic Surgery Scale. Hierarchical linear regression was performed. The results indicated that media pressure and appearance conversations with peers predicted the outcome variable through the full mediation of internalization of thin ideals. The relation between peer attributions and interest in cosmetic surgery was partially mediated by internalization of thin ideals. Although social comparison was significantly related to both sociocultural variables and consideration of cosmetic procedures, it was not a significant mediator of this relationship. Neither family influence nor perception of teasing predicted the outcome variable. Overall, these results provide important information about the factors implicated in the consideration of cosmetic surgery by women. This research confirms that cosmetic surgeons need to adopt a base psychological approach. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The roles of family, culture, and social cognitive variables in the career interests and goals of Asian American college students.

PubMed

Hui, Kayi; Lent, Robert W

2018-01-01

Although family and cultural factors have been assumed to play important roles in the career development of Asian Americans, theory-driven research on this topic remains limited. We examined culturally relevant factors that may contribute to Asian Americans' consideration of fields in which they are overrepresented (e.g., science, technology, engineering) and underrepresented (e.g., education, social science). Drawing from social cognitive career theory, a culture-specific, social cognitive model of career interests and choice was tested in Holland's (1997) Investigative (I) and Social (S) themes. A sample of 802 Asian American undergraduates completed measures of family support, self-efficacy, outcome expectations, interest, and career choice consideration in relation to both Holland themes. Two indicators of acculturation/enculturation (adherence to Asian values and generation status in the United States) were also obtained. The model accounted for a substantial amount of variance in Asian American college students' career consideration in both themes. Family support and acculturation played varying roles, depending on the Holland theme. For example, family support was linked to career choice consideration both directly (in the S theme) and indirectly, via other predictors (in both themes). Contrary to expectations, the acculturation variables did not moderate the relation of family support or interest to career consideration in either theme. We discuss the implications of these findings for efforts to understand and facilitate the career development of Asian American college students. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

[Total knee and hip prosthesis: variables associated with costs].

PubMed

Herrera-Espiñeira, Carmen; Escobar, Antonio; Navarro-Espigares, José Luis; Castillo, Juan de Dios Lunadel; García-Pérez, Lidia; Godoy-Montijano, Amparo

2013-01-01

The elevated prevalence of osteoarthritis in Western countries, the high costs of hip and knee arthroplasty, and the wide variations in the clinical practice have generated considerable interest in comparing the associated costs before and after surgery. To determine the influence of a number of variables on the costs of total knee and hip arthroplasty surgery during the hospital stay and during the one-year post-discharge. A prospective multi-center study was performed in 15 hospitals from three Spanish regions. Relationships between the independent variables and the costs of hospital stay and postdischarge follow-up were analyzed by using multilevel models in which the "hospital" variable was used to group cases. Independent variables were: age, sex, body mass index, preoperative quality of life (SF-12, EQ-5 and Womac questionnaires), surgery (hip/knee), Charlson Index, general and local complications, number of beds and economic-institutional dependency of the hospital, the autonomous region to which it belongs, and the presence of a caregiver. The cost of hospital stay, excluding the cost of the prosthesis, was 4,734 Euros, and the post-discharge cost was 554 Euros. With regard to hospital stay costs, the variance among hospitals explained 44-46% of the total variance among the patients. With regard to the post-discharge costs, the variability among hospitals explained 7-9% of the variance among the patients. There is considerable potential for reducing the hospital stay costs of these patients, given that more than 44% of the observed variability was not determined by the clinical conditions of the patients but rather by the behavior of the hospitals.

Simultaneous pharmacogenetics-based population pharmacokinetic analysis of darunavir and ritonavir in HIV-infected patients.

PubMed

Moltó, José; Xinarianos, George; Miranda, Cristina; Pushpakom, Sudeep; Cedeño, Samandhy; Clotet, Bonaventura; Owen, Andrew; Valle, Marta

2013-07-01

Darunavir is a potent protease inhibitor of HIV. To enhance its pharmacokinetic profile, darunavir must be co-administered with ritonavir. There is wide inter-patient variability in darunavir pharmacokinetics among HIV-infected individuals, however. Darunavir is a known substrate for influx transporters, such as the 1A2 and the 1B1 members of the solute carrier organic anion transporter family (SLCO1A2, SLCO1B1), as well as for efflux transporters such as the multi-drug resistance protein 1 (MRP1). The aim of this study was to develop a semi-mechanistic population pharmacokinetic model for darunavir and ritonavir administered in HIV-infected adults. The desired model would incorporate patient characteristics and pharmacogenetic data contributing to variability in drug concentrations and also take into account the interaction between the two compounds. A population pharmacokinetic analysis was performed with 705 plasma samples from 75 Caucasian individuals receiving darunavir/ritonavir (600/100 mg twice daily) for at least 4 weeks. At least one full pharmacokinetic profile was obtained for each participant, and darunavir and ritonavir concentrations in plasma were determined by high performance liquid chromatography. Genotyping for 148 polymorphisms in genes coding for transporters or metabolizing enzymes was conducted by two methods: MALDI-TOF mass spectrometry and real-time polymerase chain reaction-based allelic discrimination. A population pharmacokinetic model was developed for darunavir and for ritonavir. The effect of single nucleotide polymorphisms on the post hoc individual pharmacokinetic parameters was first explored using graphic methods and regression analysis. Those covariates related to changes in darunavir or ritonavir pharmacokinetic parameters were then further evaluated using non-linear mixed effects modeling (NONMEM version VII). Darunavir and ritonavir pharmacokinetics were best described by a two- and one-compartment model, respectively, both with first-order absorption and elimination. The darunavir peripheral volume of distribution decreased as α1-acid glycoprotein concentrations increased. Darunavir clearance was 12 % lower in patients with SLCO3A1 rs8027174 GT/TT genotypes, while homozygosity for the rs4294800 A allele was associated with 2.5-fold higher central volume of distribution. Body weight influenced ritonavir clearance. Ritonavir inhibited darunavir clearance following a maximum-effect model. A population pharmacokinetic model to simultaneously describe the pharmacokinetics of darunavir and ritonavir was developed in HIV-infected patients. The model provides better understanding of the interaction between darunavir and ritonavir and suggests an association between SLCO3A1 polymorphisms and darunavir pharmacokinetics. Bayesian estimates of individual darunavir parameters and ritonavir may be useful to predict darunavir exposure.

Estimating verbal fluency and naming ability from the test of premorbid functioning and demographic variables: Regression equations derived from a regional UK sample.

PubMed

Jenkinson, Toni-Marie; Muncer, Steven; Wheeler, Miranda; Brechin, Don; Evans, Stephen

2018-06-01

Neuropsychological assessment requires accurate estimation of an individual's premorbid cognitive abilities. Oral word reading tests, such as the test of premorbid functioning (TOPF), and demographic variables, such as age, sex, and level of education, provide a reasonable indication of premorbid intelligence, but their ability to predict other related cognitive abilities is less well understood. This study aimed to develop regression equations, based on the TOPF and demographic variables, to predict scores on tests of verbal fluency and naming ability. A sample of 119 healthy adults provided demographic information and were tested using the TOPF, FAS, animal naming test (ANT), and graded naming test (GNT). Multiple regression analyses, using the TOPF and demographics as predictor variables, were used to estimate verbal fluency and naming ability test scores. Change scores and cases of significant impairment were calculated for two clinical samples with diagnosed neurological conditions (TBI and meningioma) using the method in Knight, McMahon, Green, and Skeaff (). Demographic variables provided a significant contribution to the prediction of all verbal fluency and naming ability test scores; however, adding TOPF score to the equation considerably improved prediction beyond that afforded by demographic variables alone. The percentage of variance accounted for by demographic variables and/or TOPF score varied from 19 per cent (FAS), 28 per cent (ANT), and 41 per cent (GNT). Change scores revealed significant differences in performance in the clinical groups, particularity the TBI group. Demographic variables, particularly education level, and scores on the TOPF should be taken into consideration when interpreting performance on tests of verbal fluency and naming ability. © 2017 The British Psychological Society.

To Cull or Not To Cull? Considerations for Studies of Endocrine-Disrupting Chemicals.

PubMed

Suvorov, Alexander; Vandenberg, Laura N

2016-07-01

The power of animal models is derived from the ability to control experimental variables so that observed effects may be unequivocally attributed to the factor that was changed. One variable that is difficult to control in animal experiments is the number and composition of offspring in a litter. To account for this variability, artificial equalization of the number of offspring in a litter (culling) is often used. The rationale for culling, however, has always been controversial. The Developmental Origins of Health and Disease concept provides a new context to evaluate the pros and cons of culling in laboratory animal studies, especially in the context of endocrine-disrupting chemicals. Emerging evidence indicates that culling, especially of large litters, can drastically change the feeding status of a pup, which can result in compensatory growth with long-term consequences for the animal, including increased risk of cardio-metabolic diseases. Similarly, culling of litters to intentionally bias sex ratios can alter the animal's behavior and physiology, with effects observed on a wide range of outcomes. Thus, in an attempt to control for variability in developmental rates, culling introduces an uncontrolled or confounding variable, which itself may affect a broad spectrum of health-related consequences. Variabilities in culling protocols could be responsible for differences in responses to endocrine-disrupting chemicals reported across studies. Because litter sex composition and size are vectors that can influence both prenatal and postnatal growth, they are essential considerations for the interpretation of results from laboratory animal studies.

Intraindividual variability as an indicator of malingering in head injury.

PubMed

Strauss, Esther; Slick, Daniel J; Levy-Bencheton, Judi; Hunter, Michael; MacDonald, Stuart W S; Hultsch, David F

2002-07-01

The utility of various measures of malingering was evaluated using an analog design in which half the participants (composed of three groups: naive healthy people, professionals working with head-injured people, individuals who suffered a head injury but not currently in litigation) were asked to try their best and the remainder was asked to feign believable injury. Participants were assessed with the Reliable Digit Span (RDS) task, the Victoria Symptom Validity Test (VSVT), and the Computerized Dot Counting Test (CDCT) on three separate occasions in order to determine whether repeat administration of tests improves prediction. The results indicated that regardless of an individual's experience, consideration of both level of performance (particularly on forced-choice symptom validity tasks) and intraindividual variability holds considerable promise for the detection of malingering.

Comparing Building and Neighborhood-Scale Variability of CO₂ and O₃ to Inform Deployment Considerations for Low-Cost Sensor System Use.

PubMed

Collier-Oxandale, Ashley; Coffey, Evan; Thorson, Jacob; Johnston, Jill; Hannigan, Michael

2018-04-26

The increased use of low-cost air quality sensor systems, particularly by communities, calls for the further development of best-practices to ensure these systems collect usable data. One area identified as requiring more attention is that of deployment logistics, that is, how to select deployment sites and how to strategically place sensors at these sites. Given that sensors are often placed at homes and businesses, ideal placement is not always possible. Considerations such as convenience, access, aesthetics, and safety are also important. To explore this issue, we placed multiple sensor systems at an existing field site allowing us to examine both neighborhood-level and building-level variability during a concurrent period for CO₂ (a primary pollutant) and O₃ (a secondary pollutant). In line with previous studies, we found that local and transported emissions as well as thermal differences in sensor systems drive variability, particularly for high-time resolution data. While this level of variability is unlikely to affect data on larger averaging scales, this variability could impact analysis if the user is interested in high-time resolution or examining local sources. However, with thoughtful placement and thorough documentation, high-time resolution data at the neighborhood level has the potential to provide us with entirely new information on local air quality trends and emissions.

Quantitative approaches in climate change ecology

PubMed Central

Brown, Christopher J; Schoeman, David S; Sydeman, William J; Brander, Keith; Buckley, Lauren B; Burrows, Michael; Duarte, Carlos M; Moore, Pippa J; Pandolfi, John M; Poloczanska, Elvira; Venables, William; Richardson, Anthony J

2011-01-01

Contemporary impacts of anthropogenic climate change on ecosystems are increasingly being recognized. Documenting the extent of these impacts requires quantitative tools for analyses of ecological observations to distinguish climate impacts in noisy data and to understand interactions between climate variability and other drivers of change. To assist the development of reliable statistical approaches, we review the marine climate change literature and provide suggestions for quantitative approaches in climate change ecology. We compiled 267 peer-reviewed articles that examined relationships between climate change and marine ecological variables. Of the articles with time series data (n = 186), 75% used statistics to test for a dependency of ecological variables on climate variables. We identified several common weaknesses in statistical approaches, including marginalizing other important non-climate drivers of change, ignoring temporal and spatial autocorrelation, averaging across spatial patterns and not reporting key metrics. We provide a list of issues that need to be addressed to make inferences more defensible, including the consideration of (i) data limitations and the comparability of data sets; (ii) alternative mechanisms for change; (iii) appropriate response variables; (iv) a suitable model for the process under study; (v) temporal autocorrelation; (vi) spatial autocorrelation and patterns; and (vii) the reporting of rates of change. While the focus of our review was marine studies, these suggestions are equally applicable to terrestrial studies. Consideration of these suggestions will help advance global knowledge of climate impacts and understanding of the processes driving ecological change.

Effectiveness of Drafting Models for Engineering Technology Students and Impacts on Spatial Visualization Ability: An Analysis and Consideration of Critical Variables

ERIC Educational Resources Information Center

Katsioloudis, Petros J.; Stefaniak, Jill E.

2018-01-01

Results from a number of studies indicate that the use of drafting models can positively influence the spatial visualization ability for engineering technology students. However, additional variables such as light, temperature, motion and color can play an important role but research provides inconsistent results. Considering this, a set of 5…

Specific gravity of hybrid poplars in the north-central region, USA: within-tree variability and site × genotype effects

Treesearch

William L. Headlee; Ronald S. Jr. Zalesny; Richard B. Hall; Edmund O. Bauer; Bradford Bender; Bruce A. Birr; Raymond O. Miller; Jesse A. Randall; Adam H. Wiese

2013-01-01

Specific gravity is an important consideration for traditional uses of hybrid poplars for pulp and solid wood products, as well as for biofuels and bioenergy production. While specific gravity has been shown to be under strong genetic control and subject to within-tree variability, the role of genotype × environment interactions is poorly understood. Most...

Compact Representations of Extended Causal Models

DTIC Science & Technology

2012-10-01

get a yet more compact representation by assuming that, by default , it is typical for the variables to obey the structural equations. Finally, in...Halpern and Hitchcock (2011), is to incorporate considerations about about defaults , typicality, and normality. “Normality” and its cognates (“normal...atypical to violate it. 17 Variables typically obey the structural equations. Thus, it is often far more efficient to assume this holds by default

Ergonomics: The Forgotten Variable.

ERIC Educational Resources Information Center

Fitterman, L. Jeffrey

1998-01-01

Defines ergonomics and discusses design and environmental considerations. Suggests work-space requirements for: tables, chairs, monitor height, ambient noise and light, electricity, and environmental hazards. Includes sources for additional information related to ergonomic design. (AEF)

Regional radiation dose-response modeling of functional liver in hepatocellular carcinoma patients with longitudinal sulfur colloid SPECT/CT: a proof of concept.

PubMed

Price, Ryan G; Apisarnthanarax, Smith; Schaub, Stephanie K; Nyflot, Matthew J; Chapman, Tobias R; Matesan, Manuela; Vesselle, Hubert J; Bowen, Stephen R

2018-06-19

We report on patient-specific quantitative changes in longitudinal sulfur colloid SPECT/CT as a function of regional radiation dose distributions to normal liver in a cohort of hepatocellular carcinoma patients. Dose-response thresholds and slopes varied with baseline liver function metrics, and extreme values were found in patients with fatal hepatotoxicity. Dose-response modeling of normal liver in individual HCC patients has potential to characterize in vivo radiosensitivity, identify high risk subgroups, and personalize treatment planning dose constraints. Hepatotoxicity risk in hepatocellular carcinoma (HCC) patients is modulated by radiation dose delivered to normal liver tissue, but reported dose-response data are limited. Our prior work established baseline [ 99m Tc]sulfur colloid (SC) SPECT/CT liver function imaging biomarkers that predict clinical outcomes. We conducted a proof-of-concept investigation with longitudinal SC SPECT/CT to characterize patient-specific radiation dose-response relationships as surrogates for liver radiosensitivity. SC SPECT/CT images of 15 HCC patients with variable Child-Pugh status (8 CP-A, 7 CP-B/C) were acquired in treatment position prior to and 1 month (nominal) after SBRT (n=6) or proton therapy (n=9). Localized rigid registrations between pre/post-treatment CT to planning CT scans were performed, and transformations were applied to pre/post-treatment SC SPECT images. Radiotherapy doses were converted to EQD2 α/β=3 and Gy (RBE), and binned in 5 GyEQD2 increments within tumor-subtracted livers. Mean dose and percent change (%ΔSC) between pre- and post-treatment SPECT uptake, normalized to regions receiving < 5 GyEQD2, were calculated in each binned dose region. Dose-response data were parameterized by sigmoid functions (double exponential) consisting of maximum reduction (%ΔSC max ), dose midpoint (D mid ), and dose-response slope (α mid ) parameters. Individual patient sigmoid dose-response curves had high goodness-of-fit (median R 2 = 0.96, range 0.76-0.99). Large inter-patient variability was observed, with median (range) in %ΔSC max of 44% (20-75%), D mid of 13 Gy (4-27 GyEQD2), and α mid of 0.11 GyEQD2 -1 (0.04-0.29 GyEQD2 -1 ), respectively. Eight of 15 patients had %ΔSC max = 20-45%, while 7/15 had %ΔSC max = 60-75%, with subgroups made up of variable baseline liver function status and radiation treatment modality. Fatal hepatotoxicity occurred in patients (2/15) with low TLF (< 0.12) and low D mid (< 7 GyEQD2). Longitudinal SC SPECT/CT imaging revealed patient-specific variations in dose-response, and may identify patients with poor baseline liver function and increased sensitivity to radiation therapy. Validation of this regional liver dose-response modeling concept as a surrogate for patient-specific radiosensitivity has potential to guide HCC therapy regimen selection and planning constraints. Copyright © 2018 Elsevier Inc. All rights reserved.

Student Failures on First-Year Medical Basic Science Courses and the USMLE Step 1: A Retrospective Study over a 20-Year Period

ERIC Educational Resources Information Center

Burns, E. Robert; Garrett, Judy

2015-01-01

Correlates of achievement in the basic science years in medical school and on the Step 1 of the United States Medical Licensing Examination® (USMLE®), (Step 1) in relation to preadmission variables have been the subject of considerable study. Preadmissions variables such as the undergraduate grade point average (uGPA) and Medical College Admission…

Variable structure control of spacecraft reorientation maneuvers

NASA Technical Reports Server (NTRS)

Sira-Ramirez, H.; Dwyer, T. A. W., III

1986-01-01

A Variable Structure Control (VSC) approach is presented for multi-axial spacecraft reorientation maneuvers. A nonlinear sliding surface is proposed which results in an asymptotically stable, ideal linear sliding motion of Cayley-Rodriques attitude parameters. By imposing a desired equivalent dynamics on the attitude parameters, the approach is devoid of optimal control considerations. The single axis case provides a design scheme for the multiple axes design problem. Illustrative examples are presented.

Methodology for utilizing survey skid data.

DOT National Transportation Integrated Search

1975-01-01

This report sets forth procedures for utilizing survey skid data with consideration given to testing variabilities and relationships between the three testing devices used in Virginia namely, the Virginia Department of Highways & Transportation's tra...

Groundwater-fed irrigation impacts spatially distributed temporal scaling behavior of the natural system: a spatio-temporal framework for understanding water management impacts

NASA Astrophysics Data System (ADS)

Condon, Laura E.; Maxwell, Reed M.

2014-03-01

Regional scale water management analysis increasingly relies on integrated modeling tools. Much recent work has focused on groundwater-surface water interactions and feedbacks. However, to our knowledge, no study has explicitly considered impacts of management operations on the temporal dynamics of the natural system. Here, we simulate twenty years of hourly moisture dependent, groundwater-fed irrigation using a three-dimensional, fully integrated, hydrologic model (ParFlow-CLM). Results highlight interconnections between irrigation demand, groundwater oscillation frequency and latent heat flux variability not previously demonstrated. Additionally, the three-dimensional model used allows for novel consideration of spatial patterns in temporal dynamics. Latent heat flux and water table depth both display spatial organization in temporal scaling, an important finding given the spatial homogeneity and weak scaling observed in atmospheric forcings. Pumping and irrigation amplify high frequency (sub-annual) variability while attenuating low frequency (inter-annual) variability. Irrigation also intensifies scaling within irrigated areas, essentially increasing temporal memory in both the surface and the subsurface. These findings demonstrate management impacts that extend beyond traditional water balance considerations to the fundamental behavior of the system itself. This is an important step to better understanding groundwater’s role as a buffer for natural variability and the impact that water management has on this capacity.

Socio-demographic diversity and unexplained variation in death rates among the most deprived parliamentary constituencies in Britain.

PubMed

Tunstall, H; Mitchell, R; Gibbs, J; Platt, S; Dorling, D

2012-06-01

There is considerable unexplained variation in death rates between deprived areas of Britain. This analysis assesses the degree of variation in socio-demographic factors among deprivation deciles and how variables associated with deaths differ among the most deprived areas. Death rates 1996-2001, Carstairs' 2001 deprivation score and indicators, population density, black and minority ethnic group (BME) and population change 1971-2001 were calculated for 641 parliamentary constituencies in Britain. Constituencies were grouped into Carstairs' deciles. We assessed standard errors of all variables by decile and the relationship between death rates and socio-demographic variables with Pearson's correlations and linear regression by decile and for all constituencies combined. Standard errors in death rates and most socio-demographic variables were greatest for the most deprived decile. Death rates among all constituencies were positively correlated with Carstairs' score and indicators, density and BME, but for the most deprived decile, there was no association with Carstairs and a negative correlation with overcrowding, density and BME. For the most deprived decile multivariate models containing population density, BME and change had substantially higher R(2). Understanding variations in death rates between deprived areas requires greater consideration of their socio-demographic diversity including their population density, ethnicity and migration.

An eco-hydrologic model of malaria outbreaks

NASA Astrophysics Data System (ADS)

Montosi, E.; Manzoni, S.; Porporato, A.; Montanari, A.

2012-03-01

Malaria is a geographically widespread infectious disease that is well known to be affected by climate variability at both seasonal and interannual timescales. In an effort to identify climatic factors that impact malaria dynamics, there has been considerable research focused on the development of appropriate disease models for malaria transmission and their consideration alongside climatic datasets. These analyses have focused largely on variation in temperature and rainfall as direct climatic drivers of malaria dynamics. Here, we further these efforts by considering additionally the role that soil water content may play in driving malaria incidence. Specifically, we hypothesize that hydro-climatic variability should be an important factor in controlling the availability of mosquito habitats, thereby governing mosquito growth rates. To test this hypothesis, we reduce a nonlinear eco-hydrologic model to a simple linear model through a series of consecutive assumptions and apply this model to malaria incidence data from three South African provinces. Despite the assumptions made in the reduction of the model, we show that soil water content can account for a significant portion of malaria's case variability beyond its seasonal patterns, whereas neither temperature nor rainfall alone can do so. Future work should therefore consider soil water content as a simple and computable variable for incorporation into climate-driven disease models of malaria and other vector-borne infectious diseases.

Variability in soil-water retention properties and implications for physics-based simulation of landslide early warning criteria

USGS Publications Warehouse

Thomas, Matthew A.; Mirus, Benjamin B.; Collins, Brian D.; Lu, Ning; Godt, Jonathan W.

