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Sample records for monitoring clinical variables

  1. Glycemic variability: Clinical implications

    PubMed Central

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

    2013-01-01

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

  2. Monitoring All Sky for Variability

    NASA Astrophysics Data System (ADS)

    Paczynski, B.; Pojmanski, G.

    2000-05-01

    A few percent of all stars are variable, yet more than 90 percent of variables brighter than 12 magnitude have not been discovered yet. There is a need for an all sky search and for the early detection of any unexpected events: optical flashes from gamma-ray bursts, novae, dwarf novae, supernovae, killer asteroids, comets, etc. The ongoing projects like ROTSE, ASAS, TASS, and others, using instruments with just 4 inch aperture, have already discovered thousands of new variable stars, a flash from an explosion at a cosmological distance, and the first partial eclipse of a nearby star by its Jupiter like planet. About one million variable stars may be discovered with such small instruments, and many more with larger telescopes. The critical elements are software and full automation of the hardware. A complete census of the brightest eclipsing binaries is needed to select objects for a robust empirical calibration of the accurate distance determination to the Magellanic Clouds, the first step towards the Hubble constant. An archive to be generated by a large number of small instruments will be very valuable for data mining projects. The real time alerts will provide great targets of opportunity for the follow-up observations with the largest telescopes. The ASAS project is supported by a generous gift from Mr. William Golden, and we are grateful for his support and interest.

  3. Monitoring All Sky for Variability

    NASA Astrophysics Data System (ADS)

    Paczyński, Bohdan

    2000-10-01

    A few percent of all stars are variable, yet over 90% of variables brighter than 12 mag have not been discovered yet. There is a need for an all-sky search and for the early detection of any unexpected events: optical flashes from gamma-ray bursts, novae, dwarf novae, supernovae, ``killer asteroids.'' The ongoing projects like ROTSE, ASAS, TASS, and others, using instruments with just 4 inch aperture, have already discovered thousands of new variable stars, a flash from an explosion at a cosmological distance, and the first partial eclipse of a nearby star by its Jupiter-like planet. About one million variables may be discovered with such small instruments, and many more with larger telescopes. The critical elements are software and full automation of the hardware. A complete census of the brightest eclipsing binaries is needed to select objects for a robust empirical calibration of the accurate distance determination to the Magellanic Clouds, the first step toward the Hubble constant. An archive to be generated by a large number of small instruments will be very valuable for data-mining projects. The real-time alerts will provide great targets of opportunity for follow-up observations with the largest telescopes. This Essay is one of a series of invited contributions which will appear in the PASP throughout the year 2000 to mark the upcoming millennium. (Eds.)

  4. Monitoring Quasar Color Variability in Stripe 82

    NASA Astrophysics Data System (ADS)

    Rogerson, J. A.; Hall, P. B.; MacLeod, C.; Ivezić, Ž.

    2012-08-01

    Broad Absorption Line (BAL) trough variability is predominantly due to cloud motion transverse to our line of sight. The rate at which the variability occurs indicates the velocity of the cloud, and that can provide constraints on the cloud's distance from the central source. Measuring this requires detailed spectroscopy during a variability event. Such spectra have proven elusive, suggesting either the timescale of variability is too short to be caught, or too long to notice until a sufficient amount of time has passed. Photometric monitoring of BAL quasar colors may potentially be used as an early warning system to trigger time-resolved spectroscopic monitoring of BAL variability. Towards this end, we are analyzing both BAL and non-BAL color variability using time series photometry from Stripe 82 in the Sloan Digital Sky Survey.

  5. Monitoring Physiological Variables with Membrane Probes

    NASA Technical Reports Server (NTRS)

    Janle, Elsa M.

    1997-01-01

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

  6. Continuous glucose monitoring: current clinical use.

    PubMed

    Kim, Hun-Sung; Shin, Jeong-Ah; Chang, Jin-Sun; Cho, Jae-Hyoung; Son, Ho-Young; Yoon, Kun-Ho

    2012-12-01

    Four kinds of subcutaneous continuous glucose monitoring (CGM) machines have been currently introduced in clinical practice. These machines exhibit real-time glucose on the monitor every 5 minutes and have alarms to indicate hypoglycaemia and hyperglycaemia. However, thus far, there is no clear consensus about the clinical indications for CGM in actual clinical practice. CGM should be an ideal and powerful tool for monitoring glucose variability. Glycaemic variability has become a major concern over the years with growing evidence on its detrimental impact with respect to the risk of diabetic complications. Although the HbA1c level is ubiquitously measures in clinical practice, this level does not adequately represent glycaemic variability. Currently available evidence indicates that CGM aids in lowering the HbA1c level without increasing the incidence of severe hypoglycaemic episodes in patients with type 1 diabetes. Thus far, CGM has not been indicated for preventing severe hypoglycaemia or for treating type 2 diabetes because sufficient supporting evidence has not been obtained. Promising results have been obtained for the use of CGM for pregnant women with diabetes and for patients with hospital hyperglycaemia. Predictions regarding the feasibility of the closed-loop system have proven to be optimistic. CGM-integrated communication systems using information technology such as smart phone help controlling blood glucose more easily and effectively.

  7. Translating Glucose Variability Metrics into the Clinic via Continuous Glucose Monitoring: A Graphical User Interface for Diabetes Evaluation (CGM-GUIDE©)

    PubMed Central

    Rawlings, Renata A.; Shi, Hang; Yuan, Lo-Hua; Brehm, William; Pop-Busui, Rodica

    2011-01-01

    Abstract Background Several metrics of glucose variability have been proposed to date, but an integrated approach that provides a complete and consistent assessment of glycemic variation is missing. As a consequence, and because of the tedious coding necessary during quantification, most investigators and clinicians have not yet adopted the use of multiple glucose variability metrics to evaluate glycemic variation. Methods We compiled the most extensively used statistical techniques and glucose variability metrics, with adjustable hyper- and hypoglycemic limits and metric parameters, to create a user-friendly Continuous Glucose Monitoring Graphical User Interface for Diabetes Evaluation (CGM-GUIDE©). In addition, we introduce and demonstrate a novel transition density profile that emphasizes the dynamics of transitions between defined glucose states. Results Our combined dashboard of numerical statistics and graphical plots support the task of providing an integrated approach to describing glycemic variability. We integrated existing metrics, such as SD, area under the curve, and mean amplitude of glycemic excursion, with novel metrics such as the slopes across critical transitions and the transition density profile to assess the severity and frequency of glucose transitions per day as they move between critical glycemic zones. Conclusions By presenting the above-mentioned metrics and graphics in a concise aggregate format, CGM-GUIDE provides an easy to use tool to compare quantitative measures of glucose variability. This tool can be used by researchers and clinicians to develop new algorithms of insulin delivery for patients with diabetes and to better explore the link between glucose variability and chronic diabetes complications. PMID:21932986

  8. Photometric monitoring of Luminous Blue Variables

    NASA Astrophysics Data System (ADS)

    Buemi, Carla; Distefano, Elisa; Leto, Paolo; Schillirò, Francesco; Trigilio, Corrado; Umana, Grazia; Bernabei, Stefano; Cutispoto, Giuseppe; Messina, Sergio

    2011-01-01

    We present some preliminary results from our program of intensive near-infrared photometric monitoring of a sample of confirmed and candidate Luminous Blue Variables (LBVs) conducted from 2008 to 2010. Clear long-term variability has been observed for Wray 17-96 and V481 Sct, with overall brightness variation greater than 1 mag in the J band. Other sources, such as LBV 1806-20 showed detectable variability with amplitudes of few tenths of a magnitude with a time-scale of about 60 days.

  9. Variability in continuous traffic monitoring data

    SciTech Connect

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

    1996-07-01

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

  10. [Glycemic variability and continuous monitoring of glycemia].

    PubMed

    Prázný, Martin; Soupal, Jan

    2014-09-01

    Blood glucose levels are not constant in ther human body even in physiological status. It fluctuates depending on food intake, exercise, psychological and other factors. Normally it fluctuates between 3.9 to 7.5 mmol/l and in fasting in the standard conditions it does not exceed even more narrow range 3.9 to 5.5 mmol/l. Fluctuations are more pronounced in patient with diabetes. Hyperglycemia is a common and basic pathology in diabetes, however, antidiabetic drug often cause hypoglycemia, both increasing the range for glucose fluctuations. The level of glucose fluctuation is called glycemic variability (GV). Glycemic variability is now a favorite target of scientific research in dia-betology. Increased glycemic variability is associated with hypoglycemia, possibly may contribute to chronic dia-betes complications and negatively influences quality of life of diabetic patients. Last but not least, thanks to the new technology of continuous glucose monitoring, we can better describe and measure it. Finally, glycemic variability emerges as a potentially important therapeutical target.Key words: continuous glucose monitoring - glycemic variability - insulin pump - sensor augmented pump.

  11. Clinical Implications of Glucose Variability: Chronic Complications of Diabetes.

    PubMed

    Jung, Hye Seung

    2015-06-01

    Glucose variability has been identified as a potential risk factor for diabetic complications; oxidative stress is widely regarded as the mechanism by which glycemic variability induces diabetic complications. However, there remains no generally accepted gold standard for assessing glucose variability. Representative indices for measuring intraday variability include calculation of the standard deviation along with the mean amplitude of glycemic excursions (MAGE). MAGE is used to measure major intraday excursions and is easily measured using continuous glucose monitoring systems. Despite a lack of randomized controlled trials, recent clinical data suggest that long-term glycemic variability, as determined by variability in hemoglobin A1c, may contribute to the development of microvascular complications. Intraday glycemic variability is also suggested to accelerate coronary artery disease in high-risk patients.

  12. [Prescribing monitoring in clinical practice: from enlightened empiricism to rational strategies].

    PubMed

    Buclin, Thierry; Herzig, Lilli

    2013-05-15

    Monitoring of a medical condition is the periodic measurement of one or several physiological or biological variables to detect a signal regarding its clinical progression or its response to treatment. We distinguish different medical situations between diagnostic, clinical and therapeutic process to apply monitoring. Many clinical, variables can be used for monitoring, once their intrinsic properties (normal range, critical difference, kinetics, reactivity) and external validity (pathophysiological importance, predictive power for clinical outcomes) are established. A formal conceptualization of monitoring is being developed and should support the rational development of monitoring strategies and their validation through appropriate clinical trials.

  13. What variables can influence clinical reasoning?

    PubMed Central

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

    2012-01-01

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

  14. Clinical and acoustical variability in hypokinetic dysarthria

    SciTech Connect

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

    1986-10-01

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

  15. Monitoring clinical trials: a practical guide.

    PubMed

    Molloy, Síle F; Henley, Patricia

    2016-12-01

    This article describes the processes and procedures involved in planning, conducting and reporting monitoring activities for large Clinical Trials of Investigational Medicinal Products (CTIMPs), focusing on those conducted in resource-limited settings.

  16. Data monitoring committees for pragmatic clinical trials.

    PubMed

    Ellenberg, Susan S; Culbertson, Richard; Gillen, Daniel L; Goodman, Steven; Schrandt, Suzanne; Zirkle, Maryan

    2015-10-01

    In any clinical trial, it is essential to monitor the accumulating data to be sure that the trial continues to be safe for participants and that the trial is being conducted properly. Data monitoring committees, independent expert panels who undertake regular reviews of the data as the trial progresses, serve an important role in safeguarding the interests of research participants and ensuring trial integrity in many trials. Many pragmatic clinical trials, which aim to inform healthcare decisions by comparing alternate interventions in heterogeneous healthcare delivery settings, will warrant review by an independent data monitoring committee due to their potential impact on clinical practice. However, the very features that make a trial "pragmatic" may pose challenges in terms of which aspects of a trial to monitor and when it is appropriate for a data monitoring committee to intervene. Using the Pragmatic-Explanatory Continuum Indicator Summary tool that draws distinctions between pragmatic and explanatory clinical trials, we review characteristics of pragmatic clinical trials that may have implications for data monitoring committees and interim monitoring plans. These include broad eligibility criteria, a focus on subjective patient-centered outcomes, and in some cases a lack of standardized follow-up procedures across study sites. Additionally, protocol adherence is often purposefully not addressed in pragmatic trials in order to accurately represent the clinical practice setting and maintain practicability of implementation; there are differing viewpoints as to whether adherence should be assessed and acted upon by data monitoring committees in these trials. Some other issues not specifically related to the Pragmatic-Explanatory Continuum Indicator Summary criteria may also merit special consideration in pragmatic trials. Thresholds for early termination of a pragmatic clinical trial might be controversial. The distinguishing features of pragmatic clinical

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

    NASA Technical Reports Server (NTRS)

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

    2011-01-01

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

  18. Heparin monitoring: clinical outcome and practical approach.

    PubMed

    Despas, Noémie; Larock, Anne-Sophie; Jacqmin, Hugues; Douxfils, Jonathan; Chatelain, Bernard; Chatelain, Marc; Mullier, François

    2016-12-01

    Traditional anticoagulant agents such as unfractionated heparin (UFH), low molecular weight heparins (LMWHs), fondaparinux, danaparoid and bivalirudine are used in the prevention and treatment of thromboembolic diseases. However, these agents have limitations: their constraining parenteral route of administration and the need for regular coagulation monitoring for HNF. The LMWHs, with their more predictable anticoagulant response, don't require a systematic monitoring. The usefulness of LMWHs monitoring in several clinical situations such as pregnancy, obesity and renal insufficiency is a matter of debate. Indeed, there is no agreement between French and American recommendations on this question. Others aspects are also controversial: the measure of trough anti-Xa activity during pregnancy and the optimal monitoring of LMWHs for patients with antithrombin deficiency (hepatic disease, new-borns). Different tests are available to ensure the monitoring of these drugs, we will see in this review their principle, their advantages and inconvenients. The management of heparin induced thrombocytopenia also needs parenteral anticoagulants: danaparoïd, bivalirudine or argatroban. The modalities of their monitoring are relatively unknown and are presented. Furthermore, platelet monitoring is capital. This article aims to provide guidance about laboratory testing of classic parenteral anticoagulants.

  19. BioMEMS for multiparameter clinical monitoring

    NASA Astrophysics Data System (ADS)

    Moser, Isabella

    2003-01-01

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

  20. Monitoring D-Region Variability from Lightning Measurements

    NASA Technical Reports Server (NTRS)

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

    2011-01-01

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

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

    PubMed

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

    2016-01-01

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

  2. Variability in traffic monitoring data. Final summary report

    SciTech Connect

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

    1997-08-01

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

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

    USGS Publications Warehouse

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

    2016-01-01

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

  4. Using business intelligence to monitor clinical quality metrics.

    PubMed

    Resetar, Ervina; Noirot, Laura A; Reichley, Richard M; Storey, Patricia; Skiles, Ann M; Traynor, Patrick; Dunagan, W Claiborne; Bailey, Thomas C

    2007-10-11

    BJC HealthCare (BJC) uses a number of industry standard indicators to monitor the quality of services provided by each of its hospitals. By establishing an enterprise data warehouse as a central repository of clinical quality information, BJC is able to monitor clinical quality performance in a timely manner and improve clinical outcomes.

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

    SciTech Connect

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

    2014-09-01

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

  6. Clinical use of real-time continuous glucose monitoring.

    PubMed

    Battelino, Tadej; Bolinder, Jan

    2008-08-01

    Maintaining near-normal glycaemia in all patients with diabetes mellitus (DM) has become a standard and a well accepted recommendation. Unfortunately, most people with DM do not achieve this clinical goal because of marked glycaemic fluctuations and hypoglycaemia. Real-time continuous glucose monitoring (RT-CGM) has been introduced recently into clinical practice offering more knowledge about current glucose concentration and trend and enabling people with DM to intervene and prevent unwanted glucose excursions by acting upon real-time and predictive alarms. Several RT-CGM devices proved to be sufficiently accurate and feasible for routine use. Observational reports with The Guardian and Paradigm RT by Medtronic, the STS by DexCom, FreeStyle Navigator by Abbott and GlucoDay by Menarini established initial clinical benefit. Five randomised controlled trials (RCT) demonstrated significantly improved glucose variability or metabolic control, one of them showing a statistically significant and clinically meaningful decrease of HbA1c with a 3 months use of the Guardian RT (Medtronic, Northridge, CA). The great potential of RT-CGM devices to improve daily glucose control and quality of life in people with DM can only be developed further through RCTs, clarifying in more details the optimal clinical use and the most beneficial indications for this novel technique.

  7. Monitoring clinical research: an obligation unfulfilled.

    PubMed Central

    Weijer, C; Shapiro, S; Fuks, A; Glass, K C; Skrutkowska, M

    1995-01-01

    The revelation that data obtained for the US-based National Surgical Adjuvant Breast and Bowel Project (NSABP) from subjects enrolled at Hôpital Saint-Luc in Montreal was falsified has eroded public trust in research. Institutions can educate researchers and help prevent unethical research practices by establishing procedures to monitor research involving human subjects. Research monitoring encompasses four categories of activity: annual reviews of continuing research, monitoring of informed consent, monitoring of adherence to approved protocols and monitoring of the integrity of data. The authors describe characteristics of research projects that may call for monitoring procedures in each category. The form taken by such monitoring depends on the nature of the protocol. Although appropriate research monitoring requires substantial investment of personnel and financial resources, it is required under guidelines regulating research involving human subjects in Canada. Research monitoring is a step forward in re-establishing public confidence in medical research. PMID:7780907

  8. Instrumentation for the remote monitoring of physiological and behavioral variables.

    PubMed

    Andrews, R D

    1998-11-01

    Few commercial products are available for investigators who wish to monitor multiple physiological and behavioral variables in unrestrained subjects. When telemetry is not practical, e.g., in studies of at-sea diving physiology, one of the only options is to design and build a custom data-logging instrument. This paper describes how a data logger was developed for the successful long-term monitoring of dive depth, swim speed, heart rate, water temperature, and multiple body temperatures from free-ranging northern elephant seals. The task was facilitated by using a commercially available single-board computer designed specifically for portable multichannel data acquisition and, where possible, off-the-shelf sensors/transducers available with integrated signal-conditioning circuits. A smaller data logger for monitoring the electrocardiogram, body temperature, and dive behavior of double-crested cormorants is also described to illustrate the flexibility and simplicity of this approach. Although it is customized for diving animals, with incorporation of the appropriate sensors the basic design should be applicable to studies of comparative, environmental, or exercise physiology involving most medium-to-large animals, including humans.

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

    NASA Astrophysics Data System (ADS)

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

    2014-05-01

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

  10. [Clinical variability of Juvenile Huntington's Disease phenotype].

    PubMed

    Błaszczyk, Magdalena; Boczarska-Jedynak, Magdalena; Rudzińska, Monika

    2015-01-01

    Huntington's disease is rare, genetically determinated, neurodegenerative disorder. It is determined by dynamic mutation of IT15 gene on short arm of 4 chromosome. Characteristic symptomatology include involuntary movements, cognitive decline and wide spectrum of mood and behaviour disorders. It typically becomes noticeable in mid-adult life, but there are reported cases of appaers of symptoms between 2 and 80 year of life. Especially interesting is juvenile Huntington's disease- the Westphal variant with the beginning in childchood (before 20 year of age) because of clinical differences causing diagnostic difficulties. It affects 5-10% of carries of the mutant gene. Symptoms became noticeable before 10 year of age only in 1% of them.

  11. Clinical variability in ataxia-telangiectasia.

    PubMed

    Lohmann, Ebba; Krüger, Stefanie; Hauser, Ann-Kathrin; Hanagasi, Hasmet; Guven, Gamze; Erginel-Unaltuna, Nihan; Biskup, Saskia; Gasser, Thomas

    2015-07-01

    Ataxia-telangiectasia (A-T) is an autosomal recessive inherited disease characterized by progressive childhood-onset cerebellar ataxia, oculomotor apraxia, choreoathetosis and telangiectasias of the conjunctivae. Further symptoms may be immunodeficiency and frequent infections, and an increased risk of malignancy. As well as this classic manifestation, several other non-classic forms exist, including milder or incomplete A-T phenotypes caused by homozygous or compound heterozygous mutations in the ATM gene. Recently, ATM mutations have been found in 13 Canadian Mennonites with early-onset, isolated, predominantly cervical dystonia, in a French family with generalized dystonia and in an Indian family with dopa-responsive cervical dystonia. In this article, we will describe a Turkish family with three affected sibs. Their phenotypes range from pure cervical dystonia associated with hand tremor to truncal and more generalized dystonic postures. Exome sequencing has revealed the potentially pathogenic compound heterozygous variants p.V2716A and p.G301VfsX19 in the ATM gene. The variants segregated perfectly with the phenotypes within the family. Both mutations detected in ATM have been shown to be pathogenic, and the α-fetoprotein, a marker of ataxia telangiectasia, was found to be increased. This report supports recent literature showing that ATM mutations are not exclusively associated with A-T but may also cause a more, even intra-familial variable phenotype in particular in association with dystonia.

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

    NASA Astrophysics Data System (ADS)

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

    2014-09-01

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

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

    NASA Technical Reports Server (NTRS)

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

    2003-01-01

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

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

    PubMed

    Oba, Koji

    2016-02-01

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

  15. Swift X-ray monitoring of M dwarf coronal variability

    NASA Astrophysics Data System (ADS)

    Miller, Brendan P.; Hagen, Cedric; Gallo, Elena; Wright, Jason

    2017-01-01

    We present new Swift observations of two M dwarfs with known exoplanets: GJ 15A and GJ 674. GJ 15A b is around 5.3 Earth masses with an 11.4 day orbital period, while GJ 674 is around 11.1 Earth masses with a 4.7 day orbital period. GJ 15A was observed several times in late 2014 and then monitored at approximately weekly intervals for several months in early 2016, for a total exposure of 18 ks. GJ 674 was monitored at approximately weekly intervals for most of 2016, for a total exposure of 40 ks. We provide light curves and hardness ratios for both sources, and also compare to earlier archival X-ray data. Both sources show significant X-ray variability, including between consecutive observations. We quantify the energy distribution for coronal flaring, and compare to optical results for M dwarfs from Kepler. Finally, we discuss the implications of M dwarf coronal activity for exoplanets orbiting within the nominal habitable zone.

  16. Guaranteeing robustness of structural condition monitoring to environmental variability

    NASA Astrophysics Data System (ADS)

    Van Buren, Kendra; Reilly, Jack; Neal, Kyle; Edwards, Harry; Hemez, François

    2017-01-01

    Advances in sensor deployment and computational modeling have allowed significant strides to be recently made in the field of Structural Health Monitoring (SHM). One widely used SHM strategy is to perform a vibration analysis where a model of the structure's pristine (undamaged) condition is compared with vibration response data collected from the physical structure. Discrepancies between model predictions and monitoring data can be interpreted as structural damage. Unfortunately, multiple sources of uncertainty must also be considered in the analysis, including environmental variability, unknown model functional forms, and unknown values of model parameters. Not accounting for these sources of uncertainty can lead to false-positives or false-negatives in the structural condition assessment. To manage the uncertainty, we propose a robust SHM methodology that combines three technologies. A time series algorithm is trained using "baseline" data to predict the vibration response, compare predictions to actual measurements collected on a potentially damaged structure, and calculate a user-defined damage indicator. The second technology handles the uncertainty present in the problem. An analysis of robustness is performed to propagate this uncertainty through the time series algorithm and obtain the corresponding bounds of variation of the damage indicator. The uncertainty description and robustness analysis are both inspired by the theory of info-gap decision-making. Lastly, an appropriate "size" of the uncertainty space is determined through physical experiments performed in laboratory conditions. Our hypothesis is that examining how the uncertainty space changes throughout time might lead to superior diagnostics of structural damage as compared to only monitoring the damage indicator. This methodology is applied to a portal frame structure to assess if the strategy holds promise for robust SHM. (Publication approved for unlimited, public release on October-28

  17. [Measurement of blood pressure variability and the clinical value].

    PubMed

    Kékes, Ede; Kiss, István

    2014-10-19

    Authors have collected and analyzed literature data on blood pressure variability. They present the methods of blood pressure variability measurement, clinical value and relationships with target organ damages and risk of presence of cardiovascular events. They collect data about the prognostic value of blood pressure variability and the effects of different antihypertensive drugs on blood pressure variability. They underline that in addition to reduction of blood pressure to target value, it is essential to influence blood pressure fluctuation and decrease blood pressure variability, because blood pressure fluctuation presents a major threat for the hypertensive subjects. Data from national studies are also presented. They welcome that measurement of blood pressure variability has been included in international guidelines.

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

    PubMed

    Bravi, Andrea; Longtin, André; Seely, Andrew J E

    2011-10-10

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

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

    PubMed Central

    2011-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2014-06-01

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

  1. Pilot Variability Study for Federal Aviation Administration Health and Usage Monitoring Mock Certification

    DTIC Science & Technology

    2015-09-01

    ARL-TR-6922 ● SEP 2015 US Army Research Laboratory Pilot Variability Study for Federal Aviation Administration Health and Usage...Laboratory Pilot Variability Study for Federal Aviation Administration Health and Usage Monitoring Mock Certification by Natasha C Bradley...October 2009–April 2014 4. TITLE AND SUBTITLE Pilot Variability Study for Federal Aviation Administration Health and Usage Monitoring Mock Certification

  2. Ambulatory blood pressure monitoring in spinal cord injury: clinical practicability.

    PubMed

    Hubli, Michèle; Krassioukov, Andrei V

    2014-05-01

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

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

    PubMed Central

    2012-01-01

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

  4. Classification of Variable Objects in Massive Sky Monitoring Surveys

    NASA Astrophysics Data System (ADS)

    Woźniak, Przemek; Wyrzykowski, Łukasz; Belokurov, Vasily

    2012-03-01

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

  5. Clozapine Monitoring in Clinical Practice: Beyond the Mandatory Requirement

    PubMed Central

    Kar, Nilamadhab; Barreto, Socorro; Chandavarkar, Rahul

    2016-01-01

    Clozapine is effective in treatment resistant schizophrenia; however, it is underutilised probably because of its side effects. The side effects are also the potential reasons for clozapine discontinuation. A mandatory requirement for its use is regular monitoring of white blood cell count and absolute neutrophil count. However there are many side effects that need monitoring in clinical practice considering their seriousness. This article tries to summarise the clinical concerns surrounding the serious side effects of clozapine some of which are associated with fatalities and presents a comprehensive way to monitor patients on clozapine in clinical practice. It emphasizes the need to broaden the monitoring beyond the mandatory investigations. This may help in improving the safety in clinical practice and increasing clinician confidence for greater and appropriate use of this effective intervention. PMID:27776383

  6. Clinical skills: cardiac rhythm recognition and monitoring.

    PubMed

    Sharman, Joanna

    With technological advances, changes in provision of healthcare services and increasing pressure on critical care services, ward patients' severity of illness is ever increasing. As such, nurses need to develop their skills and knowledge to care for their client group. Competency in cardiac rhythm monitoring is beneficial to identify changes in cardiac status, assess response to treatment, diagnosis and post-surgical monitoring. This paper describes the basic anatomy and physiology of the heart and its conduction system, and explains a simple and easy to remember process of analysing cardiac rhythms (Resuscitation Council UK, 2000) that can be used in first-line assessment to assist healthcare practitioners in providing care to their patients.

  7. Clinical tests of noninvasive optoacoustic cerebral venous oxygenation monitoring system

    NASA Astrophysics Data System (ADS)

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

    2009-02-01

    Monitoring of cerebral venous oxygenation is critically important for management of patients with traumatic brain injury and cardiac surgery patients. At present, there is no technique for noninvasive, accurate monitoring of this important physiologic parameter. We built a compact optoacoustic system for noninvasive, accurate cerebral venous oxygenation monitoring using a novel optoacoustic probe and algorithm that allow for direct probing of sagittal sinus blood with minimal signal contamination from other tissues. We tested the system in large animal and clinical studies and identified wavelengths for accurate measurement of cerebral blood oxygenation. The studies demonstrated that the system may be used for noninvasive, continuous, and accurate monitoring of cerebral venous blood oxygenation.

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

    PubMed Central

    Hubli, Michèle

    2014-01-01

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

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

    PubMed

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

    2013-01-01

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

  10. Microdialysis in clinical practice: monitoring intraoral free flaps.

    PubMed

    Jyränki, Janne; Suominen, Sinikka; Vuola, Jyrki; Bäck, Leif

    2006-04-01

    Clinical examination is still the gold standard of postoperative free flap monitoring, but with intraorally situated and/or buried flaps, it can be difficult or impossible. Microdialysis is a sampling technique which offers the possibility to monitor the metabolism of a flap continuously. Ischemia can be detected by monitoring the changes in glucose, lactate, and pyruvate levels in interstitial fluid of the specific tissue. Our aim was to use microdialysis to monitor the metabolism of free flaps used for reconstructions inside the oral cavity/oropharynx and to evaluate the reliability and usefulness of this new monitoring method.Twenty-five consecutive patients who underwent oral cavity/oropharynx cancer resection and immediate reconstruction with free flap were included in the study. A microdialysis catheter was placed into the subcutaneous adipose tissue of the flap in the end of the surgical procedure. Dialysate samples were taken on an hourly basis for 72 hours postoperatively. Routine clinical monitoring was carried out by experienced nursing staff. Clinical findings were recorded and later compared with microdialysis values. Two flaps out of 25 failed in spite of reoperations. In both problem cases, microdialysis indicated ischemia 1 to 2 hours before it became clinically evident. During flap ischemia, the lactate/pyruvate ratio increased, glucose concentrations reduced, whereas lactate level increased when compared with normal values. Our results indicate that microdialysis is safe for the patient and the flap. It can reliably detect flap ischemia at an early stage. This is especially useful in buried flaps when clinical monitoring is difficult. Microdialysis may also reduce the patient discomfort caused by repeated clinical examination of the flap.

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

    PubMed

    Gersten, Jennifer

    2012-01-01

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

  12. Influence of Study Design Variables on Clinical Pathology Data.

    PubMed

    Aulbach, Adam; Provencher, Anne; Tripathi, Niraj

    2017-02-01

    A number of factors related to study design have the potential to impact clinical pathology test results during the conduct of nonclinical safety studies. A thorough understanding of these factors is paramount in drawing accurate conclusions from clinical pathology data generated during such studies, particularly when attempting to make the distinction between test article and nontest article-related effects. Study design and conduct variables with potential to impact clinical pathology data discussed in this overview include those related to species and test system, animal age, animal care and husbandry practices, fasting, acclimatization periods, effects of transportation and stressors, route of administration, effects of in-life and surgical procedures, influence of study length, timing of blood collections, impact of vehicle/formulation composition, and some general concepts related to drug class. The material presented here is a summary based on information presented at the 35th Annual Symposium of the Society of Toxicologic Pathology (June 2016), during Symposium Session 2 titled "Deciphering Sources of Variability in Clinical Pathology-It's Not Just about the Numbers."