2018-01-01

Rainfall-induced shallow landsliding is a persistent hazard to human life and property. Despite the observed connection between infiltration through the unsaturated zone and shallow landslide initiation, there is considerable uncertainty in how estimates of unsaturated soil-water retention properties affect slope stability assessment. This source of uncertainty is critical to evaluating the utility of physics-based hydrologic modeling as a tool for landslide early warning. We employ a numerical model of variably saturated groundwater flow parameterized with an ensemble of texture-, laboratory-, and field-based estimates of soil-water retention properties for an extensively monitored landslide-prone site in the San Francisco Bay Area, CA, USA. Simulations of soil-water content, pore-water pressure, and the resultant factor of safety show considerable variability across and within these different parameter estimation techniques. In particular, we demonstrate that with the same permeability structure imposed across all simulations, the variability in soil-water retention properties strongly influences predictions of positive pore-water pressure coincident with widespread shallow landsliding. We also find that the ensemble of soil-water retention properties imposes an order-of-magnitude and nearly two-fold variability in seasonal and event-scale landslide susceptibility, respectively. Despite the reduced factor of safety uncertainty during wet conditions, parameters that control the dry end of the soil-water retention function markedly impact the ability of a hydrologic model to capture soil-water content dynamics observed in the field. These results suggest that variability in soil-water retention properties should be considered for objective physics-based simulation of landslide early warning criteria.

Improved prediction of disturbed flow via hemodynamically-inspired geometric variables.

PubMed

Bijari, Payam B; Antiga, Luca; Gallo, Diego; Wasserman, Bruce A; Steinman, David A

2012-06-01

Arterial geometry has long been considered as a pragmatic alternative for inferring arterial flow disturbances, and their impact on the natural history and treatment of vascular diseases. Traditionally, definition of geometric variables is based on convenient shape descriptors, with only superficial consideration of their influence on flow and wall shear stress patterns. In the present study we demonstrate that a more studied consideration of the actual (cf. nominal) local hemodynamics can lead to substantial improvements in the prediction of disturbed flow by geometry. Starting from a well-characterized computational fluid dynamics (CFD) dataset of 50 normal carotid bifurcations, we observed that disturbed flow tended to be confined proximal to the flow divider, whereas geometric variables previously shown to be significant predictors of disturbed flow included features distal to the flow divider in their definitions. Flaring of the bifurcation leading to flow separation was redefined as the maximum relative expansion of the common carotid artery (CCA), proximal to the flow divider. The beneficial effect of primary curvature on flow inertia, via suppression of flow separation, was characterized by the in-plane tortuosity of CCA as it enters the flare region. Multiple linear regressions of these redefined geometric variables against various metrics of disturbed flow revealed R(2) values approaching 0.6, better than the roughly 0.3 achieved using the conventional shape-based variables, while maintaining their demonstrated real-world reproducibility. Such a hemodynamically-inspired approach to the definition of geometric variables may reap benefits for other applications where geometry is used as a surrogate marker of local hemodynamics. Copyright © 2012 Elsevier Ltd. All rights reserved.

Atypical Reactivity of Heart Rate Variability to Stress and Depression: Systematic Review of the Literature and Directions for Future Research

PubMed Central

Hamilton, Jessica L.; Alloy, Lauren B.

2017-01-01

Heart rate variability has received growing attention in the depression literature, with several recent meta-analyses indicating that lower resting heart rate variability is associated with depression. However, the role of fluctuations in heart rate variability (or reactivity) in response to stress in depression remains less clear. The present review provides a systematic examination of the literature on heart rate variability reactivity to a laboratory-induced stressor task and depression, including 26 studies of reactivity in heart rate variability and clinical depression, remitted (or history of) depression, and subthreshold depression (or symptom-level depression) among adults, adolescents, and children. In addition to reviewing the findings of these studies, methodological considerations and conceptual gaps in the literature are addressed. We conclude by highlighting the importance of investigating the potential transactional relationship between heart rate variability reactivity and depression and possible mechanisms underlying this relationship. PMID:27697746

Modeling of pharmacokinetics, efficacy, and hemodynamic effects of macitentan in patients with pulmonary arterial hypertension.

PubMed

Krause, Andreas; Zisowsky, Jochen; Dingemanse, Jasper

2018-04-01

Macitentan is the first endothelin receptor antagonist with demonstrated efficacy on morbidity and mortality in pulmonary arterial hypertension (PAH) in the pivotal study SERAPHIN. The pharmacokinetics (PK) of macitentan and its active metabolite, ACT-132577, were characterized in a population model. Efficacy and hemodynamics (pharmacodynamics, PD) were related to PK based on PK/PD modeling. Sex, age, and body weight influenced the PK to a statistically significant extent. Model-based simulations showed that these variables are clinically not relevant. Concomitant use of PAH medication (PDE-5 inhibitors) did not influence macitentan trough concentration to a relevant extent. Efficacy and hemodynamics showed clear differences from placebo for macitentan concentrations on 3 and 10 mg with consistent superior effects for 10 mg. After 6 months, PAH patients showed model-predicted 6-min walk distance (6-MWD) improvements of 1.0 m on placebo compared to 29.8 and 34.1 m on 3 and 10 mg of macitentan, respectively. Higher macitentan concentrations were associated with reductions in pulmonary vascular resistance (PVR), mean right atrial and pulmonary arterial pressure, and total pulmonary resistance (TPR) and increases in cardiac index (CI) and mixed venous oxygen saturation. Statistical significance was determined for PVR, TPR, and CI but not for 6-MWD. In addition, PVR showed more pronounced differences between active treatment and placebo than 6-MWD. Modeling identified statistically significant inter-patient differences; simulations to assess the magnitude of the effects permitted clinical judgment. The same approach will allow for extrapolation to children. Hemodynamic markers might be better markers of treatment effects than 6-MWD. The SERAPHIN study and its open-label extension are registered with ClinicalTrials.gov with identifiers NCT00660179 (https://www.clinicaltrials.gov/ct2/show/NCT00660179) and NCT00667823 (https://clinicaltrials.gov/ct2/show/NCT00667823) and with EudraCT with identifiers 2007-002440-14 (https://www.clinicaltrialsregister.eu/ctr-search/search?query=2007-002440-14) and 2007-003694-27 (https://www.clinicaltrialsregister.eu/ctr-search/search?query=2007-003694-27). Copyright © 2018 Elsevier Ltd. All rights reserved.

Gut Microbiota and Tacrolimus Dosing in Kidney Transplantation

PubMed Central

Lee, John R.; Muthukumar, Thangamani; Dadhania, Darshana; Taur, Ying; Jenq, Robert R.; Toussaint, Nora C.; Ling, Lilan; Pamer, Eric; Suthanthiran, Manikkam

2015-01-01

Tacrolimus dosing to establish therapeutic levels in recipients of organ transplants is a challenging task because of much interpatient and intrapatient variability in drug absorption, metabolism, and disposition. In view of the reported impact of gut microbial species on drug metabolism, we investigated the relationship between the gut microbiota and tacrolimus dosing requirements in this pilot study of adult kidney transplant recipients. Serial fecal specimens were collected during the first month of transplantation from 19 kidney transplant recipients who either required a 50% increase from initial tacrolimus dosing during the first month of transplantation (Dose Escalation Group, n=5) or did not require such an increase (Dose Stable Group, n=14). We characterized bacterial composition in the fecal specimens by deep sequencing of the PCR amplified 16S rRNA V4-V5 region and we investigated the hypothesis that gut microbial composition is associated with tacrolimus dosing requirements. Initial tacrolimus dosing was similar in the Dose Escalation Group and in the Stable Group (4.2±1.1 mg/day vs. 3.8±0.8 mg/day, respectively, P=0.61, two-way between-group ANOVA using contrasts) but became higher in the Dose Escalation Group than in the Dose Stable Group by the end of the first transplantation month (9.6±2.4 mg/day vs. 3.3±1.5 mg/day, respectively, P<0.001). Our systematic characterization of the gut microbial composition identified that fecal Faecalibacterium prausnitzii abundance in the first week of transplantation was 11.8% in the Dose Escalation Group and 0.8% in the Dose Stable Group (P=0.002, Wilcoxon Rank Sum test, P<0.05 after Benjamini-Hochberg correction for multiple hypotheses). Fecal Faecalibacterium prausnitzii abundance in the first week of transplantation was positively correlated with future tacrolimus dosing at 1 month (R=0.57, P=0.01) and had a coefficient±standard error of 1.0±0.6 (P=0.08) after multivariable linear regression. Our novel observations may help further explain inter-individual differences in tacrolimus dosing to achieve therapeutic levels. PMID:25815766

Femoral nerve block Intervention in Neck of Femur fracture (FINOF): study protocol for a randomized controlled trial

PubMed Central

2014-01-01

Background Hip fractures are very painful leading to lengthy hospital stays. Conventional methods of treating pain are limited. Non-steroidal anti-inflammatories are relatively contraindicated and opioids have significant side effects.Regional anaesthesia holds promise but results from these techniques are inconsistent. Trials to date have been inconclusive with regard to which blocks to use and for how long. Interpatient variability remains a problem. Methods/Design This is a single centre study conducted at Queen’s Medical Centre, Nottingham; a large regional trauma centre in England. It is a pragmatic, parallel arm, randomized controlled trial. Sample size will be 150 participants (75 in each group). Randomization will be web-based, using computer generated concealed tables (service provided by Nottingham University Clinical Trials Unit). There is no blinding. Intervention will be a femoral nerve block (0.5 mls/kg 0.25% levo-bupivacaine) followed by ropivacaine (0.2% 5 ml/hr−1) infused via a femoral nerve catheter until 48 hours post-surgery. The control group will receive standard care. Participants will be aged over 70 years, cognitively intact (abbreviated mental score of seven or more), able to provide informed consent, and admitted directly through the Emergency Department from their place of residence. Primary outcomes will be cumulative ambulation score (from day 1 to 3 postoperatively) and cumulative dynamic pain scores (day 1 to 3 postoperatively). Secondary outcomes will be cumulative dynamic pain score preoperatively, cumulative side effects, cumulative calorific and protein intake, EUROQOL EQ-5D score, length of stay, and rehabilitation outcome (measured by mobility score). Discussion Many studies have shown the effectiveness of regional blockade in neck of femur fractures, but the techniques used have varied. This study aims to identify whether early and continuous femoral nerve block can be effective in relieving pain and enhancing mobilization.Trial registration. Trial registration The trial is registered with the European clinical trials database Eudract ref: 2010-023871-25. (17/02/2011). ISRCTN: ISRCTN92946117. Registered 26 October 2012. PMID:24885267

Automated respiratory cycles selection is highly specific and improves respiratory mechanics analysis.

PubMed

Rigo, Vincent; Graas, Estelle; Rigo, Jacques

2012-07-01

Selected optimal respiratory cycles should allow calculation of respiratory mechanic parameters focusing on patient-ventilator interaction. New computer software automatically selecting optimal breaths and respiratory mechanics derived from those cycles are evaluated. Retrospective study. University level III neonatal intensive care unit. Ten mins synchronized intermittent mandatory ventilation and assist/control ventilation recordings from ten newborns. The ventilator provided respiratory mechanic data (ventilator respiratory cycles) every 10 secs. Pressure, flow, and volume waves and pressure-volume, pressure-flow, and volume-flow loops were reconstructed from continuous pressure-volume recordings. Visual assessment determined assisted leak-free optimal respiratory cycles (selected respiratory cycles). New software graded the quality of cycles (automated respiratory cycles). Respiratory mechanic values were derived from both sets of optimal cycles. We evaluated quality selection and compared mean values and their variability according to ventilatory mode and respiratory mechanic provenance. To assess discriminating power, all 45 "t" values obtained from interpatient comparisons were compared for each respiratory mechanic parameter. A total of 11,724 breaths are evaluated. Automated respiratory cycle/selected respiratory cycle selections agreement is high: 88% of maximal κ with linear weighting. Specificity and positive predictive values are 0.98 and 0.96, respectively. Averaged values are similar between automated respiratory cycle and ventilator respiratory cycle. C20/C alone is markedly decreased in automated respiratory cycle (1.27 ± 0.37 vs. 1.81 ± 0.67). Tidal volume apparent similarity disappears in assist/control: automated respiratory cycle tidal volume (4.8 ± 1.0 mL/kg) is significantly lower than for ventilator respiratory cycle (5.6 ± 1.8 mL/kg). Coefficients of variation decrease for all automated respiratory cycle parameters in all infants. "t" values from ventilator respiratory cycle data are two to three times higher than ventilator respiratory cycles. Automated selection is highly specific. Automated respiratory cycle reflects most the interaction of both ventilator and patient. Improving discriminating power of ventilator monitoring will likely help in assessing disease status and following trends. Averaged parameters derived from automated respiratory cycles are more precise and could be displayed by ventilators to improve real-time fine tuning of ventilator settings.

The posterior cruciate ligament: a study on its bony and soft tissue anatomy using novel 3D CT technology.

PubMed

Van Hoof, Tom; Cromheecke, Michiel; Tampere, Thomas; D'herde, Katharina; Victor, Jan; Verdonk, Peter C M

2013-05-01

The bony insertion sites of the PCL have been studied and described extensively using 2D technology such as macroscopic images, plain radiograph, computerized tomography (CT) and MRI. The purpose of this study is to visualize both the tibial and the femoral bony insertion sites but also the soft tissue anatomy of the native PCL using novel 3D CT imaging. In addition, new concepts of best-fit cylinder and central axis are introduced and evaluated. Nine unpaired knees of embalmed cadavers were used in this study. Following the dissection process, the PCL was injected with a contrast medium for computed tomography (CT) imaging. The obtained CT images were segmented and rendered in 3D allowing morphological and morphometric analysis of PCL. Femoral and tibial footprint surface area, best-fit PCL-cylinder intersection area, best-fit PCL-cylinder/footprint coverage ratio, best-fit PCL-cylinder central axis projections at the tibial and femoral footprint were used to describe the anatomy of the PCL. Mean footprint surface area of the tibial and femoral footprint were 189.1 and 293.3 mm², respectively. The mean diameter of the best-fit cylinder was 10.5 mm. The mean coverage of the best-fit cylinder on the tibial and femoral footprint was 76.5 and 46.5, respectively. The best-fit cylinder central axis was located in the anterolateral AL bundle footprint on the femur and more centrally in the PCL footprint on the tibia. This study is the first to describe the detailed anatomy of the human PCL with respect to its course and footprints using a 3D approach. It confirms the large difference between the tibial and the femoral footprint area with the former being significantly smaller. In addition, a large inter-patient variability is observed. The best-fit cylinder and central axis concept offer additional insights into the optimal tunnel placement at the tibia and femoral footprint in order to cover the largest portion of the native PCL soft tissue.

Lopinavir/ritonavir combined with twice-daily 400 mg indinavir: pharmacokinetics and pharmacodynamics in blood, CSF and semen.

PubMed

Isaac, Adil; Taylor, Stephen; Cane, Patricia; Smit, Erasmus; Gibbons, Sarah E; White, David J; Drake, Susan M; Khoo, Saye; Back, David J

2004-08-01

To evaluate the steady-state blood plasma (BP), CSF and seminal plasma (SP) pharmacokinetics (PK) of twice-daily indinavir 400 mg and lopinavir/ritonavir. Ten HIV-1-positive men on lopinavir/ritonavir participated in a PK study. PK sampling was performed before and 2 weeks after adding indinavir to lopinavir/ritonavir-containing regimens. BP, CSF and SP RNA levels, CD4 counts and blood chemistry were checked at baseline and 2 weeks after indinavir. At baseline: lopinavir parameters (n=10) in BP were within expected levels. Median lopinavir trough concentrations (n=5) in CSF and SP were below the limit of detection (BLD) (i.e. <10 ng/mL) and 248 ng/mL (range 96-2777), respectively. After indinavir: lopinavir C(max), C(min) and AUC(0-12) increased by 9%, 46% and 20%, respectively (P<0.32, P<0.32 and P<0.20). In two of four men lopinavir concentrations in CSF were detectable at 27 and 29 ng/mL. Median SP lopinavir concentration was 655 ng/mL (20-2734). Median indinavir PK parameters were C(max) 3365 ng/mL (range 2130-5194), C(min) 293 ng/mL (14-766), T(max) 2.25 h (1-3), AUC(0-12) 22452 ng/mL.h (11243-33661), and t(1/2) 2.8 h (1.4-3.7). Median indinavir concentrations in CSF and SP were 39 ng/mL (21-86) and 592 ng/mL (96-983). Two of eight men who initially had detectable BP viral load (VL) became BLD (<50 copies/mL) after the addition of indinavir, and in 2/4 men with low-level viraemia in SP (BPVL BLD) their SPVL became BLD after addition of indinavir. Adding indinavir 400 mg twice daily to lopinavir/ritonavir-containing regimens did not significantly alter the median lopinavir PK parameters. However, wide interpatient variability in lopinavir concentrations was seen. In contrast plasma indinavir levels were >80 ng/mL in seven of eight plasma samples, and all CSF and semen samples collected.

Adsorption of 99mTc-sestamibi onto plastic syringes: evaluation of factors affecting the degree of adsorption and their impact on clinical studies.

PubMed

Swanson, Tiffinee N; Troung, Duong T; Paulsen, Andrew; Hruska, Carrie B; O'Connor, Michael K

2013-12-01

The purpose of this study was to document the extent of adhesion of (99m)Tc-sestamibi to syringes in patient procedures, determine factors that influence the degree of adhesion, and evaluate alternatives to our current practice that would either result in a more reproducible degree of adhesion or, ideally, eliminate adhesion. The extent of adhesion was documented in 216 patient procedures and evaluated in detail in an additional 73 patient procedures. We evaluated the nature of the adhesion and its possible causes, including the location of adhesion in injection sets, the effect of syringe type, and the effect of prerinsing of syringes with various solutions of nonradiolabeled sestamibi and (99m)Tc-sestamibi. The extent of adhesion was reevaluated in 50 procedures performed using the syringe type that demonstrated the lowest adhesion rate. The degree of adhesion of (99m)Tc-sestamibi to the injection set was found to be 20.1% ± 8.0%, with a range (10th-90th percentiles) of 9%-31%. The primary cause of adhesion appeared to be the lubricant used inside the syringe barrel. Evaluation of 6 different syringe types identified a brand with a lower adhesion rate. Reevaluation in patient procedures using this brand showed a 5.2% ± 2.5% degree of adhesion, with a range (10th-90th percentiles) of 2.5%-7.7%. Selection of the appropriate type of syringe can significantly reduce the magnitude and variability of residual (99m)Tc-sestamibi activity. With more reproducible residual activities, we have been able to achieve an approximately 20% reduction in the dispensed dose of (99m)Tc-sestamibi used in clinical procedures and a more consistent injected dose with less interpatient variation. The frequent changes in syringe design by manufacturers require that a quality control program for monitoring of residual activity be incorporated into clinical practice. This program has allowed us to maintain image quality and achieve more consistent injected patient doses in clinical procedures that use (99m)Tc-sestamibi.

Grid sensitivity capability for large scale structures

NASA Technical Reports Server (NTRS)

Nagendra, Gopal K.; Wallerstein, David V.

1989-01-01

The considerations and the resultant approach used to implement design sensitivity capability for grids into a large scale, general purpose finite element system (MSC/NASTRAN) are presented. The design variables are grid perturbations with a rather general linking capability. Moreover, shape and sizing variables may be linked together. The design is general enough to facilitate geometric modeling techniques for generating design variable linking schemes in an easy and straightforward manner. Test cases have been run and validated by comparison with the overall finite difference method. The linking of a design sensitivity capability for shape variables in MSC/NASTRAN with an optimizer would give designers a powerful, automated tool to carry out practical optimization design of real life, complicated structures.

Wisconsin's approach to variation in traffic data

DOT National Transportation Integrated Search

2000-08-01

Traffic data exhibits considerable variability, both spatially and temporally. Given limited resources and the large geographic coverage required for data collection efforts, short period (24-hours to 7-day) traffic data collection must often serve t...

Potential of spark ignition engine, electronic engine and transmission control : final report

DOT National Transportation Integrated Search

1980-03-01

This report identifies, evaluates, and documents the characteristics and functions of significant electronic engine and powertrain control systems. Important considerations in the assessment are the powertrain variables controlled, the technology uti...

Rationale and methods for an epidemiologic study of cancer among Seventh-Day Adventists.

PubMed

Phillips, R L; Kuzma, J W

1977-12-01

Considerable evidence was found that Adventists are a low-risk population to develop cancer of many sites. Adventists have numerous unique life-style and dietary habits with great variability within the population in adherence to these practices as well as considerable variation in duration of exposure to these characteristics. Thus this study population will likely be extremely productive in identifying dietary habits or other life-style characteristics that are etiologically related to various cancer sites.

Implications of complete watershed soil moisture measurements to hydrologic modeling

NASA Technical Reports Server (NTRS)

Engman, E. T.; Jackson, T. J.; Schmugge, T. J.

1983-01-01

A series of six microwave data collection flights for measuring soil moisture were made over a small 7.8 square kilometer watershed in southwestern Minnesota. These flights were made to provide 100 percent coverage of the basin at a 400 m resolution. In addition, three flight lines were flown at preselected areas to provide a sample of data at a higher resolution of 60 m. The low level flights provide considerably more information on soil moisture variability. The results are discussed in terms of reproducibility, spatial variability and temporal variability, and their implications for hydrologic modeling.

Nutrition Considerations in the Pediatric Cardiac Intensive Care Unit Patient.

PubMed

Justice, Lindsey; Buckley, Jason R; Floh, Alejandro; Horsley, Megan; Alten, Jeffrey; Anand, Vijay; Schwartz, Steven M

2018-05-01

Adequate caloric intake plays a vital role in the course of illness and the recovery of critically ill patients. Nutritional status and nutrient delivery during critical illness have been linked to clinical outcomes such as mortality, incidence of infection, and length of stay. However, feeding practices with critically ill pediatric patients after cardiac surgery are variable. The Pediatric Cardiac Intensive Care Society sought to provide an expert review on provision of nutrition to pediatric cardiac intensive care patients, including caloric requirements, practical considerations for providing nutrition, safety of enteral nutrition in controversial populations, feeding considerations with chylothorax, and the benefits of feeding beyond nutrition. This article addresses these areas of concern and controversy.

Optimization of helicopter airframe structures for vibration reduction considerations, formulations and applications

NASA Technical Reports Server (NTRS)

Murthy, T. Sreekanta

1988-01-01

Several key issues involved in the application of formal optimization technique to helicopter airframe structures for vibration reduction are addressed. Considerations which are important in the optimization of real airframe structures are discussed. Considerations necessary to establish relevant set of design variables, constraints and objectives which are appropriate to conceptual, preliminary, detailed design, ground and flight test phases of airframe design are discussed. A methodology is suggested for optimization of airframes in various phases of design. Optimization formulations that are unique to helicopter airframes are described and expressions for vibration related functions are derived. Using a recently developed computer code, the optimization of a Bell AH-1G helicopter airframe is demonstrated.

Trajectory controllability of semilinear systems with multiple variable delays in control

DOE Office of Scientific and Technical Information (OSTI.GOV)

Klamka, Jerzy, E-mail: Jerzy.Klamka@polsl.pl, E-mail: Michal.Niezabitowski@polsl.pl; Niezabitowski, Michał, E-mail: Jerzy.Klamka@polsl.pl, E-mail: Michal.Niezabitowski@polsl.pl

In this paper, finite-dimensional dynamical control system described by semilinear differential state equation with multiple variable delays in control are considered. The concept of controllability we extend on trajectory controllability for systems with multiple point delays in control. Moreover, remarks and comments on the relationships between different concepts of controllability are presented. Finally, simple numerical example, which illustrates theoretical considerations is also given. The possible extensions are also proposed.

Contamination of disposable tonometer prisms during tonometry.

PubMed

Rajak, S N; Paul, J; Sharma, V; Vickers, S

2006-03-01

Due to the theoretical possibility of prion transmission in applanation tonometry, many ophthalmological units in the United Kingdom now use disposable tonometer prisms. We have investigated the potential for bacterial and viral transmission from the health practitioner to the patient via disposable prisms. All staff who perform applanation tonometry at the Sussex Eye Hospital (SEH) received a questionnaire to evaluate if the applanating face of the prism is touched during tonometry and the ease of use of the disposable prism compared to the reusable prisms that were previously used. We then cultured prisms handled by a random sample of staff members for common bacteria. Finally, we constructed a model to investigate the possibility of interpatient adenoviral transmission via disposable tonometer prisms. The questionnaire revealed that almost 50% of the staff admit to touching the applanating face of the tonometer prism prior to applanation. Cultures of the prisms grew a range of bacteria including Staphylococcus epidermidis, Staphylococcus aureus, and Bacillus species. The viral model suggested that adenovirus could be transmitted by applanation tonometry. The use of disposable prisms for applanation tonometry may reduce the risk of prion transmission but is not bacteriologically or virologically aseptic. This is a potential infection risk to patients.