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

    NASA Technical Reports Server (NTRS)

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

    2011-01-01

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

  14. Low heart rate variability in patients with clinical burnout.

    PubMed

    Lennartsson, Anna-Karin; Jonsdottir, Ingibjörg; Sjörs, Anna

    2016-12-01

    Several studies have shown that acute psychosocial stress and chronic psychosocial stress reduce heart rate variability (HRV). It is likely that individuals suffering from burnout have reduced HRV, as a consequence of the long-term stress exposure. This study investigated HRV in 54 patients with clinical burnout (40 women and 14 men) and in 55 individuals reporting low burnout scores (healthy; 24 women and 31 men) and 52 individuals reporting high burnout scores (non-clinical burnout; 33 women and 19 men). The participants underwent a 300s ECG recording in the supine position. Standard deviation of normal R-R intervals (SDNN) and the root mean square of successive normal interval differences (RMSSD) were derived from time domain HRV analysis. Frequency domain HRV measures; total power (TP), low frequency power (LF), high frequency power (HF), and LF/HF ratio were calculated. All HRV measures, except LF/HF ratio, were lower in the clinical burnout patients compared to both the non-clinical burnout group and the healthy group. The difference was larger between the patients and the healthy group than between the patients and the non-clinical burnout group. HRV did not differ significantly between the non-clinical burnout group and the healthy group. Low HRV in burnout patients may constitute one of the links to associated adverse health, since low HRV reflects low parasympathetic activity - and accordingly low anabolic/regenerative activity.

  15. Multiparametric monitoring of tissue vitality in clinical situations

    NASA Astrophysics Data System (ADS)

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

    2001-05-01

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

  16. Immunological monitoring of the tumor immunoenvironment for clinical trials.

    PubMed

    Malyguine, Anatoli M; Strobl, Susan L; Shurin, Michael R

    2012-02-01

    Monitoring of immunotherapeutic clinical trials has undergone a considerable change in the last decade resulting in a general agreement that immune monitoring should guide the development of cancer vaccines. The emphasis on immune cell functions and quantitation of antigen-specific T cells have been playing a major role in the attempts to establish meaningful correlations between therapy-induced alterations in immune responses and clinical endpoints. However, one significant unresolved issue in modern immunotherapy is that when a tumor-specific cellular immune response is observed following the course of immunotherapy, it does not always lead to clinically proven cancer regression. This disappointing lack of a correlation between the tumor-specific cytotoxic immune responses and the clinical efficacy of immunotherapy may be explained, among other reasons, by the notion that the analysis of any single immunological parameter is not sufficient to provide clinically feasible information about the complex interactions between different cell subsets in the peripheral blood and immune, tumor, and stromal cells in the tumor milieu. By contrast, a systemic approach is required for improving the quality of a serial monitoring to ensure that it adequately and reliably measures potential changes induced in patients by administered vaccines or immunomodulators. Comprehensive evaluation of the balance between the immunostimulatory and immunosuppressive compartments of the immune system could be critical for a better understanding of how a given immunotherapy works or does not work in a particular clinical trial. New approaches to characterize tumor-infiltrating leukocytes, their phenotypic, biochemical, and genetic characteristics within the tumor microenvironment need to be developed and validated and should complement current monitoring techniques. These immune-monitoring assays for the local tumor immunoenvironment should be developed, validated, and standardized for

  17. Clinical variability in KBG syndrome: report of three unrelated families.

    PubMed

    Maegawa, Gustavo Henrique Boff; Leite, Júlio Cesar Loguercio; Félix, Têmis Maria; da Silveira, Heraldo Luís Dias; da Silveira, Heloísa Emília

    2004-12-01

    The KBG syndrome is characterized by short stature, macrodontia, a specific combination of minor anomalies, developmental delay, and/or mental retardation. We reported on four patients from three unrelated families. The most frequent clinical findings were: atypical face, long/flat philtrum, thin upper lip, macrodontia, dental malposition, enamel hypoplasia, and cleft teeth. Skeletal anomalies such as cervical ribs and vertebral abnormalities were also noted. Hand anomalies were observed in three patients. Mental retardation and developmental delay were present in three of the four patients. There is wide clinical variability in the expression of this syndrome. The males are usually more severely affected then the females, suggesting possible X-linked inheritance in some cases.

  18. Ultrasound clinical progress monitoring: Who, where and how?

    PubMed

    Harrison, Gill

    2015-11-01

    Prior to assessment of final ultrasound clinical competency it is important to monitor clinical progress, provide high quality feedback and encourage skills development. The role of the supervisor, mentor and assessor are fundamental to the on-going progress monitoring of ultrasound trainees. This article forms the second part of a larger project which was to elicit ultrasound practitioners' opinions on how progress should be monitored, where and by whom. An on-line questionnaire was used to gain opinions from ultrasound practitioners. Totally, 116 responses were received from professionals with an interest in ultrasound assessment. Results suggested that experienced, qualified ultrasound practitioners should undertake the role of supervisor and assessor, having been prepared for that role by the training centre. Formative monitoring should take place both within the clinical department and possibly the training centre, using a range of methods. Following completion of the training, practitioners should have a preceptorship period to consolidate their knowledge and skills for 3 to 6 months or until further competencies have been demonstrated. Formative progress monitoring should be a recognised part of ultrasound training. Essentially, staff undertaking supervision and assessor roles should be supported and trained to ensure a high quality, consistent learning experience for ultrasound trainees. Additionally, they should provide appropriate feedback to the trainee and education centre.

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

    ERIC Educational Resources Information Center

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

    2008-01-01

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

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

    PubMed

    Timmermans, Catherine; Venet, David; Burzykowski, Tomasz

    2016-02-01

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

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

    NASA Technical Reports Server (NTRS)

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

    2004-01-01

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

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

    EPA Science Inventory

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

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

    EPA Science Inventory

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

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

    NASA Astrophysics Data System (ADS)

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

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

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

    ERIC Educational Resources Information Center

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

    2010-01-01

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

  6. Fecal indicator bacteria variability in samples pumped from monitoring wells.

    PubMed

    Kozuskanich, J; Novakowski, K S; Anderson, B C

    2011-01-01

    The detection of microbiological contamination in drinking water from groundwater wells is often made with a limited number of samples that are collected using traditional geochemical sampling protocols. The objective of this study is to examine the variability of fecal indicator bacteria, as observed using discrete samples, due to pumping. Two wells were instrumented as multilevel piezometers in a bedrock aquifer, and bacterial enumeration was conducted on a total of 166 samples (for total coliform, fecal coliform, Escherichia coli, and fecal streptococci) using standard membrane filtration methods. Five tests were conducted using pumping rates ranging from 0.3 to 17 L/min in a variety of purging scenarios, which included constant and variable (incremental increase and decrease) flow. The results clearly show a rapid and reproducible, 1 to 2 log-unit decrease in fecal indicator bacteria at the onset of pumping to stabilized, low-level concentrations prior to the removal of three to five well volumes. The pumping rate was not found to be correlated with the magnitude of observed bacterial counts. Based on the results, we suggest sampling protocols for fecal indicator bacteria that include multiple collections during the course of pumping, including early-time samples, and consider other techniques such as microscopic enumeration when assessing the source of bacteria from the well-aquifer system.

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

    PubMed

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

    2015-06-01

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

  8. Monitoring cancer stem cells: insights into clinical oncology

    PubMed Central

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

    2016-01-01

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

  9. Velocity Loss as a Variable for Monitoring Resistance Exercise.

    PubMed

    González-Badillo, Juan José; Yañez-García, Juan Manuel; Mora-Custodio, Ricardo; Rodríguez-Rosell, David

    2017-03-01

    This study aimed to analyze: 1) the pattern of repetition velocity decline during a single set to failure against different submaximal loads (50-85% 1RM) in the bench press exercise; and 2) the reliability of the percentage of performed repetitions, with respect to the maximum possible number that can be completed, when different magnitudes of velocity loss have been reached within each set. Twenty-two men performed 8 tests of maximum number of repetitions (MNR) against loads of 50-55-60-65-70-75-80-85% 1RM, in random order, every 6-7 days. Another 28 men performed 2 separate MNR tests against 60% 1RM. A very close relationship was found between the relative loss of velocity in a set and the percentage of performed repetitions. This relationship was very similar for all loads, but particularly for 50-70% 1RM, even though the number of repetitions completed at each load was significantly different. Moreover, the percentage of performed repetitions for a given velocity loss showed a high absolute reliability. Equations to predict the percentage of performed repetitions from relative velocity loss are provided. By monitoring repetition velocity and using these equations, one can estimate, with considerable precision, how many repetitions are left in reserve in a bench press exercise set.

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

    PubMed

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

    2016-01-15

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

  11. Latent class instrumental variables: A clinical and biostatistical perspective

    PubMed Central

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

    2015-01-01

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

  12. Monitoring Regulatory Immune Responses in Tumor Immunotherapy Clinical Trials

    PubMed Central

    Olson, Brian M.; McNeel, Douglas G.

    2013-01-01

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

  13. Monitoring of clinical signs in goats with transmissible spongiform encephalopathies

    PubMed Central

    2010-01-01

    Background As there is limited information about the clinical signs of BSE and scrapie in goats, studies were conducted to describe the clinical progression of scrapie and BSE in goats and to evaluate a short clinical protocol for its use in detecting scrapie-affected goats in two herds with previously confirmed scrapie cases. Clinical assessments were carried out in five goats intracerebrally infected with the BSE agent as well as five reported scrapie suspects and 346 goats subject to cull from the two herds, 24 of which were retained for further monitoring. The brain and selected lymphoid tissue were examined by postmortem tests for disease confirmation. Results The sensitivity and specificity of the short clinical protocol in detecting a scrapie case in the scrapie-affected herds was 3.9% and 99.6%, respectively, based on the presence of tremor, positive scratch test, extensive hair loss, ataxia and absent menace response. All BSE- and scrapie-affected goats displayed abnormalities in sensation (over-reactivity to external stimuli, startle responses, pruritus, absent menace response) and movement (ataxia, tremor, postural deficits) at an advanced clinical stage but the first detectable sign associated with scrapie or BSE could vary between animals. Signs of pruritus were not always present despite similar prion protein genotypes. Clinical signs of scrapie were also displayed by two scrapie cases that presented with detectable disease-associated prion protein only in lymphoid tissues. Conclusions BSE and scrapie may present as pruritic and non-pruritic forms in goats. Signs assessed for the clinical diagnosis of scrapie or BSE in goats should include postural and gait abnormalities, pruritus and visual impairment. However, many scrapie cases will be missed if detection is solely based on the display of clinical signs. PrPd accumulation in the brain appeared to be related to the severity of clinical disease but not to the display of individual neurological signs

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

    PubMed

    Suvorov, I M

    2013-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2015-12-01

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

  16. Short-Term Variability in Apnea-Hypopnea Index during Extended Home Portable Monitoring

    PubMed Central

    Prasad, Bharati; Usmani, Sarah; Steffen, Alana D.; Van Dongen, Hans P.A.; Pack, Francis M.; Strakovsky, Inna; Staley, Bethany; Dinges, David; Maislin, Greg; Pack, Allan I.; Weaver, Terri E.

    2016-01-01

    Study Objectives: Apnea-hypopnea index (AHI) is the primary measure used to confirm a diagnosis of obstructive sleep apnea (OSA). However, there may be significant night-to-night variability (NNV) in AHI, limiting the value of AHI in clinical decision-making related to OSA management. We examined short-term NNV in AHI and its predictors during home portable monitoring (PM). Methods: Single center prospective observational study of patients (n = 84) with newly diagnosed OSA by polysomnography (PSG) AHI ≥ 5/h. All participants underwent 2 to 8 consecutive nights of PM. Results: Participants (n = 84) were middle-aged (47 ± 8.3 y, mean ± standard deviation; SD), including 28 women, with mean AHI on baseline PSG (AHIPSG) of 30.1 ± 31.8. Mean AHI on PM (AHIPM) was 27.4 ± 23.7. Intraclass correlation coefficient (ICC) for AHIPM in the entire sample was 0.73 (95% CI 0.66–0.8), indicating that 27% of the variability in AHIPM was due to intra-individual factors. Mild severity of OSA, defined by AHIPSG 5–15/h, was associated with higher NNV (likelihood ratio, −0.4 ± 0.14; p = 0.006) and absence of comorbidity showed a trend towards higher NNV (−0.54 ± 0.27, p = 0.05) on AHIPM. Conclusions: The intraindividual short-term NNV in AHIPM is higher in mild versus moderately severe OSA, even in the home setting, where first-night effect is not expected. Larger studies of NNV focused on patients with mild OSA are needed to identify characteristics that predict need and timing for repeated diagnostic testing and treatment. Commentary: A commentary on this article appears in this issue on page 787. Citation: Prasad B, Usmani S, Steffen AD, Van Dongen HP, Pack FM, Strakovsky I, Staley B, Dinges D, Maislin G, Pack AI, Weaver TE. Short-term variability in apnea-hypopnea index during extended home portable monitoring. J Clin Sleep Med 2016;12(6):855–863. PMID:26857059

  17. Clinical assessment of intraarterial blood gas monitor accuracy

    NASA Astrophysics Data System (ADS)

    Aziz, Salim; Spiess, R.; Roby, Paul; Kenny, Margaret

    1993-08-01

    The accuracy of intraarterial blood gas monitoring (IABGM) devices is challenging to assess under routine clinical conditions. When comparing discrete measurements by blood gas analyzer (BGA) to IABGM values, it is important that the BGA determinations (reference method) be as accurate as possible. In vitro decay of gas tensions caused by delay in BGA analysis is particularly problematic for specimens with high arterial oxygen tension (PaO2) values. Clinical instability of blood gases in the acutely ill patient may cause disagreement between BGA and IABGM values because of IABGM response time lag, particularly in the measurement of arterial blood carbon dioxide tension (PaCO2). We recommend that clinical assessments of IABGM accuracy by comparison with BGA use multiple bedside BGA instruments, and that blood sampling only occur during periods when IABGM values appear stable.

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

    USGS Publications Warehouse

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

    2009-01-01

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

  19. [Therapeutic monitoring of vancomycin in routine clinical practice].

    PubMed

    Kacířová, Ivana; Grundmann, Milan

    2014-10-01

    Therapeutic drug monitoring (TDM) is specific method of clinical pharmacology for monitoring of the therapy using measurement of drug serum concentrations followed interpretation and good cooperation with clinician. TDM help clinicians to quickly optimize vancomycin dosing regimens to maximize the clinical effect and minimize the toxicity of the drugs. Minimum serum vancomycin trough concentrations should always be maintained above 10 mg/L to avoid development of resistance, neverthelles trough concentrations > 20 mg/L are not recommended because of the risk of nephrotoxicity. For serious infections vancomycin trough concentrations of 15-20 mg/L are recommended and for a pathogen with an MIC of 1 mg/L, the minimum trough concentration would have to be at least 15 mg/L to generate the target AUC24/MIC 400 (area under the curve/minimal inhibitory concentration). In non-complicated infections trough concentrations of 10-15 mg/L should be sufficient. For continuous infusions of vancomycin target steady-state concentration values of 15-25 mg/L have been advocated for critically ill patients.Key words: therapeutic monitoring - trough concentration - vancomycin.

  20. Development of quality indicators to evaluate the monitoring of SLE patients in routine clinical practice

    PubMed Central

    Mosca, M.; Tani, C.; Aringer, M.; Bombardieri, S.; Boumpas, D.; Cervera, R.; Doria, A.; Jayne, D.; Khamashta, M. A.; Kuhn, A.; Gordon, C.; Petri, M.; Schneider, M.; Shoenfeld, Y.; Smolen, J. S.; Talarico, R.; Tincani, A.; Ward, M. M.; Werth, V. P.; Carmona, L.

    2014-01-01

    The assessment of systemic lupus erythematosus (SLE) patients in routine clinical practice is mainly based on the experience of the treating physician. This carries the risk of unwanted variability. Variability may have an impact on the quality of care offered to SLE patients, thereby affecting outcomes. Recommendations represent systematically developed statements to help practitioners in reducing variability. However, major difficulties arise in the application of recommendations into clinical practice. In this respect, the use of quality indicators may raise the awareness among rheumatologists regarding potential deficiencies in services and improve the quality of health care. The aim of this study was to develop a set of quality indicators (QI) for SLE by translating into QIs the recently developed EULAR Recommendations for monitoring SLE patients in routine clinical practice and observational studies. Eleven QIs have been developed referring to the use of validated activity and damage indices in routine clinical practice, general evaluation of drug toxicity, evaluation of comorbidities, eye evaluation, laboratory assessment, evaluation of the presence of chronic viral infections, documentation of vaccination and of antibody testing at baseline. A disease specific set of quality assessment tools should help physicians deliver high quality of care across populations. Routine updates will be needed. PMID:21224016

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

    PubMed Central

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

    1989-01-01

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

  2. Mosaic Trisomy 17: Variable Clinical and Cytogenetic Presentation

    PubMed Central

    Daber, Robert D.; Chapman, Kimberly A.; Ruchelli, Eduardo; Kasperski, Stefanie; Mulchandani, Surabhi; Thiel, Brian D.; Hakonarson, Hakon; Zackai, Elaine H.; Conlin, Laura K.; Spinner, Nancy B.

    2011-01-01

    Mosaic trisomy 17 is rare with only 28 cases reported and the clinical presentation is highly variable. The diagnosis is most commonly made by prenatal karyotype and in most cases is followed by a normal postnatal karyotype on blood lymphocytes. We present two cases of mosaic trisomy 17 diagnosed prenatally, with follow up in multiple tissues at birth. In the first case, trisomy 17 was identified in all amniocytes, and at birth standard results of chromosome analysis in peripheral blood were normal, but mosaic trisomy 17 was identified (50–75%) in skin fibroblasts by genome-wide SNP array analysis. This patient presented with minor anomalies, congenital heart disease, asymmetry, intestinal malrotation and died on day 9 of life. In the second patient amniocentesis after ultrasound finding of tetralogy of Fallot showed mosaic trisomy 17. Postnatally, results of a SNP array were normal in blood, buccal mucosa and skin. It is possible that the cardiac defect is related to trisomy 17 in key tissues during heart development, although at birth the aneuploidy could not be identified in tissues that are routinely analyzed for diagnosis. These cases add to our understanding of mosaic trisomy 17, highlighting the failure to diagnose this aneuploidy in peripheral blood. PMID:21998853

  3. Characterization of Common Measures of Heart Period Variability in Healthy Human Subjects: Implications for Patient Monitoring

    DTIC Science & Technology

    2010-01-01

    RRI) variability preceded other signs of fetal distress [1], heart period variability has been extensively reported in the literature, with consid...application of these metrics to patient monitoring must take into account the impact of other external stimuli, such as pain , anxiety and activity status...Lee ST. Electronic evaluation of the fetal heart rate VIII. Patterns preceding fetal death, further observations. Am J Obstet Gynecol 1963; 87: 814

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

    NASA Astrophysics Data System (ADS)

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

    2015-09-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

    Porter, Emily; Coates, Mark; Popović, Milica

    2016-03-01

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

  7. Mitigating the effects of variable speed on drive-by infrastructure monitoring

    NASA Astrophysics Data System (ADS)

    Thorsen, Andrew; Lederman, George; Oshima, Yoshinobu; Bielak, Jacobo; Noh, Hae Young

    2015-03-01

    Vehicle-based monitoring has the potential to become an accurate and cost-efficient way to monitor infrastructure assets, but a number of challenges must be addressed for such a technique to be implemented widely. The majority of vehicle-based infrastructure sensing has assumed that the vehicle's speed profile is identical every time it passes over the asset of interest. Ultimately, however this technology will be most practical if damage detection schemes can be applied regardless of the speed of the vehicle. Thus methods must be designed to handle speed variability to make this method more practical. In this paper we investigate the effects of variable speed when monitoring infrastructure from the dynamic response of a passing vehicle, which we measure by placing accelerometers on the vehicle of interest. We have conducted a series of laboratory tests to study this phenomenon, in which a vehicle crosses over a scaled model bridge structure with a varying speed profile. We quantify the ability of several features to detect changes in the infrastructure, independent of the variable speed. We show that aligning signals to normalize for speed variability improves the classification results. This work brings us closer to the ultimate goal of using vehicle-based monitoring to ensure more efficient and more reliable infrastructure in the future.

  8. Clinical evaluation of a novel respiratory rate monitor.

    PubMed

    Lee, Peter J

    2016-04-01

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

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

    PubMed Central

    2010-01-01

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

  10. Reliable real-time clinical monitoring using sensor network technology.

    PubMed

    Chipara, Octav; Brooks, Christopher; Bhattacharya, Sangeeta; Lu, Chenyang; Chamberlain, Roger D; Roman, Gruia-Catalin; Bailey, Thomas C

    2009-11-14

    We propose wireless sensor networks composed of nodes using low-power 802.15.4 radios as an enabling technology for patient monitoring in general hospital wards. A key challenge for such applications is to reliably deliver sensor data from mobile patients. We propose a monitoring system with two types of nodes: patient nodes equipped with wireless pulse oximeters and relays nodes used to route data to a base station. A reliability analysis of data collection from mobile users shows that mobility leads to packet losses exceeding 30%. The majority of packet losses occur between the mobile subjects and the first-hop relays. Based on this insight we developed the Dynamic Relay Association Protocol (DRAP), an effective mechanism for discovering the right relays for patient nodes. DRAP enables highly reliable data collection from mobile subjects. Empirical evaluation showed that DRAP delivered at least 96% of data from multiple users. Our results demonstrate the feasibility of wireless sensor networks for real-time clinical monitoring.

  11. The Gaia spectrophotometric standard stars survey - III. Short-term variability monitoring

    NASA Astrophysics Data System (ADS)

    Marinoni, S.; Pancino, E.; Altavilla, G.; Bellazzini, M.; Galleti, S.; Tessicini, G.; Valentini, G.; Cocozza, G.; Ragaini, S.; Braga, V.; Bragaglia, A.; Federici, L.; Schuster, W. J.; Carrasco, J. M.; Castro, A.; Figueras, F.; Jordi, C.

    2016-11-01

    We present the results of the short-term constancy monitoring of candidate Gaia Spectrophotometric Standard Stars (SPSS). We obtained time series of typically 1.24 h - with sampling periods from 1-3 min to a few hours, depending on the case - to monitor the constancy of our candidate SPSS down to 10 mmag, as required for the calibration of Gaia photometric data. We monitored 162 out of a total of 212 SPSS candidates. The observing campaign started in 2006 and finished in 2015, using 143 observing nights on nine different instruments covering both hemispheres. Using differential photometry techniques, we built light curves with a typical precision of 4 mmag, depending on the data quality. As a result of our constancy assessment, 150 SPSS candidates were validated against short-term variability, and only 12 were rejected because of variability including some widely used flux standards such as BD+174708, SA 105-448, 1740346, and HD 37725.

  12. Statistical process monitoring based on orthogonal multi-manifold projections and a novel variable contribution analysis.

    PubMed

    Tong, Chudong; Shi, Xuhua; Lan, Ting

    2016-11-01

    Multivariate statistical methods have been widely applied to develop data-based process monitoring models. Recently, a multi-manifold projections (MMP) algorithm was proposed for modeling and monitoring chemical industrial processes, the MMP is an effective tool for preserving the global and local geometric structure of the original data space in the reduced feature subspace, but it does not provide orthogonal basis functions for data reconstruction. Recognition of this issue, an improved version of MMP algorithm named orthogonal MMP (OMMP) is formulated. Based on the OMMP model, a further processing step and a different monitoring index are proposed to model and monitor the variation in the residual subspace. Additionally, a novel variable contribution analysis is presented for fault diagnosis by integrating the nearest in-control neighbor calculation and reconstruction-based contribution analysis. The validity and superiority of the proposed fault detection and diagnosis strategy are then validated through case studies on the Tennessee Eastman benchmark process.

  13. Levetiracetam Clinical Pharmacokinetic Monitoring in Pediatric Patients with Epilepsy.

    PubMed

    Tan, Jason; Paquette, Vanessa; Levine, Marc; Ensom, Mary H H

    2017-03-28

    Levetiracetam is a broad-spectrum antiepileptic drug (AED) with a unique mechanism of action. Older AEDs can cause serious short- and long-term adverse drug reactions and complications, rendering them undesirable to use in pediatric patients. Characteristics that make levetiracetam a near-ideal AED include its broad spectrum of activity, good tolerability profile, and minimal drug-drug interactions. Clinical pharmacokinetic monitoring (CPM) is often recommended in pediatric patients for certain AEDs due to large interindividual pharmacokinetic differences and unpredictable drug disposition. Our objective was to determine whether monitoring levetiracetam concentrations is warranted for pediatric patients with epilepsy, using a previously published 9-step decision-making algorithm. A literature search of the MEDLINE (1946-August 2016), EMBASE (1974-August 2016), CENTRAL, and Google Scholar databases was performed to identify relevant English-language articles and answer the questions posed in the algorithm for levetiracetam CPM in pediatric epilepsies. Additional articles were identified from a manual bibliographic review of the relevant literature. We found that levetiracetam CPM met some criteria of the algorithm: levetiracetam is an appropriate adjunctive or monotherapy for pediatric patients with either focal or generalized seizures; it is readily measurable in plasma, with an appropriate degree of sensitivity, accuracy, and precision; it exhibits interindividual variation in pharmacokinetics; often, its pharmacologic effect cannot be easily measured; and the duration of therapy is expected to be long-term. However, important criteria not met include the following: there is no clear evidence for a concentration-response relationship for efficacy or toxicity; the proposed therapeutic range of 12-46 μg/mL is not well-defined and is generally considered as wide. Thus, clinical decision making is unlikely to be affected as a result of routine levetiracetam CPM. In

  14. Weather variability permitted within amphibian monitoring protocol and affects on calling Hylidae.

    PubMed

    Milne, Robert; Bennett, Lorne; Hoyle, Mathew

    2013-11-01

    Anuran populations are sensitive to changing environmental conditions and act as useful indicators. Presently, much information collected concerning frog populations comes from volunteers following the North American Amphibian Monitoring Protocol. Does weather variability allowed within protocol affect the abundance of calling frogs? For 10 years, Credit Valley Conservation (Ontario, Canada) has been collecting anuran data concerning nine frog species employing three frog monitoring runs. Records include frog abundance by protocol code and five weather variables. Antecedent precipitation and temperature were determined from the nearest weather station. Locations with large source populations of two Hylidae species were selected (spring peeper calling in April and gray tree frog in May). Spearman correlations suggested there were no significant relationships between calling abundance of Hylidae species and ambient wind speed or humidity. However, gray tree frogs were temperature sensitive and calling was significantly related to increased water and air temperatures as well as day time high temperatures over the previous 2 weeks. Both species of calling Hylidae were affected by the volume and timing of precipitation (though, in different ways). Gray tree frogs seem to prefer drier conditions (when temperatures are significantly warmer) while spring peepers prefer to call during, or closely following, precipitation. Monitors targeting gray tree frog should track local weather conditions and focus on evenings when it is (a) warmer than the minimum temperatures and (b) drier than suggested by the protocol. It is recommended that an additional monitoring run could be added to reduce detection variability of this species.

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

    NASA Astrophysics Data System (ADS)

    Larson, T.

    2010-12-01

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

  16. [Noninvasive monitoring of gas exchange: methodologic prerequisites and clinical use].

    PubMed

    Kreymann, G; Gottschall, C; Grosser, S; Matthaei, S; Raedler, A; Schubmann, R; Beck, H

    1989-02-01

    The noninvasive determination of the respiratory gas exchange (measurement of oxygen uptake and carbon dioxide delivery) permits the calculation of cardiac output by Fick principle and of the actual energy requirement of the patient (indirect calorimetry). A system is presented for the continuous measurement of oxygen uptake and carbon dioxide delivery, that bases on simple components, which are available on most intensive care units. The methodical problems are discussed and the improvement of the signal of the oxygen sensor by digital signal processing is described. Clinical measurements on 16 patients are presented, whose metabolic rate early after extracorporal circulation was measured. The results reveal, that 4.4 hours after ECC the metabolic rate is close to the calculated basic metabolic rate. They demonstrate the importance of indirect calorimetry as a future bedside monitoring routine.

  17. Clinical results from a noninvasive blood glucose monitor

    NASA Astrophysics Data System (ADS)

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

    2002-05-01

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

  18. Monitoring ankylosing spondylitis: clinically useful markers and prediction of clinical outcomes.

    PubMed

    Braun, Juergen; Kiltz, Uta; Sarholz, Michael; Heldmann, Frank; Regel, Andrea; Baraliakos, Xenofon

    2015-01-01

    Patient assessment in axial spondyloarthritis (axSpA) is multidimensional, and monitoring of disease activity, function and radiographic progression is complex. There is no simple 'gold standard' for measuring disease activity in all individual patients, as disease activity in axSpA is the sum of many different aspects and a complexity that cannot be represented by a single variable. Limited spinal mobility is a cardinal sign of ankylosing spondylitis and loss of spinal mobility has been reported to be a prognostic factor and most often evaluated with the Bath Ankylosing Spondylitis Functional Index. Imaging of the spine and assessment of safety aspects plays an important role in the monitoring of patients with axSpA. The timeframe for collecting information regarding disease activity, function and radiographic progression are recommended on an individual basis.

  19. Optical signal to noise ratio monitoring using variable phase difference phase portrait with software synchronization.

    PubMed

    Yu, Yi; Yu, Changyuan

    2015-05-04

    In this paper, a novel optical signal to noise ratio (OSNR) monitoring method using 2-dimension (2-D) phase portrait is proposed and demonstrated, which is generated by using a single low-speed sampling channel with software synchronization technique. Moreover, variable phase difference is proposed to generate the X-Y pairs, which increases the tolerance of synchronization accuracy significantly. This method is a cost effective solution with simple system setup.

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

    NASA Astrophysics Data System (ADS)

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

    2013-05-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2015-04-01

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

  2. [Orofacial clinical manifestations in adult patients with variable common immunodeficiency].

    PubMed

    Chávez-García, Aurora Alejandra; Moreno-Alba, Miguel Ángel; Elizalde-Monroy, Martín; Segura-Méndez, Nora Hilda; Romero-Flores, Jovita; Cambray-Gutiérrez, Julio César; López-Pérez, Patricia; Del Rivero-Hernández, Leonel Gerardo

    2015-01-01

    Antecedentes: la inmunodeficiencia común variable es la inmunodeficienci primaria más común en adultos. Su prevalencia se estima en 1 por cada 25,000 a 75,000 recién nacidos vivos; existen variaciones por grupos étnicos, se estima en 50 a 70% en pacientes de raza caucásica. Las lesiones de la cavidad oral raramente se describen en pacientes adultos con inmunodeficiencia común variable, en niños con esta enfermedad existen informes de lesiones principalmente de origen infeccioso. Objetivo: describir las lesiones orofaciales (cavidad oral, macizo facial y cuello) en pacientes adultos con inmunodeficiencia común variable. Material y método: estudio transversal, prospectivo, efectuado en todos los adultos con inmunodeficiencia común variable adscritos a la Clínica de inmunodeficiencias primarias, del Hospital de Especialidades, Centro Médico Nacional Siglo XXI, que fueron examinados por un cirujano maxilofacial; se realizó el reporte de hallazgos en lista de cotejo y, posteriormente, el análisis descriptivo de las lesiones. Resultados: se incluyeron 26 pacientes, 16 mujeres y 10 hombres, con edad promedio de 38.6 años. En 18 de 26 pacientes estudiados se observaron lesiones orales, con siete lesiones diferentes y predominio en el sexo femenino 2:1. Las lesiones más frecuentes fueron: hiperplasia de glándulas salivales menores (19/26), petequias (12/26) y úlceras herpetiformes (7/26). En la cara y el cuello se observaron cuatro lesiones distintas, las adenopatías < 2 cm (4/26) fueron las más comunes. Conclusiones: las alteraciones inmunológicas asociadas con la inmunodeficiencia común variable favorecen la aparición de lesiones de origen infeccioso y probablemente autoinmunitario que afectan la cavidad oral, la cara y el cuello.

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

    USGS Publications Warehouse

    Litzow, Michael A.; Piatt, J.F.; Abookire, Alisa A.; Prichard, A.K.; Robards, Martin D.

    2000-01-01

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

  4. Walking function in clinical monitoring of multiple sclerosis by telemedicine.

    PubMed

    Sola-Valls, Núria; Blanco, Yolanda; Sepúlveda, Maria; Llufriu, Sara; Martínez-Lapiscina, Elena H; La Puma, Delon; Graus, Francesc; Villoslada, Pablo; Saiz, Albert

    2015-07-01

    Walking limitation is a key component of disability in patients with multiple sclerosis (MS), but the information on daily walking activity and disability over time is limited. To determine, (1) the agreement between the standard measurements of MS-related disability [expanded disability status scale (EDSS), functional systems (FS) and ambulation index (AI)] obtained by conventional and remote evaluation using a multimedia platform; (2) the usefulness of monitoring 6-min walk test (6MWT) and average daily walking activity (aDWA) to better characterize patients disability. Twenty-five patients (EDSS score 1.0-6.5) were evaluated every 3 months for the first year, and aDWA repeated at year 2. Remote visits included the recording of a video with self-performed neurological examination and specific multimedia questionnaires. aDWA was measured by a triaxial accelerometer. All but two patients completed the study. Modest agreement between conventional and multimedia EDSS was found for EDSS ≤ 4.0 (kappa = 0.2) and good for EDSS ≥ 4.5 (kappa = 0.6). For the overall sample, pyramidal, cerebellar and brainstem FS showed the greatest agreement (kappa = 0.7). SR-AI showed a modest agreement for EDSS ≤ 4.0 and good for EDSS ≥ 4.5 (kappa = 0.3 and 0.6, respectively). There was a strong correlation between conventional and 6MWT measured by accelerometer (r = 0.76). The aDWA correlated strongly with the EDSS (r = -0.86) and a cut-off point of 3279.3 steps/day discriminated patients with ambulatory impairment. There was a significant decline in aDWA over 2 years in patients with ambulatory impairment that were not observed by standard measurements of disability. MS clinical monitoring by telemedicine is feasible, but the observed lower agreement in less disabled patients emphasizes the need to optimize the assessment methodology. Accelerometers capture changes that may indicate deterioration over time.

  5. Quantification of Peptides from Immunoglobulin Constant and Variable Regions by Liquid Chromatography-Multiple Reaction Monitoring Mass Spectrometry for Assessment of Multiple Myeloma Patients

    PubMed Central

    Remily-Wood, Elizabeth R.; Benson, Kaaron; Baz, Rachid C.; Chen, Y. Ann; Hussein, Mohamad; Hartley-Brown, Monique A.; Sprung, Robert W.; Perez, Brianna; Liu, Richard Z.; Yoder, Sean; Teer, Jamie; Eschrich, Steven A.; Koomen, John M.

    2014-01-01

    Purpose Quantitative mass spectrometry assays for immunoglobulins (Igs) are compared with existing clinical methods in samples from patients with plasma cell dyscrasias, e.g. multiple myeloma. Experimental design Using LC-MS/MS data, Ig constant region peptides and transitions were selected for liquid chromatography-multiple reaction monitoring mass spectrometry (LC-MRM). Quantitative assays were used to assess Igs in serum from 83 patients. Results LC-MRM assays quantify serum levels of Igs and their isoforms (IgG1–4, IgA1–2, IgM, IgD, and IgE, as well as kappa(κ) and lambda(λ) light chains). LC-MRM quantification has been applied to single samples from a patient cohort and a longitudinal study of an IgE patient undergoing treatment, to enable comparison with existing clinical methods. Proof-of-concept data for defining and monitoring variable region peptides are provided using the H929 multiple myeloma cell line and two MM patients. Conclusions and Clinical Relevance LC-MRM assays targeting constant region peptides determine the type and isoform of the involved immunoglobulin and quantify its expression; the LC-MRM approach has improved sensitivity compared with the current clinical method, but slightly higher interassay variability. Detection of variable region peptides is a promising way to improve Ig quantification, which could produce a dramatic increase in sensitivity over existing methods, and could further complement current clinical techniques. PMID:24723328

  6. Association of morning fasting blood glucose variability with insulin antibodies and clinical factors in type 1 diabetes.

    PubMed

    Yoneda, Chihiro; Tashima-Horie, Kanako; Fukushima, Sayaka; Saito, Satoko; Tanaka, Sayoko; Haruki, Takenori; Ogino, Jun; Suzuki, Yoshifumi; Hashimoto, Naotake

    2016-07-30

    The fasting blood glucose concentration in type 1 diabetes may vary without being much affected by diet and exercise. This study aimed to identify association of morning fasting blood glucose concentration variability with insulin antibodies and clinical factors. The subjects in this study were 54 patients with type 1 diabetes who had high variation of fasting blood glucose. The insulin antibody level was measured, and correlations of glycemic variability with antibody levels, binding rates, and other clinical factors were investigated. The standard deviation (SD) of the 30-day morning self-monitored fasting blood glucose concentration (FBG SD) was evaluated as an index of glycemic variability. The mean glucose level was 159.8±42.1 mg/dL and the FBG SD was 47.5±22.0 mg/dL. Glycemic variability (FBG SD) was positively correlated with insulin antibody level, but not with insulin antibody binding rate, and had a negative correlation with C-peptide immunoreactivity/plasma glucose (CPR/PG) and positive correlations with diabetes duration, basal insulin dose and bolus insulin dose. Glycemic variability was not correlated with BMI, HbA1c or age. In multiple regression analysis of glycemic variability, CPR/PG was the only significant related factor. The results showed that glycemic variability was mainly influenced by endogenous insulin secretion capacity and was high in patients with high insulin antibody levels. In some patients with a high insulin antibody titer, the antibody may have an effect on the variability of the fasting glucose concentration in type 1 diabetes.

  7. Relationships among different glycemic variability indices obtained by continuous glucose monitoring.

    PubMed

    Saisho, Yoshifumi; Tanaka, Chihiro; Tanaka, Kumiko; Roberts, Rachel; Abe, Takayuki; Tanaka, Masami; Meguro, Shu; Irie, Junichiro; Kawai, Toshihide; Itoh, Hiroshi

    2015-08-01

    The aim of this study was to assess the relationships among indices of glycemic variability obtained by continuous glucose monitoring (CGM). CGM was performed in 88 patients with diabetes (20 type 1 and 68 type 2 diabetes, age 59 ± 15 years) admitted to our hospital (Keio University Hospital, Tokyo, Japan) between 2010 and 2012. Mean glucose, glucose standard deviation (SDglu) and other glycemic indices such as index of glycemic control (ICG), J-index, mean of daily differences (MODD), continuous overlapping net glycemic action 1 (CONGA1), mean amplitude of glycemic excursions (MAGE) and M value were calculated from CGM data, and the correlations among these indices were assessed. There were strong correlations between SDglu and the indices MAGE, CONGA1, MODD and M value (all r > 0.8, P < 0.05). On the other hand, mean glucose was strongly correlated with J index and M value (both r > 0.8, P < 0.05). SDglu and other glycemic variability indices were more strongly correlated with hypoglycemia than was mean glucose, and the combination of mean glucose and SDglu was useful for predicting hypoglycemia in patients with diabetes. In this study, we demonstrated the characteristics of various glycemic variability indices in relation to mean glucose and SDglu. This information will help physicians to understand the characteristics of various glycemic variability indices and to select an appropriate index for their purpose. Our results also underpin the importance of glycemic variability in relation to risk of hypoglycemia in patients with diabetes.

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

    PubMed Central

    Goldman, Sylvie; Greene, Paul E.

    2012-01-01

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

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

    SciTech Connect

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

    2009-11-01

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

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

    ERIC Educational Resources Information Center

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

    2015-01-01

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

  11. Monitoring the Far Infrared Variability of Deeply Embedded Protostars with SOFIA/HAWC

    NASA Astrophysics Data System (ADS)

    Johnstone, Doug

    2015-10-01

    Low-mass stars form via gravitational collapse of molecular cloud cores. The evolution of the mass accretion onto a forming protostar depends on the rate at which the interior of the core collapses, the significance of a circumstellar disk as a temporary mass reservoir, and the physics of how the gas is transported through the disk and accretes onto the central star. Despite a clear requirement for time dependency in the accretion rate onto deeply embedded protostars and a large number of theoretical mechanisms for powering variability, our understanding of both the timescale and amplitude of variability is almost entirely unconstrained. The bolometric luminosity of deeply embedded protostars is a direct proxy for the accretion luminosity, modified only by the addition of the stellar luminosity itself. For deeply embedded protostars, the spectral energy distribution peaks in the far infrared, near 100 microns, making this an ideal wavelength for long-term monitoring of accretion variability. We propose to use SOFIA/HAWC at 89 and 154 microns to monitor three star-forming fields (Cepheus, Perseus, and Serpens) as part of a long-term campaign dedicated to uncovering the observational signature of episodic accretion. These observations will aid in our understanding of how stars accumulate their final mass and are neceassry for discriminating between the various theoretical models of episodic accretion onto deeply embedded protostars.

  12. Primary Vascular Leiomyosarcoma: Clinical Observations and Molecular Variables

    PubMed Central

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

    2016-01-01

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

  13. Impulsive Behavior and Associated Clinical Variables in Parkinson's Disease

    PubMed Central

    Abosch, Aviva; Gupte, Akshay; Eberly, Lynn E.; Tuite, Paul J.; Nance, Martha; Grant, Jon E.

    2011-01-01

    Parkinson's disease (PD) is a degenerative brain disorder accompanied by the loss of dopaminergic neurons and the presence of motor and non-motor symptoms. We performed a cross-sectional, questionnaire-based analysis of impulsive behavior in our PD clinic population to assess prevalence and associated characteristics. We found a higher prevalence of impulsive behavior (29.7%) than previously reported, and found multiple, concurrent impulsive behaviors in 26% of subjects reporting impulsive behavior. Our findings contribute to the growing awareness of impulsive behavior in PD, and support the need for longitudinal studies to assess changes in impulsive behaviors in Parkinson's patients. PMID:21300194

  14. Use of structured decision making to identify monitoring variables and management priorities for salt marsh ecosystems

    USGS Publications Warehouse

    Neckles, Hilary A.; Lyons, James E.; Guntenspergen, Glenn R.; Shriver, W. Gregory; Adamowicz, Susan C.

    2015-01-01

    Most salt marshes in the USA have been degraded by human activities, and coastal managers are faced with complex choices among possible actions to restore or enhance ecosystem integrity. We applied structured decision making (SDM) to guide selection of monitoring variables and management priorities for salt marshes within the National Wildlife Refuge System in the northeastern USA. In general, SDM is a systematic process for decomposing a decision into its essential elements. We first engaged stakeholders in clarifying regional salt marsh decision problems, defining objectives and attributes to evaluate whether objectives are achieved, and developing a pool of alternative management actions for achieving objectives. Through this process, we identified salt marsh attributes that were applicable to monitoring National Wildlife Refuges on a regional scale and that targeted management needs. We then analyzed management decisions within three salt marsh units at Prime Hook National Wildlife Refuge, coastal Delaware, as a case example of prioritizing management alternatives. Values for salt marsh attributes were estimated from 2 years of baseline monitoring data and expert opinion. We used linear value modeling to aggregate multiple attributes into a single performance score for each alternative, constrained optimization to identify alternatives that maximized total management benefits subject to refuge-wide cost constraints, and used graphical analysis to identify the optimal set of alternatives for the refuge. SDM offers an efficient, transparent approach for integrating monitoring into management practice and improving the quality of management decisions.

  15. MONITOR Ionospheric Network: two case studies on scintillation and electron content variability

    NASA Astrophysics Data System (ADS)

    Béniguel, Yannick; Cherniak, Iurii; Garcia-Rigo, Alberto; Hamel, Pierrick; Hernández-Pajares, Manuel; Kameni, Roland; Kashcheyev, Anton; Krankowski, Andrzej; Monnerat, Michel; Nava, Bruno; Ngaya, Herbert; Orus-Perez, Raül; Secrétan, Hughes; Sérant, Damien; Schlüter, Stefan; Wilken, Volker

    2017-03-01

    The ESA MONITOR network is composed of high-frequency-sampling global navigation satellite systems (GNSS) receivers deployed mainly at low and high latitudes to study ionosphere variability and jointly with global GNSS data and ionospheric processing software in support of the GNSS and its satellite-based augmentation systems (SBAS) like the European EGNOS. In a recent phase of the project, the network was merged with the CNES/ASECNA network and new receivers were added to complement the latter in the western African sector. This paper summarizes MONITOR, presenting two case studies on scintillations (using almost 2 years of data measurements). The first case occurred during the major St. Patrick's Day geomagnetic storm in 2015. The second case study was performed in the last phase of the project, which was supported by ESA EGNOS Project Office, when we paid special attention to extreme events that might degrade the system performance of the European EGNOS.

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

    NASA Astrophysics Data System (ADS)

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

    2014-12-01

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

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

    PubMed

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

    2015-07-01

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

  18. The Potential Clinical Utility of Transdermal Alcohol Monitoring Data to Estimate the Number of Alcoholic Drinks Consumed

    PubMed Central

    Dougherty, Donald M.; Hill-Kapturczak, Nathalie; Liang, Yuanyuan; Karns, Tara E.; Lake, Sarah L.; Cates, Sharon E.; Roache, John D.

    2014-01-01

    Objectives Transdermal alcohol monitoring is used extensively in forensic settings to identify whether individuals have violated court-ordered mandates to abstain from drinking. Despite widespread use in that setting, comparatively few studies have explored the clinical utility of transdermal alcohol monitoring. Furthermore, of the few studies conducted, most have relied on the forensically established conservative criteria to identify whether or not a drinking episode has occurred. Here, we explore how transdermal alcohol monitoring data can be used to estimate more clinically meaningful parameters relevant to clinical treatment programs. Methods We developed a procedure to use transdermal data to objectively estimate the number of standardized drinks an individual has consumed. Participants included 46 men and women who consumed 1 to 5 beers within 2 hours in the laboratory on separate days while wearing devices to monitor transdermal alcohol concentrations (TAC). Results A mathematical model was derived to estimate the number of standardized alcohol drinks consumed, which included a number of variables (time-to-peak TAC, area under the TAC curve, and sex). The model was then validated by applying it to data from a separate study. Our results indicate that transdermal alcohol devices can be used to estimate the number of standard drinks consumed. Conclusions Objective methods characterizing both the level of intoxication achieved and the number of drinks consumed, such as transdermal alcohol monitoring, could be useful in both research and treatment settings. PMID:26500459

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

    NASA Technical Reports Server (NTRS)

    Sprinkle, Danny R.; Shen, Chih-Ping

    1988-01-01

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

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

    SciTech Connect

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

    2012-11-15

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

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

    DOEpatents

    Hammerstrom, Donald J.

    2013-10-15

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

  2. Sporadic phaeochromocytoma in childhood: clinical and molecular variability.

    PubMed

    Pozo, Jesús; Muñoz, Maria Teresa; Martos, Gabriel; Argente, Jesús

    2005-06-01

    Sporadic phaeochromocytoma is an infrequent tumour during paediatric age and may or may not be associated with specific autosomal dominant inherited cancer syndromes such as multiple endocrine neoplasia type 2 (MEN2), von Hippel-Lindau syndrome (VHL) type 2 or neurofibromatosis (NF) type 1. We report two cases of benign, adrenal, and unilateral phaeochromocytoma that clearly demonstrate the clinical and molecular heterogeneity of this disease during the paediatric period. The first patient presented a characteristic symptomatic form of sporadic phaeochromocytoma. The second patient, an incidental finding, was practically asymptomatic and had a de novo germline point mutation in the VHL gene (Arg167Trp). The frequency of de novo mutations in susceptible genes (especially the VHL gene) in paediatric patients with sporadic phaeochromocytoma and the elevated mortality of these cancer syndromes suggest that screening for mutations should be performed even in cases of non-familial sporadic phaeochromocytoma.

  3. Sleep quality in Parkinson disease: an examination of clinical variables.

    PubMed

    Stavitsky, Karina; Cronin-Golomb, Alice

    2011-06-01

    The etiology of sleep problems in Parkinson disease (PD) is not well understood, as they may arise from the pathology of the disease or from other disease-related factors such as motor dysfunction, dopaminergic medication, and mood disturbances. The aim of this study was to investigate factors associated with sleep, including disease-related variables such as motor symptom severity, dose of medication, and mood and disease subtypes. Thirty-five nondemented patients with PD were included. Sleep was measured using 24-hour wrist actigraphy over a 7-day period, during which time participants kept a sleep diary. Subjective sleep and arousal questionnaires included the PD Sleep Scale and Epworth Sleepiness Scale. Motor symptom severity and dopaminergic medication were significantly related to measures of sleep quality. Sex differences in sleep quality were found, with men having worse sleep quality and more excessive daytime sleepiness than women. We also found that actigraphy may serve as a useful tool for identifying individuals with possible rapid eye movement behavior disorder, a sleep disorder that has important implications in early detection of PD.

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

    PubMed Central

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

    2015-01-01

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

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

    SciTech Connect

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

    2014-04-10

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

  6. A Monitoring Campaign for Luhman 16AB. I. Detection of Resolved Near-infrared Spectroscopic Variability

    NASA Astrophysics Data System (ADS)

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

    2014-04-01

    We report resolved near-infrared spectroscopic monitoring of the nearby L dwarf/T dwarf binary WISE J104915.57-531906.1AB (Luhman 16AB), as part of a broader campaign to characterize the spectral energy distribution and temporal variability of this system. A continuous 45 minute sequence of low-resolution IRTF/SpeX data spanning 0.8-2.4 μm were obtained, concurrent with combined-light optical photometry with ESO/TRAPPIST. Our spectral observations confirm the flux reversal of this binary, and we detect a wavelength-dependent decline in the relative spectral fluxes of the two components coincident with a decline in the combined-light optical brightness of the system over the course of the observation. These data are successfully modeled as a combination of achromatic (brightness) and chromatic (color) variability in the T0.5 Luhman 16B, consistent with variations in overall cloud opacity; and no significant variability was found in L7.5 Luhman 16A, consistent with recent resolved photometric monitoring. We estimate a peak-to-peak amplitude of 13.5% at 1.25 μm over the full light curve. Using a simple two-spot brightness temperature model for Luhman 16B, we infer an average cold covering fraction of ≈30%-55%, varying by 15%-30% over a rotation period assuming a ≈200-400 K difference between hot and cold regions. We interpret these variations as changes in the covering fraction of a high cloud deck and corresponding "holes" which expose deeper, hotter cloud layers, although other physical interpretations are possible. A Rhines scale interpretation for the size of the variable features explains an apparent correlation between period and amplitude for Luhman 16B and the variable T dwarfs SIMP 0136+0933 and 2MASS J2139+0220, and predicts relatively fast winds (1-3 km s-1) for Luhman 16B consistent with light curve evolution on an advective time scale (1-3 rotation periods). The strong variability observed in this flux reversal brown dwarf pair supports the model of

  7. Inter-observer Variability of Clinical Criteria in Nursing Home Residents with Suspected UTI

    PubMed Central

    Juthani-Mehta, Manisha; Tinetti, Mary; Perrelli, Eleanor; Towle, Virginia; Van Ness, Peter H.; Quagliarello, Vincent

    2009-01-01

    We determined the inter-observer variability of clinical criteria for urinary tract infection (UTI) in nursing home residents. Pairs of nursing home staff caring for thirty residents were interviewed at times of suspected UTI. At least one measure from each clinical criteria category was reliably observed by nursing home staff members. PMID:18419369

  8. Control and monitoring system for clinically employed pneumatic blood pumps.

    PubMed

    Normann, N A; Henrichsen, D W; Cooper, T G; King, R E; Noon, G P; DeBakey, M E

    1977-01-01

    Instantaneous position of the flexing member in pneumatic blood pumps is monitored on-line by measuring the electrical capacitance across the gas space within the pump. Monitor output is utilized in closed-loop pump control and for automatic pump shutdown in response to operational abnormalities. Thus, safety and efficacy are enhanced through operational optimization, automatic safety features, and facilitated evaluation.

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

    NASA Astrophysics Data System (ADS)

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

    2014-05-01

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

  10. Distal arthrogryposis with variable clinical expression caused by TNNI2 mutation

    PubMed Central

    Čulić, Vida; Miyake, Noriko; Janković, Sunčana; Petrović, Davor; Šimunović, Marko; Đapić, Tomislav; Shiina, Masaaki; Ogata, Kazuhiro; Matsumoto, Naomichi

    2016-01-01

    Distal arthrogryposis (DA) is a clinically and genetically heterogeneous disorder with multiple joint contractures. We describe a female DA patient with hand and foot deformities, and right-sided torticollis. Using exome sequencing, we identified a novel TNNI2 mutation (c.485>A, p.Arg162Lys) in the patient and her father. The father has no typical DA but hip dysplasia. This may explain the clinical features of DA2B in this family, but with variable clinical expression. PMID:27790376

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

    NASA Astrophysics Data System (ADS)

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

    2011-12-01

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

  12. Precipitation variability within an urban monitoring network via microcanonical cascade generators

    NASA Astrophysics Data System (ADS)

    Licznar, P.; De Michele, C.; Adamowski, W.

    2015-01-01

    Understanding the variability of precipitation at small scales is fundamental in urban hydrology. Here we consider the case study of Warsaw, Poland, characterized by a precipitation-monitoring network of 25 gauges and microcanonical cascade models as the instrument of investigation. We address the following issues partially investigated in literature: (1) the calibration of microcanonical cascade model generators in conditions of short time series (i.e., 2.5-5 years), (2) the identification of the probability distribution of breakdown coefficients (BDCs) through ranking criteria and (3) the variability among the gauges of the monitoring network of the empirical distribution of BDCs. In particular, (1) we introduce an overlapping moving window algorithm to determine the histogram of BDCs and compare it with the classic non-overlapping moving window algorithm; (2) we compare the 2N-B distribution, a mixed distribution composed of two normal (N) and one beta (B), with the classic B distribution to represent the BDCs using the Akaike information criterion; and (3) we use the cluster analysis to identify patterns of BDC histograms among gauges and timescales. The scarce representation of the BDCs at large timescales, due to the short period of observation (~ 2.5 years), is solved through the overlapping moving window algorithm. BDC histograms are described by a 2N-B distribution. A clear evolution of this distribution is observed, in all gauges, from 2N-B for small timescales, N-B for intermediate timescales and B distribution for large timescales. The performance of the microcanonical cascades is evaluated for the considered gauges. Synthetic time series are analyzed with respect to the intermittency and the variability of intensity and compared to observed series. BDC histograms for each timescale are compared with the 25 gauges in Warsaw and with other gauges located in Poland and Germany.

  13. Monitoring of airborne biological particles in outdoor atmosphere. Part 1: Importance, variability and ratios.

    PubMed

    Núñez, Andrés; Amo de Paz, Guillermo; Rastrojo, Alberto; García, Ana M; Alcamí, Antonio; Gutiérrez-Bustillo, A Montserrat; Moreno, Diego A

    2016-03-01

    The first part of this review ("Monitoring of airborne biological particles in outdoor atmosphere. Part 1: Importance, variability and ratios") describes the current knowledge on the major biological particles present in the air regarding their global distribution, concentrations, ratios and influence of meteorological factors in an attempt to provide a framework for monitoring their biodiversity and variability in such a singular environment as the atmosphere. Viruses, bacteria, fungi, pollen and fragments thereof are the most abundant microscopic biological particles in the air outdoors. Some of them can cause allergy and severe diseases in humans, other animals and plants, with the subsequent economic impact. Despite the harsh conditions, they can be found from land and sea surfaces to beyond the troposphere and have been proposed to play a role also in weather conditions and climate change by acting as nucleation particles and inducing water vapour condensation. In regards to their global distribution, marine environments act mostly as a source for bacteria while continents additionally provide fungal and pollen elements. Within terrestrial environments, their abundances and diversity seem to be influenced by the land-use type (rural, urban, coastal) and their particularities. Temporal variability has been observed for all these organisms, mostly triggered by global changes in temperature, relative humidity, et cetera. Local fluctuations in meteorological factors may also result in pronounced changes in the airbiota. Although biological particles can be transported several hundreds of meters from the original source, and even intercontinentally, the time and final distance travelled are strongly influenced by factors such as wind speed and direction. [Int Microbiol 2016; 19(1):1-1 3].

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

    PubMed

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

    2010-01-01

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

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

    PubMed

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

    2013-09-01

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

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

    Code of Federal Regulations, 2011 CFR

    2011-04-01

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

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

    Code of Federal Regulations, 2014 CFR

    2014-04-01

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

  18. 21 CFR 312.87 - Active monitoring of conduct and evaluation of clinical trials.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

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

  19. 21 CFR 312.87 - Active monitoring of conduct and evaluation of clinical trials.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

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

  20. Role of Large Clinical Datasets From Physiologic Monitors in Improving the Safety of Clinical Alarm Systems and Methodological Considerations: A Case From Philips Monitors

    PubMed Central

    Reed, Charles Calhoun; Staggers, Nancy

    2016-01-01

    Background Large datasets of the audit log of modern physiologic monitoring devices have rarely been used for predictive modeling, capturing unsafe practices, or guiding initiatives on alarm systems safety. Objective This paper (1) describes a large clinical dataset using the audit log of the physiologic monitors, (2) discusses benefits and challenges of using the audit log in identifying the most important alarm signals and improving the safety of clinical alarm systems, and (3) provides suggestions for presenting alarm data and improving the audit log of the physiologic monitors. Methods At a 20-bed transplant cardiac intensive care unit, alarm data recorded via the audit log of bedside monitors were retrieved from the server of the central station monitor. Results Benefits of the audit log are many. They include easily retrievable data at no cost, complete alarm records, easy capture of inconsistent and unsafe practices, and easy identification of bedside monitors missed from a unit change of alarm settings adjustments. Challenges in analyzing the audit log are related to the time-consuming processes of data cleaning and analysis, and limited storage and retrieval capabilities of the monitors. Conclusions The audit log is a function of current capabilities of the physiologic monitoring systems, monitor’s configuration, and alarm management practices by clinicians. Despite current challenges in data retrieval and analysis, large digitalized clinical datasets hold great promise in performance, safety, and quality improvement. Vendors, clinicians, researchers, and professional organizations should work closely to identify the most useful format and type of clinical data to expand medical devices’ log capacity. PMID:27694097

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

    PubMed

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

    2013-04-01

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

  2. Real-time monitoring for human clinical trials

    SciTech Connect

    Harker, Y.D.

    1995-11-01

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

  3. Prediction of hypertensive crisis based on average, variability and approximate entropy of 24-h ambulatory blood pressure monitoring.

    PubMed

    Schoenenberger, A W; Erne, P; Ammann, S; Perrig, M; Bürgi, U; Stuck, A E

    2008-01-01

    Approximate entropy (ApEn) of blood pressure (BP) can be easily measured based on software analysing 24-h ambulatory BP monitoring (ABPM), but the clinical value of this measure is unknown. In a prospective study we investigated whether ApEn of BP predicts, in addition to average and variability of BP, the risk of hypertensive crisis. In 57 patients with known hypertension we measured ApEn, average and variability of systolic and diastolic BP based on 24-h ABPM. Eight of these fifty-seven patients developed hypertensive crisis during follow-up (mean follow-up duration 726 days). In bivariate regression analysis, ApEn of systolic BP (P<0.01), average of systolic BP (P=0.02) and average of diastolic BP (P=0.03) were significant predictors of hypertensive crisis. The incidence rate ratio of hypertensive crisis was 14.0 (95% confidence interval (CI) 1.8, 631.5; P<0.01) for high ApEn of systolic BP as compared to low values. In multivariable regression analysis, ApEn of systolic (P=0.01) and average of diastolic BP (P<0.01) were independent predictors of hypertensive crisis. A combination of these two measures had a positive predictive value of 75%, and a negative predictive value of 91%, respectively. ApEn, combined with other measures of 24-h ABPM, is a potentially powerful predictor of hypertensive crisis. If confirmed in independent samples, these findings have major clinical implications since measures predicting the risk of hypertensive crisis define patients requiring intensive follow-up and intensified therapy.

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

    NASA Technical Reports Server (NTRS)

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

    2011-01-01

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

  5. Observing Campaign to Monitor Magnetically-Active Dwarfs for Long-Term Variability

    NASA Astrophysics Data System (ADS)

    Templeton, Matthew R.