Pharmacogenomics in Heart Failure: Where Are We Now and How Can We Reach Clinical Application

PubMed Central

Oni-Orisan, Akinyemi

2015-01-01

Heart failure is becoming increasingly prevalent in the United States and is a significant cause of morbidity and mortality. Several therapies are currently available to treat this chronic illness; however, clinical response to these treatment options exhibit significant interpatient variation. It is now clearly understood that genetics is a key contributor to diversity in therapeutic response, and evidence that genetic polymorphisms alter the pharmacokinetics, pharmacodynamics, and clinical response of heart failure drugs continues to accumulate. This suggests that pharmacogenomics has the potential to help clinicians improve the management of heart failure by choosing the safest and most effective medications and doses. Unfortunately, despite much supportive data, pharmacogenetic optimization of heart failure treatment regimens is not yet a reality. In order to attenuate the rising burden of heart failure, particularly in the context of the recent paucity of new effective interventions, there is an urgent need to extend pharmacogenetic knowledge and leverage these associations in order to enhance the effectiveness of existing heart failure therapies. The present review focuses on the current state of pharmacogenomics in heart failure and provides a glimpse of the aforementioned future needs. PMID:25093738

Evidence for label-retaining tumour-initiating cells in human glioblastoma

PubMed Central

Deleyrolle, Loic P.; Harding, Angus; Cato, Kathleen; Siebzehnrubl, Florian A.; Rahman, Maryam; Azari, Hassan; Olson, Sarah; Gabrielli, Brian; Osborne, Geoffrey; Vescovi, Angelo

2011-01-01

Individual tumour cells display diverse functional behaviours in terms of proliferation rate, cell–cell interactions, metastatic potential and sensitivity to therapy. Moreover, sequencing studies have demonstrated surprising levels of genetic diversity between individual patient tumours of the same type. Tumour heterogeneity presents a significant therapeutic challenge as diverse cell types within a tumour can respond differently to therapies, and inter-patient heterogeneity may prevent the development of general treatments for cancer. One strategy that may help overcome tumour heterogeneity is the identification of tumour sub-populations that drive specific disease pathologies for the development of therapies targeting these clinically relevant sub-populations. Here, we have identified a dye-retaining brain tumour population that displays all the hallmarks of a tumour-initiating sub-population. Using a limiting dilution transplantation assay in immunocompromised mice, label-retaining brain tumour cells display elevated tumour-initiation properties relative to the bulk population. Importantly, tumours generated from these label-retaining cells exhibit all the pathological features of the primary disease. Together, these findings confirm dye-retaining brain tumour cells exhibit tumour-initiation ability and are therefore viable targets for the development of therapeutics targeting this sub-population. PMID:21515906

A Comparison of Neuroimaging Abnormalities in Multiple Sclerosis, Major Depression and Chronic Fatigue Syndrome (Myalgic Encephalomyelitis): is There a Common Cause?

PubMed

Morris, Gerwyn; Berk, Michael; Puri, Basant K

2018-04-01

There is copious evidence of abnormalities in resting-state functional network connectivity states, grey and white matter pathology and impaired cerebral perfusion in patients afforded a diagnosis of multiple sclerosis, major depression or chronic fatigue syndrome (CFS) (myalgic encephalomyelitis). Systemic inflammation may well be a major element explaining such findings. Inter-patient and inter-illness variations in neuroimaging findings may arise at least in part from regional genetic, epigenetic and environmental variations in the functions of microglia and astrocytes. Regional differences in neuronal resistance to oxidative and inflammatory insults and in the performance of antioxidant defences in the central nervous system may also play a role. Importantly, replicated experimental findings suggest that the use of high-resolution SPECT imaging may have the capacity to differentiate patients afforded a diagnosis of CFS from those with a diagnosis of depression. Further research involving this form of neuroimaging appears warranted in an attempt to overcome the problem of aetiologically heterogeneous cohorts which probably explain conflicting findings produced by investigative teams active in this field. However, the ionising radiation and relative lack of sensitivity involved probably preclude its use as a routine diagnostic tool.

Climate Impact of Solar Variability

NASA Technical Reports Server (NTRS)

Schatten, Kenneth H. (Editor); Arking, Albert (Editor)

1990-01-01

The conference on The Climate Impact of Solar Variability, was held at Goddard Space Flight Center from April 24 to 27, 1990. In recent years they developed a renewed interest in the potential effects of increasing greenhouse gases on climate. Carbon dioxide, methane, nitrous oxide, and the chlorofluorocarbons have been increasing at rates that could significantly change climate. There is considerable uncertainty over the magnitude of this anthropogenic change. The climate system is very complex, with feedback processes that are not fully understood. Moreover, there are two sources of natural climate variability (volcanic aerosols and solar variability) added to the anthropogenic changes which may confuse our interpretation of the observed temperature record. Thus, if we could understand the climatic impact of the natural variability, it would aid our interpretation and understanding of man-made climate changes.

Cold Regions Environmental Considerations

DTIC Science & Technology

2009-02-03

braided streams, variable discharge, seasonal breakup) limited seasonally limited abundant Hydrology (frozen lakes and bogs) not present seasonally...fuel hoses may crack increasing the potential for fuel spills. Extreme care must be used when handling cables at cold temperatures, protecting the

Subgrade variability on the Ohio SHRP test road

DOT National Transportation Integrated Search

1999-01-01

This paper documents the extent to which subgrade uniformity was achieved on the Ohio SHRP test road. As construction proceeded, considerably more subgrade undercutting was required than originally anticipated. Much of the undercutting was due to the...

Mechanisms of long-term mean sea level variability in the North Sea

NASA Astrophysics Data System (ADS)

Dangendorf, Sönke; Calafat, Francisco; Øie Nilsen, Jan Even; Richter, Kristin; Jensen, Jürgen

2015-04-01

We examine mean sea level (MSL) variations in the North Sea on timescales ranging from months to decades under the consideration of different forcing factors since the late 19th century. We use multiple linear regression models, which are validated for the second half of the 20th century against the output of a state-of-the-art tide+surge model (HAMSOM), to determine the barotropic response of the ocean to fluctuations in atmospheric forcing. We demonstrate that local atmospheric forcing mainly triggers MSL variability on timescales up to a few years, with the inverted barometric effect dominating the variability along the UK and Norwegian coastlines and wind (piling up the water along the coast) controlling the MSL variability in the south from Belgium up to Denmark. However, in addition to the large inter-annual sea level variability there is also a considerable fraction of decadal scale variability. We show that on decadal timescales MSL variability in the North Sea mainly reflects steric changes, which are mostly remotely forced. A spatial correlation analysis of altimetry observations and baroclinic ocean model outputs suggests evidence for a coherent signal extending from the Norwegian shelf down to the Canary Islands. This supports the theory of longshore wind forcing along the eastern boundary of the North Atlantic causing coastally trapped waves to propagate along the continental slope. With a combination of oceanographic and meteorological measurements we demonstrate that ~80% of the decadal sea level variability in the North Sea can be explained as response of the ocean to longshore wind forcing, including boundary wave propagation in the Northeast Atlantic. These findings have important implications for (i) detecting significant accelerations in North Sea MSL, (ii) the conceptual set up of regional ocean models in terms of resolution and boundary conditions, and (iii) the development of adequate and realistic regional climate change projections.

Considerations of multiple imputation approaches for handling missing data in clinical trials.

PubMed

Quan, Hui; Qi, Li; Luo, Xiaodong; Darchy, Loic

2018-07-01

Missing data exist in all clinical trials and missing data issue is a very serious issue in terms of the interpretability of the trial results. There is no universally applicable solution for all missing data problems. Methods used for handling missing data issue depend on the circumstances particularly the assumptions on missing data mechanisms. In recent years, if the missing at random mechanism cannot be assumed, conservative approaches such as the control-based and returning to baseline multiple imputation approaches are applied for dealing with the missing data issues. In this paper, we focus on the variability in data analysis of these approaches. As demonstrated by examples, the choice of the variability can impact the conclusion of the analysis. Besides the methods for continuous endpoints, we also discuss methods for binary and time to event endpoints as well as consideration for non-inferiority assessment. Copyright © 2018. Published by Elsevier Inc.

Rate of dehydration, state of subcellular organisation and nature of cryoprotection are critical factors contributing to the variable success of cryopreservation: studies on recalcitrant zygotic embryos of Haemanthus montanus.

PubMed

Sershen; Berjak, Patricia; Pammenter, N W; Wesley-Smith, James

2012-01-01

Effects of sequential procedures required for cryopreservation of embryos excised from the recalcitrant seeds of Haemanthus montanus were assessed ultrastructurally and in conjunction with respiratory activity and the rate of protein synthesis. Fresh material (water content, 5.05 ± 0.92 g g(-1) dry mass) afforded ultrastructural evidence of considerable metabolic activity, borne out by respiratory rates. Neither exposure to glycerol nor sucrose as penetrating and non-penetrating cryoprotectants, respectively, brought about degradative changes, although increased vacuolation and autophagy accompanied both, while respiratory and protein synthetic activity were not adversely affected. Glycerol-cryoprotected embryos flash dried to water contents >0.4 g g(-1) showed organised ultrastructural features and considerable autophagy consistent with metabolic activity, and although respiratory activity was lower, protein synthesis rate was enhanced relative to fresh material. However, at water contents <0.4 g g(-1), embryo tissue presented a mosaic of cells of variable density and ultrastructural status, but trends in rates of respiration and protein synthesis remained similar. Flash drying after sucrose exposure was accompanied by considerable ultrastructural abnormality particularly at water contents <0.4 g g(-1), lysis of individual and groups of cells and considerable depression of respiration, but not of protein synthesis. Success, assessed as ≥50% axes forming seedlings after cryogen exposure, was obtained only when glycerol-cryoprotected embryos at water contents >0.4 g g(-1)-in which the degree of vacuolation remained moderate-were rapidly cooled. The outcomes of this study are considered particularly in terms of the stresses imposed by prolonged, relatively slow dehydration and ultimate water contents, on embryos showing considerable metabolic activity.

Lost in Translation: Piloting a Novel Framework to Assess the Challenges in Translating Scientific Uncertainty From Empirical Findings to WHO Policy Statements

PubMed Central

Benmarhnia, Tarik; Huang, Jonathan Y.; Jones, Catherine M.

2017-01-01

Background: Calls for evidence-informed public health policy, with implicit promises of greater program effectiveness, have intensified recently. The methods to produce such policies are not self-evident, requiring a conciliation of values and norms between policy-makers and evidence producers. In particular, the translation of uncertainty from empirical research findings, particularly issues of statistical variability and generalizability, is a persistent challenge because of the incremental nature of research and the iterative cycle of advancing knowledge and implementation. This paper aims to assess how the concept of uncertainty is considered and acknowledged in World Health Organization (WHO) policy recommendations and guidelines. Methods: We selected four WHO policy statements published between 2008-2013 regarding maternal and child nutrient supplementation, infant feeding, heat action plans, and malaria control to represent topics with a spectrum of available evidence bases. Each of these four statements was analyzed using a novel framework to assess the treatment of statistical variability and generalizability. Results: WHO currently provides substantial guidance on addressing statistical variability through GRADE (Grading of Recommendations Assessment, Development, and Evaluation) ratings for precision and consistency in their guideline documents. Accordingly, our analysis showed that policy-informing questions were addressed by systematic reviews and representations of statistical variability (eg, with numeric confidence intervals). In contrast, the presentation of contextual or "background" evidence regarding etiology or disease burden showed little consideration for this variability. Moreover, generalizability or "indirectness" was uniformly neglected, with little explicit consideration of study settings or subgroups. Conclusion: In this paper, we found that non-uniform treatment of statistical variability and generalizability factors that may contribute to uncertainty regarding recommendations were neglected, including the state of evidence informing background questions (prevalence, mechanisms, or burden or distributions of health problems) and little assessment of generalizability, alternate interventions, and additional outcomes not captured by systematic review. These other factors often form a basis for providing policy recommendations, particularly in the absence of a strong evidence base for intervention effects. Consequently, they should also be subject to stringent and systematic evaluation criteria. We suggest that more effort is needed to systematically acknowledge (1) when evidence is missing, conflicting, or equivocal, (2) what normative considerations were also employed, and (3) how additional evidence may be accrued. PMID:29179291

A Cautious Note on Auxiliary Variables That Can Increase Bias in Missing Data Problems.

PubMed

Thoemmes, Felix; Rose, Norman

2014-01-01

The treatment of missing data in the social sciences has changed tremendously during the last decade. Modern missing data techniques such as multiple imputation and full-information maximum likelihood are used much more frequently. These methods assume that data are missing at random. One very common approach to increase the likelihood that missing at random is achieved consists of including many covariates as so-called auxiliary variables. These variables are either included based on data considerations or in an inclusive fashion; that is, taking all available auxiliary variables. In this article, we point out that there are some instances in which auxiliary variables exhibit the surprising property of increasing bias in missing data problems. In a series of focused simulation studies, we highlight some situations in which this type of biasing behavior can occur. We briefly discuss possible ways how one can avoid selecting bias-inducing covariates as auxiliary variables.

Operation ranges and dynamic capabilities of variable-speed pumped-storage hydropower

NASA Astrophysics Data System (ADS)

Mercier, Thomas; Olivier, Mathieu; Dejaeger, Emmanuel

2017-04-01

The development of renewable and intermittent power generation creates incentives for the development of both energy storage solutions and more flexible power generation assets. Pumped-storage hydropower (PSH) is the most established and mature energy storage technology, but recent developments in power electronics have created a renewed interest by providing PSH units with a variable-speed feature, thereby increasing their flexibility. This paper reviews technical considerations related to variable-speed PSH in link with the provision of primary frequency control, also referred to as frequency containment reserves (FCRs). Based on the detailed characteristics of a scale model pump-turbine, the variable-speed operation ranges in pump and turbine modes are precisely assessed and the implications for the provision of FCRs are highlighted. Modelling and control for power system studies are discussed, both for fixed- and variable-speed machines and simulation results are provided to illustrate the high dynamic capabilities of variable-speed PSH.

Optimal lay-up design of variable stiffness laminated composite plates by a layer-wise optimization technique

NASA Astrophysics Data System (ADS)

Houmat, A.

2018-02-01

The optimal lay-up design for the maximum fundamental frequency of variable stiffness laminated composite plates is investigated using a layer-wise optimization technique. The design variables are two fibre orientation angles per ply. Thin plate theory is used in conjunction with a p-element to calculate the fundamental frequencies of symmetrically and antisymmetrically laminated composite plates. Comparisons with existing optimal solutions for constant stiffness symmetrically laminated composite plates show excellent agreement. It is observed that the maximum fundamental frequency can be increased considerably using variable stiffness design as compared to constant stiffness design. In addition, optimal lay-ups for the maximum fundamental frequency of variable stiffness symmetrically and antisymmetrically laminated composite plates with different aspect ratios and various combinations of free, simply supported and clamped edge conditions are presented. These should prove a useful benchmark for optimal lay-ups of variable stiffness laminated composite plates.

Phenology at the crossroads?

NASA Astrophysics Data System (ADS)

Menzel, Annette

2014-05-01

Phenology is the study of the timing of natural events such as plant growth or animal migration. Currently nearly 500 papers are published annually that include 'phenolog*' in their title; many are related to anthropogenic change. Since seasonal events are triggered predominantly by climate, phenology has emerged as a key asset in identifying fingerprints of climate change in natural systems, especially since recent warming has been mirrored by significantly advancing spring events. Phenological changes have been reported across continents, habitats and taxa, predominantly as mean temporal changes ('trends') or as relationships to temperature and other drivers ('responses'), and have been summarised in various meta-analyses. However, a considerable variability in observed trends and responses is reported along with mixed messages of the footprint of climate change in nature. Phenology has made considerable advances but is a crossroads of understanding this variability. At the same time a change of emphasis in explanation, prediction and adaptation is emerging, which needs a full acknowledgement of this variability; likely yielding to more plasticity and resilience. In this review, I summarize current knowledge and recent insights into the role of • different observation methods, their accuracy and their target phenophases • observed events, species, traits, ontogenetic effects • species-specific safeguarding strategies, e.g. chilling, photoperiod • additional drivers other than climate, e.g. nutrients, GHG, biotic effects, anthropogenic / agricultural management • seasonal as well as spatio-temporal variation, effects of regional climate changes and analogous climates. This review clearly demonstrated that, comparable to weather and climate ensembles, only a full consideration of variation in responses allows a complete understanding of ecological, cultural and socioeconomic consequences of these phenological changes.

Tree-based flood damage modeling of companies: Damage processes and model performance

NASA Astrophysics Data System (ADS)

Sieg, Tobias; Vogel, Kristin; Merz, Bruno; Kreibich, Heidi

2017-07-01

Reliable flood risk analyses, including the estimation of damage, are an important prerequisite for efficient risk management. However, not much is known about flood damage processes affecting companies. Thus, we conduct a flood damage assessment of companies in Germany with regard to two aspects. First, we identify relevant damage-influencing variables. Second, we assess the prediction performance of the developed damage models with respect to the gain by using an increasing amount of training data and a sector-specific evaluation of the data. Random forests are trained with data from two postevent surveys after flood events occurring in the years 2002 and 2013. For a sector-specific consideration, the data set is split into four subsets corresponding to the manufacturing, commercial, financial, and service sectors. Further, separate models are derived for three different company assets: buildings, equipment, and goods and stock. Calculated variable importance values reveal different variable sets relevant for the damage estimation, indicating significant differences in the damage process for various company sectors and assets. With an increasing number of data used to build the models, prediction errors decrease. Yet the effect is rather small and seems to saturate for a data set size of several hundred observations. In contrast, the prediction improvement achieved by a sector-specific consideration is more distinct, especially for damage to equipment and goods and stock. Consequently, sector-specific data acquisition and a consideration of sector-specific company characteristics in future flood damage assessments is expected to improve the model performance more than a mere increase in data.

National variability in provision of health services for major long-term conditions in New Zealand (a report from the ABCC NZ study).

PubMed

Connolly, Martin J; Kenealy, Timothy; Barber, P Alan; Carswell, Peter; Clinton, Janet; Dyall, Lorna; Devlin, Gerard; Doughty, Robert N; Kerse, Ngaire; Kolbe, John; Lawrenson, Ross; Moffitt, Allan; Sheridan, Nicolette

2011-10-14

Chronic illness is the leading cause of morbidity, mortality, and inequitable health outcomes in New Zealand. The ABCCNZ Stocktake aimed to identify extent of long-term conditions management evidence-based practices in stroke, cardiovascular disease, chronic obstructive pulmonary disease and congestive heart failure in New Zealand's District Health Boards (DHBs). Eleven 'dimensions' of care for long-term conditions, identified by literature review and confirmed at workshops with long-term conditions professionals, formed the basis of the Stocktake of all 21 DHBs. It comprised two questionnaires: a generic component capturing perceptions of practice; and a disease-specific component assessing service provision. Fifteen DHBs completed all or parts of the questionnaires. Data accrual was completed in July 2008. Although most DHBs had developed long-term conditions management strategies to a moderate degree, there was considerable variability of practice between DHBs. DHBs thought their PHOs had developed strategies in some areas to a low to moderate level, though cardiovascular disease provision rated more highly. Regarding disease-specific services, larger DHBs had greater long-term conditions management provision not only of tertiary services, but of standard care, leadership, self-management, case-management, and audit. There is considerable variability in perceptions of long-term conditions management service provision across DHBs. In many instances variability in actual disease-specific service provision appears to relate to DHB size.

Quantifying ADHD classroom inattentiveness, its moderators, and variability: a meta-analytic review.

PubMed

Kofler, Michael J; Rapport, Mark D; Alderson, R Matt

2008-01-01

Most classroom observation studies have documented significant deficiencies in the classroom attention of children with attention-deficit/hyperactivity disorder (ADHD) compared to their typically developing peers. The magnitude of these differences, however, varies considerably and may be influenced by contextual, sampling, diagnostic, and observational differences. Meta-analysis of 23 between-group classroom observation studies using weighted regression, publication bias, goodness of fit, best case, and original metric analyses. Across studies, a large effect size (ES = .73) was found prior to consideration of potential moderators. Weighted regression, best case, and original metric estimation indicate that this effect may be an underestimation of the classroom visual attention deficits of children with ADHD. Several methodological factors-classroom environment, sample characteristics, diagnostic procedures, and observational coding schema-differentially affect observed rates of classroom attentive behavior for children with ADHD and typically developing children. After accounting for these factors, children with ADHD were on-task approximately 75% of the time compared to 88% for their classroom peers (ES = 1.40). Children with ADHD were also more variable in their attentive behavior across studies. The present study confirmed that children with ADHD exhibit deficient and more variable visual attending to required stimuli in classroom settings and provided an aggregate estimation of the magnitude of these deficits at the group level. It also demonstrated the impact of situational, sampling, diagnostic, and observational variables on observed rates of on-task behavior.

Dose-response relationships and extrapolation in toxicology - Mechanistic and statistical considerations

EPA Science Inventory

Controversy on toxicological dose-response relationships and low-dose extrapolation of respective risks is often the consequence of misleading data presentation, lack of differentiation between types of response variables, and diverging mechanistic interpretation. In this chapter...

[Chonic diarrhea and malabsorption due to common variable immunodeficiency, gastrectomy and giardiasis infection: a difficult nutritional management].

PubMed

Domínguez-López, M E; González-molero, I; Ramírez-Plaza, C P; Soriguer, F; Olveira, G

2011-01-01

Gastric cancer is a frequent cause of cancer-related mortality in the world. Surgery is the only potentially curative therapy, although the adverse effects of surgery are common and considerable. Common variable immunodeficiency is in many cases cause of gastrointestinal system problems such as chronic diarrhea caused by infestation with giardia lamblia, nodular lymphoid hiperplasia ad loss of villi leading frequently to malapsortion and malnutrition. Nutritional deficiencies due to malapsorption (postgastrectomy and secondary to loss of villi, giardiasis and common variable inmunodeficiency) are common. We present the case of a patient with gastric cancer who underwent a gastrectomy with common variable hipogammaglobulinemia and chronic infestation by giardia lamblia, with serious diarrhea resistant to treatment and malabsorption.

Plasticity models of material variability based on uncertainty quantification techniques

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jones, Reese E.; Rizzi, Francesco; Boyce, Brad

The advent of fabrication techniques like additive manufacturing has focused attention on the considerable variability of material response due to defects and other micro-structural aspects. This variability motivates the development of an enhanced design methodology that incorporates inherent material variability to provide robust predictions of performance. In this work, we develop plasticity models capable of representing the distribution of mechanical responses observed in experiments using traditional plasticity models of the mean response and recently developed uncertainty quantification (UQ) techniques. Lastly, we demonstrate that the new method provides predictive realizations that are superior to more traditional ones, and how these UQmore » techniques can be used in model selection and assessing the quality of calibrated physical parameters.« less

Forgiveness and Consideration of Future Consequences in Aggressive Driving

PubMed Central

Moore, Michael; Dahlen, Eric R.