    2009-10-01

    Dr. Styliani (Stella) Kafka of the Department of Terrestrial Magnetism, Carnegie Institute of Washington, requests AAVSO observers to perform long-term photometric monitoring on a number of magnetically active dwarf stars, with an observing frequency of one observation every three days taken with one or more filters. When multiple filters are available, the preferred observations are (in order of precedence): Rc, V, Ic, and B. Please observe such that you obtain a signal to noise of at least 50 (100 or higher is preferred). These objects are all nearby dwarfs known or suspected to have magnetic activity, primarily of the UV Ceti (flare star) or BY Draconis subtypes. Long-term photometric monitoring of these objects will be used in conjunction with other multiwavelength observations from ground-based facilities including the Magellan 6.5-meter and DuPont 2.5-meter telescopes in Chile to understand the long-term magnetic activity cycles of these stars. Such a study can reveal information about the physical natures of these stars, but also about their near space environments and habitability for life. These objects are red, and the variability amplitudes are low, often well below 0.1 magnitudes. The long-term variability due to stellar activity cycles may be much lower. Photometric accuracy rather than the number of observations are key to the success of this project. Unaccounted-for atmospheric effects such as extinction will likely overwhelm any long-term signal from these stars. Observers are strongly urged to fully calibrate their systems and to carefully reduce and transform their photometry to standard photometric passbands, including corrections for airmass/atmospheric extinction. Parameters for 40 objects are given. Observations should be submitted to the AAVSO International Database.

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

    PubMed

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

    2016-02-01

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

  7. Evaluating clinical accuracy of continuous glucose monitoring devices: other methods.

    PubMed

    Wentholt, Iris M E; Hart, August A; Hoekstra, Joost B L; DeVries, J Hans

    2008-08-01

    With more and more continuous glucose monitoring devices entering the market, the importance of adequate accuracy assessment grows. This review discusses pros and cons of Regression Analysis and Correlation Coefficient, Relative Difference measures, Bland Altman plot, ISO criteria, combined curve fitting, and epidemiological analyses, the latter including sensitivity, specificity and positive predictive value for hypoglycaemia. Finally, recommendations for much needed head-to-head studies are given. This paper is a revised and adapted version of How to assess and compare the accuracy of continuous glucose monitors?, Diabetes Technology and Therapeutics 2007, in press, published with permission of the editor.

  8. Internight sleep variability: its clinical significance and responsiveness to treatment in primary and comorbid insomnia.

    PubMed

    Sánchez-Ortuño, María M; Edinger, Jack D

    2012-10-01

    Although sleep diary and actigraphy data are usually collected daily for 1 or 2 weeks, traditional analytical approaches aggregate these data into mean values. Internight variability of sleep often accompanies insomnia. However, few studies have explored the relevance of this 'construct' in the context of diagnosis, clinical impact, treatment effects and/or whether having 'variable sleep' carries any prognostic significance. We explored these questions by conducting secondary analyses of data from a randomized clinical trial. The sample included primary (PI: n = 40) and comorbid insomnia (CMI: n = 41) sufferers receiving four biweekly sessions of cognitive-behavioural therapy (CBT) or sleep hygiene education. Using the within-subject standard deviations of diary- and actigraphy-derived measures collected for 2-week periods [sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST) and sleep efficiency (SE)], we found that CMI sufferers displayed more variable self-reported SOLs and SEs than PI sufferers. However, higher variability in diary and actigraphy-derived measures was related to poorer sleep quality only within the PI group, as measured by the Pittsburgh Sleep Quality Index (PSQI). Within both groups, the variability of diary-derived measures was reduced after CBT, but the variability of actigraphy-derived measures remained unchanged. Interestingly, the variability of actigraphy measures at baseline was correlated with PSQI scores at 6-month follow-up. Higher SOL variability was associated with worse treatment outcomes within the PI group, whereas higher WASO variability was correlated with better treatment outcomes within the CMI group. Sleep variability differences across insomnia diagnoses, along with their distinctive correlates, suggest that mechanisms underlying the sleep disruption/complaint and treatment response in both patient groups are distinct. Further studies are warranted to support variability as a useful metric in

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

    PubMed

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

    2014-07-01

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

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

    ERIC Educational Resources Information Center

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

    2008-01-01

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

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

    NASA Technical Reports Server (NTRS)

    Molnar, Gyula; Susskind, Joel

    2008-01-01

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

  12. Assessing the performance of the International Monitoring System's infrasound network: Geographical coverage and temporal variabilities

    NASA Astrophysics Data System (ADS)

    Le Pichon, A.; Vergoz, J.; Blanc, E.; Guilbert, J.; Ceranna, L.; Evers, L.; Brachet, N.

    2009-04-01

    A global-scale analysis of detections made at all 36 currently operating International Monitoring System (IMS) infrasound arrays confirms that the primary factor controlling signal detectability is the seasonal variability of the stratospheric zonal wind. At most arrays, ˜80% of the detections in the 0.2- to 2-Hz bandpass are associated with propagation downwind of the dominant stratospheric wind direction. Previous IMS infrasound network performance models neglect the time- and site-dependent effects of both stratospheric meteorological variability and ambient noise models. In this study both effects are incorporated; we compare empirical and improved specifications of the stratospheric wind and include station-dependent wind noise models. Using a deterministic approach, the influence of individual model parameters on the network performance is systematically assessed. At frequencies of interest for detecting atmospheric explosions (0.2-2 Hz), the simulations predict that explosions equivalent to ˜500 t of TNT would be detected by at least two stations at any time of the year. The detection capability is best around January and July when stratospheric winds are strongest, compared to the equinox periods when zonal winds reduce and reverse. The model predicts that temporal fluctuations in the ground-to-stratosphere meteorological variables generate detection threshold variations on daily and seasonal timescales of ˜50 and ˜500 t, respectively. While the strong zonal winds lead to an improvement in detection capability, their highly directional nature leads to an increase in the location uncertainty owing to the decreased azimuthal separation of the detecting stations.

  13. Variability of Aerosol Optical Properties at Four North American Surface Monitoring Sites.

    NASA Astrophysics Data System (ADS)

    Delene, David J.; Ogren, John A.

    2002-03-01

    Aerosol optical properties measured over several years at surface monitoring stations located at Bondville, Illinois (BND); Lamont, Oklahoma (SGP); Sable Island, Nova Scotia (WSA); and Barrow, Alaska (BRW), have been analyzed to determine the importance of the variability in aerosol optical properties to direct aerosol radiative forcing calculations. The amount of aerosol present is of primary importance and the aerosol optical properties are of secondary importance to direct aerosol radiative forcing calculations. The mean aerosol light absorption coefficient (ap) is 10 times larger and the mean aerosol scattering coefficient (sp) is 5 times larger at the anthropogenically influenced site at BND than at BRW. The aerosol optical properties of single scattering albedo (o) and hemispheric backscatter fraction (b) have variability of approximately ±3% and ±8%, respectively, in mean values among the four stations. To assess the importance of the variability in o and b on top of the atmosphere aerosol radiative forcing calculations, the aerosol radiative forcing efficiency (F/) is calculated. The F/ is defined as the aerosol forcing (F) per unit optical depth () and does not depend explicitly on the amount of aerosol present. Based on measurements at four North American stations, radiative transfer calculations that assume fixed aerosol properties can have errors of 1%-6% in the annual average forcing at the top of the atmosphere due to variations in average single scattering albedo and backscatter fraction among the sites studied. The errors increase when shorter-term variations in aerosol properties are considered; for monthly and hourly timescales, errors are expected to be greater than 8% and 15%, respectively, approximately one-third of the time. Systematic relationships exist between various aerosol optical properties [ap, o, b, F/, and Ångström exponent (å)] and the amount of aerosol present (measured by sp) that are qualitatively similar but quantitatively

  14. Exposure-response modeling of clinical end points using latent variable indirect response models.

    PubMed

    Hu, C

    2014-06-04

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

  15. [Heart rate variability analysis: a new approach in clinical research methodology for neonatal sepsis].

    PubMed

    Cuestas, Eduardo; Rizzotti, Alina; Agüero, Guillermo

    2011-08-01

    The knowledge on neonatal sepsis has increase significantly, but a clinical or biochemical marker is not available for an early and appropriate diagnosis. This fact results of an inadequate analysis which might be missing important quantum of biological information. A new method of nonlinear analysis have been proposed to investigate time series of physiological data, particularly heart rate variability analysis, that apparently would detect abnormal changes which precedes clinical or biochemical signs of infection by as much as 12-24 hours.

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

    PubMed Central

    Hu, C

    2014-01-01

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

  17. Heart rate variability with deep breathing as a clinical test of cardiovagal function.

    PubMed

    Shields, Robert W

    2009-04-01

    Research into heart rate variability (HRV) and respiration over the past 150 years has led to the insight that HRV with deep breathing (HRVdb) is a highly sensitive measure of cardiovagal or parasympathetic cardiac function. This sensitivity makes HRVdb an important part of the battery of cardiovascular autonomic function tests used in clinical autonomic laboratories. HRVdb is a reliable and sensitive clinical test for early detection of cardiovagal dysfunction in a wide range of autonomic disorders.

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

    PubMed Central

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

    2016-01-01

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

  19. Clinical relevance of fetal hemodynamic monitoring: Perinatal implications.

    PubMed

    Pruetz, Jay D; Votava-Smith, Jodie; Miller, David A

    2015-08-01

    Comprehensive assessment of fetal wellbeing involves monitoring of fetal growth, placental function, central venous pressure, and cardiac function. Ultrasound evaluation of the fetus using 2D, color Doppler, and pulse-wave Doppler techniques form the foundation of antenatal diagnosis of structural anomalies, rhythm abnormalities and altered fetal circulation. Accurate and timely prenatal identification of the fetus at risk is critical for appropriate parental counseling, antenatal diagnostic testing, consideration for fetal intervention, perinatal planning, and coordination of postnatal care delivery. Fetal hemodynamic monitoring and serial assessment are vital to ensuring fetal wellbeing, particularly in the setting of complex congenital anomalies. A complete hemodynamic evaluation of the fetus gives important information on the likelihood of a smooth postnatal transition and contributes to ensuring the best possible outcome for the neonate.

  20. PlaIMoS: A Remote Mobile Healthcare Platform to Monitor Cardiovascular and Respiratory Variables

    PubMed Central

    Miramontes, Ramses; Aquino, Raúl; Flores, Arturo; Rodríguez, Guillermo; Anguiano, Rafael; Ríos, Arturo; Edwards, Arthur

    2017-01-01

    The number of elderly and chronically ill patients has grown significantly over the past few decades as life expectancy has increased worldwide, leading to increased demands on the health care system and significantly taxing traditional health care practices. Consequently, there is an urgent need to use technology to innovate and more constantly and intensely monitor, report and analyze critical patient physiological parameters beyond conventional clinical settings in a more efficient and cost effective manner. This paper presents a technological platform called PlaIMoS which consists of wearable sensors, a fixed measurement station, a network infrastructure that employs IEEE 802.15.4 and IEEE 802.11 to transmit data with security mechanisms, a server to analyze all information collected and apps for iOS, Android and Windows 10 mobile operating systems to provide real-time measurements. The developed architecture, designed primarily to record and report electrocardiogram and heart rate data, also monitors parameters associated with chronic respiratory illnesses, including patient blood oxygen saturation and respiration rate, body temperature, fall detection and galvanic resistance. PMID:28106832

  1. PlaIMoS: A Remote Mobile Healthcare Platform to Monitor Cardiovascular and Respiratory Variables.

    PubMed

    Miramontes, Ramses; Aquino, Raúl; Flores, Arturo; Rodríguez, Guillermo; Anguiano, Rafael; Ríos, Arturo; Edwards, Arthur

    2017-01-19

    The number of elderly and chronically ill patients has grown significantly over the past few decades as life expectancy has increased worldwide, leading to increased demands on the health care system and significantly taxing traditional health care practices. Consequently, there is an urgent need to use technology to innovate and more constantly and intensely monitor, report and analyze critical patient physiological parameters beyond conventional clinical settings in a more efficient and cost effective manner. This paper presents a technological platform called PlaIMoS which consists of wearable sensors, a fixed measurement station, a network infrastructure that employs IEEE 802.15.4 and IEEE 802.11 to transmit data with security mechanisms, a server to analyze all information collected and apps for iOS, Android and Windows 10 mobile operating systems to provide real-time measurements. The developed architecture, designed primarily to record and report electrocardiogram and heart rate data, also monitors parameters associated with chronic respiratory illnesses, including patient blood oxygen saturation and respiration rate, body temperature, fall detection and galvanic resistance.

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

    PubMed Central

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

    2014-01-01

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

  3. [Phenotypic variability in 47, XXX patients: Clinical report of four new cases].

    PubMed

    Goldschmidt, Ernesto; Márquez, Marisa; Solari, Andrea; Ziembar, María I; Laudicina, Alejandro

    2010-08-01

    The 47, XXX karyotype has a frequency of 1 in 1000 female newborns. However, this karyotype is not usually suspected at birth or childhood. These patients are usually diagnosed during adulthood when they develop premature ovarian failure or infertility, because the early phenotype doesn t have any specific features. The study describes four cases and the clinical variability of the 47, XXX karyotype.

  4. Monitoring recruitment success and cost in a randomized clinical trial.

    PubMed

    Perri, Romina; Wollin, Stephanie; Drolet, Nicolas; Mai, Stephanie; Awad, Manal; Feine, Jocelyne

    2006-09-01

    Recruitment of older adults into research studies is challenging and, as a consequence, the recruitment period is often extended and more expensive than planned. This study monitored the effectiveness (number of subjects attracted) and cost of different recruitment strategies when recruiting edentulous elderly adults. Socio-demographic data were gathered and compared to 2001 Canadian census data. Advertisements in major Montreal newspapers attracted the most people (24.3%). However, the most economical recruitment method proved to be placement of ads in senior newspapers (dollar 73.74 per subject). The information gathered in this study will assist others in planning recruitment strategies for edentulous elderly populations.

  5. Exposure assessment and heart rate variability monitoring in workers handling titanium dioxide particles: a pilot study

    NASA Astrophysics Data System (ADS)

    Ichihara, Sahoko; Li, Weihua; Omura, Seiichi; Fujitani, Yuji; Liu, Ying; Wang, Qiangyi; Hiraku, Yusuke; Hisanaga, Naomi; Wakai, Kenji; Ding, Xuncheng; Kobayashi, Takahiro; Ichihara, Gaku

    2016-03-01

    Titanium dioxide (TiO2) particles are used for surface coating and in a variety of products such as inks, fibers, food, and cosmetics. The present study investigated possible respiratory and cardiovascular effects of TiO2 particles in workers exposed to this particle at high concentration in a factory in China. The diameter of particles collected on filters was measured by scanning electron microscopy. Real-time size-dependent particle number concentration was monitored in the nostrils of four workers using condensation particle counter and optical particle counter. Electrocardiogram was recorded using Holter monitors for the same four workers to record heart rate variability. Sixteen workers underwent assessment of the respiratory and cardiovascular systems. Mass-based individual exposure levels were also measured with personal cascade impactors. The primary particle diameter ranged from 46 to 562 nm. Analysis of covariance of the pooled data of the four workers showed that number of particles with a diameter <300 nm was associated positively with total number of N-N and negatively with total number of increase or decrease in successive RR intervals greater than 50 ms (RR50+/-) or percentage of RR 50+/- that were parameters of parasympathetic function. The total mass concentration was 9.58-30.8 mg/m3 during work, but significantly less before work (0.36 mg/m3). The clear abnormality in respiratory function was not observed in sixteen workers who had worked for 10 months to 13 years in the factory. The study showed that exposure to particles with a diameter <300 nm might affect HRV in workers handling TiO2 particles. The results highlight the need to investigate the possible impact of exposure to nano-scaled particles on the autonomic nervous system.

  6. Clinical Pharmacokinetic Monitoring of Leflunomide in Renal Transplant Recipients with BK Virus Reactivation: A Review of the Literature.

    PubMed

    Ng, Joan C Y; Leung, Marianna; Wright, Alissa J; Ensom, Mary H H

    2017-02-28

    Leflunomide is an immunosuppressive drug with in vitro and initial observational evidence of antiviral activity against BK virus (BKV), a pathogen that causes opportunistic infection upon reactivation in renal transplant recipients. Leflunomide is considered an ancillary option to immunosuppression reduction in the management of BKV reactivation. Plasma or blood concentrations of teriflunomide, the active metabolite of leflunomide, are commonly monitored because of high leflunomide doses being used, known inter-individual variability in pharmacokinetics, and hepatotoxicity risk. However, the utility of clinical pharmacokinetic monitoring for leflunomide is as yet unclear. A literature search of MEDLINE (1946-December 2016), EMBASE (1974-December 2016), the CENTRAL database, and Google Scholar was performed to identify relevant English-language articles. Further articles were identified from references in relevant literature. A previously published 9-step decision-making algorithm was used to assess the available literature and determine the utility of clinical pharmacokinetic monitoring for leflunomide. Teriflunomide is readily measurable in the plasma or blood, but a clear relationship between concentration and efficacy or toxicity is lacking, and its therapeutic range is not well-established. Efficacy and toxicity endpoints such as renal function and BKV clearance can be readily assessed without measuring teriflunomide concentrations. Pharmacokinetic parameters are affected by genetic polymorphisms in cytochrome P450 CYP2C19 and ABCG2 genes. Therefore, routine clinical pharmacokinetic monitoring of leflunomide cannot be recommended based on current available evidence. However, it may provide clinical benefit in difficult situations when patients demonstrate a lack of therapeutic response or exhibit signs of drug toxicity.

  7. Latent variable indirect response joint modeling of a continuous and a categorical clinical endpoint.

    PubMed

    Hu, Chuanpu; Szapary, Philippe O; Mendelsohn, Alan M; Zhou, Honghui

    2014-08-01

    Informative exposure-response modeling of clinical endpoints is important in drug development. There has been much recent progress in latent variable modeling of ordered categorical endpoints, including the application of indirect response (IDR) models and accounting for residual correlations between multiple categorical endpoints. This manuscript describes a framework of latent-variable-based IDR models that facilitate easy simultaneous modeling of a continuous and a categorical clinical endpoint. The model was applied to data from two phase III clinical trials of subcutaneously administered ustekinumab for the treatment of psoriatic arthritis, where Psoriasis Area and Severity Index scores and 20, 50, and 70 % improvement in the American College of Rheumatology response criteria were used as efficacy endpoints. Visual predictive check and external validation showed reasonable parameter estimation precision and model performance.

  8. Missing data and measurement variability in assessing progression-free survival endpoint in randomized clinical trials.

    PubMed

    Sridhara, Rajeshwari; Mandrekar, Sumithra J; Dodd, Lori E

    2013-05-15

    Progression-free survival (PFS) is frequently used as the primary efficacy endpoint in the evaluation of cancer treatment that is considered for marketing approval. Missing or incomplete data problems become more acute with a PFS endpoint (compared with overall survival). In a given clinical trial, it is common to observe incomplete data due to premature treatment discontinuation, missed or flawed assessments, change of treatment, lack of follow-up, and unevaluable data. When incomplete data issues are substantial, interpretation of the data becomes tenuous. Plans to prevent, minimize, or properly analyze incomplete data are critical for generalizability of results from the clinical trial. Variability in progressive disease measurement between radiologists further contributes to data problems with a PFS endpoint. The repercussions of this on phase III clinical trials are complex and depend on several factors, including the magnitude of the variability and whether there is a systematic reader evaluation bias favoring one treatment arm particularly in open-label trials.

  9. Precipitation variability within an urban monitoring network in terms of microcanonical cascade generators

    NASA Astrophysics Data System (ADS)

    Licznar, P.; De Michele, C.; Adamowski, W.

    2014-05-01

    Understanding the variability of precipitation at small scales is fundamental in urban hydrology. Stochastic models of precipitation are required to feed hydrodynamic models with high resolution data, in order to obtain a probabilistic assessment of urban drainage networks. Microcanonical random cascades are considered here to represent precipitation time series collected in 25 gauges of a monitoring network in Warsaw, Poland. Breakdown coefficients (BDCs) are calculated separately for a hierarchy of subdaily timescales from 5 min (time resolution) to 1280 min, for all gauges. Strong deformations of BDC histograms in form of sharp peaks at small timescales are observed due to the truncation of precipitation depths recorded by gauges. Satisfactory smoothing of empirical BDC histograms is obtained statistically by a slight randomization of nonzero precipitation amounts. The scarce representation of BDCs at large timescales, due to the short period of observation, is solved by the introduction of an algorithm based on overlapping moving windows. BDC histograms are modeled by a 2N-B distribution, which combines two Normal (N) and one Beta (B) distribution. A clear evolution of the distribution from 2N-B at small timescales, to N-B at intermediate timescales, and finally to Beta distribution for large timescales is observed in all gauges. The performance of the microcanonical cascades is evaluated for the considered gauges. Synthetic time series are analyzed with respect to their intermittency and variability of intensity, and compared to observed series. BDC histograms, for each timescale, are compared among the 25 gauges in Warsaw, and with other gauges located in Poland and Germany. The cluster analysis is used to identify patterns of BDC histograms among analyzed set of gauges and timescales, as well as to detect outlier gauges.

  10. Clinical validation of software for a versatile variability analyzer: Assessment of autonomic function

    PubMed Central

    Ananthakrishnan, T. S.; Jindal, G. D.; Sinha, Vineet; Jain, Rajesh K.; Kataria, S. K.; Deshpande, Alaka K.

    2007-01-01

    Study of physiological variability is an upcoming area of research having manifold clinical applications. Considerable work has been done on heart rate variability and blood pressure variability during the past four decades. Electronics division, Bhabha Atomic Research Centre, has developed an instrument called medical analyzer, which can be used to study several variabilities simultaneously. This instrument has been used to collect data from control subjects and patients with established diagnosis. The data has been analyzed with the help of a software package developed for this purpose and has been found to be consistent with expected manifestations of the disease on the autonomic nervous system. The description of the software package and results of the study are briefly described in this paper. PMID:21157528

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

    PubMed

    Williams, David

    2012-10-01

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

  12. Clinical value of monitoring eosinophil activity in asthma.

    PubMed Central

    Koller, D Y; Herouy, Y; Götz, M; Hagel, E; Urbanek, R; Eichler, I

    1995-01-01

    To evaluate the use of eosinophil cationic protein (ECP) in monitoring disease activity in childhood asthma, serum ECP in 175 asthmatic children was assessed. Forty five patients with cystic fibrosis, 23 with lower respiratory tract infections (LRTI), and 87 healthy children were used as controls. Serum ECP concentrations (34.3 micrograms/l v 9.8 micrograms/l) were significantly higher in children with bronchial asthma than in healthy control subjects. In symptomatic patients with asthma serum ECP concentrations were increased compared with those from asymptomatic patients (40.2 micrograms/l v 14.4 micrograms/l), irrespective of treatment modalities (that is steroids, beta 2 agonists, or sodium cromoglycate). Moreover, atopy and infection appeared to be factors enhancing eosinophil activity in bronchial asthma as measured by serum ECP (58.4 micrograms/l v 36.8 micrograms/l and 68.8 micrograms/l v 42.2 micrograms/l, respectively). In a longitudinal trial, antiasthmatic treatment modalities (that is steroids) reduced serum ECP within four weeks (42.2 micrograms/l v 19.0 micrograms/l). In conclusion, the data indicate that (1) eosinophils also play a central part in childhood asthma; (2) serum concentrations of ECP in children with bronchial asthma are related to the disease severity and may thus be used for monitoring inflammation in childhood asthma; (3) eosinophil activity appears to be enhanced by atopy and infection; and (4) longitudinal measurements of serum ECP concentrations may be useful for optimising anti-inflammatory treatment in children with bronchial asthma. PMID:8554357

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

    PubMed Central

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

    2015-01-01

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

  14. Variable input observer for structural health monitoring of high-rate systems

    NASA Astrophysics Data System (ADS)

    Hong, Jonathan; Laflamme, Simon; Cao, Liang; Dodson, Jacob

    2017-02-01

    The development of high-rate structural health monitoring methods is intended to provide damage detection on timescales of 10 µs -10ms where speed of detection is critical to maintain structural integrity. Here, a novel Variable Input Observer (VIO) coupled with an adaptive observer is proposed as a potential solution for complex high-rate problems. The VIO is designed to adapt its input space based on real-time identification of the system's essential dynamics. By selecting appropriate time-delayed coordinates defined by both a time delay and an embedding dimension, the proper input space is chosen which allows more accurate estimations of the current state and a reduction of the convergence rate. The optimal time-delay is estimated based on mutual information, and the embedding dimension is based on false nearest neighbors. A simulation of the VIO is conducted on a two degree-of-freedom system with simulated damage. Results are compared with an adaptive Luenberger observer, a fixed time-delay observer, and a Kalman Filter. Under its preliminary design, the VIO converges significantly faster than the Luenberger and fixed observer. It performed similarly to the Kalman Filter in terms of convergence, but with greater accuracy.

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

    NASA Astrophysics Data System (ADS)

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

    2015-11-01

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

  16. Step-length variability in minimally disabled women with multiple sclerosis or clinically isolated syndrome.

    PubMed

    Flegel, Melanie; Knox, Katherine; Nickel, Darren

    2012-01-01

    Gait is one of the most frequently impaired bodily functions in multiple sclerosis (MS). Determining abnormal parameters of gait in early MS could influence MS treatment and rehabilitation. The purpose of this study was to determine whether increased step-length variability could be detected in minimally disabled patients with MS or clinically isolated syndrome (CIS) using a sensored walkway gait analysis system. Nine participants with MS/CIS and nine age- and gender-matched controls were recruited for this study. MS/CIS participants underwent a neurologic examination, and all participants completed a screening interview. Each participant completed three walks at a self-selected pace and three walks at a brisk pace across the GAITRite walkway (MAP/CIR Inc, Havertown, PA). Mean values for step-length variability, step length, and velocity were calculated for each participant's self-selected and brisk trials. Independent t tests were used to compare MS/CIS participants with controls, and effect sizes were calculated. Step-length variability in the left leg at the self-selected pace was found to be greater in participants with MS/CIS than in controls, although no significant differences were found in velocity or step length. Step-length variability measurement shows promise in detecting subtle gait dysfunction. Larger, prospective studies exploring step-length variability may determine its clinical viability for detecting subtle gait dysfunction and could lead to improved prognostication of disability progression in MS.

  17. A systematic review and meta-analysis of clinical variables used in Huntington disease research.

    PubMed

    Franciosi, Sonia; Shim, Yaein; Lau, Margaret; Hayden, Michael R; Leavitt, Blair R

    2013-12-01

    Treatment effect in Huntington disease (HD) clinical trials has relied on primary outcome measures such as total motor score or functional rating scales. However, these measures have limited sensitivity, particularly in pre- to early stages of the disease. We performed a systematic review of HD clinical studies to identify endpoints that correlate with disease severity. Using standard HD keywords and terms, we identified 749 published studies from 1993 to 2011 based on the availability of demographic, biochemical, and clinical measures. The average and variability of each measure was abstracted and stratified according to pre-far, pre-close, early, mild, moderate, and severe HD stages. A fixed-effect meta-analysis on selected variables was conducted at various disease stages. A total of 1,801 different clinical variables and treatment outcomes were identified. Unified Huntington Disease Rating Scale (UHDRS) Motor, UHDRS Independence, and Trail B showed a trend toward separation between HD stages. Other measures, such as UHDRS Apathy, Verbal Fluency, and Symbol Digit, could only distinguish between pre- and early stages of disease and later stages, whereas other measures showed little correlation with increasing HD stages. Using cross-sectional data from published HD clinical trials, we have identified potential endpoints that could be used to track HD disease progression and treatment effect. Longitudinal studies, such as TRACK-HD, are critical for assessing the value of potential markers of disease progression for use in future HD therapeutic trials. A list of variables, references used in this meta-analysis, and database is available at http://www.cmmt.ubc.ca/research/investigators/leavitt/publications.

  18. [In order to perform clinical trials efficiently in Japan--important issues regarding monitoring by sponsors].

    PubMed

    Kaichi, Satsuki; Oda, Toshihiko; Goto, Koji; Sato, Kei

    2007-11-01

    The guideline for Good Clinical Practice (GCP) of new drugs was enforced as Ministerial Ordinance No. 28, dated March 27, by the Ministry of Health, Labor and Welfare. In Article 21 of the guideline, a sponsor shall prepare the operating procedures of monitoring, and perform monitoring in conformity with the procedures. The Pharmaceuticals and Medical Devices Agency (PMDA) performs the GCP review of the application of pharmaceuticals and medical devices, including both the document-based conformity review and on-site GCP review, in order to protect human subjects and ensure the integrity of data in clinical trials. The purpose of monitoring is to perform clinical trials ethically and scientifically. Important issues in monitoring raised by the GCP reviews by the PMDA are summarized in this study. Our findings both directly and indirectly reflect the verification of the GCP guidance of investigational sites. We hope that the appropriate monitoring will encourage investigators to perform clinical trials effectively, resulting in clinical trials conforming to the GCP guidelines. Our review will lead to more effective and safer new drugs and medical devices applied in Japan. This is not an official PMDA guidance or policy statement.

  19. Observed inter-camera variability of clinically relevant performance characteristics for Siemens Symbia gamma cameras.

    PubMed

    Kappadath, S Cheenu; Erwin, William D; Wendt, Richard E

    2006-11-28

    We conducted an evaluation of the intercamera (i.e., between cameras) variability in clinically relevant performance characteristics for Symbia gamma cameras (Siemens Medical Solutions, Malvern, PA) based on measurements made using nine separate systems. The significance of the observed intercamera variability was determined by comparing it to the intracamera (i.e., within a single camera) variability. Measurements of performance characteristics were based on the standards of the National Electrical Manufacturers Association and reports 6, 9, 22, and 52 from the American Association of Physicists in Medicine. All measurements were performed using 99mTc (except 57Co used for extrinsic resolution) and low-energy, high-resolution collimation. Of the nine cameras, four have crystals 3/8 in. thick and five have crystals 5/8 in. thick. We evaluated intrinsic energy resolution, intrinsic and extrinsic spatial resolution, intrinsic integral and differential flood uniformity over the useful field-of-view, count rate at 20% count loss, planar sensitivity, single-photon emission computed tomography (SPECT) resolution, and SPECT integral uniformity. The intracamera variability was estimated by repeated measurements of the performance characteristics on a single system. The significance of the observed intercamera variability was evaluated using the two-tailed F distribution. The planar sensitivity of the gamma cameras tested was found be variable at the 99.8% confidence level for both the 3/8-in. and 5/8-in. crystal systems. The integral uniformity and energy resolution were found to be variable only for the 5/8-in. crystal systems at the 98% and 90% confidence level, respectively. All other performance characteristics tested exhibited no significant variability between camera systems. The measured variability reported here could perhaps be used to define nominal performance values of Symbia gamma cameras for planar and SPECT imaging.