2008-01-01

Most research on aggressive driving has focused on identifying aspects of driver personality which will exacerbate it (e.g., sensation seeking, impulsiveness, driving anger, etc.). The present study was designed to examine two theoretically relevant but previously unexplored personality factors predicted to reduce the risk of aggressive driving: trait forgiveness and consideration of future consequences. The utility of these variables in predicting aggressive driving and driving anger expression was evaluated among 316 college student volunteers. Hierarchical multiple regressions permitted an analysis of the incremental validity of these constructs beyond respondent gender, age, miles driven per week, and driving anger. Both forgiveness and consideration of future consequences contributed to the prediction of aggressive driving and driving anger expression, independent of driving anger. Research on aggressive driving may be enhanced by greater attention to adaptive, potentially risk-reducing traits. Moreover, forgiveness and consideration of future consequences may have implications for accident prevention. PMID:18760093

Market Evolution: Wholesale Electricity Market Design for 21st Century Power Systems

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cochran, Jaquelin; Miller, Mackay; Milligan, Michael

2013-10-01

Demand for affordable, reliable, domestically sourced, and low-carbon electricity is on the rise. This growing demand is driven in part by evolving public policy priorities, especially reducing the health and environmental impacts of electricity service and expanding energy access to under-served customers. Consequently, variable renewable energy resources comprise an increasing share ofelectricity generation globally. At the same time, new opportunities for addressing the variability of renewables are being strengthened through advances in smart grids, communications, and technologies that enable dispatchable demand response and distributed generation to extend to the mass market. A key challenge of merging these opportunities is marketmore » design -- determining how to createincentives and compensate providers justly for attributes and performance that ensure a reliable and secure grid -- in a context that fully realizes the potential of a broad array of sources of flexibility in both the wholesale power and retail markets. This report reviews the suite of wholesale power market designs in use and under consideration to ensure adequacy, security, and flexibilityin a landscape of significant variable renewable energy. It also examines considerations needed to ensure that wholesale market designs are inclusive of emerging technologies, such as demand response, distributed generation, and storage.« less

A Requirements-Driven Optimization Method for Acoustic Liners Using Analytic Derivatives

NASA Technical Reports Server (NTRS)

Berton, Jeffrey J.; Lopes, Leonard V.

2017-01-01

More than ever, there is flexibility and freedom in acoustic liner design. Subject to practical considerations, liner design variables may be manipulated to achieve a target attenuation spectrum. But characteristics of the ideal attenuation spectrum can be difficult to know. Many multidisciplinary system effects govern how engine noise sources contribute to community noise. Given a hardwall fan noise source to be suppressed, and using an analytical certification noise model to compute a community noise measure of merit, the optimal attenuation spectrum can be derived using multidisciplinary systems analysis methods. In a previous paper on this subject, a method deriving the ideal target attenuation spectrum that minimizes noise perceived by observers on the ground was described. A simple code-wrapping approach was used to evaluate a community noise objective function for an external optimizer. Gradients were evaluated using a finite difference formula. The subject of this paper is an application of analytic derivatives that supply precise gradients to an optimization process. Analytic derivatives improve the efficiency and accuracy of gradient-based optimization methods and allow consideration of more design variables. In addition, the benefit of variable impedance liners is explored using a multi-objective optimization.

Selected options supporting use of the group embedded figures test in modeling achievement in clinical laboratory science programs.

PubMed

Powell, M E

1995-01-01

To identify, in light of predicted future shortages of allied-health personnel, student and curricular characteristics of clinical laboratory science (CLS) programs relevant to recruitment and retention at the baccalaureate level. Not applicable. Not applicable. Options for modeling achievement in CLS programs are developed, and designs and procedures for clarifying procedural questions are considered in a context of delivery of instruction for specialized curricula and skill development. Considerable attention is given to the potential for using the Group Embedded Figures Test (GEFT) in modeling, advising, designing curricula, and monitoring quality improvement of programs and graduates. Not applicable. Supporting evidence is supplied from the literature for options in developing an appropriate model for examining those salient variables known to have linkages to achievement. An argument is presented for better understanding of antecedent variables affecting achievement and retention of CLS students. In addition, a case is made for development of an appropriate model examining variables identified in the literature as being linked to achievement. Dynamic models based on these considerations should be developed chronologically from entry through graduation with emphasis on growth at year-end milestones.

Comparative Study of Drift Compensation Methods for Environmental Gas Sensors

NASA Astrophysics Data System (ADS)

Abidin, M. Z.; Asmat, Arnis; Hamidon, M. N.

2018-02-01

Most drift compensation attempts in environmental gas sensors are only emphasize on the “already-known” drift-causing parameter (i.e., ambient temperature, relative humidity) in compensating the sensor drift. Less consideration is taken to another parameter (i.e., baseline responses) that might have affected indirectly with the promotion of drift-causing parameter variable (in this context, is ambient temperature variable). In this study, the “indirect” drift-causing parameter (drifted baseline responses) has been taken into consideration in compensating the sensor drift caused by ambient temperature variable, by means of a proposed drift compensation method (named as RT-method). The effectiveness of this method in its efficacy of compensating drift was analysed and compared with the common method that used the “already-known” drift-causing parameter (named as T-method), using drift reduction percentage. From the results analysis, the RT-method has outperformed T- method in the drift reduction percentage, with its ability to reduce drift up to 64% rather than the T-method which only able to reduce up to 45% for TGS2600 sensor. It has proven that the inclusion of drifted baseline responses into drift compensation attempt would resulted to an improved drift compensation efficiency.

Development of Probabilistic Flood Inundation Mapping For Flooding Induced by Dam Failure

NASA Astrophysics Data System (ADS)

Tsai, C.; Yeh, J. J. J.

2017-12-01

A primary function of flood inundation mapping is to forecast flood hazards and assess potential losses. However, uncertainties limit the reliability of inundation hazard assessments. Major sources of uncertainty should be taken into consideration by an optimal flood management strategy. This study focuses on the 20km reach downstream of the Shihmen Reservoir in Taiwan. A dam failure induced flood herein provides the upstream boundary conditions of flood routing. The two major sources of uncertainty that are considered in the hydraulic model and the flood inundation mapping herein are uncertainties in the dam break model and uncertainty of the roughness coefficient. The perturbance moment method is applied to a dam break model and the hydro system model to develop probabilistic flood inundation mapping. Various numbers of uncertain variables can be considered in these models and the variability of outputs can be quantified. The probabilistic flood inundation mapping for dam break induced floods can be developed with consideration of the variability of output using a commonly used HEC-RAS model. Different probabilistic flood inundation mappings are discussed and compared. Probabilistic flood inundation mappings are hoped to provide new physical insights in support of the evaluation of concerning reservoir flooded areas.

Empirical and semi-analytical models for predicting peak outflows caused by embankment dam failures

NASA Astrophysics Data System (ADS)

Wang, Bo; Chen, Yunliang; Wu, Chao; Peng, Yong; Song, Jiajun; Liu, Wenjun; Liu, Xin

2018-07-01

Prediction of peak discharge of floods has attracted great attention for researchers and engineers. In present study, nine typical nonlinear mathematical models are established based on database of 40 historical dam failures. The first eight models that were developed with a series of regression analyses are purely empirical, while the last one is a semi-analytical approach that was derived from an analytical solution of dam-break floods in a trapezoidal channel. Water depth above breach invert (Hw), volume of water stored above breach invert (Vw), embankment length (El), and average embankment width (Ew) are used as independent variables to develop empirical formulas of estimating the peak outflow from breached embankment dams. It is indicated from the multiple regression analysis that a function using the former two variables (i.e., Hw and Vw) produce considerably more accurate results than that using latter two variables (i.e., El and Ew). It is shown that the semi-analytical approach works best in terms of both prediction accuracy and uncertainty, and the established empirical models produce considerably reasonable results except the model only using El. Moreover, present models have been compared with other models available in literature for estimating peak discharge.

Wireless Power Transfer for Space Applications

NASA Technical Reports Server (NTRS)

Ramos, Gabriel Vazquez; Yuan, Jiann-Shiun

2011-01-01

This paper introduces an implementation for magnetic resonance wireless power transfer for space applications. The analysis includes an equivalent impedance study, loop material characterization, source/load resonance coupling technique, and system response behavior due to loads variability. System characterization is accomplished by executing circuit design from analytical equations and simulations using Matlab and SPICE. The theory was validated by a combination of different experiments that includes loop material consideration, resonance coupling circuits considerations, electric loads considerations and a small scale proof-of-concept prototype. Experiment results shows successful wireless power transfer for all the cases studied. The prototype provided about 4.5 W of power to the load at a separation of -5 cm from the source using a power amplifier rated for 7 W.

Plausible Effect of Weather on Atlantic Meridional Overturning Circulation with a Coupled General Circulation Model

NASA Astrophysics Data System (ADS)

Liu, Zedong; Wan, Xiuquan

2018-04-01

The Atlantic meridional overturning circulation (AMOC) is a vital component of the global ocean circulation and the heat engine of the climate system. Through the use of a coupled general circulation model, this study examines the role of synoptic systems on the AMOC and presents evidence that internally generated high-frequency, synoptic-scale weather variability in the atmosphere could play a significant role in maintaining the overall strength and variability of the AMOC, thereby affecting climate variability and change. Results of a novel coupling technique show that the strength and variability of the AMOC are greatly reduced once the synoptic weather variability is suppressed in the coupled model. The strength and variability of the AMOC are closely linked to deep convection events at high latitudes, which could be strongly affected by the weather variability. Our results imply that synoptic weather systems are important in driving the AMOC and its variability. Thus, interactions between atmospheric weather variability and AMOC may be an important feedback mechanism of the global climate system and need to be taken into consideration in future climate change studies.

Understanding Human-Coyote Encounters in Urban Ecosystems Using Citizen Science Data: What Do Socioeconomics Tell Us?

NASA Astrophysics Data System (ADS)

Wine, Stuart; Gagné, Sara A.; Meentemeyer, Ross K.

2015-01-01

The coyote ( Canis latrans) has dramatically expanded its range to include the cities and suburbs of the western US and those of the Eastern Seaboard. Highly adaptable, this newcomer's success causes conflicts with residents, necessitating research to understand the distribution of coyotes in urban landscapes. Citizen science can be a powerful approach toward this aim. However, to date, the few studies that have used publicly reported coyote sighting data have lacked an in-depth consideration of human socioeconomic variables, which we suggest are an important source of overlooked variation in data that describe the simultaneous occurrence of coyotes and humans. We explored the relative importance of socioeconomic variables compared to those describing coyote habitat in predicting human-coyote encounters in highly-urbanized Mecklenburg County, North Carolina, USA using 707 public reports of coyote sightings, high-resolution land cover, US Census data, and an autologistic multi-model inference approach. Three of the four socioeconomic variables which we hypothesized would have an important influence on encounter probability, namely building density, household income, and occupation, had effects at least as large as or larger than coyote habitat variables. Our results indicate that the consideration of readily available socioeconomic variables in the analysis of citizen science data improves the prediction of species distributions by providing insight into the effects of important factors for which data are often lacking, such as resource availability for coyotes on private property and observer experience. Managers should take advantage of citizen scientists in human-dominated landscapes to monitor coyotes in order to understand their interactions with humans.

Simulation of ferromagnetic nanomaterial flow of Maxwell fluid

NASA Astrophysics Data System (ADS)

Hayat, T.; Ahmad, Salman; Khan, M. Ijaz; Alsaedi, A.

2018-03-01

Ferromagnetic flow of rate type liquid over a stretched surface is addressed in this article. Heat and mass transport are investigated with Brownian movement and thermophoresis effects. Magnetic dipole is also taken into consideration. Procedure of similarity transformation is employed. The obtained nonlinear expressions have been tackled numerically by means of Shooting method. Graphical results are shown and analyzed for the impact of different variables. Temperature and concentration gradients are numerically computed in Tables 1 and 2. The results described here demonstrate that ferromagnetic variable boosts the thermal field. It is noticed that velocity and concentration profiles are higher when elastic and thermophoresis variables are enhanced.

Discerning the impact of personal and situational variables in risk perception of coronary heart disease.

PubMed

Figueiras, Maria João; Maroco, João; Monteiro, Rita; Caeiro, Raúl; Neto, David D

2017-03-01

Research into how people perceive risk has highlighted the interaction between the available information and personal variables and their impact on judgement. This study sought to identify demographic and health variables that influenced risk and the influence of individual risk assessment, dispositional optimism and negative affect on judgement. A total of 476 participants were asked to make risks judgements of 24 vignettes depicting hypothetical risk scenarios. The findings showed that while people are able to correctly recognise, in others, relevant risk factors for coronary heart disease, risk perception is likely to imply a personal consideration of the same risk factors in themselves.

The Development of Talent through Curriculum.

ERIC Educational Resources Information Center

Van Tassel-Baska, Joyce

1995-01-01

An integrated curriculum model (ICM) is applied to the talent development process. Discussion focuses on a rationale for such a model, model features, applications in two federally funded curriculum projects, and relationship of the ICM to curriculum reform variables and implementation considerations. (DB)

Understanding your capital options.

PubMed

Payne, Christopher T

2012-05-01

When planning capital expenditures, hospitals and health systems should understand the following financing considerations: Traditional fixed-rate tax-exempt bonds; Variable-rate financing alternatives; Basel III Accord requirements; Direct tax-exempt bank loans; Total return swaps Taxable financings; Interest-rate swaps and collateral requirements

COLLOIDAL-FACILITATED TRANSPORT OF INORGANIC CONTAMINANTS IN GROUND WATER: PART I. SAMPLING CONSIDERATIONS

EPA Science Inventory

Investigations at Pinal Creek, Arizona, evaluated routine sampling procedures for determination of aqueous inorganic geochemistry and assessment of contaminant transport by colloidal mobility. Sampling variables included pump type and flow rate, collection under air or nitrogen,...

Thermosphere-Ionosphere-Mesosphere Modeling Using the TIE-GCM, TIME-GCM, and WACCM That Will Lead to the Development of a Seamless Model of the Whole Atmosphere

DTIC Science & Technology

2006-09-30

disturbances from the lower atmosphere and ocean affect the upper atmosphere and how this variability interacts with the variability generated by solar and...represents “ general circulation model.” Both models include self-consistent ionospheric electrodynamics, that is, a calculation of the electric fields...and currents generated by the ionospheric dynamo, and consideration of their effects on the neutral dynamics. The TIE-GCM is used for studies that

Transverse Motion of a Particle with an Oscillating Charge and Variable Mass in a Magnetic Field

NASA Astrophysics Data System (ADS)

Alisultanov, Z. Z.; Ragimkhanov, G. B.

2018-03-01

The problem of motion of a particle with an oscillating electric charge and variable mass in an uniform magnetic field has been solved. Three laws of mass variation have been considered: linear growth, oscillations, and stepwise growth. Analytical expressions for the particle velocity at different time dependences of the particle mass are obtained. It is established that simultaneous consideration of changes in the mass and charge leads to a significant change in the particle trajectory.

Hydrologic Remote Sensing and Land Surface Data Assimilation.

PubMed

Moradkhani, Hamid

2008-05-06

Accurate, reliable and skillful forecasting of key environmental variables such as soil moisture and snow are of paramount importance due to their strong influence on many water resources applications including flood control, agricultural production and effective water resources management which collectively control the behavior of the climate system. Soil moisture is a key state variable in land surface-atmosphere interactions affecting surface energy fluxes, runoff and the radiation balance. Snow processes also have a large influence on land-atmosphere energy exchanges due to snow high albedo, low thermal conductivity and considerable spatial and temporal variability resulting in the dramatic change on surface and ground temperature. Measurement of these two variables is possible through variety of methods using ground-based and remote sensing procedures. Remote sensing, however, holds great promise for soil moisture and snow measurements which have considerable spatial and temporal variability. Merging these measurements with hydrologic model outputs in a systematic and effective way results in an improvement of land surface model prediction. Data Assimilation provides a mechanism to combine these two sources of estimation. Much success has been attained in recent years in using data from passive microwave sensors and assimilating them into the models. This paper provides an overview of the remote sensing measurement techniques for soil moisture and snow data and describes the advances in data assimilation techniques through the ensemble filtering, mainly Ensemble Kalman filter (EnKF) and Particle filter (PF), for improving the model prediction and reducing the uncertainties involved in prediction process. It is believed that PF provides a complete representation of the probability distribution of state variables of interests (according to sequential Bayes law) and could be a strong alternative to EnKF which is subject to some limitations including the linear updating rule and assumption of jointly normal distribution of errors in state variables and observation.

CMAQ MODELING FOR AIR TOXICS AT FINE SCALES: A PROTOTYPE STUDY

EPA Science Inventory

Toxic air pollutants (TAPs) or hazardous air pollutants (HAPs) exhibit considerable spatial and temporal variability across urban areas. Therefore, the ability of chemical transport models (CTMs), e.g. Community Multi-scale Air Quality (CMAQ), to reproduce the spatial and tempor...

Using Large Data Sets to Study College Education Trajectories

ERIC Educational Resources Information Center

Oseguera, Leticia; Hwang, Jihee

2014-01-01

This chapter presents various considerations researchers undertook to conduct a quantitative study on low-income students using a national data set. Specifically, it describes how a critical quantitative scholar approaches guiding frameworks, variable operationalization, analytic techniques, and result interpretation. Results inform how…

Methods and Techniques of Revenue Forecasting.

ERIC Educational Resources Information Center

Caruthers, J. Kent; Wentworth, Cathi L.

1997-01-01

Revenue forecasting is the critical first step in most college and university budget-planning processes. While it seems a straightforward exercise, effective forecasting requires consideration of a number of interacting internal and external variables, including demographic trends, economic conditions, and broad social priorities. The challenge…

Symbolic Representation of Probabilistic Worlds

ERIC Educational Resources Information Center

Feldman, Jacob

2012-01-01

Symbolic representation of environmental variables is a ubiquitous and often debated component of cognitive science. Yet notwithstanding centuries of philosophical discussion, the efficacy, scope, and validity of such representation has rarely been given direct consideration from a mathematical point of view. This paper introduces a quantitative…

Tuned Normalization Explains the Size of Attention Modulations

PubMed Central

Ni, Amy M.; Ray, Supratim; Maunsell, John H. R.

2012-01-01

SUMMARY The effect of attention on firing rates varies considerably within a single cortical area. The firing rate of some neurons is greatly modulated by attention while others are hardly affected. The reason for this variability across neurons is unknown. We found that the variability in attention modulation across neurons in area MT of macaques can be well explained by variability in the strength of tuned normalization across neurons. The presence of tuned normalization also explains a striking asymmetry in attention effects within neurons: when two stimuli are in a neuron’s receptive field, directing attention to the preferred stimulus modulates firing rates more than directing attention to the non-preferred stimulus. These findings show that much of the neuron-to-neuron variability in modulation of responses by attention depends on variability in the way the neurons process multiple stimuli, rather than differences in the influence of top-down signals related to attention. PMID:22365552

Mechanisms driving variability in the ocean forcing of Pine Island Glacier

PubMed Central

Webber, Benjamin G. M.; Heywood, Karen J.; Stevens, David P.; Dutrieux, Pierre; Abrahamsen, E. Povl; Jenkins, Adrian; Jacobs, Stanley S.; Ha, Ho Kyung; Lee, Sang Hoon; Kim, Tae Wan

2017-01-01

Pine Island Glacier (PIG) terminates in a rapidly melting ice shelf, and ocean circulation and temperature are implicated in the retreat and growing contribution to sea level rise of PIG and nearby glaciers. However, the variability of the ocean forcing of PIG has been poorly constrained due to a lack of multi-year observations. Here we show, using a unique record close to the Pine Island Ice Shelf (PIIS), that there is considerable oceanic variability at seasonal and interannual timescales, including a pronounced cold period from October 2011 to May 2013. This variability can be largely explained by two processes: cumulative ocean surface heat fluxes and sea ice formation close to PIIS; and interannual reversals in ocean currents and associated heat transport within Pine Island Bay, driven by a combination of local and remote forcing. Local atmospheric forcing therefore plays an important role in driving oceanic variability close to PIIS. PMID:28211473

Tuned normalization explains the size of attention modulations.

PubMed

Ni, Amy M; Ray, Supratim; Maunsell, John H R

2012-02-23

The effect of attention on firing rates varies considerably within a single cortical area. The firing rate of some neurons is greatly modulated by attention while others are hardly affected. The reason for this variability across neurons is unknown. We found that the variability in attention modulation across neurons in area MT of macaques can be well explained by variability in the strength of tuned normalization across neurons. The presence of tuned normalization also explains a striking asymmetry in attention effects within neurons: when two stimuli are in a neuron's receptive field, directing attention to the preferred stimulus modulates firing rates more than directing attention to the nonpreferred stimulus. These findings show that much of the neuron-to-neuron variability in modulation of responses by attention depends on variability in the way the neurons process multiple stimuli, rather than differences in the influence of top-down signals related to attention. Copyright © 2012 Elsevier Inc. All rights reserved.

Using climate model simulations to assess the current climate risk to maize production

NASA Astrophysics Data System (ADS)

Kent, Chris; Pope, Edward; Thompson, Vikki; Lewis, Kirsty; Scaife, Adam A.; Dunstone, Nick

2017-05-01

The relationship between the climate and agricultural production is of considerable importance to global food security. However, there has been relatively little exploration of climate-variability related yield shocks. The short observational yield record does not adequately sample natural inter-annual variability thereby limiting the accuracy of probability assessments. Focusing on the United States and China, we present an innovative use of initialised ensemble climate simulations and a new agro-climatic indicator, to calculate the risk of severe water stress. Combined, these regions provide 60% of the world’s maize, and therefore, are crucial to global food security. To probe a greater range of inter-annual variability, the indicator is applied to 1400 simulations of the present day climate. The probability of severe water stress in the major maize producing regions is quantified, and in many regions an increased risk is found compared to calculations from observed historical data. Analysis suggests that the present day climate is also capable of producing unprecedented severe water stress conditions. Therefore, adaptation plans and policies based solely on observed events from the recent past may considerably under-estimate the true risk of climate-related maize shocks. The probability of a major impact event occurring simultaneously across both regions—a multi-breadbasket failure—is estimated to be up to 6% per decade and arises from a physically plausible climate state. This novel approach highlights the significance of climate impacts on crop production shocks and provides a platform for considerably improving food security assessments, in the present day or under a changing climate, as well as development of new risk based climate services.

Effectiveness of cross-cultural education for medical residents caring for burmese refugees.

PubMed

McHenry, Megan Song; Nutakki, Kavitha; Swigonski, Nancy L

2016-01-01

Limited resources are available to educate health professionals on cultural considerations and specific healthcare needs of Burmese refugees. The objective of this study was to determine the effectiveness of a module focused on cross-cultural considerations when caring for Burmese refugees. A brief educational module using anonymously tracked pre- and post-intervention, self-administered surveys was developed and studied. The surveys measured pediatric and family medicine residents' knowledge, attitudes, and comfort in caring for Burmese refugees. Paired t-tests for continuous variables and Fisher's exact tests for categorical variables were used to test pre- and post-intervention differences. We included open-ended questions for residents to describe their experiences with the Burmese population. The survey was available to 173 residents. Forty-four pre- and post-intervention surveys were completed (response rate of 25%). Resident comfort in caring for Burmese increased significantly after the module (P = 0.04). Resident knowledge of population-specific cultural information increased regarding ethnic groups (P = 0.004), appropriate laboratory use (P = 0.04), and history gathering (P = 0.001). Areas of improved resident attitudes included comprehension of information from families (P = 0.03) and length of time required with interpreter (P = 0.01). Thematic evaluation of qualitative data highlighted four themes: access to interpreter and resources, verbal communication, nonverbal communication, and relationship building with cultural considerations. A brief intervention for residents has the potential to improve knowledge, attitudes, and comfort in caring for Burmese patients. Interventions focused on cultural considerations in medical care may improve cultural competency when caring for vulnerable patient populations.