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

    PubMed

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

    2014-12-30

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

  1. Raman spectroscopy towards clinical application: drug monitoring and pathogen identification.

    PubMed

    Neugebauer, Ute; Rösch, Petra; Popp, Jürgen

    2015-12-01

    Raman spectroscopy is a label-free method that measures quickly and contactlessly, providing detailed information from the sample, and has proved to be an ideal tool for medical and life science research. In this review, recent advances of the technique towards drug monitoring and pathogen identification by the Jena Research Groups are reviewed. Surface-enhanced Raman spectroscopy (SERS) and ultraviolet resonance Raman spectroscopy in hollow-core optical fibres enable the detection of drugs at low concentrations as shown for the metabolites of the immunosuppressive drug 6-mercaptopurine as well as antimalarial agents. Furthermore, Raman spectroscopy can be used to characterise pathogenic bacteria in infectious diseases directly from body fluids, making time-consuming cultivation processes dispensable. Using the example of urinary tract infection, it is shown how bacteria can be identified from patients' urine samples within <1 h. The methods cover both single-cell analysis and dielectrophoretic capturing of bacteria in suspension. The latter method could also be used for fast (<3.5 h) identification of antibiotic resistance as shown exemplarily for vancomycin-resistant enterococci.

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

    PubMed Central

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

    2016-01-01

    Background and Objectives Blood pressure variability (BPV) was recently shown to be a risk factor of stroke. White coat hypertension (WCH) used to be regarded as innocuous, but one long-term follow-up study reported that WCH increased stroke rate compared to normotension (NT). In this study, we aimed to evaluate the relationship between WCH and BPV. Subjects and Methods We analyzed 1398 subjects from the Korean Ambulatory Blood Pressure Registry, who were divided into NT (n=364), masked hypertension (n=122), white coat hypertension (n=254), and sustained hypertension (n=658) groups. Results Baseline characteristics were similar among groups. The average real variability (ARV), a highly sensitive BPV parameter, was highest in the WCH group, followed by the sustained hypertension, masked hypertension, and NT groups. The results persisted after being adjusted for covariates. The WCH vs. sustained hypertension results (adjusted mean±standard error) were as follows: 24-h systolic ARV, 22.9±0.8 vs. 19.4±0.6; 24-h diastolic ARV, 16.8±0.6 vs. 14.3±0.5; daytime systolic ARV, 21.8±0.8 vs. 16.8±0.6; and daytime diastolic ARV, 16.2±0.6 vs. 13.4±0.5 (p<0.001 for all comparisons). Conclusion From the registry data, we found that subjects with WCH or masked hypertension had higher BPV than NT. However, long-term follow-up data assessing the clinical influences of WCH on stroke are needed. PMID:27275173

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

    PubMed Central

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

    2000-01-01

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

  4. An innovative statistical approach for analysing non-continuous variables in environmental monitoring: assessing temporal trends of TBT pollution.

    PubMed

    Santos, José António; Galante-Oliveira, Susana; Barroso, Carlos

    2011-03-01

    The current work presents an innovative statistical approach to model ordinal variables in environmental monitoring studies. An ordinal variable has values that can only be compared as "less", "equal" or "greater" and it is not possible to have information about the size of the difference between two particular values. The example of ordinal variable under this study is the vas deferens sequence (VDS) used in imposex (superimposition of male sexual characters onto prosobranch females) field assessment programmes for monitoring tributyltin (TBT) pollution. The statistical methodology presented here is the ordered logit regression model. It assumes that the VDS is an ordinal variable whose values match up a process of imposex development that can be considered continuous in both biological and statistical senses and can be described by a latent non-observable continuous variable. This model was applied to the case study of Nucella lapillus imposex monitoring surveys conducted in the Portuguese coast between 2003 and 2008 to evaluate the temporal evolution of TBT pollution in this country. In order to produce more reliable conclusions, the proposed model includes covariates that may influence the imposex response besides TBT (e.g. the shell size). The model also provides an analysis of the environmental risk associated to TBT pollution by estimating the probability of the occurrence of females with VDS ≥ 2 in each year, according to OSPAR criteria. We consider that the proposed application of this statistical methodology has a great potential in environmental monitoring whenever there is the need to model variables that can only be assessed through an ordinal scale of values.

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

    USGS Publications Warehouse

    Converse, Sarah J.; Royle, J. Andrew; Gitzen, Robert A.; Millspaugh, Joshua J.; Cooper, Andrew B.; Licht, Daniel S.

    2012-01-01

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

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

    PubMed Central

    Singh, Kalyani

    2016-01-01

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

  7. Towards the Implementation of Quality of Life Monitoring in Daily Clinical Routine: Methodological Issues and Clinical Implication

    PubMed Central

    Giesinger, Johannes; Kemmler, Georg; Meraner, Verena; Gamper, Eva-Maria; Oberguggenberger, Anne; Sperner-Unterweger, Barbara; Holzner, Bernhard

    2009-01-01

    Summary Quality of life (QOL) has become a widely used outcome parameter in the evaluation of treatment modalities in clinical oncology research. By now, many of the practical problems associated with measuring QOL in clinical practice can be overcome by the use of computer-based assessment methods. QOL assessment in oncology is dominated by two measurement systems, the FACT scales and the EORTC QLQ-C30 with its modules. The amount of human resources required to implement routine data collection has been reduced significantly by advanced computer technology allowing data collection in busy clinical practice. Monitoring of QOL can contribute to oncologic care by facilitating detection of physical and psychological problems and tracking the course of disease and treatment over time. Furthermore, the integration of screening for psychosocial problems into QOL monitoring contributes to the identification of patients who are in need of psychooncologic interventions. Computer-based QOL monitoring does not replace the direct physician-patient communication but enables to identify specific impairments and symptoms including psychological problems. Beyond clinical practice, QOL data can be used for research purposes and may help health care planners to determine those patient services that should be maintained or ones that should be developed. PMID:20847874

  8. Towards the Implementation of Quality of Life Monitoring in Daily Clinical Routine: Methodological Issues and Clinical Implication.

    PubMed

    Giesinger, Johannes; Kemmler, Georg; Meraner, Verena; Gamper, Eva-Maria; Oberguggenberger, Anne; Sperner-Unterweger, Barbara; Holzner, Bernhard

    2009-01-01

    Quality of life (QOL) has become a widely used outcome parameter in the evaluation of treatment modalities in clinical oncology research. By now, many of the practical problems associated with measuring QOL in clinical practice can be overcome by the use of computer-based assessment methods. QOL assessment in oncology is dominated by two measurement systems, the FACT scales and the EORTC QLQ-C30 with its modules. The amount of human resources required to implement routine data collection has been reduced significantly by advanced computer technology allowing data collection in busy clinical practice. Monitoring of QOL can contribute to oncologic care by facilitating detection of physical and psychological problems and tracking the course of disease and treatment over time. Furthermore, the integration of screening for psychosocial problems into QOL monitoring contributes to the identification of patients who are in need of psychooncologic interventions. Computer-based QOL monitoring does not replace the direct physician-patient communication but enables to identify specific impairments and symptoms including psychological problems. Beyond clinical practice, QOL data can be used for research purposes and may help health care planners to determine those patient services that should be maintained or ones that should be developed.

  9. Ability of clinicopathologic variables and clinical examination findings to predict race elimination in endurance horses.

    PubMed

    Fielding, C Langdon; Meier, Chloe A; Fellers, Greg K; Magdesian, K Gary

    2017-01-01

    OBJECTIVE To compare results of point-of-care laboratory testing with standard veterinary clinical examination findings at a single time point during endurance competition to identify horses at risk for elimination. ANIMALS 101 endurance horses participating in the 2013 Western States 160-km (100-mile) endurance ride. PROCEDURES At the 58-km checkpoint, blood samples were collected from all horses. Samples were analyzed for pH, Pco2, base excess, anion gap, PCV, and whole blood concentrations of sodium, potassium, chloride, total carbon dioxide, BUN, glucose, and bicarbonate. Corrected electrolyte and PCV values were calculated on the basis of plasma total protein concentration. Immediately following the blood sample collection, each horse underwent a clinical examination. In addition to standard examination variables, an adjusted heart rate was calculated on the basis of the variable interval between entry into the checkpoint and heart rate recording. A combination of stepwise logistic regression, classification and regression tree analysis, and generalized additive models was used to identify variables that were associated with overall elimination or each of 3 other elimination categories (metabolic elimination, lameness elimination, and elimination for other reasons). RESULTS Corrected whole blood potassium concentration and adjusted heart rate were predictive for overall elimination. Breed, plasma total protein concentration, and attitude were predictive for elimination due to metabolic causes. Whole blood chloride concentration and corrected PCV were predictive for elimination due to lameness. Corrected PCV was predictive for elimination due to other causes. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that for horses in endurance competition, a combination of breed and clinical examination and laboratory variables provided the best prediction of overall elimination.

  10. Validation of heart rate monitor Polar RS800 for heart rate variability analysis during exercise.

    PubMed

    Hernando, David; Garatachea, Nuria; Almeida, Rute; Casajús, Jose Antonio; Bailón, Raquel

    2016-09-27

    Heart rate variability (HRV) analysis during exercise is an interesting non-invasive tool to measure the cardiovascular response to the stress of exercise. Wearable heart rate monitors are a comfortable option to measure RR intervals while doing physical activities. It is necessary to evaluate the agreement between HRV parameters derived from the RR series recorded by wearable devices and those derived from an ECG during dynamic exercise of low to high intensity.23 male volunteers performed an exercise stress test on a cycle ergometer. Subjects wore a Polar RS800 device while ECG was also recorded simultaneously to extract the reference RR intervals. A time-frequency spectral analysis was performed to extract the instantaneous mean heart rate (HRM), and the power of low frequency (PLF) and high frequency (PHF) components, the latter centred on the respiratory frequency. Analysis was done in intervals of different exercise intensity based on oxygen consumption. Linear correlation, reliability and agreement were computed in each interval.The agreement between the RR series obtained from the Polar device and from the ECG is high throughout the whole test, although the shorter the RR is, the more differences there are. Both methods are interchangeable when analysing HRV at rest. At high exercise intensity, HRM and PLF still presented a high correlation (ρ>0.8) and excellent reliability and agreement indices (above 0.9). However, the PHF measurements from the Polar showed reliability and agreement coefficients around 0.5 or lower when the level of the exercise increases (for levels of O2 above 60%).

  11. The Johns Hopkins RTR Consortium: A Collaborative Approach to Advance Translational Science and Standardize Clinical Monitoring of Restorative Transplantation

    DTIC Science & Technology

    2015-10-01

    Clinical Monitoring of Restorative Transplantation PRINCIPAL INVESTIGATOR: Gerald Brandacher, MD CONTRACTING ORGANIZATION: Johns Hopkins...Approach to Advance Translational Science and Standardize Clinical Monitoring of Restorative Transplantation 5a. CONTRACT NUMBER 5b. GRANT NUMBER...high dose immunosuppressive drugs have curtailed wider application. Thus the purpose of this project is to develop novel clinically relevant

  12. An evaluation of a Simon 2-Stage phase II clinical trial design incorporating toxicity monitoring.

    PubMed

    Ray, H E; Rai, S N

    2011-05-01

    Phase II clinical trials are usually designed to measure efficacy but patient safety is also a very important aspect. Previous authors suggested a methodology that allows one to monitor the cumulative number of toxic events after each patient is treated, which is also known as continuous toxicity monitoring. In this work we describe how to combine the continuous toxicity monitoring methodology with the Simon 2-Stage design for response. Then we investigate through simulation the combined procedure's type I and type II error rates under various combinations of design parameters. We include the underlying relationship between toxicity and response in our examination of the error rates.

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

    NASA Astrophysics Data System (ADS)

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

    2016-03-01

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

  14. The use of an explanation algorithm in a clinical event monitor.

    PubMed

    Hogan, W R; Wagner, M M

    1999-01-01

    Clinical event monitors (CEMs) seek to improve patient care and reduce its cost by prompting clinicians to take actions that have these effects. To persuade clinicians to act, CEMs have used prewritten-text explanations. However, we encountered limitations of prewritten-text explanations in our CEM. Therefore, we decided to implement an advanced method for explanation (Suermondt's method for belief-network explanation). This method is promising, but whether it is generally applicable to all of clinical event monitoring and whether it is as efficacious as prewritten-text explanations remain areas for future research.

  15. Monitoring versus interim analysis of clinical trials: a perspective from the pharmaceutical industry.

    PubMed

    Enas, G G; Dornseif, B E; Sampson, C B; Rockhold, F W; Wuu, J

    1989-03-01

    The definitions of "interim analysis" and "monitoring" of clinical trials are often ambiguous in the current literature. The resulting confusion can lead to erroneous conclusions and misguided decisions, especially when activities that are operational or observational are evaluated in a probabilistic sense as inferential. The authors seek to define "interim analysis" and "monitoring" in a mutually exclusive fashion. These definitions will then provide the opportunity to review and categorize existing clinical trial practices and procedures. This will clarify such issues as "when to look" and "when to pay a price" (e.g., test size and power) and characterize such issues in the context of pharmaceutical industry drug development.

  16. Thrombin generation testing for monitoring hemophilia treatment: a clinical perspective.

    PubMed

    Salvagno, Gian Luca; Berntorp, Erik

    2010-10-01

    systems suitable for detecting changes in the kinetics of thrombin generation, and the test's clinical utility for patients with hemophilia or von Willebrand disease.

  17. Role of Ambulatory and Home Blood Pressure Monitoring in Clinical Practice: A Narrative Review

    PubMed Central

    Shimbo, Daichi; Abdalla, Marwah; Falzon, Louise; Townsend, Raymond R.; Muntner, Paul

    2015-01-01

    Hypertension, a common cardiovascular disease (CVD) risk factor, is usually diagnosed and treated based on blood pressure readings obtained in the clinic setting. Blood pressure may differ considerably when measured in the clinic versus outside of the clinic setting. Over the past several decades, evidence has accumulated on two approaches for measuring out-of-clinic blood pressure: ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM). Blood pressure measures on ABPM and HBPM each have a stronger association with CVD outcomes than clinic blood pressure. Controversy exists whether ABPM or HBPM is superior for estimating CVD risk, and under what circumstances these methods should be used in clinical practice for assessing out-of-clinic blood pressure. This review describes ABPM and HBPM procedures, the blood pressure phenotypic measures that can be ascertained, and the evidence that supports the use of each approach to measure out-of-clinic blood pressure. This review also describes barriers to the successful implementation of ABPM and HBPM in clinical practice, proposes core competencies for the conduct of these procedures, and highlights important areas for future research. PMID:26457954

  18. The discriminant power of simultaneous monitoring of spontaneous electroencephalogram and evoked potentials as a predictor of different clinical states of general anesthesia.

    PubMed

    Jeleazcov, Christian; Schneider, Gerhard; Daunderer, Michael; Scheller, Bertram; Schüttler, Jürgen; Schwilden, Helmut

    2006-10-01

    Spontaneous or evoked electrical brain activity is increasingly used to monitor general anesthesia. Previous studies investigated the variables from spontaneous electroencephalogram (EEG), acoustic (AEP), or somatosensory evoked potentials (SSEP). But, by monitoring them separately, the available information from simultaneous gathering could be missed. We investigated whether the combination of simultaneous information from EEG, AEP, and SSEP shows a more discriminant power to differentiate between anesthesia states than from information derived from each measurement alone. Therefore, we assessed changes of 30 EEG, 21 SSEP, and 29 AEP variables recorded from 59 patients during four clinical states of general anesthesia: "awake," "light anesthesia," "surgical anesthesia," and "deep surgical anesthesia." The single and combined discriminant powers of EEG, AEP, and SSEP variables as predictors of these states were investigated by discriminant analysis. EEG variables showed a higher discriminant power than AEP or SSEP variables: 85%, 46%, and 32% correctly classified cases, respectively. The frequency of correctly classified cases increased to 90% and 91% with information from EEG + AEP and EEG + AEP + SSEP, respectively. Thus, future anesthesia monitoring should consider combined information simultaneously distributed on different electrophysiological measurements, rather than single variables or their combination from EEG or AEP or SSEP.

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

    PubMed Central

    Fenichel, G. M.

    1987-01-01

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

  20. Knowledge discovery in clinical databases based on variable precision rough set model.

    PubMed Central

    Tsumoto, S.; Ziarko, W.; Shan, N.; Tanaka, H.

    1995-01-01

    Since a large amount of clinical data are being stored electronically, discovery of knowledge from such clinical databases is one of the important growing research area in medical informatics. For this purpose, we develop KDD-R (a system for Knowledge Discovery in Databases using Rough sets), an experimental system for knowledge discovery and machine learning research using variable precision rough sets (VPRS) model, which is an extension of original rough set model. This system works in the following steps. First, it preprocesses databases and translates continuous data into discretized ones. Second, KDD-R checks dependencies between attributes and reduces spurious data. Third, the system computes rules from reduced databases. Finally, fourth, it evaluates decision making. For evaluation, this system is applied to a clinical database of meningoencephalitis, whose computational results show that several new findings are obtained. PMID:8563283

  1. Variability of the diagnosis of stroke by clinical judgement and by a scoring method

    PubMed Central

    Hatano, S.

    1976-01-01

    Existing criteria for the diagnosis of acute cerebrovascular disease (stroke) have not been satisfactory in epidemiological studies. Variability of the diagnosis of stroke, which had not been studied before, was investigated in a WHO collaborative study. Intra-observer and inter-observer variation of the diagnosis of stroke was studied by means of 45 case reports drawn at random from among those included in the study. Diagnosis of stroke and of the type of stroke was made by clinical judgement and by a scoring method. The clinical diagnosis of stroke was more consistent and more comparable than the diagnosis of the type of stroke. Inter-observer agreement in clinical diagnosis was improved by using the score method. PMID:1088403

  2. Predictive monitoring of mobile patients by combining clinical observations with data from wearable sensors.

    PubMed

    Clifton, Lei; Clifton, David A; Pimentel, Marco A F; Watkinson, Peter J; Tarassenko, Lionel

    2014-05-01

    The majority of patients in the hospital are ambulatory and would benefit significantly from predictive and personalized monitoring systems. Such patients are well suited to having their physiological condition monitored using low-power, minimally intrusive wearable sensors. Despite data-collection systems now being manufactured commercially, allowing physiological data to be acquired from mobile patients, little work has been undertaken on the use of the resultant data in a principled manner for robust patient care, including predictive monitoring. Most current devices generate so many false-positive alerts that devices cannot be used for routine clinical practice. This paper explores principled machine learning approaches to interpreting large quantities of continuously acquired, multivariate physiological data, using wearable patient monitors, where the goal is to provide early warning of serious physiological determination, such that a degree of predictive care may be provided. We adopt a one-class support vector machine formulation, proposing a formulation for determining the free parameters of the model using partial area under the ROC curve, a method arising from the unique requirements of performing online analysis with data from patient-worn sensors. There are few clinical evaluations of machine learning techniques in the literature, so we present results from a study at the Oxford University Hospitals NHS Trust devised to investigate the large-scale clinical use of patient-worn sensors for predictive monitoring in a ward with a high incidence of patient mortality. We show that our system can combine routine manual observations made by clinical staff with the continuous data acquired from wearable sensors. Practical considerations and recommendations based on our experiences of this clinical study are discussed, in the context of a framework for personalized monitoring.

  3. Unravelling the genetic basis of variable clinical expression in neurofibromatosis 1

    PubMed Central

    Sabbagh, Audrey; Pasmant, Eric; Laurendeau, Ingrid; Parfait, Béatrice; Barbarot, Sébastien; Guillot, Bernard; Combemale, Patrick; Ferkal, Salah; Vidaud, Michel; Aubourg, Patrick; Vidaud, Dominique; Wolkenstein, Pierre

    2009-01-01

    Neurofibromatosis type 1 (NF1) is a common autosomal dominant disorder which displays considerable inter- and intra-familial variability in phenotypic expression. To evaluate the genetic component of variable expressivity in NF1, we examined the phenotypic correlations between affected relatives in 750 NF1 patients from 275 multiplex families collected through the NF-France Network. Twelve NF1-related clinical features, including five quantitative traits (number of café-au-lait spots of small size and of large size, and number of cutaneous, subcutaneous and plexiform neurofibromas) and seven binary ones, were scored. All clinical features studied, with the exception of neoplasms, showed significant familial aggregation after adjusting for age and sex. For most of them, patterns of familial correlations indicated a strong genetic component with no apparent influence of the constitutional NF1 mutation. Heritability estimates of the five quantitative traits ranged from 0.26 to 0.62. Moreover, we investigated for the first time the role of the normal NF1 allele in the variable expression of NF1 through a family-based association study. Nine tag SNPs in NF1 were genotyped in 1132 individuals from 313 NF1 families. No significant deviations of transmission of any of the NF1 variants to affected offspring was found for any of the 12 clinical features examined, based on single marker or haplotype analysis. Taken together, our results provided evidence that genetic modifiers, unlinked to the NF1 locus, contribute to the variable expressivity of the disease. PMID:19417008

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

    PubMed

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

    2015-12-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2004-12-01

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

  6. Capturing PLMS and their variability in children with sickle cell disease: Does ankle activity monitoring measure up to polysomnography?

    PubMed Central

    Gallagher, Paul R.; Marcus, Carole L.; Ohene-Frempong, Kwaku; Traylor, Joel T.; Mason, Thornton B. A.

    2015-01-01

    Objectives To test agreement and define differences in periodic limb movements in sleep (PLMS) measured by polysomnography and an ankle activity monitor, and to describe PLMS variability across nights, feasibility of home monitoring, and correlates of PLMS in children with sickle cell disease (SCD). Methods Twenty children with SCD and restless legs syndrome (RLS) symptoms or polysomnography-documented PLMS underwent concurrent attended polysomnography and ankle activity monitoring over 1–2 nights and home activity monitoring for 3 nights. Serum iron and ferritin were measured pre- and post-polysomnography. Results Adequate sensitivity (1.00), specificity (0.69), and mean bias (5.0±7.4 PLMS/h) for identifying elevated PLMS by activity monitor were obtained when scoring the period from sleep onset to offset rather than time in bed per manufacturer recommendation, and using a cut-point of 10 PLMS/h. Compared to activity monitor, only polysomnographic PLMS demonstrated periodicity, at inter-movement intervals (IMI) 20–35 s; the activity monitor overscored PLMS at the beginning and end of sleep and at shorter IMI (5–15 s; p≤0.003), suggesting misclassification of nonperiodic leg movements as PLMS by activity monitor. PLMS varied across 4 nights by 16.1±13.4 PLMS/h. Post-polysomnography ferritin was associated (positively) with PLMS (p=0.034); RLS symptoms were not. Conclusions Ankle activity monitoring is a valid screening measure for PLMS in children with SCD and can readily be performed at home. Interpretation should incorporate a threshold for elevated PLMS of 10/h and scoring from sleep onset to offset which could be identified with concurrent wrist actigraphy, to better account for true PLMS. PMID:22841030

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

    NASA Astrophysics Data System (ADS)

    Licznar, Paweł; Rupp, David; Adamowski, Witold

    2013-04-01

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

  8. The Impact of the Perceived Purpose of Electronic Performance Monitoring on an Array of Attitudinal Variables

    ERIC Educational Resources Information Center

    Wells, Deborah L.; Moorman, Robert H.; Werner, Jon M.

    2007-01-01

    As a form of performance monitoring, electronic performance monitoring (EPM) offers the opportunity for unobtrusive and continuous performance data gathering. These strengths can also make EPM stressful and threatening. Many features of performance evaluation systems, including the organizational purposes for which they are used, can affect…

  9. OVERSEER: a prototype expert system for monitoring drug treatment in the psychiatric clinic.

    PubMed

    Bronzino, J D; Morelli, R A; Goethe, J W

    1989-05-01

    This paper describes the development of OVERSEER: a prototype knowledge-based system that monitors the drug treatment of psychiatric patients in real time. Using treatment protocols developed by the expert clinician, OVERSEER monitors the drug treatment process and issues alerts when standard clinical practices are not followed or when laboratory results are abnormal. Written in Prolog, OVERSEER is designed to interface directly with the hospital's database, and, thereby, utilizes all available pharmacy and laboratory data. Moreover, unlike the interactive expert systems developed for the psychiatric clinic, OVERSEER does not require extensive data entry by the clinician. Consequently, the chief benefit of OVERSEER's monitoring approach is the unobtrusive manner in which it evaluates psychopharmacological treatment and provides information regarding patient management to the hospital.

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

    PubMed Central

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

    2016-01-01

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

  11. Therapeutic drug monitoring of racemic venlafaxine and its main metabolites in an everyday clinical setting.

    PubMed

    Reis, Margareta; Lundmark, Jöns; Björk, Henrik; Bengtsson, Finn

    2002-08-01

    When Efexor (venlafaxine) became available in Sweden, a therapeutic drug monitoring (TDM) service was developed in the authors' laboratory. This analytical service was available to all physicians in the country. From March 1996, to November 1997, 797 serum concentration analyses of venlafaxine (VEN) and its main metabolites, O-desmethylvenlafaxine (ODV), N-desmethylvenlafaxine (NDV), and N,O-didesmethylvenlafaxine (DDV) were requested. These samples, each of which was accompanied by clinical information on a specially designed request form, represented 635 inpatients or outpatients, comprising all ages, treated in a naturalistic setting. The first sample per patient, drawn as a trough value in steady state and with documented concomitant medication, was further evaluated pharmacokinetically (n = 187). The doses prescribed were from 37.5 mg/d to 412.5 mg/d. There was a wide interindividual variability of serum concentrations on each dose level, and the mean coefficient of variation of the dose-corrected concentrations (C/D) was 166% for C/D VEN, 60% for C/D ODV, 151% for C/D NDV, and 59% for C/D DDV. The corresponding CV for the ratio ODV/VEN was 110%. However, within patients over time, the C/D VEN and ODV/VEN variation was low, indicating stability in individual metabolizing capacity. Patients over 65 years of age had significantly higher concentrations of C/D VEN and C/D ODV than the younger patients. Women had higher C/D NDV and C/D DDV, and a higher NDV/VEN ratio than men, and smokers showed lower C/D ODV and C/D DDV than nonsmokers. A number of polycombinations of drugs were assessed for interaction screening, and a trend for lowered ODV/VEN ratio was found, predominantly with concomitant medication with CNS-active drug(s) known to inhibit CYP2D6.

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

    PubMed Central

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

    2007-01-01

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

  13. Learning neuroendoscopy with an exoscope system (video telescopic operating monitor): Early clinical results

    PubMed Central

    Parihar, Vijay; Yadav, Y. R.; Kher, Yatin; Ratre, Shailendra; Sethi, Ashish; Sharma, Dhananjaya

    2016-01-01

    Context: Steep learning curve is found initially in pure endoscopic procedures. Video telescopic operating monitor (VITOM) is an advance in rigid-lens telescope systems provides an alternative method for learning basics of neuroendoscopy with the help of the familiar principle of microneurosurgery. Aims: The aim was to evaluate the clinical utility of VITOM as a learning tool for neuroendoscopy. Materials and Methods: Video telescopic operating monitor was used 39 cranial and spinal procedures and its utility as a tool for minimally invasive neurosurgery and neuroendoscopy for initial learning curve was studied. Results: Video telescopic operating monitor was used in 25 cranial and 14 spinal procedures. Image quality is comparable to endoscope and microscope. Surgeons comfort improved with VITOM. Frequent repositioning of scope holder and lack of stereopsis is initial limiting factor was compensated for with repeated procedures. Conclusions: Video telescopic operating monitor is found useful to reduce initial learning curve of neuroendoscopy. PMID:27695549

  14. Clinical monitoring scales in acute brain injury: assessment of coma, pain, agitation, and delirium.

    PubMed

    Riker, Richard R; Fugate, Jennifer E

    2014-12-01

    Serial clinical examination represents the most fundamental and basic form of neurological monitoring, and is often the first and only form of such monitoring in patients. Even in patients subjected to physiological monitoring using a range of technologies, the clinical examination remains an essential tool to follow neurological progress. Key aspects of the clinical examination have now been systematized into scoring schemes, and address consciousness, pain, agitation, and delirium (PAD). The Glasgow Coma Scale has been the traditional tool to measure consciousness, but the full outline of unresponsiveness (FOUR) score has recently been validated in a variety of settings, and at present, both represent clinically useful tools. Assessment of PAD in neurologically compromised patients present special challenges. For pain, the Numeric Rating Scale is the preferred initial approach, with either the Behavioral Pain Scale or the Critical Care Pain Observation Tool in subjects who are not able to respond. The Nociception Coma Scale-Revised may be useful in patients with severe disorders of consciousness. Conventional sedation scoring tools for critical care, such as the Richmond Area Sedation Scale (RASS) and Sedation-Agitation Scale (SAS) may provide reasonable tools in some neurocritical care patients. The use of sedative drugs and neuromuscular blockers may invalidate the use of some clinical examination tools in others. The use of sedation interruption to assess neurological status can result in physiological derangement in unstable patients (such as those with uncontrolled intracranial hypertension), and is not recommended.

  15. Mass Spectrometry in Clinical Laboratory: Applications in Therapeutic Drug Monitoring and Toxicology.

    PubMed

    Garg, Uttam; Zhang, Yan Victoria

    2016-01-01

    Mass spectrometry (MS) has been used in research and specialized clinical laboratories for decades as a very powerful technology to identify and quantify compounds. In recent years, application of MS in routine clinical laboratories has increased significantly. This is mainly due to the ability of MS to provide very specific identification, high sensitivity, and simultaneous analysis of multiple analytes (>100). The coupling of tandem mass spectrometry with gas chromatography (GC) or liquid chromatography (LC) has enabled the rapid expansion of this technology. While applications of MS are used in many clinical areas, therapeutic drug monitoring, drugs of abuse, and clinical toxicology are still the primary focuses of the field. It is not uncommon to see mass spectrometry being used in routine clinical practices for those applications.

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

    PubMed

    Trigueros Genao, M; Torres, R J

    2014-11-01

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

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

    PubMed Central

    2013-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  19. Continuous safety monitoring for randomized controlled clinical trials with blinded treatment information. Part 3: Design considerations.

    PubMed

    Ball, Greg; Silverman, Michael H

    2011-09-01

    Ongoing safety monitoring of clinical trials of investigational treatments must operate at levels that range from the minute and detailed - namely, mathematical treatment of trial data - to the philosophical and societal - namely, ethical concerns for individuals and populations. Between those two poles lies a realm of environmental and pragmatic considerations that reflect the goals, biases, risk-tolerance, and constraints of study sponsors and organizers. These factors, while more difficult to quantify or, at times, to justify, also have a meaningful impact on the approach to safety monitoring and the resulting actions and outcomes. This paper considers the influence and interaction of two such factors, study design and statistical framework, on continuous safety monitoring procedures. Group sequential designs have been generally preferred for clinical trials over continuous sequential designs because of practical considerations. The group means and greater time for deliberation when using a group sequential procedure, as opposed to a continuous sequential procedure, can improve the quality of the analyses with minimal loss in sensitivity. However, undertaking any sequential analysis within a frequentist framework provokes considerable theoretical and practical difficulties. Continuous monitoring with a likelihood based method, on the other hand, has the advantages that all available information, including new data, can be used; sample sizes need not be fixed; and decisions can be made at any time without statistical penalty, irrespective of trial design. Such responsive statistical rules are needed to provide guidance to the human beings charged with trial monitoring.

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

    SciTech Connect

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

    2014-11-01

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

  1. Design of adaptive two-stage double-arm clinical trials for dichotomous variables.

    PubMed

    Jiang, Zhiwei; Xue, Fubo; Li, Chanjuan; Wang, Ling; Cai, Hongwei; Zhang, Chunmao; Xia, Jielai

    2010-05-01

    It is well known that flexibility is one of the major advantages of an adaptive two-stage design, and the intended adaptation should be as preplanned as possible to maintain the integrity of the clinical trial. The design of adaptive two-stage double-arm clinical trials for dichotomous variables was proposed by simulation and forecasting procedure at the planning stage. To further ensure the integrity of the clinical trial, the sample size scheme for each scenario, which was supposed to be based on the first stage, was provided in the protocol by Monte Carlo simulation. In addition, the study parameters were determined by comparing the assessment indexes such as total sample size, expected sample size and the test power at the first stage. Furthermore, Fisher's combination test and pooled data analysis were considered and compared through the simulation. The latter, which has the larger overall power and the better overall type I error control, with the same sample size was adopted for further simulation and statistical analysis in the clinical trial.

  2. Guard Earth, but Monitor the Universe: ATLAS and the Variable Sky

    NASA Astrophysics Data System (ADS)

    Heinze, Aren; Tonry, John; Denneau, Larry; Stalder, Brian; Sherstyuk, Andrei; Rest, Armin; Smith, Ken; Smartt, Steven

    2017-01-01

    The Asteroid Terrestrial-Impact Last Alert Survey uses custom-built 0.5 meter telescopes to scan the whole accessible sky with a cadence optimized to detect small asteroids on their 'final plunge' toward impact with Earth. In the process, ATLAS produces calibrated images and photometry of two hundred million point source detections per night to 19th magnitude -- a rich data set for analysis of variable stars and transients with a huge range of timescales. We report our early results, including the discoveries of several hundred supernovae and several new variables stars, and we explore the potential of ATLAS data to contribute to the science of astronomical transients and variables.

  3. Monitoring antiretroviral therapy in resource-limited settings: balancing clinical care, technology, and human resources.

    PubMed

    Hosseinipour, Mina C; Schechter, Mauro

    2010-08-01

    Due to the rapid expansion of first-line antiretroviral therapy in resource-limited settings (RLS), increasing numbers of people are living with HIV for prolonged periods of time. Treatment programs must now decide how to balance monitoring costs necessary to maximize health benefits for those already on treatment with the continued demand to initiate more patients on first-line treatment. We review currently available evidence related to monitoring strategies in RLS and discuss their implications on timing of switching to second-line treatment, development of HIV resistance, and clinical outcome.

  4. A language activity monitor for supporting AAC evidence-based clinical practice.

    PubMed

    Hill, K J; Romich, B A

    2001-01-01

    Augmentative and alternative communication (AAC) evidence-based practice requires the collection and analysis of performance data. This article presents the development, evaluation, and application of automated performance monitoring tools for use in clinical practice. Language activity monitoring (LAM) is the systematic data collection of the actual language activity of an individual who relies on AAC. Work completed to date includes the development and evaluation of the language activity monitor function, which now is commercially available in three forms: (1) a standard feature built into modern high performance AAC systems, (2) an external add-on package for use with older AAC devices based on synthetic speech, and (3) software that allows the personal computer to serve as an LAM in the clinical environment. The LAM records the time and content of language events (the generation of one or more letters or words). A logging protocol suitable for clinical application has been in use since late 1998. The logged data is uploaded periodically to a computer for editing, analysis, and the generation of a summary measure report. The applications of this work in the areas of clinical service delivery are presented.

  5. [Variability in the autonomous communities of the clinical recommendations in the service portfolios in primary care].

    PubMed

    Miguel-García, Félix; Hernández-Rubio, María de los Santos Ichaso; Quintana, Ana Isabel Fernández; Latorre, Mercedes Alfaro

    2011-10-01

    The quality guidelines established in Primary Care Service Portfolios of Autonomous Communities were analysed. It was observed that there were similarities in the number and content of the controls in children over 2 years-old, time intervals of cardiovascular risk and breast cancer mammography screening. Variability was observed in the number of controls (from 2 to 8) recommended for infants less than 2 years old, in the time intervals of monitoring parameters of patients with risk factors (for example, glycosylated haemoglobin in the diabetic every 2, 6, or 12 months), in the time intervals in cervical cytology (every 3 or 5 years) and in the age periods of performing the cytology (from 15, 20, 25, or 30 years up to 55 or 60 years) or mammography (from 45 or 50 years up to 60 or 65 years).

  6. Monitoring the clinical outcomes in advanced prostate cancer: what imaging modalities and other markers are reliable?

    PubMed

    Morris, Michael J; Autio, Karen A; Basch, Ethan M; Danila, Daniel C; Larson, Steven; Scher, Howard I

    2013-06-01

    Effective patient care and efficient drug development require accurate tools to assess treatment effects. For metastatic castration-resistant prostate cancer (mCRPC), response biomarkers have historically been poorly reproducible, inaccurate, inconsistently applied, or only loosely associated with tangible clinical benefits such as survival. However, the field of response assessments for prostate cancer is maturing, in compliance with a rigorous process defined by analytic validation, clinical validation, and clinical qualification. For example, bone imaging with technetium-99m scintigraphy has historically been poorly used in prostate cancer clinical trials and routine patient care, and frequently has led to poor decision-making. However, contemporary clinical trial consensus criteria (Prostate Cancer Working Group 2 [PCWG2]) have standardized the definition of progression on bone scintigraphy and the clinical trials endpoint of radiographic progression-free survival (rPFS). A validated bone scan interpretation form captures the relevant data elements. rPFS and the forms have been undergoing prospective testing in multiple phase III studies. The first of these trials demonstrated a high degree of reproducibility and correlation with overall survival, and rPFS was used by the US Food and Drug Administration (FDA) for approval of abiraterone in chemotherapy-naïve mCRPC. Circulating tumor cells (CTC) are another class of assays with significant promise as response-indicator biomarkers. CTC enumeration has undergone analytic validation and has been FDA-cleared for monitoring patients with prostate cancer in conjunction with other clinical methods. It is not yet a surrogate for survival. Patient-reported outcomes (PROs) are direct indicators of patient benefit. The assays to measure PROs must undergo each of the steps of biomarker development, and are increasingly being standardized and used as clinical trial endpoints. In this review, we critically assess each of

  7. The Speulderbos Fiducial Reference Site for Continuous Monitoring of Forest Biophysical Variables

    NASA Astrophysics Data System (ADS)

    Brede, Benjamin; Bartholomeus, Harm; Suomalainen, Juha; Clevers, Jan; Verbesselt, Jan; Herold, Martin; Culvenor, Darius; Gascon, Ferran

    2016-08-01

    This contribution describes the Speulderbos fiducial reference site for biophysical variables with a focus on foliage variables and Leaf Area Index (LAI). The site implements Unmanned Aerial Vehicle (UAV)- and ground-based sensing systems that aim at high temporal resolution observations to capture fast canopy changes like spring leaf flush. It aims at validating decametre resolution satellite observations. The sensor systems and their respective sampling design are described. Opportunities and restrictions of the set up are discussed.

  8. The influence of clinical variables on the psychological adaptation of adolescents after solid organ transplantation.

    PubMed

    de Castro, Elisa Kern; Moreno Jiménez, Bernardo

    2008-06-01

    This study assessed the influence of clinical and socio-demographic variables on the psychological adaptation of transplanted adolescents. Twenty-six transplanted adolescents and 25 healthy adolescents, aged 13-17, and their parents participated in the study. The following domains were measured: social competence, emotional/behavioral problems, self-concept, self-esteem and subjective well-being. The findings revealed that transplanted boys presented significantly less social competence (U = 26,000, p < .05) and more externalizing problems (U = 25,000, p < .05), social problems (U = 25,000, p < .05) and attention problems (U = 17,500, p < .01) than healthy boys. In contrast, transplanted girls displayed significantly more internalizing problems (U = 47,000, p < .05) and lower physical self-concept (U = 49,500, p < .05) than healthy girls. Hierarchical regression analysis showed clinical variables, especially waiting-list time, significantly predicted attention problems (beta = .364, p < .05) and negative affect (beta = .632, p < .05) in transplanted adolescents. Also, male (beta = -0.554, p < .01) and younger (beta = -0.444, p < .01) transplanted adolescents were at risk for attention problems. Our data suggest the importance of the waiting-list time for transplanted adolescents. Efforts to reduce the pretransplant phase would help adolescents achieve better psychological adaptation at long-term posttransplant.

  9. Clinical Variables Associated with Hydration Status in Acute Ischemic Stroke Patients with Dysphagia.

    PubMed

    Crary, Michael A; Carnaby, Giselle D; Shabbir, Yasmeen; Miller, Leslie; Silliman, Scott

    2016-02-01

    Acute stroke patients with dysphagia are at increased risk for poor hydration. Dysphagia management practices may directly impact hydration status. This study examined clinical factors that might impact hydration status in acute ischemic stroke patients with dysphagia. A retrospective chart review was completed on 67 ischemic stroke patients who participated in a prior study of nutrition and hydration status during acute care. Prior results indicated that patients with dysphagia demonstrated elevated BUN/Cr compared to non-dysphagia cases during acute care and that BUN/Cr increased selectively in dysphagic patients. This chart review evaluated clinical variables potentially impacting hydration status: diuretics, parenteral fluids, tube feeding, oral diet, and nonoral (NPO) status. Exposure to any variable and number of days of exposure to each variable were examined. Dysphagia cases demonstrated significantly more NPO days, tube fed days, and parenteral fluid days, but not oral fed days, or days on diuretics. BUN/Cr values at discharge were not associated with NPO days, parenteral fluid days, oral fed days, or days on diuretics. Patients on modified solid diets had significantly higher mean BUN/Cr values at discharge (27.12 vs. 17.23) as did tube fed patients (28.94 vs. 18.66). No difference was noted between these subgroups at baseline (regular diet vs. modified solids diets). Any modification of solid diets (31.11 vs. 17.23) or thickened liquids (28.50 vs. 17.81) resulted in significantly elevated BUN/Cr values at discharge. Liquid or diet modifications prescribed for acute stroke patients with dysphagia may impair hydration status in these patients.

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

    NASA Astrophysics Data System (ADS)

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

    2016-01-01

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

  11. Birth Control in Clinical Trials: Industry Survey of Current Use Practices, Governance, and Monitoring.

    PubMed

    Stewart, J; Breslin, W J; Beyer, B K; Chadwick, K; De Schaepdrijver, L; Desai, M; Enright, B; Foster, W; Hui, J Y; Moffat, G J; Tornesi, B; Van Malderen, K; Wiesner, L; Chen, C L

    2016-03-01

    The Health and Environmental Sciences Institute (HESI) Developmental and Reproductive Toxicology Technical Committee sponsored a pharmaceutical industry survey on current industry practices for contraception use during clinical trials. The objectives of the survey were to improve our understanding of the current industry practices for contraception requirements in clinical trials, the governance processes set up to promote consistency and/or compliance with contraception requirements, and the effectiveness of current contraception practices in preventing pregnancies during clinical trials. Opportunities for improvements in current practices were also considered. The survey results from 12 pharmaceutical companies identified significant variability among companies with regard to contraception practices and governance during clinical trials. This variability was due primarily to differences in definitions, areas of scientific uncertainty or misunderstanding, and differences in company approaches to enrollment in clinical trials. The survey also revealed that few companies collected data in a manner that would allow a retrospective understanding of the reasons for failure of birth control during clinical trials. In this article, suggestions are made for topics where regulatory guidance or scientific publications could facilitate best practice. These include provisions for a pragmatic definition of women of childbearing potential, guidance on how animal data can influence the requirements for male and female birth control, evidence-based guidance on birth control and pregnancy testing regimes suitable for low- and high-risk situations, plus practical methods to ascertain the risk of drug-drug interactions with hormonal contraceptives.

  12. Variability of wavefront aberration measurements in small pupil sizes using a clinical Shack-Hartmann aberrometer

    PubMed Central

    Ginis, Harilaos S; Plainis, Sotiris; Pallikaris, Aristophanis

    2004-01-01

    Background Recently, instruments for the measurement of wavefront aberration in the living human eye have been widely available for clinical applications. Despite the extensive background experience on wavefront sensing for research purposes, the information derived from such instrumentation in a clinical setting should not be considered a priori precise. We report on the variability of such an instrument at two different pupil sizes. Methods A clinical aberrometer (COAS Wavefront Scienses, Ltd) based on the Shack-Hartmann principle was employed in this study. Fifty consecutive measurements were perfomed on each right eye of four subjects. We compared the variance of individual Zernike expansion coefficients as determined by the aberrometer with the variance of coefficients calculated using a mathematical method for scaling the expansion coefficients to reconstruct wavefront aberration for a reduced-size pupil. Results Wavefront aberration exhibits a marked variance of the order of 0.45 microns near the edge of the pupil whereas the central part appears to be measured more consistently. Dispersion of Zernike expansion coefficients was lower when calculated by the scaling method for a pupil diameter of 3 mm as compared to the one introduced when only the central 3 mm of the Shack – Hartmann image was evaluated. Signal-to-noise ratio was lower for higher order aberrations than for low order coefficients corresponding to the sphero-cylindrical error. For each subject a number of Zernike expansion coefficients was below noise level and should not be considered trustworthy. Conclusion Wavefront aberration data used in clinical care should not be extracted from a single measurement, which represents only a static snapshot of a dynamically changing aberration pattern. This observation must be taken into account in order to prevent ambiguous conclusions in clinical practice and especially in refractive surgery. PMID:15018630

  13. Incorporating electronic monitoring feedback into clinical care: a novel and promising adherence promotion approach.

    PubMed

    Herzer, Michele; Ramey, Christina; Rohan, Jennifer; Cortina, Sandra

    2012-10-01

    This paper presents case examples that document the preliminary clinical utility of using electronic monitoring (EM) feedback to tailor empirically validated adherence-promoting interventions, delivered in standard clinical practice. Challenges of utilizing EM in standard clinical practice as well as future directions are also discussed. Two adolescents referred for behavioral adherence promotion intervention are described. Each youth was provided a MEMS® bottle and one oral medication was chosen jointly by the therapist, family, and medical provider for adherence monitoring. Graphical MEMS® feedback was provided to families during intervention visits and subsequently used to tailor adherence interventions to target each family's unique needs. EM feedback was a feasible and clinically rich supplement to adherence-promoting interventions. EM facilitated identification of adherence barriers and successes, and open and non-adversarial discussions regarding adherence between patients, families, and clinicians, and provided real-time representations of patients' medication administration. These case presentations suggest that EM feedback can be a clinically useful tool when used as a supplement to an empirically supported intervention delivered in standard psychological practice aimed at adherence promotion among chronically ill youth.

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

    PubMed Central

    Urbani, Francesca; Proietti, Enrico

    2013-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2016-05-01

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

  16. [A new neuromuscular transmission monitor (TOF Guard): the rationale behind the method and its clinical usefulness].

    PubMed

    Ueda, N; Masuda, Y; Muteki, T; Tsuda, H; Hiraki, T; Harada, H; Tobata, H

    1994-01-01

    TOF Guard is one of the latest developments in the field of neuromuscular monitoring equipment. This system uses a miniature acceleration transducer (a piezo-electric ceramic wafer is used), simply fastened to the thumb with tape. The rationale behind the method is Newton's second law, stating that the acceleration is directly proportional to the force. In this study, authors assessed the accuracy of this system in clinical use, comparing with the force transducer method (Myograph 2000). The result showed that there was a very close positive correlation between the values of T1, TOF ratio and posttetanic count simultaneously measured by both methods. The coefficient of correlation was 0.96, and its significance level was P < 0.001. From the clinical view point, it is concluded that TOF Guard is very useful because of its accuracy and because the equipment is easy to handle, compact and of low price as a neuromuscular monitoring system for routine anesthesia.

  17. Improved flow measurement using microbubble contrast agents and disruption-replenishment: clinical application to tumour monitoring.

    PubMed

    Hudson, John M; Williams, Ross; Lloyd, Brendan; Atri, Mostafa; Kim, Tae Kyoung; Bjarnason, Georg; Burns, Peter N

    2011-08-01

    Dynamic contrast-enhanced ultrasound (DCE-US) and the method of disruption replenishment has been used for the past 10 years to measure flow noninvasively in the microcirculation. However, the method's perceived poor reproducibility remains a major impediment to widespread clinical acceptance. Poor reproducibility can be attributed, in part, to the curve fitting model that is used to quantify microbubble enhancement. Flow measurement in tumours is further complicated by the spatial and temporal heterogeneity of tumour blood flow. In this work, we evaluate three models of microbubble disruption and replenishment (mono-exponential, a simplified multivessel model by Krix and the lognormal perfusion model) using clinical data (11 patients, 41 sessions) from an antiangiogenic drug trial for metastatic renal cell carcinoma (RCC) and evaluate their contribution to the measurement's variability. Compared with the mono-exponential model, the lognormal perfusion model decreased the variability of intra-session velocity and blood volume measurements by 33% and 34%, respectively. Blood volume assessment using the lognormal perfusion model was comparable to Krix's mutlivessel model. Flow velocity measurement was 18% less variable for the lognormal perfusion model compared with the multivessel model. To further decrease flow measurement variability, we examine a method that exploits microbubble flow dynamics to discard the contribution of flow in large arteries and isolate the portion of the tumour microvasculature that is most sensitive to vessel targeting therapies. The method is validated with an in vitro phantom study prior to its application to the RCC clinical data set. Combined with the lognormal perfusion model, this method decreased the inter-plane variability of clinical measurements of relative tumour blood volume, in some cases by up to 20%.

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

    EPA Science Inventory

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

  19. Quantification of reef benthos communities and variability inherent to the monitoring using video transect method.

    PubMed

    Ramos, Carla Alecrim Colaço; Amaral, Fernanda Duarte; de Kikuchi, Ruy Kenji Papa; Chaves, Eduardo Marocci; de Melo, Gabriel Rivas

    2010-03-01

    Long-term monitoring program of organisms is the most recommended for understanding changing processes on reefs. The video transect method presents advantages for that. Specialists state that it is important to make sure that the recorded coverage is always the same between campaigns, so that differences in results may be entirely attributed to environmental changes. This study aimed to test the capability of implementing this requirement through tracking simulation and its validity for monitoring the benthic communities of reefs using the video transect method. Ten transects 20 m long were established in Todos os Santos Bay coral reefs. Subsequent to the first transect capture, a second diver repeated the same track, simulating two different monitoring campaigns. Data were transformed and a matrix of similarity was generated using Bray-Curtis' Index. ANOSIM analysis was performed to test the similarity of the ten transects and its repetitions. The result, R = 0.08 (P = 0.928), shows that reef monitoring using video transect, the way it is described in the literature, is appropriate, but it is important to consider some premises discussed in this work.

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

    PubMed Central

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

    2015-01-01

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

  1. The laboratory of clinical virology in monitoring patients undergoing monoclonal antibody therapy.

    PubMed

    Cavallo, R

    2011-12-01

    The relevant efficacy of monoclonal antibodies (mAbs) has resulted in the successful treatment of several diseases, although susceptibility to infections remains a major problem. This review summarizes aspects of the literature regarding viral infections and mAbs, specifically addressing the risk of infection/reactivation, the measures that can reduce this risk, and the role played by the laboratory of clinical virology in monitoring patients undergoing mAb therapy.

  2. [Muscle relaxants and neuromuscular monitoring - Introduction for a safe clinical application].

    PubMed

    Döcker, Dennis; Walther, Andreas

    2012-05-01

    The use of muscle relaxants facilitates endotracheal intubation and ameliorates the conditions of surgery. But, their use should be controlled - otherwise there will be postoperative residual curarisation which can lead to patient discomfort up to severe medical complications. Therefore, an appropriate surveillance via objective neuromuscular monitoring is essential. This article gives a review of the basic principles of muscle relaxants, their clinical application and the surveillance of their effects and degradation.

  3. Noninvasive Strategy Based on Real-Time in Vivo Cataluminescence Monitoring for Clinical Breath Analysis.

    PubMed

    Zhang, Runkun; Huang, Wanting; Li, Gongke; Hu, Yufei

    2017-03-21

    The development of noninvasive methods for real-time in vivo analysis is of great significant, which provides powerful tools for medical research and clinical diagnosis. In the present work, we described a new strategy based on cataluminescence (CTL) for real-time in vivo clinical breath analysis. To illustrate such strategy, a homemade real-time CTL monitoring system characterized by coupling an online sampling device with a CTL sensor for sevoflurane (SVF) was designed, and a real-time in vivo method for the monitoring of SVF in exhaled breath was proposed. The accuracy of the method was evaluated by analyzing the real exhaled breath samples, and the results were compared with those obtained by GC/MS. The measured data obtained by the two methods were in good agreement. Subsequently, the method was applied to real-time monitoring of SVF in exhaled breath from rat models of the control group to investigate elimination pharmacokinetics. In order to further probe the potential of the method for clinical application, the elimination pharmacokinetics of SVF from rat models of control group, liver fibrosis group alcohol liver group, and nonalcoholic fatty liver group were monitored by the method. The raw data of pharmacokinetics of different groups were normalized and subsequently subjected to linear discriminant analysis (LDA). These data were transformed to canonical scores which were visualized as well-clustered with the classification accuracy of 100%, and the overall accuracy of leave-one-out cross-validation procedure is 88%, thereby indicating the utility of the potential of the method for liver disease diagnosis. Our strategy undoubtedly opens up a new door for real-time clinical analysis in a pain-free and noninvasive way and also guides a promising development direction for CTL.

  4. Update on Clinical Utility of Continuous Glucose Monitoring in Type 1 Diabetes.

    PubMed

    Haviland, Nalani; Walsh, John; Roberts, Ruth; Bailey, Timothy S

    2016-11-01

    Since the early 2000s, continuous glucose monitoring (CGM) technology has advanced to become a standard of care in the treatment of type 1 diabetes. Unfortunately, CGM use is not commonly integrated into practice. This article will review the history, technology, and need for systematic training in CGM. Additionally, it will review recent clinical trial data demonstrating the benefits that CGM offers to all people with type 1 diabetes and the clinicians who care for them.

  5. Design and Clinical Feasibility of Personal Wearable Monitor for Measurement of Activity and Environmental Exposure

    PubMed Central

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

    2015-01-01

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

  6. Investigation of the variability of NIR in-line monitoring of roller compaction process by using Fast Fourier Transform (FFT) analysis.

    PubMed

    Feng, Tao; Wang, Feng; Pinal, Rodolfo; Wassgren, Carl; Carvajal, M Teresa

    2008-01-01

    The purpose of this research was to investigate the variability of the roller compaction process while monitoring in-line with near-infrared (NIR) spectroscopy. In this paper, a pragmatic method in determining this variability of in-line NIR monitoring roller compaction process was developed and the variability limits were established. Fast Fourier Transform (FFT) analysis was used to study the source of the systematic fluctuations of the NIR spectra. An off-line variability analysis method was developed as well to simulate the in-line monitoring process in order to determine the variability limits of the roller compaction process. For this study, a binary formulation was prepared composed of acetaminophen and microcrystalline cellulose. Different roller compaction parameters such as roll speed and feeding rates were investigated to understand the variability of the process. The best-fit line slope of NIR spectra exhibited frequency dependence only on the roll speed regardless of the feeding rates. The eccentricity of the rolling motion of rollers was identified as the major source of variability and correlated with the fluctuations of the slopes of NIR spectra. The off-line static and dynamic analyses of the compacts defined two different variability of the roller compaction; the variability limits were established. These findings were proved critical in the optimization of the experimental setup of the roller compaction process by minimizing the variability of NIR in-line monitoring.

  7. Study of TeV Variability of MRK 421 from 3 Years of Monitoring with the MILAGRO Observatory

    NASA Astrophysics Data System (ADS)

    Patricelli, B.; González, M. M.; Fraija, N.; Marinelli, A.

    2015-01-01

    The Milagro experiment was a TeV gamma-ray observatory designed to continuously monitor the overhead sky in the 0.1-100 TeV energy range. It operated from 2000 and 2008 and was characterized by a large field of view (˜ 2 sr) and a high duty cycle (≥ 90%). Here we report on the long-term monitoring of the blazar Mrk 421 with Milagro over the period from September 21, 2005 to March 15, 2008. We present a study of the TeV variability of the source and provide upper limits for the measured flux for different time scales, ranging from one week up to one year.

  8. FreezeFramer: A prototype tool to monitor stress and heart rate variability.

    PubMed

    Chatterjee, Samir; Hilton, Brian; Li, Haiqing; Hassan, Taimur; Tulu, Bengisu; McCraty, Rollin

    2007-10-11

    This paper describes the design, architecture, and implementation of a software application, FreezeFramer, developed to help individuals manage stress. The application measures heart rate variability through a finger or earlobe clip-on sensor that reads pulse information. While a detailed subjective evaluation is on going, system performance analyses are reported here.

  9. Variability of the human heart rate as a diagnostic instrument obtained by mean of a wireless monitor

    NASA Astrophysics Data System (ADS)

    Barajas Mauricio, Sánchez; Hernández González, Martha Alicia; Figueroa Vega, Nicte; Malacara Hernández, Juan Manuel; Fraga Teodoro, Córdova

    2014-11-01

    Introduction: Heart rate variability (HRV) is the cyclic measurement of RR intervals between normal beats. Aim: To determine the VFC via a wireless Polar monitor. Material and methods: 100 symptomatic menopausal women were studied for measurements of HRV were I post a Polar RS400 Watch four hrs. Results: Obtained through the fast Fourier transform, the frequency domain HRV low frequency (LF) 0.04-0.15 Hz, high frequency (HF) 0.15-0.4Hz and the ratio LF / HF. Conclusion: obtaining HRV is important for cardiovascular autonomic assessment in menopausal women.

  10. A novel online method to monitor autonomic nervous activity based on arterial wall impedance and heart rate variability.

    PubMed

    Kutluk, Abdugheni; Tsuji, Toshio; Ukawa, Teiji; Nakamura, Ryuji; Saeki, Noboru; Yoshizumi, Masao; Kawamoto, Masashi

    2010-04-01

    This paper proposes a new method of evaluating autonomic nervous activity using the mechanical impedance of arterial walls and heart rate variability. The cardiovascular system is indispensable to life maintenance functions, and homeostasis is maintained by the autonomic nervous system. Accordingly, it is very important to be able to make diagnosis based on autonomic nervous activity within the body's circulation. The proposed method was evaluated in surgical operations; the mechanical impedance of the arterial wall was estimated from arterial blood pressure and a photoplethysmogram, and heart rate variability was estimated using electrocardiogram R-R interval spectral analysis. In this paper, we monitored autonomic nervous system activity using the proposed system during endoscopic transthoracic sympathetic block surgery in eight patients with hyperhidrosis. The experimental results indicated that the proposed system can be used to estimate autonomic nervous activity in response to events during operations.

  11. Variable expressivity and clinical heterogeneity can complicate the diagnosis and management of Pfeiffer syndrome.

    PubMed

    Ettinger, Nicholas; Williams, Misti; Phillips, John A

    2013-01-01

    We report here a newborn female infant with striking features consistent with severe Pfeiffer syndrome (PS). Pfeiffer syndrome is a rare craniofacial disorder that has an autosomal dominant mode of inheritance (OMIM 101600). Our patient had unexpected differences between her clinical features and those predicted from her genetic tests. The following clinical features were noted: severe exophthalmos, syndactyly, upper extremity contractures, and relative macroglossia. A head computed tomography with three-dimensional reconstruction showed that she did not have craniosynostosis. Genetic tests included a normal 46,XX karyotype and a chromosomal microarray that revealed a copy number gain at 14q23.1 as well as a copy number loss at 16p13.2. FGFR2 sequencing revealed a c.870G>T transversion in exon 8, which is predicted to encode a Trp290Cys substitution.The clinical features of severe exophthalmos and other features typical of PS without craniosynostosis were most consistent with a diagnosis of PS type III. However, her Trp290Cys FGFR2 mutation is reported to be associated with PS type II that includes kleeblatschädel (or "cloverleaf") skull anomalies as a cardinal feature. Our patient's lack of craniosynostosis predicted from this mutation is a striking example of variable expressivity. Such discrepancies between the physical findings (phenotype) and the mutation identified (genotype) and the association of different findings with different mutations in the same gene (clinical heterogeneity) can present difficulties in case management. Clinicians should be guided by careful phenotyping rather than by genotypic predictions alone.

  12. Arrhythmias in mitral valve prolapse: relation to anterior mitral leaflet thickening, clinical variables, and color Doppler echocardiographic parameters.