Exposure Estimation and Interpretation of Occupational Risk: Enhanced Information for the Occupational Risk Manager

PubMed Central

Waters, Martha; McKernan, Lauralynn; Maier, Andrew; Jayjock, Michael; Schaeffer, Val; Brosseau, Lisa

2015-01-01

The fundamental goal of this article is to describe, define, and analyze the components of the risk characterization process for occupational exposures. Current methods are described for the probabilistic characterization of exposure, including newer techniques that have increasing applications for assessing data from occupational exposure scenarios. In addition, since the probability of health effects reflects variability in the exposure estimate as well as the dose-response curve—the integrated considerations of variability surrounding both components of the risk characterization provide greater information to the occupational hygienist. Probabilistic tools provide a more informed view of exposure as compared to use of discrete point estimates for these inputs to the risk characterization process. Active use of such tools for exposure and risk assessment will lead to a scientifically supported worker health protection program. Understanding the bases for an occupational risk assessment, focusing on important sources of variability and uncertainty enables characterizing occupational risk in terms of a probability, rather than a binary decision of acceptable risk or unacceptable risk. A critical review of existing methods highlights several conclusions: (1) exposure estimates and the dose-response are impacted by both variability and uncertainty and a well-developed risk characterization reflects and communicates this consideration; (2) occupational risk is probabilistic in nature and most accurately considered as a distribution, not a point estimate; and (3) occupational hygienists have a variety of tools available to incorporate concepts of risk characterization into occupational health and practice. PMID:26302336

Phenotypic variability in unicellular organisms: from calcium signalling to social behaviour

PubMed Central

Vogel, David; Nicolis, Stamatios C.; Perez-Escudero, Alfonso; Nanjundiah, Vidyanand; Sumpter, David J. T.; Dussutour, Audrey

2015-01-01

Historically, research has focused on the mean and often neglected the variance. However, variability in nature is observable at all scales: among cells within an individual, among individuals within a population and among populations within a species. A fundamental quest in biology now is to find the mechanisms that underlie variability. Here, we investigated behavioural variability in a unique unicellular organism, Physarum polycephalum. We combined experiments and models to show that variability in cell signalling contributes to major differences in behaviour underpinning some aspects of social interactions. First, following thousands of cells under various contexts, we identified distinct behavioural phenotypes: ‘slow–regular–social’, ‘fast–regular–social’ and ‘fast–irregular–asocial’. Second, coupling chemical analysis and behavioural assays we found that calcium signalling is responsible for these behavioural phenotypes. Finally, we show that differences in signalling and behaviour led to alternative social strategies. Our results have considerable implications for our understanding of the emergence of variability in living organisms. PMID:26609088

Phenotypic variability in unicellular organisms: from calcium signalling to social behaviour.

PubMed

Vogel, David; Nicolis, Stamatios C; Perez-Escudero, Alfonso; Nanjundiah, Vidyanand; Sumpter, David J T; Dussutour, Audrey

2015-11-22

Historically, research has focused on the mean and often neglected the variance. However, variability in nature is observable at all scales: among cells within an individual, among individuals within a population and among populations within a species. A fundamental quest in biology now is to find the mechanisms that underlie variability. Here, we investigated behavioural variability in a unique unicellular organism, Physarum polycephalum. We combined experiments and models to show that variability in cell signalling contributes to major differences in behaviour underpinning some aspects of social interactions. First, following thousands of cells under various contexts, we identified distinct behavioural phenotypes: 'slow-regular-social', 'fast-regular-social' and 'fast-irregular-asocial'. Second, coupling chemical analysis and behavioural assays we found that calcium signalling is responsible for these behavioural phenotypes. Finally, we show that differences in signalling and behaviour led to alternative social strategies. Our results have considerable implications for our understanding of the emergence of variability in living organisms. © 2015 The Author(s).

Improving non-native fish larvae detection based on temporal habitat use.

EPA Science Inventory

As part of the development of an early detection monitoring strategy for non-native fishes, larval fish surveys have been conducted since 2012 in the St. Louis River estuary. Survey data demonstrates considerable variability in fish abundance and species assemblages across habit...

Language and Communication Development in Down Syndrome

ERIC Educational Resources Information Center

Roberts, Joanne E.; Price, Johanna; Malkin, Cheryl

2007-01-01

Although there is considerable variability, most individuals with Down syndrome have mental retardation and speech and language deficits, particularly in language production and syntax and poor speech intelligibility. This article describes research findings in the language and communication development of individuals with Down syndrome, first…

Detectability and Interpretational Uncertainties: Considerations in Gauging the Impacts of Land Disturbance on Streamflow

EPA Science Inventory

Hydrologic impacts of land disturbance and management can be confounded by rainfall variability. As a consequence, attempts to gauge and quantify these effects through streamflow monitoring are typically subject to uncertainties. This paper addresses the quantification and deline...

14 CFR 25.941 - Inlet, engine, and exhaust compatibility.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., engine, and exhaust compatibility. For airplanes using variable inlet or exhaust system geometry, or both— (a) The system comprised of the inlet, engine (including thrust augmentation systems, if incorporated... configurations; (b) The dynamic effects of the operation of these (including consideration of probable...

Pile/shaft designs using artificial neural networks (i.e., genetic programming) with spatial variability considerations : [summary].

DOT National Transportation Integrated Search

2014-03-01

In this project, University of Florida researchers : sought to improve the unit skin friction and tip : resistance correlations embedded in the FB-Deep : software algorithm for estimating driven pile and : drilled shaft resistance. They utilized an a...

Postpartum Depression: An Overview.

ERIC Educational Resources Information Center

Albright, Angela

1993-01-01

Occurring in about 12 percent of postpartum women, postpartum depression has been focus of considerable research. Variables that have been correlated with postpartum depression range from biological causes, to lack of social support, to relationship with husband, to attributional styles, to psychodynamic explanations. There is need for more…

Implications for social policy of variability in racial groups.

PubMed

Helms, Janet E

2008-11-01

Social policy and federal and state legislation require the use of single cut scores when tests of cognitive ability, knowledge, or skills (CAKS) are used to make high-stakes assessment decisions, such as whether students or employees may be promoted. Rationales offered for the requirement are that cut scores provide objective standards and are fairer than using subjective criteria, such as racial group membership. It is argued that failure to consider threats to statistical conclusion validity, such as differences in variability between groups, obscures the differential impact of using a common cut score as the basis for highstakes decisions. Analyses of 40 Black and White samples revealed that (a) Whites might be considerably advantaged and Blacks might be considerably disadvantaged by the same cut score and (b) depending on where the cut score is set, decisions based on ratios of numbers of Whites numbers of Blacks might be fairer than use of CAKS test cut scores. Implications for assessment practice and social policy are discussed.

Violation of a Bell-like inequality in single-neutron interferometry.

PubMed

Hasegawa, Yuji; Loidl, Rudolf; Badurek, Gerald; Baron, Matthias; Rauch, Helmut

2003-09-04

Non-local correlations between spatially separated systems have been extensively discussed in the context of the Einstein, Podolsky and Rosen (EPR) paradox and Bell's inequalities. Many proposals and experiments designed to test hidden variable theories and the violation of Bell's inequalities have been reported; usually, these involve correlated photons, although recently an experiment was performed with (9)Be(+) ions. Nevertheless, it is of considerable interest to show that such correlations (arising from quantum mechanical entanglement) are not simply a peculiarity of photons. Here we measure correlations between two degrees of freedom (comprising spatial and spin components) of single neutrons; this removes the need for a source of entangled neutron pairs, which would present a considerable technical challenge. A Bell-like inequality is introduced to clarify the correlations that can arise between observables of otherwise independent degrees of freedom. We demonstrate the violation of this Bell-like inequality: our measured value is 2.051 +/- 0.019, clearly above the value of 2 predicted by classical hidden variable theories.

Predictors of alcohol abusers' inconsistent self-reports of their drinking and life events.

PubMed

Toneatto, T; Sobell, L C; Sobell, M B

1992-06-01

Although considerable research supports the veridicality of alcohol abusers' self-reports, all studies find that some proportion of self-reports are inaccurate. Recently, a few studies have examined variables predictive of inaccurate self-reports and found considerable intersubject variability. The present study examined predictors of alcohol abusers' inconsistent reports of life events and drinking using test-retest reliability data from two questionnaires. Results indicated that inconsistent self-reports were associated with the type (i.e., objective versus subjective) and amount (i.e., more drinking involvement at the first interview was associated with greater discrepant reports at the second interview) of information to be recalled. It appears that the nature of the questions asked may be as much or more of a contributing factor to inaccurate self-reports as subject or setting factors, especially for individuals who report high levels of alcohol use, for whom special efforts may be necessary to gather valid self-report data.

Global distribution and epidemiologic associations of Escherichia coli clonal group A, 1998-2007.

PubMed

Johnson, James R; Menard, Megan E; Lauderdale, Tsai-Ling; Kosmidis, Chris; Gordon, David; Collignon, Peter; Maslow, Joel N; Andrasević, Arjana Tambić; Kuskowski, Michael A

2011-11-01

Escherichia coli clonal group A (CGA) was first reported in 2001 as an emerging multidrug-resistant extraintestinal pathogen. Because CGA has considerable implications for public health, we examined the trends of its global distribution, clinical associations, and temporal prevalence for the years 1998-2007. We characterized 2,210 E. coli extraintestinal clinical isolates from 32 centers on 6 continents by CGA status for comparison with trimethoprim/sulfamethoxazole (TMP/SMZ) phenotype, specimen type, inpatient/outpatient source, and adult/child host; we adjusted for clustering by center. CGA prevalence varied greatly by center and continent, was strongly associated with TMP/SMZ resistance but not with other epidemiologic variables, and exhibited no temporal prevalence trend. Our findings indicate that CGA is a prominent, primarily TMP/SMZ-resistant extraintestinal pathogen concentrated within the Western world, with considerable pathogenic versatility. The stable prevalence of CGA over time suggests full emergence by the late 1990s, followed by variable endemicity worldwide as an antimicrobial drug-resistant public health threat.

Design of state-feedback controllers including sensitivity reduction, with applications to precision pointing

NASA Technical Reports Server (NTRS)

Hadass, Z.

1974-01-01

The design procedure of feedback controllers was described and the considerations for the selection of the design parameters were given. The frequency domain properties of single-input single-output systems using state feedback controllers are analyzed, and desirable phase and gain margin properties are demonstrated. Special consideration is given to the design of controllers for tracking systems, especially those designed to track polynomial commands. As an example, a controller was designed for a tracking telescope with a polynomial tracking requirement and some special features such as actuator saturation and multiple measurements, one of which is sampled. The resulting system has a tracking performance comparing favorably with a much more complicated digital aided tracker. The parameter sensitivity reduction was treated by considering the variable parameters as random variables. A performance index is defined as a weighted sum of the state and control convariances that sum from both the random system disturbances and the parameter uncertainties, and is minimized numerically by adjusting a set of free parameters.

Linkage and Anomeric Differentiation in Trisaccharides by Sequential Fragmentation and Variable-Wavelength Infrared Photodissociation

NASA Astrophysics Data System (ADS)

Tan, Yanglan; Polfer, Nicolas C.

2015-02-01

Carbohydrates and their derivatives play important roles in biological systems, but their isomeric heterogeneity also presents a considerable challenge for analytical techniques. Here, a stepwise approach using infrared multiple-photon dissociation (IRMPD) via a tunable CO2 laser (9.2-10.7 μm) was employed to characterize isomeric variants of glucose-based trisaccharides. After the deprotonated trisaccharides were trapped and fragmented to disaccharide C2 fragments in a Fourier transform ion cyclotron resonance (FTICR) cell, a further variable-wavelength infrared irradiation of the C2 ion produced wavelength-dependent dissociation patterns that are represented as heat maps. The photodissociation patterns of these C2 fragments are shown to be strikingly similar to the photodissociation patterns of disaccharides with identical glycosidic bonds. Conversely, the photodissociation patterns of different glycosidic linkages exhibit considerable differences. On the basis of these results, the linkage position and anomericity of glycosidic bonds of disaccharide units in trisaccharides can be systematically differentiated and identified, providing a promising approach to characterize the structures of isomeric oligosaccharides.

High Velocity Burner Rig Oxidation and Thermal Fatigue Behavior of Si3N4- and SiC Base Ceramics to 1370 Deg C

NASA Technical Reports Server (NTRS)

Sanders, W. A.; Johnston, J. R.

1978-01-01

One SiC material and three Si3N4 materials including hot-pressed Si3N4 as a baseline were exposed in a Mach-1-gas-velocity burner rig simulating a turbine engine environment. Criteria for the materials selection were: potential for gas-turbine usage, near-net-shape fabricability and commercial/domestic availability. Cyclic exposures of test vanes up to 250 cycles (50 hr at temperature) were at leading-edge temperatures to 1370 C. Materials and batches were compared as to weight change, surface change, fluorescent penetrant inspection, and thermal fatigue behavior. Hot-pressed Si3N4 survived the test to 1370 C with slight weight losses. Two types of reaction-sintered Si3N4 displayed high weight gains and considerable weight-change variability, with one material exhibiting superior thermal fatigue behavior. A siliconized SiC showed slight weight gains, but considerable batch variability in thermal fatigue.

Semiautomated digital analysis of knee joint space width using MR images.

PubMed

Agnesi, Filippo; Amrami, Kimberly K; Frigo, Carlo A; Kaufman, Kenton R

2007-05-01

The goal of this study was to (a) develop a semiautomated computer algorithm to measure knee joint space width (JSW) from magnetic resonance (MR) images using standard imaging techniques and (b) evaluate the reproducibility of the algorithm. Using a standard clinical imaging protocol, bilateral knee MR images were obtained twice within a 2-week period from 17 asymptomatic research participants. Images were analyzed to determine the variability of the measurements performed by the program compared with the variability of manual measurements. Measurement variability of the computer algorithm was considerably smaller than the variability of manual measurements. The average difference between two measurements of the same slice performed with the computer algorithm by the same user was 0.004 +/- 0.07 mm for the tibiofemoral joint (TF) and 0.009 +/- 0.11 mm for the patellofemoral joint (PF) compared with an average of 0.12 +/- 0.22 mm TF and 0.13 +/- 0.29 mm PF, respectively, for the manual method. Interuser variability of the computer algorithm was also considerably smaller, with an average difference of 0.004 +/- 0.1 mm TF and 0.0006 +/- 0.1 mm PF compared with 0.38 +/- 0.59 mm TF and 0.31 +/- 0.66 mm PF obtained using a manual method. The between-day reproducibility was larger but still within acceptable limits at 0.09 +/- 0.39 mm TF and 0.09 +/- 0.51 mm PF. This technique has proven consistently reproducible on a same slice base,while the reproducibility comparing different acquisitions of the same subject was larger. Longitudinal reproducibility improvement needs to be addressed through acquisition protocol improvements. A semiautomated method for measuring knee JSW from MR images has been successfully developed.

Spatio-temporal scaling effects on longshore sediment transport pattern along the nearshore zone

NASA Astrophysics Data System (ADS)

Khorram, Saeed; Ergil, Mustafa

2018-03-01

A measure of uncertainties, entropy has been employed in such different applications as coastal engineering probability inferences. Entropy sediment transport integration theories present novel visions in coastal analyses/modeling the application and development of which are still far-reaching. Effort has been made in the present paper to propose a method that needs an entropy-power index for spatio-temporal patterns analyses. Results have shown that the index is suitable for marine/hydrological ecosystem components analyses based on a beach area case study. The method makes use of six Makran Coastal monthly data (1970-2015) and studies variables such as spatio-temporal patterns, LSTR (long-shore sediment transport rate), wind speed, and wave height all of which are time-dependent and play considerable roles in terrestrial coastal investigations; the mentioned variables show meaningful spatio-temporal variability most of the time, but explanation of their combined performance is not easy. Accordingly, the use of an entropy-power index can show considerable signals that facilitate the evaluation of water resources and will provide an insight regarding hydrological parameters' interactions at scales as large as beach areas. Results have revealed that an STDDPI (entropy based spatio-temporal disorder dynamics power index) can simulate wave, long-shore sediment transport rate, and wind when granulometry, concentration, and flow conditions vary.

The Magnitude of Trial-By-Trial Neural Variability Is Reproducible over Time and across Tasks in Humans.

PubMed

Arazi, Ayelet; Gonen-Yaacovi, Gil; Dinstein, Ilan

2017-01-01

Numerous studies have shown that neural activity in sensory cortices is remarkably variable over time and across trials even when subjects are presented with an identical repeating stimulus or task. This trial-by-trial neural variability is relatively large in the prestimulus period and considerably smaller (quenched) following stimulus presentation. Previous studies have suggested that the magnitude of neural variability affects behavior such that perceptual performance is better on trials and in individuals where variability quenching is larger. To what degree are neural variability magnitudes of individual subjects flexible or static? Here, we used EEG recordings from adult humans to demonstrate that neural variability magnitudes in visual cortex are remarkably consistent across different tasks and recording sessions. While magnitudes of neural variability differed dramatically across individual subjects, they were surprisingly stable across four tasks with different stimuli, temporal structures, and attentional/cognitive demands as well as across experimental sessions separated by one year. These experiments reveal that, in adults, neural variability magnitudes are mostly solidified individual characteristics that change little with task or time, and are likely to predispose individual subjects to exhibit distinct behavioral capabilities.

Disputed family claims to bury or cremate the dead.

PubMed

Freckelton, Ian

2009-10-01

A significant number of court decisions in Australia have wrestled with the issue of who among equally ranked next-of-kin should have priority in determining the timing and place of a loved one's burial or cremation. The first port of call for such decision-making can be the coroner who must determine to whom to release a body, where a death has been reportable, but disputation occurs also in non-coronial contexts and has repeatedly fallen for resolution by Supreme Court judges. The decisions have identified a variety of practical considerations which have been taken into account. However, there remains considerable uncertainty about the significance of factors such as religious, spiritual and cultural values, as well as the nature and extent of the care-giving role, as influential considerations in respect of courts' decisions. While greater predictability of courts' decision-making might be therapeutic, it may be that the variability of factual situations precludes the construction of a hierarchy of relevant considerations.

Cultural Differences in Opportunity Cost Consideration.

PubMed

Zhang, Ning; Ji, Li-Jun; Li, Ye

2017-01-01

Two studies were conducted to investigate cultural differences in opportunity cost consideration between Chinese and Euro-Canadians. Opportunity cost is defined as the cost of a benefit that must be forgone in order to pursue a better alternative (Becker et al., 1974). In both studies, participants read about hypothetical purchase scenarios, and then decided whether they would buy a certain product. Opportunity cost consideration was measured in two ways: (1) participants' thoughts pertaining to other (nonfocal) products while making decisions; (2) participants' decisions not to buy a focal product (Study 1) or a more expensive product (Study 2). Across both indexes, we found that after controlling for individual difference variables and amount of pocket money, Chinese participants in China considered financial opportunity cost more than Euro-Canadians in Study 1. Similar results were observed in Study 2 when comparing Chinese in Canada with Euro-Canadians However, the cultural effect on opportunity cost consideration was confounded by family income in Study 2. Implications for resource management, limitations of the current research and directions for future research are discussed.

Operational considerations for laminar flow aircraft

NASA Technical Reports Server (NTRS)

Maddalon, Dal V.; Wagner, Richard D.

1986-01-01

Considerable progress has been made in the development of laminar flow technology for commercial transports during the NASA Aircraft Energy Efficiency (ACEE) laminar flow program. Practical, operational laminar flow control (LFC) systems have been designed, fabricated, and are undergoing flight testing. New materials, fabrication methods, analysis techniques, and design concepts were developed and show much promise. The laminar flow control systems now being flight tested on the NASA Jetstar aircraft are complemented by natural laminar flow flight tests to be accomplished with the F-14 variable-sweep transition flight experiment. An overview of some operational aspects of this exciting program is given.

What scientists want from their research ethics committee.

PubMed

Keith-Spiegel, Patricia; Tabachnick, Barbara

2006-03-01

Whereas investigators have directed considerable criticism against Institutional Review Boards (IRBs), the desirable characteristics of IRBs have not previously been empirically determined. A sample of 886 experienced biomedical and social and behavioral scientists rated 45 descriptors of IRB actions and functions as to their importance. Predictions derived from organizational justice research findings in other work settings were generally borne out. Investigators place high value on the fairness and respectful consideration of their IRBs. Expected differences between biomedical and social behavioral researchers and other variables were unfounded. Recommendations are offered for educating IRBs to accord researchers greater respect and fair treatment.

Making the most of sparse clinical data by using a predictive-model-based analysis, illustrated with a stavudine pharmacokinetic study.

PubMed

Zhang, L; Price, R; Aweeka, F; Bellibas, S E; Sheiner, L B

2001-02-01

A small-scale clinical investigation was done to quantify the penetration of stavudine (D4T) into cerebrospinal fluid (CSF). A model-based analysis estimates the steady-state ratio of AUCs of CSF and plasma concentrations (R(AUC)) to be 0.270, and the mean residence time of drug in the CSF to be 7.04 h. The analysis illustrates the advantages of a causal (scientific, predictive) model-based approach to analysis over a noncausal (empirical, descriptive) approach when the data, as here, demonstrate certain problematic features commonly encountered in clinical data, namely (i) few subjects, (ii) sparse sampling, (iii) repeated measures, (iv) imbalance, and (v) individual design variation. These features generally require special attention in data analysis. The causal-model-based analysis deals with features (i) and (ii), both of which reduce efficiency, by combining data from different studies and adding subject-matter prior information. It deals with features (iii)--(v), all of which prevent 'averaging' individual data points directly, first, by adjusting in the model for interindividual data differences due to design differences, secondly, by explicitly differentiating between interpatient, interoccasion, and measurement error variation, and lastly, by defining a scientifically meaningful estimand (R(AUC)) that is independent of design.

Dexamethasone exposure and asparaginase antibodies affect relapse risk in acute lymphoblastic leukemia

PubMed Central

Kawedia, Jitesh D.; Liu, Chengcheng; Pei, Deqing; Cheng, Cheng; Fernandez, Christian A.; Howard, Scott C.; Campana, Dario; Panetta, John C.; Bowman, W. Paul; Evans, William E.; Pui, Ching-Hon

2012-01-01

We have previously hypothesized that higher systemic exposure to asparaginase may cause increased exposure to dexamethasone, both critical chemotherapeutic agents for acute lymphoblastic leukemia. Whether interpatient pharmaco-kinetic differences in dexamethasone contribute to relapse risk has never been studied. The impact of plasma clearance of dexamethasone and anti–asparaginase antibody levels on risk of relapse was assessed in 410 children who were treated on a front-line clinical trial for acute lymphoblastic leukemia and were evaluable for all pharmacologic measures, using multivariate analyses, adjusting for standard clinical and biologic prognostic factors. Dexamethasone clearance (mean ± SD) was higher (P = 3 × 10−8) in patients whose sera was positive (17.7 ± 18.6 L/h per m2) versus nega-tive (10.6 ± 5.99 L/h per m2) for anti–asparaginase antibodies. In multivariate analyses, higher dexamethasone clearance was associated with a higher risk of any relapse (P = .01) and of central nervous system relapse (P = .014). Central nervous system relapse was also more common in patients with anti–asparaginase antibodies (P = .019). In conclusion, systemic clearance of dexamethasone is higher in patients with anti–asparaginase antibodies. Lower exposure to both drugs was associated with an increased risk of relapse. PMID:22117041

Atlas-based segmentation technique incorporating inter-observer delineation uncertainty for whole breast

NASA Astrophysics Data System (ADS)

Bell, L. R.; Dowling, J. A.; Pogson, E. M.; Metcalfe, P.; Holloway, L.

2017-01-01

Accurate, efficient auto-segmentation methods are essential for the clinical efficacy of adaptive radiotherapy delivered with highly conformal techniques. Current atlas based auto-segmentation techniques are adequate in this respect, however fail to account for inter-observer variation. An atlas-based segmentation method that incorporates inter-observer variation is proposed. This method is validated for a whole breast radiotherapy cohort containing 28 CT datasets with CTVs delineated by eight observers. To optimise atlas accuracy, the cohort was divided into categories by mean body mass index and laterality, with atlas’ generated for each in a leave-one-out approach. Observer CTVs were merged and thresholded to generate an auto-segmentation model representing both inter-observer and inter-patient differences. For each category, the atlas was registered to the left-out dataset to enable propagation of the auto-segmentation from atlas space. Auto-segmentation time was recorded. The segmentation was compared to the gold-standard contour using the dice similarity coefficient (DSC) and mean absolute surface distance (MASD). Comparison with the smallest and largest CTV was also made. This atlas-based auto-segmentation method incorporating inter-observer variation was shown to be efficient (<4min) and accurate for whole breast radiotherapy, with good agreement (DSC>0.7, MASD <9.3mm) between the auto-segmented contours and CTV volumes.

Informatics in radiology: Efficiency metrics for imaging device productivity.