    PubMed

    Zuppiroli, A; Mori, F; Favilli, S; Barchielli, A; Corti, G; Montereggi, A; Dolara, A

    1994-11-01

    Atrial and ventricular arrhythmias have been reported with variable incidence in symptomatic patients with mitral valve prolapse (MVP). The role of clinical and echocardiographic parameters as predictors for arrhythmias still needs to be clarified. One hundred nineteen consecutive patients (56 women and 63 men, mean age 40 +/- 17 years) with echocardiographically diagnosed MVP were examined. A complete echocardiographic study (M-mode, two-dimensional, and Doppler) and 24-hour electrocardiographic monitoring were performed in all patients. Complex atrial arrhythmias (CAAs) included atrial couplets, atrial tachycardia, and paroxysmal or sustained atrial flutter or fibrillation. Complex ventricular arrhythmias (CVAs) included multiform ventricular premature contractions (VPCs), VPC couplets, and runs of three or more sequential VPCs (salvos of ventricular tachycardia). The relation between complex arrhythmias and clinical parameters (age and gender) and echocardiographic parameters (left atrial and left ventricular dimensions, anterior mitral leaflet thickness [AMLT], and presence and severity of mitral regurgitation) was evaluated by multiple logistic regression analysis. CAA were present in 14% of patients and CVA in 30%. According to multiple logistic modeling, CAA correlated separately in the univariate analysis with age, presence of MR, and left ventricular and left atrial diameters; age was the only independent predictor (p < 0.001). CVA, in the univariate analysis, correlated with age, female gender, left ventricular end-diastolic diameter, and AMLT; only female gender and AMLT were independent predictors in the multivariate analysis (p < 0.01). The incidence of mitral regurgitation (59%) was higher than expected in a general population of MVP patients.(ABSTRACT TRUNCATED AT 250 WORDS)

  13. Categorisation of air quality monitoring stations by evaluation of PM(10) variability.

    PubMed

    Barrero, M A; Orza, J A G; Cabello, M; Cantón, L

    2015-08-15

    Air Quality Monitoring Networks (AQMNs) are composed by a number of stations, which are typically classified as urban, suburban or rural, and background, industrial or traffic, depending on the location and the influence of the immediate surroundings. These categories are not necessarily homogeneous and distinct from one another, regarding the levels of the monitored pollutants. A classification providing groups with these features is of interest for air quality management and research purposes, and therefore, other classification criteria should be explored. In this work, the variations of PM10 concentrations in 43 stations in the AQMN of the Basque Country in the period 2005-2012 have been studied to group them according to common characteristics. The characteristic variations in time are synthesised by the autocorrelation function (ACF), with both daily and hourly data, and by the average diurnal evolution pattern of the normalised concentrations on a seasonal basis (Evol-P). A methodology based on k-means clustering of these features is proposed. Each classification gives a different piece of information that has been phenomenologically related with specific dispersion and emission dynamics. The classification based on Evol-Ps is found to be the most influential one when comparing PM10 levels between groups. A combination of these categorisations provides 5 groups with significantly different levels of PM10, improving the discrimination of the conventional classification. Our results indicate that the time series of the pollutant concentrations contain enough information to provide an objective classification of the monitoring stations in an AQMN.

  14. Monitoring of a Dramatically Variable C IV Mini-BAL in the Quasar HS1603+3820

    NASA Astrophysics Data System (ADS)

    Misawa, Toru; Eracleous, M.; Charlton, J. C.; Kashikawa, N.

    2006-12-01

    We present eight high-resolution spectra of an optically bright quasar, HS1603+3820 (z_em=2.542), taken over an interval of 4.2 years (1.2 years in the quasar rest frame) with Subaru Telescope and Hobby-Eberly Telescope, for the purpose of monitoring absorption lines that are physically associated to the quasar. Among eight C IV absorption systems in this quasar spectrum, only one mini-BAL system at z_abs 2.43, which was already identified as an intrinsic system based on partial coverage analysis (Misawa et al. 2003,2005), showed dramatic time variability. We fitted Voigt profiles to the mini-BAL, and found that there were no clear correlations between the fit parameters such as the column density, Doppler parameter, and coverage fraction. This result suggests that the mini-BAL absorber has an inhomogeneous internal structure. Another important observational clue is that all absorption components in the system varied in concert, which suggests the observed time variability was due to a change of the ionization conditions (not due to the gas motion) in the mini-BAL absorber. Because such rapid UV continuum variability is not expected in luminous quasars such as our target, we suggest that a variable screen of material between the quasar continuum source and the absorber is the cause of the changes in the ionization state of the mini-BAL system. We acknowledge support from NASA grant NAG5-10817.

  15. A hybrid approach to achieving both marginal and conditional balances for stratification variables in sequential clinical trials.

    PubMed

    Lin, Yunzhi; Su, Zheng

    2013-01-01

    Various methods exist in the literature for achieving marginal balance for baseline stratification variables in sequential clinical trials. One major limitation with balancing on the margins of the stratification variables is that there is an efficiency loss when the primary analysis is stratified. To preserve the efficiency of a stratified analysis one recently proposed approach balances on the crossing of the stratification variables included in the analysis, which achieves conditional balance for the variables. A hybrid approach to achieving both marginal and conditional balances in sequential clinical trials is proposed, which is applicable to both continuous and categorical stratification variables. Numerical results based on extensive simulation studies and a real dataset show that the proposed approach outperforms the existing ones and is particularly useful when both additive and stratified models are planned for a trial.

  16. A new variable angled locking volar plate system for Colles' fracture: outcome study and time-course improvement of objective clinical variables.

    PubMed

    Yasuda, Masataka; Ando, Yoshiyuki

    2009-01-01

    Our purposes were to report the radiographic outcomes and complications of patients with Colles' fracture treated with the Nakashima locking volar plate system (variable angled distal screw locking mechanism) prospectively and to report the results of objective clinical variables such as grip strength and range of motion of the wrist prospectively at up to one year. This study consisted of eight men and 32 women for analysis of radiographic parameters (volar tilt, radial inclination and radial length) and complications. Radiographic parameters were measured pre-operatively, immediately post-operatively and at final follow-up visit. The average age at operation was 60.3 years old. Among them, we selected 25 cases (6 men and 19 women) whom we followed up at six weeks, three months, six months and one year post-operatively. The average age at operation in this group was 62 years old. We measured objective clinical variables (grip strength, forearm rotation, wrist extension/flexion) at each visit. Except for volar tilt, radiographic parameters revealed no significant changes between immediately post-operative radiographs and radiographs at final follow-up visit. Complications included loss of reduction in two cases. Objective clinical variables other than pronation measurement showed significant increase at each visit up to one year post-operatively. Satisfactory clinical and radiographic results were obtained by using this system. The variable angled distal fragment plating system appears to be a reliable construct for rigid fixation of Colles' fractures; however, technical errors can occur, as with other fixation systems. We demonstrated that the follow-up of Colles' fracture treated by our volar locking plate less than one year post-operative may be insufficient.

  17. Canine visceral leishmaniasis: relationships between oxidative stress, liver and kidney variables, trace elements, and clinical status.

    PubMed

    Heidarpour, M; Soltani, S; Mohri, M; Khoshnegah, J

    2012-10-01

    The aim of this study was to investigate the role of oxidative stress in the pathology of canine visceral leishmaniasis (CVL). We therefore studied the relationships between oxidative stress markers, liver and kidney variables, trace elements, and clinical status in dogs naturally infected with Leishmania infantum. Two groups of Leishmania-infected dogs [asymptomatic (AD, n = 14) and symptomatic (SD, n = 16)] were assessed and compared with a group of non-infected control dogs (CD, n = 30). A significant decrease (p < 0.001) in serum total antioxidant status (TAS) and albumin concentration (p < 0.05) and a significant increase in serum malondialdehyde (MDA) and blood urea nitrogen (BUN) concentrations (p < 0.001), in the SD group, were observed when compared to CD and AD groups. Dogs of the AD group presented a significant decrease in copper (p < 0.01) and zinc (p < 0.001) concentrations, when compared to CD group, while the SD group presented a significant decrease (p < 0.001) in copper and zinc concentrations, when compared to CD and AD groups. Oxidative stress markers (MDA and TAS) showed significant correlations (p < 0.001) with trace elements (copper and zinc) and liver (alanine aminotransferase) and kidney (BUN and creatinine) variables. The results of the present study revealed that symptomatic dogs showed more severe oxidative stress than asymptomatic and non-infected dogs and enhanced lipid peroxidation may be linked to liver and kidney damage in canine visceral leishmaniasis.

  18. Sample size estimation of multiregional clinical trials with heterogeneous variability across regions.

    PubMed

    Wu, Yuh-Jenn; Tan, Te-Sheng; Chow, Shein-Chung; Hsiao, Chin-Fu

    2014-01-01

    In recent years, global collaboration has become a conventional strategy for new drug development. To accelerate the development process and shorten approval time, the design of multiregional clinical trials (MRCTs) incorporates subjects from many countries around the world under the same protocol. After showing the overall efficacy of a drug in all global regions, one can also simultaneously evaluate the possibility of applying the overall trial results to all regions and subsequently support drug registration in each of them. Several statistical methods have been proposed for the design and evaluation of MRCTs. Most of these approaches, however, assume a common variability of the primary endpoint across regions. In practice, this assumption may not be true, due to differences across regions (e.g., differences in ethnic factors and/or medical culture/practice). In this article, we use a random-effect model for modeling heterogeneous variability across regions for the design and evaluation of MRCTs. We also address consideration on the determination of the number of subjects in a specific region to establish the consistency of treatment effects between the specific region and the entire group.

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

    PubMed Central

    Passik, Steven D.; Lowery, Amy

    2014-01-01

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

  20. Undertaking clinical audit, with reference to a Prescribing Observatory for Mental Health audit of lithium monitoring.

    PubMed

    Paton, Carol; Barnes, Thomas R E

    2014-06-01

    Audit is an important tool for quality improvement. The collection of data on clinical performance against evidence-based and clinically relevant standards, which are considered by clinicians to be realistic in routine practice, can usefully prompt reflective practice and the implementation of change. Evidence of participation in clinical audit is required to achieve intended learning outcomes for trainees in psychiatry and revalidation for those who are members of the Royal College of Psychiatrists. This article addresses some of the practical steps involved in conducting an audit project, and, to illustrate key points, draws on lessons learnt from a national, audit-based, quality improvement programme of lithium prescribing and monitoring conducted through the Prescribing Observatory for Mental Health.

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

    NASA Astrophysics Data System (ADS)

    Corwin, D. L.

    2006-05-01

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

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

    NASA Astrophysics Data System (ADS)

    Gourcy, Laurence; Baran, Nicole

    2014-05-01

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

  3. High-dimensional pattern regression using machine learning: from medical images to continuous clinical variables.

    PubMed

    Wang, Ying; Fan, Yong; Bhatt, Priyanka; Davatzikos, Christos

    2010-05-01

    This paper presents a general methodology for high-dimensional pattern regression on medical images via machine learning techniques. Compared with pattern classification studies, pattern regression considers the problem of estimating continuous rather than categorical variables, and can be more challenging. It is also clinically important, since it can be used to estimate disease stage and predict clinical progression from images. In this work, adaptive regional feature extraction approach is used along with other common feature extraction methods, and feature selection technique is adopted to produce a small number of discriminative features for optimal regression performance. Then the Relevance Vector Machine (RVM) is used to build regression models based on selected features. To get stable regression models from limited training samples, a bagging framework is adopted to build ensemble basis regressors derived from multiple bootstrap training samples, and thus to alleviate the effects of outliers as well as facilitate the optimal model parameter selection. Finally, this regression scheme is tested on simulated data and real data via cross-validation. Experimental results demonstrate that this regression scheme achieves higher estimation accuracy and better generalizing ability than Support Vector Regression (SVR).

  4. Cryptococcus neoformans infection in organ transplant recipients: variables influencing clinical characteristics and outcome.

    PubMed Central

    Husain, S.; Wagener, M. M.; Singh, N.

    2001-01-01

    Unique clinical characteristics and other variables influencing the outcome of Cryptococcus neoformans infection in organ transplant recipients have not been well defined. From a review of published reports, we found that C. neoformans infection was documented in 2.8% of organ transplant recipients (overall death rate 42%). The type of primary immunosuppressive agent used in transplantation influenced the predominant clinical manifestation of cryptococcosis. Patients receiving tacrolimus were significantly less likely to have central nervous system involvement (78% versus 11%, p =0.001) and more likely to have skin, soft-tissue, and osteoarticular involvement (66% versus 21%, p = 0.006) than patients receiving nontacrolimus- based immunosuppression. Renal failure at admission was the only independently significant predictor of death in these patients (odds ratio 16.4, 95% CI 1.9-143, p = 0.004). Hypotheses based on these data may elucidate the pathogenesis and may ultimately guide the management of C. neoformans infection in organ transplant recipients. PMID:11384512

  5. Semantic and Phonemic Verbal Fluency in Parkinson’s Disease: Influence of Clinical and Demographic Variables

    PubMed Central

    Obeso, Ignacio; Casabona, Enrique; Bringas, Maria Luisa; Álvarez, Lázaro; Jahanshahi, Marjan

    2012-01-01

    Changes of cognitive function in PD have been extensively documented and defined as a ‘frontal’ type executive dysfunction. One of the main components of this executive dysfunction is the impairment of verbal fluency. The aim of the present study was to assess semantic and phonemic fluency in a large sample of PD patients and to investigate the effect of clinical and sociodemographic variables on verbal fluency in this patient group. Three hundred patients with idiopathic Parkinson's disease who were consecutive referrals to our clinic and 50 age and education matched healthy controls completed the phonemic and semantic verbal fluency tasks. Both phonemic and semantic verbal fluency were significantly impaired in PD patients relative to matched controls. Stage of illness, presence of depression, education and age influenced verbal fluency measures. Regression analyses established that global measures of cognitive ability (MMSE) and executive function (FAB) and side of onset of motor symptoms predicted 36–37% of variance of phonemic or semantic verbal fluency measures. Thus, future studies aimed at assessing cognitive functioning in PD patients treated by deep brain stimulation (DBS) should adequately take into account several factors (stage of illness, depression, executive functioning) which may potentially influence performance on verbal fluency tasks. PMID:22530265

  6. Clinical variability of type 1 neurofibromatosis: is there a neurofibromatosis-Noonan syndrome?

    PubMed Central

    Stern, H J; Saal, H M; Lee, J S; Fain, P R; Goldgar, D E; Rosenbaum, K N; Barker, D F

    1992-01-01

    Detailed clinical, ophthalmological, and molecular studies were performed on a multigeneration family in which there were many subjects with type 1 neurofibromatosis, a common autosomal dominant disorder. Affected family members displayed a wide range of clinical findings including, in two subjects, features seen in Noonan syndrome (triangular facies, downward slanting palpebral fissures, micrognathia, short stature, and learning disability). Subjects have been described previously whose features have overlapped with neurofibromatosis and Noonan syndrome, and it has been suggested that these persons might represent a separate condition. DNA haplotype analysis showed linkage of the neurofibromatosis phenotype seen in this family to the proximal long arm of chromosome 17 in the region where the type 1 neurofibromatosis gene has been mapped. These results imply that the Noonan phenotype seen in some patients with type 1 neurofibromatosis might be the result of variable or variant expression of the neurofibromatosis gene on chromosome 17. The possible role of non-specific factors, such as fetal hypotonia, in producing the neurofibromatosis-Noonan phenotype needs further investigation. The availability of closely linked and intragenic molecular markers for neurofibromatosis could potentially be useful in the diagnosis and characterisation of patients and families with atypical forms of neurofibromatosis. Images PMID:1348094

  7. Influence of M. tuberculosis lineage variability within a clinical trial for pulmonary tuberculosis.

    PubMed

    Nahid, Payam; Bliven, Erin E; Kim, Elizabeth Y; Mac Kenzie, William R; Stout, Jason E; Diem, Lois; Johnson, John L; Gagneux, Sebastien; Hopewell, Philip C; Kato-Maeda, Midori

    2010-05-20

    Recent studies suggest that M. tuberculosis lineage and host genetics interact to impact how active tuberculosis presents clinically. We determined the phylogenetic lineages of M. tuberculosis isolates from participants enrolled in the Tuberculosis Trials Consortium Study 28, conducted in Brazil, Canada, South Africa, Spain, Uganda and the United States, and secondarily explored the relationship between lineage, clinical presentation and response to treatment. Large sequence polymorphisms and single nucleotide polymorphisms were analyzed to determine lineage and sublineage of isolates. Of 306 isolates genotyped, 246 (80.4%) belonged to the Euro-American lineage, with sublineage 724 predominating at African sites (99/192, 51.5%), and the Euro-American strains other than 724 predominating at non-African sites (89/114, 78.1%). Uneven distribution of lineages across regions limited our ability to discern significant associations, nonetheless, in univariate analyses, Euro-American sublineage 724 was associated with more severe disease at baseline, and along with the East Asian lineage was associated with lower bacteriologic conversion after 8 weeks of treatment. Disease presentation and response to drug treatment varied by lineage, but these associations were no longer statistically significant after adjustment for other variables associated with week-8 culture status.

  8. Myocardial architecture and patient variability in clinical patterns of atrial fibrillation

    PubMed Central

    Manani, Kishan A.; Christensen, Kim; Peters, Nicholas S.

    2016-01-01

    Atrial fibrillation (AF) increases the risk of stroke by a factor of 4–5 and is the most common abnormal heart rhythm. The progression of AF with age, from short self-terminating episodes to persistence, varies between individuals and is poorly understood. An inability to understand and predict variation in AF progression has resulted in less patient-specific therapy. Likewise, it has been a challenge to relate the microstructural features of heart muscle tissue (myocardial architecture) with the emergent temporal clinical patterns of AF. We use a simple model of activation wave-front propagation on an anisotropic structure, mimicking heart muscle tissue, to show how variation in AF behavior arises naturally from microstructural differences between individuals. We show that the stochastic nature of progressive transversal uncoupling of muscle strands (e.g., due to fibrosis or gap junctional remodeling), as occurs with age, results in variability in AF episode onset time, frequency, duration, burden, and progression between individuals. This is consistent with clinical observations. The uncoupling of muscle strands can cause critical architectural patterns in the myocardium. These critical patterns anchor microreentrant wave fronts and thereby trigger AF. It is the number of local critical patterns of uncoupling as opposed to global uncoupling that determines AF progression. This insight may eventually lead to patient-specific therapy when it becomes possible to observe the cellular structure of a patient’s heart. PMID:27766317

  9. Influence of M. tuberculosis Lineage Variability within a Clinical Trial for Pulmonary Tuberculosis

    PubMed Central

    Nahid, Payam; Bliven, Erin E.; Kim, Elizabeth Y.; Mac Kenzie, William R.; Stout, Jason E.; Diem, Lois; Johnson, John L.; Gagneux, Sebastien; Hopewell, Philip C.; Kato-Maeda, Midori

    2010-01-01

    Recent studies suggest that M. tuberculosis lineage and host genetics interact to impact how active tuberculosis presents clinically. We determined the phylogenetic lineages of M. tuberculosis isolates from participants enrolled in the Tuberculosis Trials Consortium Study 28, conducted in Brazil, Canada, South Africa, Spain, Uganda and the United States, and secondarily explored the relationship between lineage, clinical presentation and response to treatment. Large sequence polymorphisms and single nucleotide polymorphisms were analyzed to determine lineage and sublineage of isolates. Of 306 isolates genotyped, 246 (80.4%) belonged to the Euro-American lineage, with sublineage 724 predominating at African sites (99/192, 51.5%), and the Euro-American strains other than 724 predominating at non-African sites (89/114, 78.1%). Uneven distribution of lineages across regions limited our ability to discern significant associations, nonetheless, in univariate analyses, Euro-American sublineage 724 was associated with more severe disease at baseline, and along with the East Asian lineage was associated with lower bacteriologic conversion after 8 weeks of treatment. Disease presentation and response to drug treatment varied by lineage, but these associations were no longer statistically significant after adjustment for other variables associated with week-8 culture status. PMID:20505778

  10. Myocardial architecture and patient variability in clinical patterns of atrial fibrillation

    NASA Astrophysics Data System (ADS)

    Manani, Kishan A.; Christensen, Kim; Peters, Nicholas S.

    2016-10-01

    Atrial fibrillation (AF) increases the risk of stroke by a factor of 4-5 and is the most common abnormal heart rhythm. The progression of AF with age, from short self-terminating episodes to persistence, varies between individuals and is poorly understood. An inability to understand and predict variation in AF progression has resulted in less patient-specific therapy. Likewise, it has been a challenge to relate the microstructural features of heart muscle tissue (myocardial architecture) with the emergent temporal clinical patterns of AF. We use a simple model of activation wave-front propagation on an anisotropic structure, mimicking heart muscle tissue, to show how variation in AF behavior arises naturally from microstructural differences between individuals. We show that the stochastic nature of progressive transversal uncoupling of muscle strands (e.g., due to fibrosis or gap junctional remodeling), as occurs with age, results in variability in AF episode onset time, frequency, duration, burden, and progression between individuals. This is consistent with clinical observations. The uncoupling of muscle strands can cause critical architectural patterns in the myocardium. These critical patterns anchor microreentrant wave fronts and thereby trigger AF. It is the number of local critical patterns of uncoupling as opposed to global uncoupling that determines AF progression. This insight may eventually lead to patient-specific therapy when it becomes possible to observe the cellular structure of a patient's heart.

  11. [Stent thrombosis and clopidogrel response variability: is the genetic test useful in clinical practice?].

    PubMed

    Notarangelo, Maria Francesca; Marziliano, Nicola; Giacalone, Rossella; Demola, Maria Antonietta; Conte, Giulio; Mantovani, Francesco; Ardissino, Diego

    2011-10-01

    The antiplatelet agent clopidogrel is an effective drug for the prevention of thrombotic events in patients with acute coronary syndrome and in those undergoing percutaneous coronary intervention with the deployment of a coronary stent. However, it has been reported that, despite adequate treatment, about 30% of patients continue to show the high degree of platelet reactivity that is central to the development of atherothrombotic complications and poorer clinical outcomes. Up to 13% of those taking clopidogrel experience a recurrent ischemic event during the first year after acute coronary syndrome, 1-3% experience subacute stent thrombosis after percutaneous coronary intervention probably due to a poor drug response, and about 1.5% experience major bleeding mainly due to an enhanced response. Recent research findings have highlighted the role of genetic variations in determining antiplatelet response variability, and this has aroused interest in genotyping all thienopyridine-eligible patients in order to identify those who would be at increased risk of harm if treated with clopidogrel. However, it remains to be determined whether this information is necessary or sufficient for risk stratification. Only when there are clinical data to support the hypothesis that genotype-guided therapy reduces the rate of ischemic and bleeding events will it be possible to justify the use of genetic testing in all potential patients. When that happens, genotype-guided antiplatelet therapy will also be available in the field of cardiovascular medicine.

  12. Ambulatory BP monitoring and clinic BP in predicting small-for-gestational-age infants during pregnancy.

    PubMed

    Eguchi, K; Ohmaru, T; Ohkuchi, A; Hirashima, C; Takahashi, K; Suzuki, H; Kario, K; Matsubara, S; Suzuki, Mitsuaki

    2016-01-01

    The significance of ambulatory blood pressure (ABP) monitoring during pregnancy has not been established. We performed a prospective study to elucidate whether ABP measures are associated with small-for-gestational-age birth weight (SGA). We studied 146 pregnant women who were seen for maternal medical checkups or suspected hypertension. ABP monitoring was performed for further assessment of hypertension. The outcome measure was SGA. The subjects were classified by their medical history and ABP as having preeclampsia or gestational hypertension (n=68 cases), chronic hypertension (n=48) or white-coat hypertension (n=30). There were 50 (34.2%) cases of SGA by the fetal growth reference standard. In multivariable logistic regression analyses adjusting for age, body mass index, the presence of prior pregnancy, current smoking habit and the use of antihypertensive medications, 24-h SBP (per 10 mm Hg (odds ratio (OR): 1.74; 95% confidence interval (CI): 1.28-2.38; P<0.001)) was more closely associated with SGA than clinic BP (OR: 1.40; 95% CI: 0.92-2.13; P=0.11). The results were essentially the same if 24-h BP was replaced by awake or sleep SBP. Ambulatory diastolic BP showed the same tendency. However, abnormal circadian rhythm was not associated with the outcome. In conclusion, ambulatory BP monitoring measures performed during pregnancy were more closely associated with SGA than clinic BP.

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

    NASA Astrophysics Data System (ADS)

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

    2015-03-01

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

  14. Clinical application of transanal ileal tube placement using X-ray monitoring

    PubMed Central

    Li, Dechun; Du, Hongtao; Shao, Guoqing; Xu, Yuanshun; Li, Ruihong; Tian, Qingzhong

    2017-01-01

    Colorectal cancer, which includes colon and rectal cancer, is a common digestive tract tumor. Although surgery is the primary form of treatment, there are a number of drawbacks, including patients experiencing considerable pain and high cost. The present study was undertaken to examine the clinical value of transanal ileal tube placement under X-ray monitoring. Thirty-six cases of left colon obstruction presenting to our hospital between July 2011 and February 2014, underwent transanal ileal tube placement using a single-curve catheter guided by a guidewire under X-ray monitoring. An ileal tube was successfully inserted into 32 patients. Clinical symptoms were alleviated effectively within 48 h. Indwelling catheter decompression time was 4–9 days with an average of 5.61 days. In two cases, the colon guidewire perforated into the abdominal cavity. Repeated exploration resistance of the guidewire and catheter indicated stenosis at this position owing to obstruction. In conclusion, transanal placement of the ileal tube through X-ray monitoring is capable of effectively alleviating the symptoms of ileus. Thus, this constitutes a safe, effective, and economical method that is acceptable to patients. PMID:28123533

  15. Risk indicators for future clinical attachment loss in adult periodontitis. Patient variables.

    PubMed

    Grbic, J T; Lamster, I B; Celenti, R S; Fine, J B

    1991-05-01

    We studied patient-derived variables to identify individuals at risk for future clinical attachment loss (CAL). Seventy-five patients with chronic adult periodontitis were followed for 6 months and clinical and epidemiological parameters collected at baseline were related to CAL. Clinical parameters were obtained from 6 sites per tooth and whole-mouth averages were calculated. Epidemiologic parameters were obtained by questionnaire and interview. After the baseline examination, patients were treated with root planing and scaling. Thirty-one patients (41.3%) demonstrated greater than or equal to 1 site with CAL of greater than or equal to 2.5 mm, while 16 patients (21.3%) demonstrated CAL at greater than or equal to 2 sites. Epidemiological factors such as gender, health status, marital status, education, and occupation were not associated with CAL. In contrast, baseline mean attachment level, age, baseline mean probing depth, baseline mean recession, percentage of sites exhibiting bleeding on probing, and the number of missing teeth were related to CAL. Using logistic modelling, we found that baseline attachment level was the primary risk indicator for post-treatment CAL. Nineteen percent of the patients with baseline attachment levels less than 4.0 mm, 50% of the patients with 4.0 to 4.9 mm, and 85% (P less than .005) of the patients with greater than or equal to 5.0 mm exhibited CAL. The age of the patient was also a major risk indicator for CAL, and was independent of baseline attachment levels. Eighty-nine percent of the 60 to 69 year old patients demonstrated CAL, compared to only 35% of patients between the ages of 30 and 59 (P less than or equal to .005).(ABSTRACT TRUNCATED AT 250 WORDS)

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2016-04-01

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

  19. ELECTRONIC MONITORING REVEALS HIGHLY VARIABLE ADHERENCE PATTERNS IN PATIENTS PRESCRIBED IVACAFTOR

    PubMed Central

    Siracusa, Christopher M.; Ryan, Jamie; Burns, Lisa; Wang, Yu; Zhang, Nanhua; Clancy, John P.; Drotar, Dennis

    2015-01-01

    Background Previous studies of CF treatments have shown suboptimal adherence, though little has been reported regarding adherence patterns to ivacaftor. Electronic monitoring (EM) of adherence is considered a gold standard of measurement. Methods Adherence rates by EM were prospectively obtained and patterns over time were analyzed. EM-derived adherence rates were compared to pharmacy refill history and self-report. Results 12 subjects (age 6-48 years; CFTR-G551D mutation) previously prescribed ivacaftor were monitored for a mean of 118 days. Overall adherence by EM was 61%(SD=28%) and decreased over time. Median duration between doses was 16.9 hours (IQR 13.9-24.1 hours) and increased over time. There was no correlation between EM-derived adherence and either refill history (84%, r=0.26, p=0.42) or self-report (100%, r=0.40, p=0.22). Conclusions Despite the promising nature of ivacaftor, our data suggest adherence rates are suboptimal and comparable to other prescribed CF therapies, and more commonly used assessments of adherence may be unreliable. PMID:26074007

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

    NASA Technical Reports Server (NTRS)

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

    1994-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2014-12-01

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

  2. Translation of lithography variability into after-etch performance: monitoring of golden hotspot

    NASA Astrophysics Data System (ADS)

    Finders, Jo; Kiers, Ton; Le Gratiet, Bertrand; Lakcher, Amine

    2016-10-01

    In the early phases of technology development, designers and process engineers have to converge toward efficient design rules. Their calculations are based on process assumptions and result in a design rule based on known process variability capabilities while taking into account enough margin to be safe not only for yield but especially for reliability. Unfortunately, even if designs tend to be regular, efficient design densities are still requiring aggressive configurations from which it is difficult to estimate dimension variabilities. Indeed, for a process engineer it is rather straightforward to estimate or even measure simple one-dimensional features (arrays of Lines & Spaces at various CD and pitches), but it starts to be less obvious for complex multidimensional features. After a context description related to the process assumptions, we will outline the work flow which is under evaluation to enable robust metrology of 2 dimensional complex features. Enabling new metrology possibilities reveals that process hotspots are showing complex behavior from lithography to etch pattern transfer. In this work we studied the interaction of lithography variability and etching for a mature 28 nm CMOS process. To study this interaction we used a test feature that has been found very sensitive to lithography process variations. This so-called "golden" hotspot shows edge-to-edge geometries from 88nm to 150nm, thus comprising all the through pitch physics in the lithography pattern transfer [1, 2]. It consists of three trenches. From previous work it was known that through trench there is a systematic variation in best focus due to the Mask 3D effects. At a given chosen focus, there is a distinct difference in profiles for the three trenches that will lead to pattern displacement effects during the etch transfer.

  3. Highly accurate moving object detection in variable bit rate video-based traffic monitoring systems.

    PubMed

    Huang, Shih-Chia; Chen, Bo-Hao

    2013-12-01

    Automated motion detection, which segments moving objects from video streams, is the key technology of intelligent transportation systems for traffic management. Traffic surveillance systems use video communication over real-world networks with limited bandwidth, which frequently suffers because of either network congestion or unstable bandwidth. Evidence supporting these problems abounds in publications about wireless video communication. Thus, to effectively perform the arduous task of motion detection over a network with unstable bandwidth, a process by which bit-rate is allocated to match the available network bandwidth is necessitated. This process is accomplished by the rate control scheme. This paper presents a new motion detection approach that is based on the cerebellar-model-articulation-controller (CMAC) through artificial neural networks to completely and accurately detect moving objects in both high and low bit-rate video streams. The proposed approach is consisted of a probabilistic background generation (PBG) module and a moving object detection (MOD) module. To ensure that the properties of variable bit-rate video streams are accommodated, the proposed PBG module effectively produces a probabilistic background model through an unsupervised learning process over variable bit-rate video streams. Next, the MOD module, which is based on the CMAC network, completely and accurately detects moving objects in both low and high bit-rate video streams by implementing two procedures: 1) a block selection procedure and 2) an object detection procedure. The detection results show that our proposed approach is capable of performing with higher efficacy when compared with the results produced by other state-of-the-art approaches in variable bit-rate video streams over real-world limited bandwidth networks. Both qualitative and quantitative evaluations support this claim; for instance, the proposed approach achieves Similarity and F1 accuracy rates that are 76

  4. Standardized principal components for vegetation variability monitoring across space and time

    NASA Astrophysics Data System (ADS)

    Mathew, T. R.; Vohora, V. K.