PubMed

Hu, Mengqi; Pavlicek, William; Liu, Patrick T; Zhang, Muhong; Langer, Steve G; Wang, Shanshan; Place, Vicki; Miranda, Rafael; Wu, Teresa Tong

2011-01-01

Acute awareness of the costs associated with medical imaging equipment is an ever-present aspect of the current healthcare debate. However, the monitoring of productivity associated with expensive imaging devices is likely to be labor intensive, relies on summary statistics, and lacks accepted and standardized benchmarks of efficiency. In the context of the general Six Sigma DMAIC (design, measure, analyze, improve, and control) process, a World Wide Web-based productivity tool called the Imaging Exam Time Monitor was developed to accurately and remotely monitor imaging efficiency with use of Digital Imaging and Communications in Medicine (DICOM) combined with a picture archiving and communication system. Five device efficiency metrics-examination duration, table utilization, interpatient time, appointment interval time, and interseries time-were derived from DICOM values. These metrics allow the standardized measurement of productivity, to facilitate the comparative evaluation of imaging equipment use and ongoing efforts to improve efficiency. A relational database was constructed to store patient imaging data, along with device- and examination-related data. The database provides full access to ad hoc queries and can automatically generate detailed reports for administrative and business use, thereby allowing staff to monitor data for trends and to better identify possible changes that could lead to improved productivity and reduced costs in association with imaging services. © RSNA, 2011.

A personalized medicine approach to the design of dry powder inhalers: Selecting the optimal amount of bypass.

PubMed

Kopsch, Thomas; Murnane, Darragh; Symons, Digby

2017-08-30

In dry powder inhalers (DPIs) the patient's inhalation manoeuvre strongly influences the release of drug. Drug release from a DPI may also be influenced by the size of any air bypass incorporated in the device. If the amount of bypass is high less air flows through the entrainment geometry and the release rate is lower. In this study we propose to reduce the intra- and inter-patient variations of drug release by controlling the amount of air bypass in a DPI. A fast computational method is proposed that can predict how much bypass is needed for a specified drug delivery rate for a particular patient. This method uses a meta-model which was constructed using multiphase computational fluid dynamic (CFD) simulations. The meta-model is applied in an optimization framework to predict the required amount of bypass needed for drug delivery that is similar to a desired target release behaviour. The meta-model was successfully validated by comparing its predictions to results from additional CFD simulations. The optimization framework has been applied to identify the optimal amount of bypass needed for fictitious sample inhalation manoeuvres in order to deliver a target powder release profile for two patients. Copyright © 2017 Elsevier B.V. All rights reserved.

Methods to Differentiate Radiation Necrosis and Recurrent Disease in Gliomas

NASA Astrophysics Data System (ADS)

Ewell, Lars

2007-03-01

Given the difficulty in differentiating Radiation Induced Necrosis (RIN) and recurrent disease in glioma patients using conventional techniques (CT scans, MRI scans), researchers have looked for different imaging modalities. Among these different modalities are Diffusion Weighted Magnetic Resonance Imaging (DWMRI) and Magnetic Resonance Spectroscopy (MRS). In DWMRI, an Apparent Diffusion Coefficient (ADC) is calculated for a Region Of Interest (ROI), and then monitored over time (longitudinally). In the brain, different anatomical features can complicate the interpretation of ADCs. In particular, the density and spatial variation of the cerebral spinal fluid filled fissures known as sulci can influence how a change in an ADC is explained. We have used the covariance of pixel intensity in T1 weighted MRI scans to study how intra-patient and inter-patient sulci density varies, and will present these results. MRS uses the shift in the MR signal due to the local chemical environment to determine the concentration of brain metabolites like choline and creatin. The ratio of metabolites such as these has been shown to have the power to discriminate between RIN and recurrent disease in glioma patients. At our institution, we have initiated a protocol whereby we will use DWMRI and MRS to study how best to utilize these complimentary forms of imaging.

Optical spectroscopy of the bladder washout fluid to optimize fluorescence cystoscopy with Hexvix®.

PubMed

Martoccia, Carla; Zellweger, Matthieu; Lovisa, Blaise; Jichlinski, Patrice; van den Bergh, Hubert; Wagnières, Georges

2014-09-01

Fluorescence cystoscopy enhances detection of early bladder cancer. Water used to inflate thebladder during the procedure rapidly contains urine, which may contain fluorochromes. This frequently degradesfluorescence images. Samples of bladder washout fluid (BWF) or urine were collected (15 subjects). We studiedtheir fluorescence properties and assessed changes induced by pH (4 to 9) and temperature (15°C to 41°C).A typical fluorescence spectrum of BWF features a main peak (excitation/emission: 320∕420 nm, FWHM =50∕100 nm) and a weaker (5% to 20% of main peak intensity), secondary peak (excitation/emission: 455∕525 nm, FWHM = 80∕50 nm). Interpatient fluctuations of fluorescence intensity are observed. Fluorescence intensity decreases when temperature increases (max 30%) or pH values vary (max 25%). Neither approach is compatible with clinical settings. Fluorescence lifetime measurements suggest that 4-pyridoxic acid/riboflavin is the most likely molecule responsible for urine’s main/secondary fluorescence peak. Our measurements give an insight into the spectroscopy of the detrimental background fluorescence. This should be included in the optical design of fluorescence cystoscopes. We estimate that restricting the excitation range from 370–430 nm to 395–415 nm would reduce the BWF background by a factor 2.

eClims: An Extensible and Dynamic Integration Framework for Biomedical Information Systems.

PubMed

Savonnet, Marinette; Leclercq, Eric; Naubourg, Pierre

2016-11-01

Biomedical information systems (BIS) require consideration of three types of variability: data variability induced by new high throughput technologies, schema or model variability induced by large scale studies or new fields of research, and knowledge variability resulting from new discoveries. Beyond data heterogeneity, managing variabilities in the context of BIS requires extensible and dynamic integration process. In this paper, we focus on data and schema variabilities and we propose an integration framework based on ontologies, master data, and semantic annotations. The framework addresses issues related to: 1) collaborative work through a dynamic integration process; 2) variability among studies using an annotation mechanism; and 3) quality control over data and semantic annotations. Our approach relies on two levels of knowledge: BIS-related knowledge is modeled using an application ontology coupled with UML models that allow controlling data completeness and consistency, and domain knowledge is described by a domain ontology, which ensures data coherence. A system build with the eClims framework has been implemented and evaluated in the context of a proteomic platform.

A Systematic Search for Short-term Variability of EGRET Sources

NASA Technical Reports Server (NTRS)

Wallace, P. M.; Griffis, N. J.; Bertsch, D. L.; Hartman, R. C.; Thompson, D. J.; Kniffen, D. A.; Bloom, S. D.

2000-01-01

The 3rd EGRET Catalog of High-energy Gamma-ray Sources contains 170 unidentified sources, and there is great interest in the nature of these sources. One means of determining source class is the study of flux variability on time scales of days; pulsars are believed to be stable on these time scales while blazers are known to be highly variable. In addition, previous work has demonstrated that 3EG J0241-6103 and 3EG J1837-0606 are candidates for a new gamma-ray source class. These sources near the Galactic plane display transient behavior but cannot be associated with any known blazers. Although, many instances of flaring AGN have been reported, the EGRET database has not been systematically searched for occurrences of short-timescale (approximately 1 day) variability. These considerations have led us to conduct a systematic search for short-term variability in EGRET data, covering all viewing periods through proposal cycle 4. Six 3EG catalog sources are reported here to display variability on short time scales; four of them are unidentified. In addition, three non-catalog variable sources are discussed.

Technical Report: Serial collections of placentomes during parturition in cattle and subsequent reproductive performance

USDA-ARS?s Scientific Manuscript database

Placental separation is a complex physiological event in reproductive physiology and the underlying molecular mechanisms remain unclear. When comparing different experiments the timing of tissue collections is a significant consideration due to the variability in time between fetal expulsion and exp...

Evaluation of a variable speed limit system for wet and extreme weather conditions : phase 1 report.

DOT National Transportation Integrated Search

2012-06-01

Weather presents considerable challenges to the highway system, both in terms of safety and operations. From a safety standpoint, weather (i.e. precipitation in the form of rain, snow or ice) reduces pavement friction, thus increasing the potential f...

Rice industrial processing worldwide and impact on macro- and micronutrient content, stability, and retention

USDA-ARS?s Scientific Manuscript database

Various processing methods are used in the food industry worldwide to produce numerous rice products with desirable sensory qualities based on cultural and cooking preferences and nutritional considerations. The processes result in variable degrees of macro- and micronutrient content, stability, and...

Editorial Commentary: International Society for Hip Arthroscopy Surgeons! Time for a Rethink on Rehab!

PubMed

Konyves, Arpad

2017-11-01

Although the majority of arthroscopic hip surgeons have active websites, only few of these provide postoperative rehabilitation protocols. The available information and instructions show considerable variability. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

The Amazon Basin in transition

Treesearch

Eric A. Davidson; Alessandro C. de Araujo; Paulo Artaxo; Jennifer K. Balch; I. Foster Brown; Mercedes M.C. Bustamente; Michael T. Coe; Ruth S. DeFriess; Michael Keller; Marcos Longo; J. William Munger; Wilfrid Schroeder; Britaldo Soares-Filho; Carlos M. Souza, Jr.; Steven C. Wofsy

2012-01-01

Agricultural expansion and climate variability have become important agents of disturbance in the Amazon basin. Recent studies have demonstrated considerable resilience of Amazonian forests to moderate annual drought, but they also show that interactions between deforestation, fire and drought potentially lead to losses of carbon storage and changes in regional...

75 FR 60327 - Fluoxastrobin; Pesticide Tolerances

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-30

... consideration to exposure of infants and children to the pesticide chemical residue in establishing a tolerance and to ``ensure that there is a reasonable certainty that no harm will result to infants and children... studies to human risk. EPA has also considered available information concerning the variability of the...

Group interaction and flight crew performance

NASA Technical Reports Server (NTRS)

Foushee, H. Clayton; Helmreich, Robert L.

1988-01-01

The application of human-factors analysis to the performance of aircraft-operation tasks by the crew as a group is discussed in an introductory review and illustrated with anecdotal material. Topics addressed include the function of a group in the operational environment, the classification of group performance factors (input, process, and output parameters), input variables and the flight crew process, and the effect of process variables on performance. Consideration is given to aviation safety issues, techniques for altering group norms, ways of increasing crew effort and coordination, and the optimization of group composition.

The variable flavor number scheme at next-to-leading order

NASA Astrophysics Data System (ADS)

Blümlein, J.; De Freitas, A.; Schneider, C.; Schönwald, K.

2018-07-01

We present the matching relations of the variable flavor number scheme at next-to-leading order, which are of importance to define heavy quark partonic distributions for the use at high energy colliders such as Tevatron and the LHC. The consideration of the two-mass effects due to both charm and bottom quarks, having rather similar masses, are important. These effects have not been considered in previous investigations. Numerical results are presented for a wide range of scales. We also present the corresponding contributions to the structure function F2 (x ,Q2).

Separation of variables solution for non-linear radiative cooling

NASA Technical Reports Server (NTRS)

Siegel, Robert

1987-01-01

A separation of variables solution has been obtained for transient radiative cooling of an absorbing-scattering plane layer. The solution applies after an initial transient period required for adjustment of the temperature and scattering source function distributions. The layer emittance, equal to the instantaneous heat loss divided by the fourth power of the instantaneous mean temperature, becomes constant. This emittance is a function of only the optical thickness of the layer and the scattering albedo; its behavior as a function of these quantities is considerably different than for a layer at constant temperature.

Bioremediation techniques applied to aqueous media contaminated with mercury.

PubMed

Velásquez-Riaño, Möritz; Benavides-Otaya, Holman D

2016-12-01

In recent years, the environmental and human health impacts of mercury contamination have driven the search for alternative, eco-efficient techniques different from the traditional physicochemical methods for treating this metal. One of these alternative processes is bioremediation. A comprehensive analysis of the different variables that can affect this process is presented. It focuses on determining the effectiveness of different techniques of bioremediation, with a specific consideration of three variables: the removal percentage, time needed for bioremediation and initial concentration of mercury to be treated in an aqueous medium.

Population genetic study in ten endogamous groups of West Bengal, India.

PubMed

Mukherjee, B N; Walter, H; Malhotra, K C; Chakraborty, R; Sauber, P; Banerjee, S; Roy, M

1987-09-01

Ten endogamous population groups of West Bengal (India)--Rabhas, Garos, Mechs, Rajbanshis, Jalia Kaibartas, Bagdis, Lodhas, Mundas, Brahmins, Vaidyas--have been typed for twelve polymorphic systems: ABO, Gm, Km, Hp, Cp, Tf, Alb, Hb, aP, EsD, AK and PGM1. The results are compared with those obtained on other Indian populations. Serological and anthropometric data, which have been included into population comparisons, reveal a considerable genetic variability of the groups under study. This variability is obviously connected with the population history of West Bengal.

Diversity of the P2 protein among nontypeable Haemophilus influenzae isolates.

PubMed Central

Bell, J; Grass, S; Jeanteur, D; Munson, R S

1994-01-01

The genes for outer membrane protein P2 of four nontypeable Haemophilus influenzae strains were cloned and sequenced. The derived amino acid sequences were compared with the outer membrane protein P2 sequence from H. influenzae type b MinnA and the sequences of P2 from three additional nontypeable H. influenzae strains. The sequences were 76 to 94% identical. The sequences had regions with considerable variability separated by regions which were highly conserved. The variable regions mapped to putative surface-exposed loops of the protein. PMID:8188390

Modelling climate change and malaria transmission.

PubMed

Parham, Paul E; Michael, Edwin

2010-01-01

The impact of climate change on human health has received increasing attention in recent years, with potential impacts due to vector-borne diseases only now beginning to be understood. As the most severe vector-borne disease, with one million deaths globally in 2006, malaria is thought most likely to be affected by changes in climate variables due to the sensitivity of its transmission dynamics to environmental conditions. While considerable research has been carried out using statistical models to better assess the relationship between changes in environmental variables and malaria incidence, less progress has been made on developing process-based climate-driven mathematical models with greater explanatory power. Here, we develop a simple model of malaria transmission linked to climate which permits useful insights into the sensitivity of disease transmission to changes in rainfall and temperature variables. Both the impact of changes in the mean values of these key external variables and importantly temporal variation in these values are explored. We show that the development and analysis of such dynamic climate-driven transmission models will be crucial to understanding the rate at which P. falciparum and P. vivax may either infect, expand into or go extinct in populations as local environmental conditions change. Malaria becomes endemic in a population when the basic reproduction number R0 is greater than unity and we identify an optimum climate-driven transmission window for the disease, thus providing a useful indicator for determing how transmission risk may change as climate changes. Overall, our results indicate that considerable work is required to better understand ways in which global malaria incidence and distribution may alter with climate change. In particular, we show that the roles of seasonality, stochasticity and variability in environmental variables, as well as ultimately anthropogenic effects, require further study. The work presented here offers a theoretical framework upon which this future research may be developed.

Deployment Considerations for Low-cost Air Quality Sensor Networks; Examining Spatial Variability of Gas-Phase Pollutants Around a Building in Los Angeles

NASA Astrophysics Data System (ADS)

Collier-Oxandale, A. M.; Hannigan, M.; Casey, J. G.; Johnston, J.; Coffey, E.; Thorson, J.

2017-12-01

The field of low-cost air quality sensing technologies is growing rapidly through the continual development of new sensors, increased research into sensor performance, and more and more community groups utilizing sensors to investigate local issues. However, as this technology is still in an exploratory phase, there are few `best-practices' available to serve as guidelines for these projects and the standardization of some procedures could benefit the research community as a whole. For example, deployment considerations such as where and how to place a monitor at a given location are often determined by accessibility and safety, power-requirements, and what is an ideal for sampling the target pollutant. Using data from multiple gas-phase sensors, we will examine the importance of siting considerations for low-cost monitoring systems. During a sampling campaign in Los Angeles, a subset of monitors was deployed at one field site to explore the variability in air quality sensor data around a single building. The site is a three story, multi-family housing unit in a primarily residential neighborhood that is near two major roadways and other potential sources of pollution. Five low-cost monitors were co-located prior to and following the field deployment. During the approximately 2.5-month deployment, these monitors were placed at various heights above street level, on different sides of the building, and on the roof. In our analysis, we will examine how monitor placement affects a sensor's ability to detect local verses more regional trends and how this building-scale spatial variability changes over time. Additionally, examining data from VOC sensors (quantified for methane and total non-methane hydrocarbon signals) and O3 sensors will allow us to compare the variability of primary and secondary pollutants. An outcome of this analysis may include guidelines or `best practices' for siting sensors that could aid in ensuring the collection of high quality field data. These may be particularly useful in community-based projects where monitor siting is typically a collaborative process.

Variations in Scientific Data Production: What Can We Learn from #Overlyhonestmethods?

PubMed

Bezuidenhout, Louise

2015-12-01

In recent months months the hashtag #overlyhonestmethods has steadily been gaining popularity. Posts under this hashtag--presumably by scientists--detail aspects of daily scientific research that differ considerably from the idealized interpretation of scientific experimentation as standardized, objective and reproducible. Over and above its entertainment value, the popularity of this hashtag raises two important points for those who study both science and scientists. Firstly, the posts highlight that the generation of data through experimentation is often far less standardized than is commonly assumed. Secondly, the popularity of the hashtag together with its relatively blasé reception by the scientific community reveal that the actions reported in the tweets are far from shocking and indeed may be considered just "part of scientific research". Such observations give considerable pause for thought, and suggest that current conceptions of data might be limited by failing to recognize this "inherent variability" within the actions of generation--and thus within data themselves. Is it possible, we must ask, that epistemic virtues such as standardization, consistency, reportability and reproducibility need to be reevaluated? Such considerations are, of course, of particular importance to data sharing discussions and the Open Data movement. This paper suggests that the notion of a "moral professionalism" for data generation and sharing needs to be considered in more detail if the inherent variability of data are to be addressed in any meaningful manner.

Bio-inspired online variable recruitment control of fluidic artificial muscles

NASA Astrophysics Data System (ADS)

Jenkins, Tyler E.; Chapman, Edward M.; Bryant, Matthew

2016-12-01

This paper details the creation of a hybrid variable recruitment control scheme for fluidic artificial muscle (FAM) actuators with an emphasis on maximizing system efficiency and switching control performance. Variable recruitment is the process of altering a system’s active number of actuators, allowing operation in distinct force regimes. Previously, FAM variable recruitment was only quantified with offline, manual valve switching; this study addresses the creation and characterization of novel, on-line FAM switching control algorithms. The bio-inspired algorithms are implemented in conjunction with a PID and model-based controller, and applied to a simulated plant model. Variable recruitment transition effects and chatter rejection are explored via a sensitivity analysis, allowing a system designer to weigh tradeoffs in actuator modeling, algorithm choice, and necessary hardware. Variable recruitment is further developed through simulation of a robotic arm tracking a variety of spline position inputs, requiring several levels of actuator recruitment. Switching controller performance is quantified and compared with baseline systems lacking variable recruitment. The work extends current variable recruitment knowledge by creating novel online variable recruitment control schemes, and exploring how online actuator recruitment affects system efficiency and control performance. Key topics associated with implementing a variable recruitment scheme, including the effects of modeling inaccuracies, hardware considerations, and switching transition concerns are also addressed.

A Model of Effective Teaching in Arts, Humanities, and Social Sciences

ERIC Educational Resources Information Center

Tahir, Khazima; Ikram, Hamid; Economos, Jennifer; Morote, Elsa-Sophia; Inserra, Albert

2017-01-01

The purpose of this study was to examine how graduate students with undergraduate majors in arts, humanities, and social sciences perceived individualized consideration, Student-Professor Engagement in Learning (SPEL), intellectual stimulation, and student deep learning, and how these variables predict effective teaching. A sample of 251 graduate…

Volitional Aspects of Multimedia Learning

ERIC Educational Resources Information Center

Deimann, Markus; Keller, John M.

2006-01-01

Research on multimedia learning has produced a vast body of findings which, however, are not yet being integrated into a comprehensive framework of reference. For a considerable time, cognitive centered approaches have dominated the literature. Although motivational variables are now being taken into account, there is still a large gap in regard…

The Role of Geriatric Assessment Units in Caring for the Elderly: An Analytic Review.

ERIC Educational Resources Information Center

Rubenstein, Laurence Z.; And Others

1982-01-01

Although their structures and objectives vary considerably Geriatric Assessment Units (GAUs) are generally designed to assess elderly patients' medical and psychosocial problems, to determine optimal placement, and often to provide therapy and rehabilitation. Offers a framework for examining structural and outcome variables for GAUs. (Author)

Comparative Research of Navy Voluntary Education at Operational Commands

DTIC Science & Technology

2017-03-01

return on investment, ROI, logistic regression, multivariate analysis, descriptive statistics, Markov, time-series, linear programming 15. NUMBER...21  B.  DESCRIPTIVE STATISTICS TABLES ...............................................25  C.  PRIVACY CONSIDERATIONS...THIS PAGE INTENTIONALLY LEFT BLANK xi LIST OF TABLES Table 1.  Variables and Descriptions . Adapted from NETC (2016). .......................21

Investigating phenology of larval fishes in St. Louis River estuary shallow water habitats

EPA Science Inventory

As part of the development of an early detection monitoring strategy for non-native fishes, larval fish surveys have been conducted since 2012 in the St. Louis River estuary. Survey data demonstrates there is considerable variability in fish abundance and species assemblages acro...

Individual and Contextual Inhibitors of Sexual Harassment Training Motivation

ERIC Educational Resources Information Center

Walsh, Benjamin M.; Bauerle, Timothy J.; Magley, Vicki J.

2013-01-01

Studies have evaluated the outcomes of sexual harassment training, but considerably less research has focused on variables that influence sexual harassment training effectiveness. To address this need, we developed and tested a model of individual and contextual inhibitors of sexual harassment training motivation to learn. Survey data collected…

Dose-dependent high-resolution electron ptychography

NASA Astrophysics Data System (ADS)

D'Alfonso, A. J.; Allen, L. J.; Sawada, H.; Kirkland, A. I.

2016-02-01

Recent reports of electron ptychography at atomic resolution have ushered in a new era of coherent diffractive imaging in the context of electron microscopy. We report and discuss electron ptychography under variable electron dose conditions, exploring the prospects of an approach which has considerable potential for imaging where low dose is needed.

Quantifying ADHD Classroom Inattentiveness, Its Moderators, and Variability: A Meta-Analytic Review

ERIC Educational Resources Information Center

Kofler, Michael J.; Rapport, Mark D.; Alderson, R. Matt

2008-01-01

Background: Most classroom observation studies have documented significant deficiencies in the classroom attention of children with attention-deficit/hyperactivity disorder (ADHD) compared to their typically developing peers. The magnitude of these differences, however, varies considerably and may be influenced by contextual, sampling, diagnostic,…

Internationalizing Business Education: Factors Affecting Student Participation in Overseas Study Programs.

ERIC Educational Resources Information Center

Kashlak, Roger J.; Jones, Raymond M.

1996-01-01

A study investigated factors encouraging and inhibiting business administration students' participation in study abroad. Subjects were 128 undergraduate and graduate students at a large urban state university. Results indicated personal factors were the strongest encouraging variables, while financial considerations were the most limiting, and a…

Teaching Beginners to Program: Some Cognitive Considerations.

ERIC Educational Resources Information Center

Rogers, Jean B.

Learning to program involves developing an understanding of two hierarchies of concepts. One hierarchy consists of data and extends from very literal data (which represents only itself) to very abstract data incorporating variable values in complex interrelationships. The other hierarchy consists of the operations performed on the data and extends…

Teachers' Perceptions of Teaching Mathematics at the Senior Secondary Level in Fiji

ERIC Educational Resources Information Center

Dayal, Hem Chand

2013-01-01

In recent times, there has been considerable interest shown in the affective domain of mathematics education with research findings pointing out that affective variables have profound impact on classroom practices of mathematics teachers. In other words, teachers' conceptions of mathematics and mathematics teaching are greatly influenced by…

Genome-wide association study for feed efficiency traits using SNP and haplotype models

USDA-ARS?s Scientific Manuscript database

Feed costs comprise the majority of variable expenses in beef cattle systems making feed efficiency an important economic consideration within the beef industry. Due to the expense of recording individual feed intake phenotypes, a genomic-enabled approach could be advantageous towards improving this...

Applying Theoretical Components to the Implementation of Health-Promoting Schools

ERIC Educational Resources Information Center

McIsaac, Jessie-Lee; Storey, Kate; Veugelers, Paul J.; Kirk, Sara F. L.

2015-01-01

Objective: Health-promoting schools (HPS) constitute an internationally recognised approach that connects health and education in a planned, integrated and holistic way. There is considerable variability, however, in how HPS is implemented and recent research has attempted to clarify the key functions of implementation. A provincial HPS strategy…

Linguistic Parameters in Performance Models.

ERIC Educational Resources Information Center

Mansell, Philip

This paper deals with problems concerning the nature of the input to a phonetic processor. Several assumptions provide the basis for consideration of the problem. There is a phonological level of processing which reflects the sound structure of the language; the rules associated with it are not affected by variables associated either with the…

Stimulus Variables in the Measurement of Attitudes Toward Disability

ERIC Educational Resources Information Center

Golin, Anne K.

1970-01-01

Negative attitudes toward mental illness and physical disability have frequently been reported. But methods of attitude measurement have varied considerably, and results have been inconsistent. This study investigated the role of amount of information, favorableness of information, and disability in determining attitudes toward a stimulus person.…

Overview of global climate change and carbon sequestration

Treesearch

Kurt Johnsen

2004-01-01

The potential influence of global climate change on southern forests is uncertain. Outputs of climate change models differ considerably in their projections for precipitation and other variables that affect forests. Forest responses, particularly effects on competition among species, are difficult to assess. Even the responses of relatively simple ecosystems, such as...

Who Will Stay and Who Will Leave? Predicting Secondary English Teacher Attrition Risk

ERIC Educational Resources Information Center

Hancock, Carl B.; Scherff, Lisa

2010-01-01

Although there are considerable large-scale data on teacher attrition, few researchers have culled information specifically related to English teachers' risk for attrition. This study examines the effects of teacher characteristics, teaching conditions, student variables, self-efficacy, external support, and salary on secondary English language…

Functional Assessment and Treatment of Migraine Reports and School Absences in an Adolescent with Asperger's Disorder

ERIC Educational Resources Information Center

Arvans, Rebecca K.; LeBlanc, Linda A.

2009-01-01

Psychological interventions for migraines typically include biofeedback training, stress-management training, or relaxation training and are implemented without consideration of environmental variables that might maintain migraines or complaints of migraines. An adolescent with daily reports of migraines that negatively impacted school attendance…

Adaptive Educational Hypermedia Accommodating Learning Styles: A Content Analysis of Publications from 2000 to 2011

ERIC Educational Resources Information Center

Akbulut, Yavuz; Cardak, Cigdem Suzan

2012-01-01

Implementing instructional interventions to accommodate learner differences has received considerable attention. Among these individual difference variables, the empirical evidence regarding the pedagogical value of learning styles has been questioned, but the research on the issue continues. Recent developments in Web-based implementations have…

Pile/shaft designs using artificial neural networks (i.e., genetic programming) with spatial variability considerations.

DOT National Transportation Integrated Search

2014-03-01

The work focused on the improvement of FB-DEEPs prediction of skin and tip resistance of concrete : piles and drilled shafts in Florida. For the work, data from 19 concrete pile sites and 18 drilled shaft sites were : collected. This included 458 ...

Culturally Responsive Adaptations in Evidence-Based Treatment: The Impact on Client Satisfaction

ERIC Educational Resources Information Center

Jones, Janine; Lee, Lisa; Zigarelli, Julia; Nakagawa, Yoko

2017-01-01

This study expands the literature on multicultural counseling competencies (MCCs) in school psychology by outlining the relationship between client satisfaction, treatment approaches, and critical clinician variables such as clinician MCC. With growing emphasis on the integration of cultural considerations in evidence-based treatments (EBTs), this…

Estimation and Model Selection for Finite Mixtures of Latent Interaction Models

ERIC Educational Resources Information Center

Hsu, Jui-Chen

2011-01-01

Latent interaction models and mixture models have received considerable attention in social science research recently, but little is known about how to handle if unobserved population heterogeneity exists in the endogenous latent variables of the nonlinear structural equation models. The current study estimates a mixture of latent interaction…

The Role of Impairment in the Diagnosis of ADHD

ERIC Educational Resources Information Center

Gathje, Rebecca A.; Lewandowski, Lawrence J.; Gordon, Michael

2008-01-01

Objective: Current diagnostic criteria for ADHD require the consideration of impairment in making a diagnosis, although clinical and research definitions of ADHD rely more heavily on reported symptoms. This study explored the relationship between impairment and symptoms, variables predictive of impairment, and variation in ADHD identification when…

Predicting the unpredictable: potential climate change impacts on vegetation in the Pacific Northwest

Treesearch

Marie Oliver; David W. Peterson; Becky Kerns

2016-01-01

Earth's climate is changing, as evidenced by warming temperatures, increased temperature variability, fluctuating precipitation patterns, and climate-related environmental disturbances. And with considerable uncertainty about the future, Forest Service land managers are now considering climate change adaptation in their planning efforts. They want practical...

Field scale spatiotemporal analysis of surface soil moisture for evaluating point-scale in situ networks

USDA-ARS?s Scientific Manuscript database

Soil moisture is an intrinsic state variable that varies considerably in space and time. From a hydrologic viewpoint, soil moisture controls runoff, infiltration, storage and drainage. Soil moisture determines the partitioning of the incoming radiation between latent and sensible heat fluxes. Althou...

Attitudes of the Macedonian Preschool Teachers toward Students with Disabilities

ERIC Educational Resources Information Center

Dimitrova-Radojichikj, Daniela Blagoj; Chichevska-Jovanova, Natasha; Rashikj-Canevska, Olivera

2016-01-01

Preschool teachers are seen as key persons to implement inclusive education. Positive attitudes are therefore argued as playing a considerable role in implementing this educational change successfully. The aim of this study was to examine what attitudes Macedonian preschool teachers hold towards early inclusive education; which variables are…

Leading in the Middle: Leadership Behaviors of Middle Level Principals that Promote Student Achievement

ERIC Educational Resources Information Center

Minus, Eric L.

2010-01-01

This study sought to investigate the relationship between middle school principals' instructional leadership behaviors and student achievement. In particular, this study investigated the specific principal leadership behaviors of middle level principals that promote student achievement in school. A secondary variable for consideration was student…

Development and Evaluation of a New Air Exchange Rate Algorithm for the Stochastic Human Exposure and Dose Simulation Model (ISES Presentation)

EPA Science Inventory

Previous exposure assessment panel studies have observed considerable seasonal, between-home and between-city variability in residential pollutant infiltration. This is likely a result of differences in home ventilation, or air exchange rates (AER). The Stochastic Human Exposure ...

The Effect of Self-Directed Work Teams on Work Ethic

ERIC Educational Resources Information Center

Petty, Gregory C.; Lim, Doo Hun; Yoon, Seung Won; Fontan, Johnny

2008-01-01

This study examined the work ethic of manufacturing machine operators between self-directed work teams and traditional work groups using four work ethic subscales: dependable, considerate, ambitious, and cooperative (Dawson, [1999]; Petty, [1991]). Differences in measured work ethic scores were also compared across six demographic variables: age,…

Regulating Approaches to Learning: Testing Learning Strategy Convergences across a Year at University

ERIC Educational Resources Information Center

Fryer, Luke K.; Vermunt, Jan D.

2018-01-01

Background: Contemporary models of student learning within higher education are often inclusive of processing and regulation strategies. Considerable research has examined their use over time and their (person-centred) convergence. The longitudinal stability/variability of learning strategy use, however, is poorly understood, but essential to…

Heterogeneity among Violence-Exposed Women: Applying Person-Oriented Research Methods

ERIC Educational Resources Information Center

Nurius, Paula S.; Macy, Rebecca J.

2008-01-01

Variability of experience and outcomes among violence-exposed people pose considerable challenges toward developing effective prevention and treatment protocols. To address these needs, the authors present an approach to research and a class of methodologies referred to as person oriented. Person-oriented tools support assessment of meaningful…

Real-time tree foliage density estimation with laser scanning sensor for variable-rate tree sprayer development

USDA-ARS?s Scientific Manuscript database

Trees, even in the same orchard or nursery, can have considerably different structures and foliage densities. Conventional chemical applications often spray the entire field at a constant rate without considering field variations, resulting in excessive chemical waste and spray drift. To address thi...

Understanding Successful and Unsuccessful EFL Students in Chinese Universities

ERIC Educational Resources Information Center

Gan, Zhengdong; Humphreys, Gillian; Hamp-Lyons, Liz

2004-01-01

Unlike success in first language acquisition, success in learning a second or foreign language is considerably more variable. Recently, second language acquisition researchers have called for more integrative research on individual difference factors. With this goal in mind, this study followed a larger, quantitative study of the links between…

Steps toward a Technology for the Diffusion of Innovations.

ERIC Educational Resources Information Center

Stolz, Stephanie B.

Research-based technologies for solving problems currently exist but are not being widely implemented. Although user variables, program effectiveness, and political considerations have been documented as correlates of implementation, general non-implementation of the technology still exists, due to a lack of methods. A technology of dissemination…

A comparative study of electrical probe techniques for plasma diagnostics

NASA Technical Reports Server (NTRS)

Szuszczewicz, E. P.

1972-01-01

Techniques for using electrical probes for plasma diagnostics are reviewed. Specific consideration is given to the simple Langmuir probe, the symmetric double probe of Johnson and Malter, the variable-area probe of Fetz and Oeschsner, and a floating probe technique. The advantages and disadvantages of each technique are discussed.

Learning Path Recommendation Based on Modified Variable Length Genetic Algorithm

ERIC Educational Resources Information Center

Dwivedi, Pragya; Kant, Vibhor; Bharadwaj, Kamal K.

2018-01-01

With the rapid advancement of information and communication technologies, e-learning has gained a considerable attention in recent years. Many researchers have attempted to develop various e-learning systems with personalized learning mechanisms for assisting learners so that they can learn more efficiently. In this context, curriculum sequencing…

Consistency of Children's Inconsistent Preferences Attributable to Novelty

ERIC Educational Resources Information Center

Bradbury, Hinton

1975-01-01

The analysis of logical and antilogical influences on preference made by Bradbury and Nelson is extended to a consideration of choices by children in kindergarten, Grade 4, and Grade 8. Conclusions are drawn concerning the dependence of intransitive preference on the collative variable of novelty in choice context. (Author/SDH)

DEVELOPMENT OF DURATION-CURVE BASED METHODS FOR QUALIFYING VARIABILITY AND CHANGE IN WATERSHED HYDROLOGY AND WATER QUALITY

EPA Science Inventory

During the past decades, U.S. Environmental Protection Agency (EPA), U.S. Department of Agriculture (USDA) and other Federal program administrative and regulatory agencies spent considerable amounts of time and money to manage risks to surface waters associated with agricultural ...

Multilevel Models for Binary Data

ERIC Educational Resources Information Center

Powers, Daniel A.

2012-01-01

The methods and models for categorical data analysis cover considerable ground, ranging from regression-type models for binary and binomial data, count data, to ordered and unordered polytomous variables, as well as regression models that mix qualitative and continuous data. This article focuses on methods for binary or binomial data, which are…

Ecohydrological Responses of Dense Canopies to Environmental Variability Part 2: Role of Acclimation Under Elevated CO2

USDA-ARS?s Scientific Manuscript database

The ability to accurately predict land-atmosphere exchange of mass, energy, and momentum over the coming century requires the consideration of plant biochemical, ecophysiological and structural acclimation to modifications of the ambient environment. Amongst the most important environmental changes ...

Combining the role of convenience and consideration set size in explaining fish consumption in Norway.

PubMed

Rortveit, Asbjorn Warvik; Olsen, Svein Ottar

2009-04-01

The purpose of this study is to explore how convenience orientation, perceived product inconvenience and consideration set size are related to attitudes towards fish and fish consumption. The authors present a structural equation model (SEM) based on the integration of two previous studies. The results of a SEM analysis using Lisrel 8.72 on data from a Norwegian consumer survey (n=1630) suggest that convenience orientation and perceived product inconvenience have a negative effect on both consideration set size and consumption frequency. Attitude towards fish has the greatest impact on consumption frequency. The results also indicate that perceived product inconvenience is a key variable since it has a significant impact on attitude, and on consideration set size and consumption frequency. Further, the analyses confirm earlier findings suggesting that the effect of convenience orientation on consumption is partially mediated through perceived product inconvenience. The study also confirms earlier findings suggesting that the consideration set size affects consumption frequency. Practical implications drawn from this research are that the seafood industry would benefit from developing and positioning products that change beliefs about fish as an inconvenient product. Future research for other food categories should be done to enhance the external validity.

On the Misconception of Multicollinearity in Detection of Moderating Effects: Multicollinearity Is Not Always Detrimental.

PubMed

Shieh, Gwowen

2010-05-28

Due to its extensive applicability and computational ease, moderated multiple regression (MMR) has been widely employed to analyze interaction effects between 2 continuous predictor variables. Accordingly, considerable attention has been drawn toward the supposed multicollinearity problem between predictor variables and their cross-product term. This article attempts to clarify the misconception of multicollinearity in MMR studies. The counterintuitive yet beneficial effects of multicollinearity on the ability to detect moderator relationships are explored. Comprehensive treatments and numerical investigations are presented for the simplest interaction model and more complex three-predictor setting. The results provide critical insight that both helps avoid misleading interpretations and yields better understanding for the impact of intercorrelation among predictor variables in MMR analyses.

Accounting for the influence of vegetation and landscape improves model transferability in a tropical savannah region

NASA Astrophysics Data System (ADS)

Gao, Hongkai; Hrachowitz, Markus; Sriwongsitanon, Nutchanart; Fenicia, Fabrizio; Gharari, Shervan; Savenije, Hubert H. G.

2016-10-01

Understanding which catchment characteristics dominate hydrologic response and how to take them into account remains a challenge in hydrological modeling, particularly in ungauged basins. This is even more so in nontemperate and nonhumid catchments, where—due to the combination of seasonality and the occurrence of dry spells—threshold processes are more prominent in rainfall runoff behavior. An example is the tropical savannah, the second largest climatic zone, characterized by pronounced dry and wet seasons and high evaporative demand. In this study, we investigated the importance of landscape variability on the spatial variability of stream flow in tropical savannah basins. We applied a stepwise modeling approach to 23 subcatchments of the Upper Ping River in Thailand, where gradually more information on landscape was incorporated. The benchmark is represented by a classical lumped model (FLEXL), which does not account for spatial variability. We then tested the effect of accounting for vegetation information within the lumped model (FLEXLM), and subsequently two semidistributed models: one accounting for the spatial variability of topography-based landscape features alone (FLEXT), and another accounting for both topographic features and vegetation (FLEXTM). In cross validation, each model was calibrated on one catchment, and then transferred with its fitted parameters to the remaining catchments. We found that when transferring model parameters in space, the semidistributed models accounting for vegetation and topographic heterogeneity clearly outperformed the lumped model. This suggests that landscape controls a considerable part of the hydrological function and explicit consideration of its heterogeneity can be highly beneficial for prediction in ungauged basins in tropical savannah.

Education and trajectories of cognitive decline over 9 years in very old people: methods and risk analysis.

PubMed

Muniz-Terrera, Graciela; Matthews, Fiona; Dening, Tom; Huppert, Felicia A; Brayne, Carol

2009-05-01

the investigation of cognitive decline in the older population has been hampered by analytical considerations. Most studies of older people over prolonged periods suffer from loss to follow-up, yet this has seldom been investigated fully to date. Such considerations limit our understanding of how basic variables such as education can affect cognitive trajectories. we examined cognitive trajectories in a population-based cohort study in Cambridge, UK, of people aged 75 and over in whom multiple interviews were conducted over time. Cognitive function was assessed using the Mini-Mental State Examination (MMSE). Socio-demographic variables were measured, including educational level and social class. An age-based quadratic latent growth model was fitted to cognitive scores. The effect of socio-demographic variables was examined on all latent variables and the probability of death and dropout. at baseline, age, education, social class and mobility were associated with cognitive performance. Education and social class were not related to decline or its rate of change. In contrast, poor mobility was associated with lower cognitive performance, increased cognitive decline and increased rate of change of cognitive decline. Gender, age, mobility and cognitive ability predicted death and dropout contrary to much of the current literature, education was not related to rate of cognitive decline or change in this rate as measured by MMSE. Higher levels of education do not appear to protect against cognitive decline, though if the MMSE is used in the diagnostic process, individuals with less education may be diagnosed as having dementia somewhat earlier.

Extremes in East African hydroclimate and links to Indo-Pacific variability on interannual to decadal timescales

NASA Astrophysics Data System (ADS)

Ummenhofer, Caroline C.; Kulüke, Marco; Tierney, Jessica E.

2018-04-01

East African hydroclimate exhibits considerable variability across a range of timescales, with implications for its population that depends on the region's two rainy seasons. Recent work demonstrated that current state-of-the-art climate models consistently underestimate the long rains in boreal spring over the Horn of Africa while overestimating the short rains in autumn. This inability to represent the seasonal cycle makes it problematic for climate models to project changes in East African precipitation. Here we consider whether this bias also has implications for understanding interannual and decadal variability in the East African long and short rains. Using a consistent framework with an unforced multi-century global coupled climate model simulation, the role of Indo-Pacific variability for East African rainfall is compared across timescales and related to observations. The dominant driver of East African rainfall anomalies critically depends on the timescale under consideration: Interannual variations in East African hydroclimate coincide with significant sea surface temperature (SST) anomalies across the Indo-Pacific, including those associated with the El Niño-Southern Oscillation (ENSO) in the eastern Pacific, and are linked to changes in the Walker circulation, regional winds and vertical velocities over East Africa. Prolonged drought/pluvial periods in contrast exhibit anomalous SST predominantly in the Indian Ocean and Indo-Pacific warm pool (IPWP) region, while eastern Pacific anomalies are insignificant. We assessed dominant frequencies in Indo-Pacific SST and found the eastern equatorial Pacific dominated by higher-frequency variability in the ENSO band, while the tropical Indian Ocean and IPWP exhibit lower-frequency variability beyond 10 years. This is consistent with the different contribution to regional precipitation anomalies for the eastern Pacific versus Indian Ocean and IPWP on interannual and decadal timescales, respectively. In the model, the dominant low-frequency signal seen in the observations in the Indo-Pacific is not well-represented as it instead exhibits overly strong variability on subdecadal timescales. The overly strong ENSO-teleconnection likely contributes to the overestimated role of the short rains in the seasonal cycle in the model compared to observations.

Classification of Dust Days by Satellite Remotely Sensed Aerosol Products

NASA Technical Reports Server (NTRS)

Sorek-Hammer, M.; Cohen, A.; Levy, Robert C.; Ziv, B.; Broday, D. M.

2013-01-01

Considerable progress in satellite remote sensing (SRS) of dust particles has been seen in the last decade. From an environmental health perspective, such an event detection, after linking it to ground particulate matter (PM) concentrations, can proxy acute exposure to respirable particles of certain properties (i.e. size, composition, and toxicity). Being affected considerably by atmospheric dust, previous studies in the Eastern Mediterranean, and in Israel in particular, have focused on mechanistic and synoptic prediction, classification, and characterization of dust events. In particular, a scheme for identifying dust days (DD) in Israel based on ground PM10 (particulate matter of size smaller than 10 nm) measurements has been suggested, which has been validated by compositional analysis. This scheme requires information regarding ground PM10 levels, which is naturally limited in places with sparse ground-monitoring coverage. In such cases, SRS may be an efficient and cost-effective alternative to ground measurements. This work demonstrates a new model for identifying DD and non-DD (NDD) over Israel based on an integration of aerosol products from different satellite platforms (Moderate Resolution Imaging Spectroradiometer (MODIS) and Ozone Monitoring Instrument (OMI)). Analysis of ground-monitoring data from 2007 to 2008 in southern Israel revealed 67 DD, with more than 88 percent occurring during winter and spring. A Classification and Regression Tree (CART) model that was applied to a database containing ground monitoring (the dependent variable) and SRS aerosol product (the independent variables) records revealed an optimal set of binary variables for the identification of DD. These variables are combinations of the following primary variables: the calendar month, ground-level relative humidity (RH), the aerosol optical depth (AOD) from MODIS, and the aerosol absorbing index (AAI) from OMI. A logistic regression that uses these variables, coded as binary variables, demonstrated 93.2 percent correct classifications of DD and NDD. Evaluation of the combined CART-logistic regression scheme in an adjacent geographical region (Gush Dan) demonstrated good results. Using SRS aerosol products for DD and NDD, identification may enable us to distinguish between health, ecological, and environmental effects that result from exposure to these distinct particle populations.

Bardoxolone methyl (CDDO-Me) as a therapeutic agent: an update on its pharmacokinetic and pharmacodynamic properties

PubMed Central

Wang, Yan-Yang; Yang, Yin-Xue; Zhe, Hong; He, Zhi-Xu; Zhou, Shu-Feng

2014-01-01

Triterpenoids have been used for medicinal purposes in many Asian countries because of their anti-inflammatory, antioxidant, antiproliferative, anticancer, and anticarcinogenic properties. Bardoxolone methyl, the C-28 methyl ester of 2-cyano-3,12-dioxoolean-1,9-dien-28-oic acid (CDDO) known as CDDO-Me or RTA 402, is one of the derivatives of synthetic triterpenoids. CDDO-Me has been used for the treatment of chronic kidney disease, cancer (including leukemia and solid tumors), and other diseases. In this review, we will update our knowledge of the clinical pharmacokinetics and pharmacodynamics of CDDO-Me, highlighting its clinical benefits and the underlying mechanisms involved. The role of the Kelch-like erythroid cell-derived protein with CNC homology-associated protein 1 (Keap1)/the nuclear factor erythroid 2-related factor 2 (Nrf2) pathway in the therapeutic activities of CDDO-Me will be discussed. CDDO-Me contains α,β-unsaturated carbonyl groups on rings A and C that can generate reversible adducts with the thiol groups of Cys residues in target proteins such as Keap1 and IκB kinase. At low nanomolar concentrations, CDDO-Me protects the cells against oxidative stress via inhibition of reactive oxygen species generation, while CDDO-Me at low micromolar concentrations induces apoptosis by increasing reactive oxygen species and decreasinging intracellular glutathione levels. Through Keap1/Nrf2 and nuclear factor-κB pathways, this agent can modulate the activities of a number of important proteins that regulate inflammation, redox balance, cell proliferation and programmed cell death. In a Phase I trial in cancer patients, CDDO-Me was found to have a slow and saturable oral absorption, a relatively long terminal phase half-life (39 hours at 900 mg/day), nonlinearity (dose-dependent) at high doses (600–1,300 mg/day), and high interpatient variability. As a multifunctional agent, CDDO-Me has improved the renal function in patients with chronic kidney disease associated with type 2 diabetes. CDDO-Me has shown a promising anticancer effect in a Phase I trial. This agent is generally well tolerated, but it may increase adverse cardiovascular events. Presently, it is being further tested for the treatment of patients with chronic kidney disease, cancer, and pulmonary arterial hypertension. PMID:25364233

Bardoxolone methyl (CDDO-Me) as a therapeutic agent: an update on its pharmacokinetic and pharmacodynamic properties.

PubMed

Wang, Yan-Yang; Yang, Yin-Xue; Zhe, Hong; He, Zhi-Xu; Zhou, Shu-Feng

2014-01-01

Triterpenoids have been used for medicinal purposes in many Asian countries because of their anti-inflammatory, antioxidant, antiproliferative, anticancer, and anticarcinogenic properties. Bardoxolone methyl, the C-28 methyl ester of 2-cyano-3,12-dioxoolean-1,9-dien-28-oic acid (CDDO) known as CDDO-Me or RTA 402, is one of the derivatives of synthetic triterpenoids. CDDO-Me has been used for the treatment of chronic kidney disease, cancer (including leukemia and solid tumors), and other diseases. In this review, we will update our knowledge of the clinical pharmacokinetics and pharmacodynamics of CDDO-Me, highlighting its clinical benefits and the underlying mechanisms involved. The role of the Kelch-like erythroid cell-derived protein with CNC homology-associated protein 1 (Keap1)/the nuclear factor erythroid 2-related factor 2 (Nrf2) pathway in the therapeutic activities of CDDO-Me will be discussed. CDDO-Me contains α,β-unsaturated carbonyl groups on rings A and C that can generate reversible adducts with the thiol groups of Cys residues in target proteins such as Keap1 and IκB kinase. At low nanomolar concentrations, CDDO-Me protects the cells against oxidative stress via inhibition of reactive oxygen species generation, while CDDO-Me at low micromolar concentrations induces apoptosis by increasing reactive oxygen species and decreasinging intracellular glutathione levels. Through Keap1/Nrf2 and nuclear factor-κB pathways, this agent can modulate the activities of a number of important proteins that regulate inflammation, redox balance, cell proliferation and programmed cell death. In a Phase I trial in cancer patients, CDDO-Me was found to have a slow and saturable oral absorption, a relatively long terminal phase half-life (39 hours at 900 mg/day), nonlinearity (dose-dependent) at high doses (600-1,300 mg/day), and high interpatient variability. As a multifunctional agent, CDDO-Me has improved the renal function in patients with chronic kidney disease associated with type 2 diabetes. CDDO-Me has shown a promising anticancer effect in a Phase I trial. This agent is generally well tolerated, but it may increase adverse cardiovascular events. Presently, it is being further tested for the treatment of patients with chronic kidney disease, cancer, and pulmonary arterial hypertension.

Accuracy and Utility of Deformable Image Registration in {sup 68}Ga 4D PET/CT Assessment of Pulmonary Perfusion Changes During and After Lung Radiation Therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hardcastle, Nicholas, E-mail: nick.hardcastle@gmail.com; Centre for Medical Radiation Physics, University of Wollongong, Wollongong; Hofman, Michael S.

2015-09-01

Purpose: Measuring changes in lung perfusion resulting from radiation therapy dose requires registration of the functional imaging to the radiation therapy treatment planning scan. This study investigates registration accuracy and utility for positron emission tomography (PET)/computed tomography (CT) perfusion imaging in radiation therapy for non–small cell lung cancer. Methods: {sup 68}Ga 4-dimensional PET/CT ventilation-perfusion imaging was performed before, during, and after radiation therapy for 5 patients. Rigid registration and deformable image registration (DIR) using B-splines and Demons algorithms was performed with the CT data to obtain a deformation map between the functional images and planning CT. Contour propagation accuracy andmore » correspondence of anatomic features were used to assess registration accuracy. Wilcoxon signed-rank test was used to determine statistical significance. Changes in lung perfusion resulting from radiation therapy dose were calculated for each registration method for each patient and averaged over all patients. Results: With B-splines/Demons DIR, median distance to agreement between lung contours reduced modestly by 0.9/1.1 mm, 1.3/1.6 mm, and 1.3/1.6 mm for pretreatment, midtreatment, and posttreatment (P<.01 for all), and median Dice score between lung contours improved by 0.04/0.04, 0.05/0.05, and 0.05/0.05 for pretreatment, midtreatment, and posttreatment (P<.001 for all). Distance between anatomic features reduced with DIR by median 2.5 mm and 2.8 for pretreatment and midtreatment time points, respectively (P=.001) and 1.4 mm for posttreatment (P>.2). Poorer posttreatment results were likely caused by posttreatment pneumonitis and tumor regression. Up to 80% standardized uptake value loss in perfusion scans was observed. There was limited change in the loss in lung perfusion between registration methods; however, Demons resulted in larger interpatient variation compared with rigid and B-splines registration. Conclusions: DIR accuracy in the data sets studied was variable depending on anatomic changes resulting from radiation therapy; caution must be exercised when using DIR in regions of low contrast or radiation pneumonitis. Lung perfusion reduces with increasing radiation therapy dose; however, DIR did not translate into significant changes in dose–response assessment.« less

Spatial aggregation of holistically-nested convolutional neural networks for automated pancreas localization and segmentation.

PubMed

Roth, Holger R; Lu, Le; Lay, Nathan; Harrison, Adam P; Farag, Amal; Sohn, Andrew; Summers, Ronald M

2018-04-01

Accurate and automatic organ segmentation from 3D radiological scans is an important yet challenging problem for medical image analysis. Specifically, as a small, soft, and flexible abdominal organ, the pancreas demonstrates very high inter-patient anatomical variability in both its shape and volume. This inhibits traditional automated segmentation methods from achieving high accuracies, especially compared to the performance obtained for other organs, such as the liver, heart or kidneys. To fill this gap, we present an automated system from 3D computed tomography (CT) volumes that is based on a two-stage cascaded approach-pancreas localization and pancreas segmentation. For the first step, we localize the pancreas from the entire 3D CT scan, providing a reliable bounding box for the more refined segmentation step. We introduce a fully deep-learning approach, based on an efficient application of holistically-nested convolutional networks (HNNs) on the three orthogonal axial, sagittal, and coronal views. The resulting HNN per-pixel probability maps are then fused using pooling to reliably produce a 3D bounding box of the pancreas that maximizes the recall. We show that our introduced localizer compares favorably to both a conventional non-deep-learning method and a recent hybrid approach based on spatial aggregation of superpixels using random forest classification. The second, segmentation, phase operates within the computed bounding box and integrates semantic mid-level cues of deeply-learned organ interior and boundary maps, obtained by two additional and separate realizations of HNNs. By integrating these two mid-level cues, our method is capable of generating boundary-preserving pixel-wise class label maps that result in the final pancreas segmentation. Quantitative evaluation is performed on a publicly available dataset of 82 patient CT scans using 4-fold cross-validation (CV). We achieve a (mean  ±  std. dev.) Dice similarity coefficient (DSC) of 81.27 ± 6.27% in validation, which significantly outperforms both a previous state-of-the art method and a preliminary version of this work that report DSCs of 71.80 ± 10.70% and 78.01 ± 8.20%, respectively, using the same dataset. Copyright © 2018. Published by Elsevier B.V.

Single nucleotide variants in metastasis-related genes are associated with breast cancer risk, by lymph node involvement and estrogen receptor status, in women with European and African ancestry

PubMed Central

Roberts, Michelle R.; Sucheston-Campbell, Lara E.; Zirpoli, Gary R.; Higgins, Michael; Freudenheim, Jo L.; Bandera, Elisa V.; Ambrosone, Christine B.; Yao, Song

2017-01-01

Background Single nucleotide polymorphisms (SNPs) in pathways influencing lymph node (LN) metastasis and estrogen receptor (ER) status in breast cancer may partially explain inter-patient variability in prognosis. We examined 154 SNPs in 12 metastasis-related genes for associations with breast cancer risk, stratified by LN and ER status, in European-American (EA) and African-American (AA) women. Methods 2,671 women enrolled in the Women’s Circle of Health Study were genotyped. Pathway analyses were conducted using the adaptive rank truncated product (ARTP) method, with pARTP≤0.10 as significant. Multi-allelic risk scores were created for the ARTP-significant gene(s). Single-SNP and risk score associations were modeled using logistic regression, with false discovery rate (FDR) p-value adjustment. Results Although single-SNP associations were not significant at pFDR<0.05, several genes were significant in the ARTP analyses. In AA women, significant ARTP gene-level associations included CDH1 with LN+ (pARTP=0.10; multi-allelic OR=1.13, 95% CI 1.07–1.19, pFDR=0.0003) and SIPA1 with ER− breast cancer (pARTP=0.10; multi-allelic OR=1.16, 95% CI 1.02–1.31, pFDR=0.03). In EA women, MTA2 was associated with overall breast cancer risk (pARTP=0.004), regardless of ER status, and with LN− disease (pARTP=0.01). Also significant were SATB1 in ER− (pARTP=0.03; multi-allelic OR=1.12, 95% CI 1.05–1.20, pFDR=0.003) and KISS1 in LN− (pARTP=0.10; multi-allelic OR=1.18, 95% CI 1.08–1.29, pFDR=0.002) analyses. Among LN+ cases, significant ARTP associations were observed for SNAI1, CD82, NME1, and CTNNB1 (multi-allelic OR=1.09, 95% CI 1.04–1.14, pFDR=0.001). Conclusion Our findings suggest that variants in several metastasis genes may affect breast cancer risk by LN or ER status, although verification in larger studies is required. PMID:27597141

Improving activity recognition using a wearable barometric pressure sensor in mobility-impaired stroke patients.

PubMed

Massé, Fabien; Gonzenbach, Roman R; Arami, Arash; Paraschiv-Ionescu, Anisoara; Luft, Andreas R; Aminian, Kamiar

2015-08-25

Stroke survivors often suffer from mobility deficits. Current clinical evaluation methods, including questionnaires and motor function tests, cannot provide an objective measure of the patients' mobility in daily life. Physical activity performance in daily-life can be assessed using unobtrusive monitoring, for example with a single sensor module fixed on the trunk. Existing approaches based on inertial sensors have limited performance, particularly in detecting transitions between different activities and postures, due to the inherent inter-patient variability of kinematic patterns. To overcome these limitations, one possibility is to use additional information from a barometric pressure (BP) sensor. Our study aims at integrating BP and inertial sensor data into an activity classifier in order to improve the activity (sitting, standing, walking, lying) recognition and the corresponding body elevation (during climbing stairs or when taking an elevator). Taking into account the trunk elevation changes during postural transitions (sit-to-stand, stand-to-sit), we devised an event-driven activity classifier based on fuzzy-logic. Data were acquired from 12 stroke patients with impaired mobility, using a trunk-worn inertial and BP sensor. Events, including walking and lying periods and potential postural transitions, were first extracted. These events were then fed into a double-stage hierarchical Fuzzy Inference System (H-FIS). The first stage processed the events to infer activities and the second stage improved activity recognition by applying behavioral constraints. Finally, the body elevation was estimated using a pattern-enhancing algorithm applied on BP. The patients were videotaped for reference. The performance of the algorithm was estimated using the Correct Classification Rate (CCR) and F-score. The BP-based classification approach was benchmarked against a previously-published fuzzy-logic classifier (FIS-IMU) and a conventional epoch-based classifier (EPOCH). The algorithm performance for posture/activity detection, in terms of CCR was 90.4 %, with 3.3 % and 5.6 % improvements against FIS-IMU and EPOCH, respectively. The proposed classifier essentially benefits from a better recognition of standing activity (70.3 % versus 61.5 % [FIS-IMU] and 42.5 % [EPOCH]) with 98.2 % CCR for body elevation estimation. The monitoring and recognition of daily activities in mobility-impaired stoke patients can be significantly improved using a trunk-fixed sensor that integrates BP, inertial sensors, and an event-based activity classifier.

Dosimetric consequences of translational and rotational errors in frame-less image-guided radiosurgery

PubMed Central

2012-01-01

Background To investigate geometric and dosimetric accuracy of frame-less image-guided radiosurgery (IG-RS) for brain metastases. Methods and materials Single fraction IG-RS was practiced in 72 patients with 98 brain metastases. Patient positioning and immobilization used either double- (n = 71) or single-layer (n = 27) thermoplastic masks. Pre-treatment set-up errors (n = 98) were evaluated with cone-beam CT (CBCT) based image-guidance (IG) and were corrected in six degrees of freedom without an action level. CBCT imaging after treatment measured intra-fractional errors (n = 64). Pre- and post-treatment errors were simulated in the treatment planning system and target coverage and dose conformity were evaluated. Three scenarios of 0 mm, 1 mm and 2 mm GTV-to-PTV (gross tumor volume, planning target volume) safety margins (SM) were simulated. Results Errors prior to IG were 3.9 mm ± 1.7 mm (3D vector) and the maximum rotational error was 1.7° ± 0.8° on average. The post-treatment 3D error was 0.9 mm ± 0.6 mm. No differences between double- and single-layer masks were observed. Intra-fractional errors were significantly correlated with the total treatment time with 0.7mm±0.5mm and 1.2mm±0.7mm for treatment times ≤23 minutes and >23 minutes (p<0.01), respectively. Simulation of RS without image-guidance reduced target coverage and conformity to 75% ± 19% and 60% ± 25% of planned values. Each 3D set-up error of 1 mm decreased target coverage and dose conformity by 6% and 10% on average, respectively, with a large inter-patient variability. Pre-treatment correction of translations only but not rotations did not affect target coverage and conformity. Post-treatment errors reduced target coverage by >5% in 14% of the patients. A 1 mm safety margin fully compensated intra-fractional patient motion. Conclusions IG-RS with online correction of translational errors achieves high geometric and dosimetric accuracy. Intra-fractional errors decrease target coverage and conformity unless compensated with appropriate safety margins. PMID:22531060

Plasma vemurafenib exposure and pre-treatment hepatocyte growth factor level are two factors contributing to the early peripheral lymphocytes depletion in BRAF-mutated melanoma patients.

PubMed

Puszkiel, Alicja; White-Koning, Mélanie; Dupin, Nicolas; Kramkimel, Nora; Thomas-Schoemann, Audrey; Noé, Gaëlle; Chapuis, Nicolas; Vidal, Michel; Goldwasser, François; Chatelut, Etienne; Blanchet, Benoit

2016-11-01

The therapeutic response to vemurafenib, a BRAF serine-threonine kinase inhibitor, exhibits large variations between patients. Evaluation of factors predicting the clinical efficacy of vemurafenib may help to identify patients at high risk of non-response in the early phase of treatment. The aim of this study was to analyze the pharmacokinetics of vemurafenib by a population approach and to evaluate the relationship between plasma drug exposure and pre-treatment plasma hepatocyte growth factor (HGF) levels with clinical effects (progression-free survival (PFS), peripheral lymphocytes depletion) in patients with metastatic BRAF V600 mutated melanoma treated with single agent vemurafenib. Concentration-time data (n=332) obtained in 44 patients were analyzed using the NONMEM program. Pre-treatment plasma levels of HGF (n=36) were assayed by ELISA method. A Cox model was used to identify prognostic factors associated with progression-free survival (PFS), and a linear regression to identify factors contributing to the depletion of peripheral lymphocytes at day 15. Steady-state pharmacokinetics of vemurafenib was described by a one compartment model with first order absorption and first order elimination. None of the tested covariates explained the inter-patient variability in CL/F. A significant decrease in total lymphocytes count was observed within the first 15days (median ratio Day15/Day0=0.66, p<0.0001). Patients with Day15/Day0 ratio below 0.66 had longer PFS (14 vs 4 months, HR=0.41, CI95%=[0.15-0.77], p=0.0095). In the multivariate Cox model analysis, ECOG PS was the only parameter independently associated with PFS (grade 1 vs 0, HR=3.26, CI95%=[1.29-8.22], p=0.01 and grade ≥2 vs 0, HR=4.77, CI95%=[1.52-14.95], p=0.007). Plasma vemurafenib exposure (p=0.046) and pre-treatment HGF levels (p=0.003) were independently associated with the total lymphocyte ratio Day15/Day0. These findings show that plasma vemurafenib exposure and pre-treatment HGF levels are two factors contributing to the early peripheral lymphocytes depletion which itself is associated with PFS. Copyright © 2016 Elsevier Ltd. All rights reserved.

Trends and Divergences in Childhood Income Dynamics, 1970-2010.

PubMed

Hill, Heather D

2018-01-01

Earnings and income variability have increased since the 1970s, particularly at the bottom of the income distribution. Considerable evidence suggests that childhood income levels-captured as average or point-in-time yearly income-are associated with numerous child and adult outcomes. The importance to child development of stable proximal processes during childhood suggests that income variability may also be important, particularly if it is unpredictable, unintentional, or does not reflect an upward trend in family income. Using the Panel Study of Income Dynamics, this study documents trends since the 1970s in three dimensions of childhood income dynamics: level, variability, and growth (n=7991). The analysis reveals that income variability during childhood has grown over time, while income growth rates have not. In addition, the economic context of childhood has diverged substantially by socioeconomic status, race, and family structure, with the most disadvantaged children facing a double-whammy of low income and high variability. © 2018 Elsevier Inc. All rights reserved.

Aircraft Turbofan Engine Health Estimation Using Constrained Kalman Filtering

NASA Technical Reports Server (NTRS)

Simon, Dan; Simon, Donald L.

2003-01-01

Kalman filters are often used to estimate the state variables of a dynamic system. However, in the application of Kalman filters some known signal information is often either ignored or dealt with heuristically. For instance, state variable constraints (which may be based on physical considerations) are often neglected because they do not fit easily into the structure of the Kalman filter. This paper develops an analytic method of incorporating state variable inequality constraints in the Kalman filter. The resultant filter is a combination of a standard Kalman filter and a quadratic programming problem. The incorporation of state variable constraints increases the computational effort of the filter but significantly improves its estimation accuracy. The improvement is proven theoretically and shown via simulation results obtained from application to a turbofan engine model. This model contains 16 state variables, 12 measurements, and 8 component health parameters. It is shown that the new algorithms provide improved performance in this example over unconstrained Kalman filtering.

The Impact of Individual Differences on E-Learning System Behavioral Intention

NASA Astrophysics Data System (ADS)

Liao, Peiwen; Yu, Chien; Yi, Chincheh

This study investigated the impact of contingent variables on the relationship between four predictors and employees' behavioral intention with e-learning. Seven hundred and twenty-two employees in online training and education were asked to answer questionnaires about their learning styles, perceptions of the quality of the proposed predictors and behavioral intention with e-learning systems. The results of analysis showed that three contingent variables, gender, job title and industry, significantly influenced the perceptions of predictors and employees' behavioral intention with the e-learning system. This study also found a statistically significant moderating effect of two contingent variables, gender, job title and industry, on the relationship between predictors and e-learning system behavioral intention. The results suggest that a serious consideration of contingent variables is crucial for improving e-learning system behavioral intention. The implications of these results for the management of e-learning systems are discussed.

Seemingly unrelated intervention time series models for effectiveness evaluation of large scale environmental remediation.

PubMed

Ip, Ryan H L; Li, W K; Leung, Kenneth M Y

2013-09-15

Large scale environmental remediation projects applied to sea water always involve large amount of capital investments. Rigorous effectiveness evaluations of such projects are, therefore, necessary and essential for policy review and future planning. This study aims at investigating effectiveness of environmental remediation using three different Seemingly Unrelated Regression (SUR) time series models with intervention effects, including Model (1) assuming no correlation within and across variables, Model (2) assuming no correlation across variable but allowing correlations within variable across different sites, and Model (3) allowing all possible correlations among variables (i.e., an unrestricted model). The results suggested that the unrestricted SUR model is the most reliable one, consistently having smallest variations of the estimated model parameters. We discussed our results with reference to marine water quality management in Hong Kong while bringing managerial issues into consideration. Copyright © 2013 Elsevier Ltd. All rights reserved.

Predicting Use of Nurse Care Coordination by Older Adults With Chronic Conditions.

PubMed

Vanderboom, Catherine E; Holland, Diane E; Mandrekar, Jay; Lohse, Christine M; Witwer, Stephanie G; Hunt, Vicki L

2017-07-01

To be effective, nurse care coordination must be targeted at individuals who will use the service. The purpose of this study was to identify variables that predicted use of care coordination by primary care patients. Data on the potential predictor variables were obtained from patient interviews, the electronic health record, and an administrative database of 178 adults eligible for care coordination. Use of care coordination was obtained from an administrative database. A multivariable logistic regression model was developed using a bootstrap sampling approach. Variables predicting use of care coordination were dependence in both activities of daily living (ADL) and instrumental activities of daily living (IADL; odds ratio [OR] = 5.30, p = .002), independent for ADL but dependent for IADL (OR = 2.68, p = .01), and number of prescription medications (OR = 1.12, p = .002). Consideration of these variables may improve identification of patients to target for care coordination.

Middle Pliocene sea surface temperature variability

USGS Publications Warehouse

Dowsett, H.J.; Chandler, M.A.; Cronin, T. M.; Dwyer, Gary S.

2005-01-01

Estimates of sea surface temperature (SST) based upon foraminifer, diatom, and ostracod assemblages from ocean cores reveal a warm phase of the Pliocene between about 3.3 and 3.0 Ma. Pollen records and plant megafossils, although not as well dated, show evidence for a warmer climate at about the same time. Increased greenhouse forcing and altered ocean heat transport are the leading candidates for the underlying cause of Pliocene global warmth. Despite being a period of global warmth, this interval encompasses considerable variability. Two new SST reconstructions are presented that are designed to provide a climatological error bar for warm peak phases of the Pliocene and to document the spatial distribution and magnitude of SST variability within the mid-Pliocene warm period. These data suggest long-term stability of low-latitude SST and document greater variability in regions of maximum warming. Copyright 2005 by the American Geophysical Union.

Design Considerations for a New Terminal Area Arrival Scheduler

NASA Technical Reports Server (NTRS)

Thipphavong, Jane; Mulfinger, Daniel

2010-01-01

Design of a terminal area arrival scheduler depends on the interrelationship between throughput, delay and controller intervention. The main contribution of this paper is an analysis of the above interdependence for several stochastic behaviors of expected system performance distributions in the aircraft s time of arrival at the meter fix and runway. Results of this analysis serve to guide the scheduler design choices for key control variables. Two types of variables are analyzed, separation buffers and terminal delay margins. The choice for these decision variables was tested using sensitivity analysis. Analysis suggests that it is best to set the separation buffer at the meter fix to its minimum and adjust the runway buffer to attain the desired system performance. Delay margin was found to have the least effect. These results help characterize the variables most influential in the scheduling operations of terminal area arrivals.

Mineral Element Contents in Commercially Valuable Fish Species in Spain

PubMed Central

Peña-Rivas, Luis; Ortega, Eduardo; López-Martínez, Concepción; Olea-Serrano, Fátima; Lorenzo, Maria Luisa

2014-01-01

The aim of this study was to measure selected metal concentrations in Trachurus trachurus, Trachurus picturatus, and Trachurus mediterraneus, which are widely consumed in Spain. Principal component analysis suggested that the variable Cr was the main responsible variable for the identification of T. trachurus, the variables As and Sn for T. mediterraneus, and the rest of variables for T. picturatus. This well-defined discrimination between fish species provided by mineral element allows us to distinguish them on the basis of their metal content. Based on the samples collected, and recognizing the inferential limitation of the sample size of this study, the metal concentrations found are below the proposed limit values for human consumption. However, it should be taken into consideration that there are other dietary sources of these metals. In conclusion, metal contents in the fish species analyzed are acceptable for human consumption from a nutritional and toxicity point of view. PMID:24895678

Gender roles, sociosexuality, and sexual behavior among US Black women

PubMed Central

Hall, Naomi M.; Pichon, Latrice C.

2014-01-01

This study examined the relationship between gender roles and sociosexuality (an individual difference variable describing attitudes about sexual permissiveness and promiscuity), and their predictive pattern of HIV-related sexual risk behaviors. A geographically diverse sample of 275 adult, heterosexual Black women (mean age = 33.60 years), participated in a self-administered survey. Significant relationships were found between feminine traits and sociosexuality, and between sociosexuality and four of the five risky sexual behavior variables. Neither masculine nor feminine gender roles were related to any risky sexual behavior variables. Sociosexuality emerged as an important correlate that requires further exploration of its relationship to the attitudes and behaviors of Black women, and its potential relationship to HIV risk-related sexual behavior. The need for more attention to psychosocial variables, and consideration of context, cultural norms, and values is discussed as an important undertaking in order to garner an accurate picture of sexual risk behavior. PMID:25614852

Observer synthesis for a class of Takagi-Sugeno descriptor system with unmeasurable premise variable. Application to fault diagnosis

NASA Astrophysics Data System (ADS)

López-Estrada, F. R.; Astorga-Zaragoza, C. M.; Theilliol, D.; Ponsart, J. C.; Valencia-Palomo, G.; Torres, L.

2017-12-01

This paper proposes a methodology to design a Takagi-Sugeno (TS) descriptor observer for a class of TS descriptor systems. Unlike the popular approach that considers measurable premise variables, this paper considers the premise variables depending on unmeasurable vectors, e.g. the system states. This consideration covers a large class of nonlinear systems and represents a real challenge for the observer synthesis. Sufficient conditions to guarantee robustness against the unmeasurable premise variables and asymptotic convergence of the TS descriptor observer are obtained based on the H∞ approach together with the Lyapunov method. As a result, the designing conditions are given in terms of linear matrix inequalities (LMIs). In addition, sensor fault detection and isolation are performed by means of a generalised observer bank. Two numerical experiments, an electrical circuit and a rolling disc system, are presented in order to illustrate the effectiveness of the proposed method.