    2016-08-01

    Vegetation at any given location changes through time and in space. In what quantity it changes, where and when can help us in identifying sources of ecosystem stress, which is very useful for understanding changes in biodiversity and its effect on climate change. Such changes known for a region are important in prioritizing management. The present study considers the dynamics of savanna vegetation in Kruger National Park (KNP) through the use of temporal satellite remote sensing images. Spatial variability of vegetation is a key characteristic of savanna landscapes and its importance to biodiversity has been demonstrated by field-based studies. The data used for the study were sourced from the U.S. Agency for International Development where AVHRR derived Normalized Difference Vegetation Index (NDVI) images available at spatial resolutions of 8 km and at dekadal scales. The study area was extracted from these images for the time-period 1984-2002. Maximum value composites were derived for individual months resulting in an image dataset of 216 NDVI images. Vegetation dynamics across spatio-temporal domains were analyzed using standardized principal components analysis (SPCA) on the NDVI time-series. Each individual image variability in the time-series is considered. The outcome of this study demonstrated promising results - the variability of vegetation change in the area across space and time, and also indicated changes in landscape on 6 individual principal components (PCs) showing differences not only in magnitude, but also in pattern, of different selected eco-zones with constantly changing and evolving ecosystem.

  5. An approach to remote monitoring of heart rate variability (HRV) using microwave radar during a calculation task.

    PubMed

    Suzuki, Satoshi; Matsui, Takemi; Sugawara, Keitaro; Asao, Takafumi; Kotani, Kentaro

    2011-01-01

    Recently, nonrestrictive and noninvasive sensing techniques to measure vital signs have been actively researched and developed. This study aimed to develop a prototype system to monitor cardiac activity using microwave radar without making contact with the body and without removing clothing--namely, a completely noncontact, remote monitoring system. In addition, heart rate and changes in heart rate variability (HRV) during simple mental arithmetic tasks were observed with the prototype system. The prototype system has a microwave Doppler radar antenna with 24 GHz frequency and approximately 7 mW output power. The experiments were conducted with seven subjects (23.00±0.82 years). We found that the prototype system captured heart rate and HRV precisely. The strong relationship between the heart rates during tasks (r=0.96), LF (cross-correlation=0.76), and LF/HF (cross-correlation=0.73) of HRV calculated from the prototype system and from electrocardiograph (ECG) measurements were confirmed. The proposed completely noncontact, remote method appears promising for future monitoring of cardiac activity as an indicator of changes in mental workload in workplaces.

  6. Accounting for interim safety monitoring of an adverse event upon termination of a clinical trial.

    PubMed

    Dallas, Michael J

    2008-01-01

    Upon termination of a clinical trial that uses interim evaluations to determine whether the trial can be stopped, a proper statistical analysis must account for the interim evaluations. For example, in a group-sequential design where the efficacy of a treatment regimen is evaluated at interim stages, and the opportunity to stop the trial based on positive efficacy findings exists, the terminal p-value, point estimate, and confidence limits of the outcome of interest must be adjusted to eliminate bias. While it is standard practice to adjust terminal statistical analyses due to opportunities to stop for "positive" findings, adjusting due to opportunities to stop for "negative" findings is also important. Stopping rules for negative findings are particularly useful when monitoring a specific rare serious adverse event in trials designed to show safety with respect to the event. In these settings, establishing conservative stopping rules are appropriate, and therefore accounting for the interim monitoring can have a substantial effect on the final results. Here I present a method to account for interim safety monitoring and illustrate its usefulness. The method is demonstrated to have advantages over methodology that does not account for interim monitoring.

  7. INVESTIGATING THE EFFICACY OF CLINICAL TRIAL MONITORING STRATEGIES: Design and Implementation of the Cluster Randomized START Monitoring Substudy

    PubMed Central

    Hullsiek, Katherine Huppler; Kagan, Jonathan M; Engen, Nicole; Grarup, Jesper; Hudson, Fleur; Denning, Eileen T; Carey, Catherine; Courtney-Rodgers, David; Finley, Elizabeth B; Jansson, Per O; Pearson, Mary T; Peavy, Dwight E; Belloso, Waldo H

    2014-01-01

    Background Trial monitoring protects participant safety and study integrity. While monitors commonly go on-site to verify source data, there is little evidence that this practice is efficient or effective. An ongoing international HIV treatment trial (START) provides an opportunity to explore the usefulness of different monitoring approaches. Methods All START sites are centrally monitored and required to follow a local monitoring plan requiring specific quality assurance activities. Additionally, sites were randomized (1:1) to receive, or not receive, annual on-site monitoring. The study will determine if on-site monitoring increases the identification of major protocol deviations (eligibility or consent violations, improper study drug use, primary or serious event underreporting, data alteration or fraud). Results The START study completed enrollment in December 2013, with planned follow-up through December 2016. The monitoring study is ongoing at 196 sites in 34 countries. Results are expected when the START study concludes in December 2016. PMID:25973346

  8. Post-Marketing Health Technology Monitoring. The Analysis of an Experience from a Clinical Perspective

    PubMed Central

    Ibargoyen-Roteta, Nora; Cabriada-Nuño, Jose Luis; Gutiérrez-Ibarluzea, Iñaki; Hernández-Ramírez, Vicent; Clofent-Vilaplana, Juan; Domènech-Morral, Eugeni; Ginard-Vicens, Daniel; Oliva-Oliva, Gloria; Queiro-Verdes, Teresa

    2011-01-01

    Introduction: A system for monitoring the use of aphaeresis in the treatment of ulcerative colitis (UC), named system for monitoring aphaeresis in ulcerative colitis (SiMAC), was designed in 2006 in the Basque Country. In the present study, the opinion of the clinicians who participated in SiMAC was evaluated, in order to identify the barriers and gather suggestions that could improve implementation of this kind of system. Methods: A mixed questionnaire was designed, in order to gather clinicians’ assessments of the SiMAC monitoring system. Results: The response rate was 73.9% (17/23). The data from 40.96% (159/388) of patients with UC treated with aphaeresis was recorded. The main reasons for not including the data from all treated patients were a lack of required data or not meeting the study inclusion criteria. Positive aspects of the SiMAC were identified, as the simplicity of data collection and its systematic, multi-center approach. The negative aspects mentioned were the use of a local computer application and the lack of time for health professionals to enter data. Discussion: The use of monitoring systems helps to formalize the introduction of technologies of little-known effectiveness; involve clinicians and medical societies in coming to agreement and obtaining information about the safety, effectiveness or efficiency of new technologies; and provide relevant information to healthcare administrations for making decisions about the introduction of new technologies into healthcare practice. In order for a monitoring system to work, the process must be straightforward. A minimum set of key variables that are easy to collect must be selected, and an effort made to involve a range of stakeholders, especially institutions and scientific societies, to support the work group. PMID:21863141

  9. Green light for liver function monitoring using indocyanine green? An overview of current clinical applications.

    PubMed

    Vos, J J; Wietasch, J K G; Absalom, A R; Hendriks, H G D; Scheeren, T W L

    2014-12-01

    The dye indocyanine green is familiar to anaesthetists, and has been studied for more than half a century for cardiovascular and hepatic function monitoring. It is still, however, not yet in routine clinical use in anaesthesia and critical care, at least in Europe. This review is intended to provide a critical analysis of the available evidence concerning the indications for clinical measurement of indocyanine green elimination as a diagnostic and prognostic tool in two areas: its role in peri-operative liver function monitoring during major hepatic resection and liver transplantation; and its role in critically ill patients on the intensive care unit, where it is used for prediction of mortality, and for assessment of the severity of acute liver failure or that of intra-abdominal hypertension. Although numerous studies have demonstrated that indocyanine green elimination measurements in these patient populations can provide diagnostic or prognostic information to the clinician, 'hard' evidence - i.e. high-quality prospective randomised controlled trials - is lacking, and therefore it is not yet time to give a green light for use of indocyanine green in routine clinical practice.

  10. Clinical and biochemical monitoring of patients with fatty acid oxidation disorders.

    PubMed

    Lund, Allan Meldgaard; Skovby, Flemming; Vestergaard, Helle; Christensen, Mette; Christensen, Ernst

    2010-10-01

    Evidence-based guidelines for monitoring patients with disorders in fatty acid oxidation (FAO) are lacking, and most protocols are based on expert statements. Here, we describe our protocol for Danish patients. Clinical monitoring is the most important measure and has the main aims of checking growth, development and diet and of bringing families to the clinic regularly to remind them of their child's risk and review how they cope and adjust, e.g. to an acute intercurrent illness. Most of these measures are simple and can be carried out during a routine out-patient visit; we seldom do more complicated assessments by a neuropsychologist, speech therapist, or physical and occupational therapists. Paraclinical measurements are not used for short-chain and medium-chain disorders; electrocardiography (including 24 h monitoring) and echocardiography are done for most patients with long-chain and carnitine transporter deficiencies. Eye examination is done in all, and liver ultrasonography in some patients with long-chain 3-hydroxyacyl-coenzyme A dehydrogenase/tri-functional protein (LCHAD/TFP) deficiencies. Biochemical follow-up includes determination of free carnitine and acylcarnitines. Free carnitine is measured to monitor carnitine supplementation in patients with multiple acyl-coenzyme A dehydrogenase deficiency (MADD) and carnitine transporter deficiency (CTD) and to follow metabolic control and disclose deficiency states in other FAO disorders. We are evaluating long-chain acylcarnitines in patients with long-chain disorders; so far there does not seem to be any clear-cut benefit in following these levels. An erythrocyte fatty acid profile is done in patients with long-chain disorders to test for essential fatty acid and docosahexanoic acid (DHA) deficiencies. The measurement of creatine kinase is helpful in long-chain disorders. Ongoing follow-up and education of the patient is important throughout life to prevent disease morbidity or death from metabolic crises.

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

    PubMed Central

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

    2015-01-01

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

  12. Evaluation of Commercial Self-Monitoring Devices for Clinical Purposes: Results from the Future Patient Trial, Phase I.

    PubMed

    Leth, Soren; Hansen, John; Nielsen, Olav W; Dinesen, Birthe

    2017-01-22

    Commercial self-monitoring devices are becoming increasingly popular, and over the last decade, the use of self-monitoring technology has spread widely in both consumer and medical markets. The purpose of this study was to evaluate five commercially available self-monitoring devices for further testing in clinical applications. Four activity trackers and one sleep tracker were evaluated based on step count validity and heart rate validity.

  13. How to Monitor AGN Intra-Day Variability at 230 GHz

    NASA Astrophysics Data System (ADS)

    Kim, Jae-Young; Trippe, Sascha

    2013-04-01

    We probe the feasibility of high-frequency radio observations of very rapid flux variations in compact active galactic nuclei (AGN). Our study assumes observations at 230 GHz with a small 6-meter class observatory, using the SNU Radio Astronomical Observatory (SRAO) as an example. We find that 33 radio-bright sources are observable with signal-to-noise ratios larger than ten. We derive statistical detection limits via exhaustive Monte Carlo simulations assuming (a) periodic, and (b) episodic flaring flux variations on time-scales as small as tens of minutes. We conclude that a wide range of flux variations is observable. This makes high-frequency radio observations - even with small observatories - a powerful probe of AGN intra-day variability; especially, those which complement observations at lower radio frequencies with larger observatories like the Korean VLBI Network (KVN).

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

    PubMed

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

    2015-01-01

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

  15. Dentin bonding-variables related to the clinical situation and the substrate treatment.

    PubMed

    Perdigão, Jorge

    2010-02-01

    The wetness of dentin surfaces, the presence of pulpal pressure, and the thickness of dentin are extremely important variables during bonding procedures, especially when testing bond strength of adhesive materials in vitro with the intention of simulating in vivo conditions. The ultimate goal of a bonded restoration is to attain an intimate adaptation of the restorative material with the dental substrate. This task is difficult to achieve as the bonding process is different for enamel and for dentin-dentin is more humid and more organic than enamel. While enamel is predominantly mineral, dentin contains a significant amount of water and organic material, mainly type I collagen. This humid and organic nature of dentin makes this hard tissue very challenging to bond to. Several other substrate-related variables may affect the clinical outcome of bonded restorations. Bonding to caries-affected dentin is hampered by its lower hardness and presence of mineral deposits in the tubules. Non-carious cervical areas contain hypermineralized dentin and denatured collagen, which is not the ideal combination for a bonding substrate. Physiological transparent root dentin forms without trauma or caries lesion as a natural part of aging. Similar to the transparent dentin observed underneath caries lesions, the tubule lumina become filled with mineral from passive chemical precipitation, making resin hybridization difficult. An increase in number of tubules with depth and, consequently, increase in dentin wetness, make bonding to deeper dentin more difficult than to superficial dentin. While the application of acidic agents open the pathway for the diffusion of monomers into the collagen network, it also facilitates the outward seepage of tubular fluid from the pulp to the dentin surface, deteriorating the bonding for some of the current adhesives. Some dentin desensitizers have shown some promise as they can block dentinal tubules to treat and prevent sensitivity and simultaneously

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

    NASA Astrophysics Data System (ADS)

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

    2010-12-01

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

  17. VERITAS 2008-2009 MONITORING OF THE VARIABLE GAMMA-RAY SOURCE M 87

    SciTech Connect

    Acciari, V. A.; Benbow, W.; Aliu, E.; Arlen, T.; Chow, Y. C.; Aune, T.; Beilicke, M.; Buckley, J. H.; Bugaev, V.; Dickherber, R.; Boltuch, D.; Bradbury, S. M.; Byrum, K.; Cannon, A.; Cesarini, A.; Ciupik, L.; Cogan, P.; Cui, W.; Finley, J. P.; Duke, C.

    2010-06-10

    M 87 is a nearby radio galaxy that is detected at energies ranging from radio to very high energy (VHE) gamma rays. Its proximity and its jet, misaligned from our line of sight, enable detailed morphological studies and extensive modeling at radio, optical, and X-ray energies. Flaring activity was observed at all energies, and multi-wavelength correlations would help clarify the origin of the VHE emission. In this paper, we describe a detailed temporal and spectral analysis of the VERITAS VHE gamma-ray observations of M 87 in 2008 and 2009. In the 2008 observing season, VERITAS detected an excess with a statistical significance of 7.2 standard deviations ({sigma}) from M 87 during a joint multi-wavelength monitoring campaign conducted by three major VHE experiments along with the Chandra X-ray Observatory. In 2008 February, VERITAS observed a VHE flare from M 87 occurring over a 4 day timespan. The peak nightly flux above 250 GeV was (1.14 {+-} 0.26) x 10{sup -11} cm{sup -2} s{sup -1}, which corresponded to 7.7% of the Crab Nebula flux. M 87 was marginally detected before this 4 day flare period, and was not detected afterward. Spectral analysis of the VERITAS observations showed no significant change in the photon index between the flare and pre-flare states. Shortly after the VHE flare seen by VERITAS, the Chandra X-ray Observatory detected the flux from the core of M 87 at a historical maximum, while the flux from the nearby knot HST-1 remained quiescent. Acciari et al. presented the 2008 contemporaneous VHE gamma-ray, Chandra X-ray, and Very Long Baseline Array radio observations which suggest the core as the most likely source of VHE emission, in contrast to the 2005 VHE flare that was simultaneous with an X-ray flare in the HST-1 knot. In 2009, VERITAS continued its monitoring of M 87 and marginally detected a 4.2{sigma} excess corresponding to a flux of {approx}1% of the Crab Nebula. No VHE flaring activity was observed in 2009.

  18. Snow season variability in a boreal-Arctic transition area monitored by MODIS data

    NASA Astrophysics Data System (ADS)

    Malnes, Eirik; Rune Karlsen, Stein; Johansen, Bernt; Bjerke, Jarle W.; Tømmervik, Hans

    2016-12-01

    The duration and extent of snow cover is expected to change rapidly with climate change. Therefore, there is a need for improved monitoring of snow for the benefit of forecasting, impact assessments and the population at large. Remotely sensed techniques prove useful for remote areas where there are few field-based monitoring stations. This paper reports on a study of snow season using snow cover area fraction data from the two northernmost counties in Norway, Troms and Finnmark. The data are derived from the daily 500 m standard snow product (MOD10A1) from the NASA Terra MODerate Resolution Imaging Spectroradiometer (MODIS) sensor for the 2000-2010 period. This dataset has been processed with multi-temporal interpolation to eliminate clouds. The resulting cloud-free daily time series of snow cover fraction maps, have subsequently been used to derive the first and last snow-free day for the entire study area. In spring, the correlation between the first snow-free day mapped by MODIS data and snow data from 40 meteorological stations was highly significant (p < 0.05) for 36 of the stations, and with a of bias of less than 10 days for 34 of the stations. In autumn, 31 of the stations show highly significant (p < 0.05) correlation with MODIS data, and the bias was less than 10 days for 27 of the stations. However, in some areas and some years, the start and end of the snow season could not be detected due to long overcast periods. In spring 2002 and 2004 the first snow-free day was early, but arrived late in 2000, 2005 and 2008. In autumn 2009 snowfall arrived more than 7 days earlier in 50% of the study area as compared to the 2000-2010 average. MODIS-based snow season products will be applicable for a wide range of sectors including hydrology, nature-based industries, climate change studies and ecology. Therefore refinement and further testing of this method should be encouraged.

  19. Variability of selected nutrients and contaminants monitored in rodent diets: A 6-year study

    SciTech Connect

    Oller, W.L.; Kendall, D.C.; Greenman, D.L. )

    1989-01-01

    The results are given from monitoring a commercial closed-formula cereal-based rodent diet (Purina 5010), two open-formula cereal-based diets (NIH-31 and NIH-07), and one purified diet (AIN-76) for selected nutrients and contaminants. The observed concentrations of nutrients (protein, fat, vitamin A, and thiamine) approximated the manufacturer specifications for closed-formula cereal diet, while the average concentrations of nutrients found in the open-formula cereal diets were well above the nominal concentrations. Nominal concentrations for these open-formula diets tended to be close to the minimum values that were observed. Except for protein levels, greater variation in nutrient concentrations was found in the purified diet than in the cereal diets. Contaminants were generally much lower in the purified diet than in the cereal diets, but the variation of contaminants was about equal in the two types of diets. Open- and closed-formula cereal diets appear to be very similar to each other in the degree of variation of nutrients and contaminants. Cadmium, lead, and selenium are the constituents of greatest concern in assuring the quality of the rodent diets that were evaluated.

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

    NASA Astrophysics Data System (ADS)

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

    2016-06-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2014-06-01

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

  2. Monitoring drip water isotope and element variability: A new device for automatic drip water collection

    NASA Astrophysics Data System (ADS)

    Breitenbach, S. F. M.; Gilbert, M.-J.; Kwiecien, O.; Seifert, R.; Fleitmann, D.

    2012-04-01

    Understanding cave drip water elemental and stable isotope composition (δD and δ18O) are vital for interpreting climate proxy records derived from stalagmites as palaeoclimate archives. Delineating the temporal changes in drip water chemistry to climatic and environmental fluctuations (such as rainfall amount, degassing, bioactivity etc.) is even more important if calibration is attempted between climatic parameters and stalagmite proxy records. Monitoring of remote study sites has often been limited by the ability to regularly and manually collect drip water samples over an extended period of time. One important complication to be considered for stable isotope analysis is that sampling vials must be closed air-tight, in order to avoid post-sampling evaporation of the sampled water. To overcome these limitations we developed an automated and programmable sampling device that can collect 12 ml of drip water at pre-defined time intervals. A total of 49 samples can be collected in a turret over a period of up to one year. The device is powered by widely available C-cell batteries and works in cave environments with positive air temperature. The autosampler has been installed and tested in Waldheim Cave, Switzerland, where we collected water at 24h intervals. We present preliminary data for the winter period December 2011 to March 2012.

  3. Phenotypic characterization of X-linked retinoschisis: Clinical, electroretinography, and optical coherence tomography variables

    PubMed Central

    Neriyanuri, Srividya; Dhandayuthapani, Sudha; Arunachalam, Jayamuruga Pandian; Raman, Rajiv

    2016-01-01

    Aims: To study the phenotypic characteristics of X-linked retinoschisis (XLRS) and report the clinical, electroretinogram (ERG), and optical coherence tomography (OCT) variables in Indian eyes. Design: A retrospective study. Materials and Methods: Medical records of 21 patients with retinoschisis who were genetically confirmed to have RS1 mutation were reviewed. The phenotype characterization included the age of onset, best-corrected visual acuity, refractive error, fundus findings, OCT, and ERG. Statistical Analysis Used: Data from both the eyes were used for analysis. A P < 0.05 was set as statistical significance. Data were not normally distributed (P < 0.05, Shapiro wilk); hence, nonparametric tests were used for statistical analysis. Results: All were males whose mean age of presentation was 9 years. Visual acuity was moderately impaired (median 0.6 logMAR, interquartile range: 0.47, 1) in these eyes with a hyperopic refractive error of median +1.75 Ds (interquartile range: +0.50 Ds, +4.25 Ds). About 54.7% of the eyes had both foveal and peripheral schisis, isolated foveal schisis was seen in 28.5% of the eyes, and schisis with retinal detachment was seen in 16.6% of the eyes. The inner nuclear layer was found to be commonly involved in the schisis, followed by outer nuclear and plexiform layers as evident on OCT. On ERG, a- and b-wave amplitudes were significantly reduced in eyes with foveal and peripheral schisis when compared to the eyes with only foveal schisis (P < 0.05). Conclusions: XLRS has phenotypic heterogeneity as evident on OCT, ERG, and clinical findings. PMID:27609164

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

    NASA Technical Reports Server (NTRS)

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

    2015-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2014-11-01

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

  6. Monitoring of disease biomarkers activity and immunophenotyping as important factors in SLE clinical management.

    PubMed

    Subasic, Djemo; Karamehic, Jasenko; Delic-Sarac, Marina; Kasumovic, Mersija; Mekic, Mevludin; Eminovic, Izet; Hasanagic, Nermina

    2012-01-01

    The highly specific biomarkers for monitoring of SLE disease activity are not yet defined up to date, due to existing of different clinical SLE phenotypes caused by individual genetic variation. Basically, numerous clinical complications follow SLE patients such as nephritis, atherosclerosis and cardial, CNS, gastrointestinal and ophthalmological complications, as well. Their monitoring in clinical SLE management can be evaluated by analysing of specific biochemical parameters and require permanent clinical observation. The presence of ANAs and anti-ds-DNAs are usual diagnostic SLE autoimmunity parameters, while SLE disease activity biomarkers are C3 and C4 level, anticardiolipin antibodies, anti-Sm/RNPs and, recently level of CD4 and CD8 lymphocytes. However, the number of TCR molecules on the T-cells surface at SLE patients is lower then in normal condition, and otherwise for these receptors CD molecules make specific connection. On the other hand, the T lymphocytes can be also, therapeutical targets at SLE patients, because of their clear direct involving in SLE pathogenesis. The SLE phenotypes are characterized by double CD negativity ( CD3 +/-, CD4-) caused by abnormal level of IL-2 and IL-17. T-lymphocytes have usually alpha-beta and gamma-delta TCR receptors, but for SLE patients is characteristic lower number gama-delta TCR molecules, detected in the peripheral blood specimens. Taking into account all of the facts, we investigated the level of specific usual SLE activity biomarkers (anti-ds-DNAs, C3, C4, anticardiolipin antibodies (beta-2-IgG, beta-2-IgM, ACA-G, ACA-M, CD4 and CD8 level) in serum specimens of SLE patients who underwent to the corresponding chemotherapy in combination with other biochemical and clinical parameters. Once again proved to be, that SLE biomarker monitoring, could be useful aproach for SLE activity disease and prediction organ damage, as well. In our investigation we used the following methods: immunofluorescence microscopy (IFA

  7. Clinical Accuracy of a Continuous Glucose Monitoring System With an Advanced Algorithm

    PubMed Central

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

    2014-01-01

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

  8. Smart respiratory monitoring: clinical development and validation of the IPI™ (Integrated Pulmonary Index) algorithm.

    PubMed

    Ronen, M; Weissbrod, R; Overdyk, F J; Ajizian, S

    2017-04-01

    Continuous electronic monitoring of patient respiratory status frequently includes PetCO2 (end tidal CO2), RR (respiration rate), SpO2 (arterial oxygen saturation), and PR (pulse rate). Interpreting and integrating these vital signs as numbers or waveforms is routinely done by anesthesiologists and intensivists but is challenging for clinicians in low acuity areas such as medical wards, where continuous electronic respiratory monitoring is becoming more common place. We describe a heuristic algorithm that simplifies the interpretation of these four parameters in assessing a patient's respiratory status, the Integrated Pulmonary Index (IPI). The IPI algorithm is a mathematical model combining SpO2, RR, PR, and PetCO2 into a single value between 1 and 10 that summarizes the adequacy of ventilation and oxygenation at that point in time. The algorithm was designed using a fuzzy logic inference model to incorporate expert clinical opinions. The algorithm was verified by comparison to experts' scoring of clinical scenarios. The validity of the index was tested in a retrospective analysis of continuous SpO2, RR, PR, and PetCO2 readings obtained from 523 patients in a variety of clinical settings. IPI correlated well with expert interpretation of the continuous respiratory data (R = 0.83, p < 0.001), with agreement of -0.5 ± 1.4. Receiver operating curves analysis resulted in high levels of sensitivity (ranging from 0.83 to 1.00), and corresponding specificity (ranging from 0.96 to 0.74), based on IPI thresholds 3-6. The IPI reliably interpreted the respiratory status of patients in multiple areas of care using off-line continuous respiratory data. Further prospective studies are required to evaluate IPI in real time in clinical settings.

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

    PubMed

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

    2015-03-01

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

  10. Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline.

    PubMed

    Armenian, Saro H; Lacchetti, Christina; Barac, Ana; Carver, Joseph; Constine, Louis S; Denduluri, Neelima; Dent, Susan; Douglas, Pamela S; Durand, Jean-Bernard; Ewer, Michael; Fabian, Carol; Hudson, Melissa; Jessup, Mariell; Jones, Lee W; Ky, Bonnie; Mayer, Erica L; Moslehi, Javid; Oeffinger, Kevin; Ray, Katharine; Ruddy, Kathryn; Lenihan, Daniel

    2016-12-05

    Purpose Cardiac dysfunction is a serious adverse effect of certain cancer-directed therapies that can interfere with the efficacy of treatment, decrease quality of life, or impact the actual survival of the patient with cancer. The purpose of this effort was to develop recommendations for prevention and monitoring of cardiac dysfunction in survivors of adult-onset cancers. Methods Recommendations were developed by an expert panel with multidisciplinary representation using a systematic review (1996 to 2016) of meta-analyses, randomized clinical trials, observational studies, and clinical experience. Study quality was assessed using established methods, per study design. The guideline recommendations were crafted in part using the Guidelines Into Decision Support methodology. Results A total of 104 studies met eligibility criteria and compose the evidentiary basis for the recommendations. The strength of the recommendations in these guidelines is based on the quality, amount, and consistency of the evidence and the balance between benefits and harms. Recommendations It is important for health care providers to initiate the discussion regarding the potential for cardiac dysfunction in individuals in whom the risk is sufficiently high before beginning therapy. Certain higher risk populations of survivors of cancer may benefit from prevention and screening strategies implemented during cancer-directed therapies. Clinical suspicion for cardiac disease should be high and threshold for cardiac evaluation should be low in any survivor who has received potentially cardiotoxic therapy. For certain higher risk survivors of cancer, routine surveillance with cardiac imaging may be warranted after completion of cancer-directed therapy, so that appropriate interventions can be initiated to halt or even reverse the progression of cardiac dysfunction.

  11. GRACE satellite gravimetry to monitor AMOC variability and coherence in the Atlantic Ocean

    NASA Astrophysics Data System (ADS)

    Bentel, K.; Landerer, F. W.; Boening, C.; Wiese, D. N.; Watkins, M. M.

    2015-12-01

    The Atlantic Meridional Overturning Circulation (AMOC) is a key mechanism in basin-scale heat transport to high latitudes. It has significant impact in particular in the Northern Hemisphere and on Northwestern Europe's climate. The dynamics of the AMOC especially in the North Atlantic have been observed and described in recent model and observational studies. However, in-situ observations are limited to a few latitudes where observational arrays are deployed. Also, the physical relationship between ocean bottom pressure (OBP) and the AMOC has been characterized in recent literature. Here, we employ GRACE-derived OBP (from the JPL-RL05M mascons solution) to derive AMOC anomalies through physical relations. Viability of the approach to infer AMOC variability from GRACE-OBP observations has been demonstrated by comparing the GRACE-derived AMOC signal to in-situ observations by the RAPID array at 26.5N. In contrast to in-situ observations, GRACE observations provide the unique opportunity to derive AMOC anomalies continuously (for the GRACE time period from 2003 until present) across all latitudes of the basin, and evaluate spatial and temporal coherence.

  12. Variability at the Edge: Rapid Cadence Monitoring of Recent FUor Outburst HBC 722

    NASA Astrophysics Data System (ADS)

    Green, Joel D.; Robertson, P.; Pak, S.; Pooley, D. A.; Lee, J.; Im, M.; Deen, C.

    2013-01-01

    We present the detection of rapid periodic variability in the r-band lightcurve of newly outbursting FU Orionis-type object HBC 722, taken from over a year of observation with CQUEAN on the 2.1m McDonald Observatory telescope. The optical/near-IR lightcurve of HBC 722 shows a 4.96 day period that we attribute to stellar rotation. After subtracting the signals of the rotation period there remains an additional 22.9 hr (0.95 d) periodic signal that has been stable for 1 yr. We hypothesize that the rotating edge of the accretion disk at Keplerian velocities is responsible for this periodicity in the lightcurve, due to the temporary increase in accretion rate associated with FUors. Assuming this inner radius to be the magnetospheric radius, we derive a magnetic field strength for HBC 722 of 2.8-3.4 kG, slightly larger than typical T Tauri stars, for comparison to Zeeman broadening measurements.

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

    PubMed

    Salonen, K; Leisola, M; Eerikäinen, T

    2009-01-01

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

  14. How Should Remote Clinical Monitoring Be Used to Treat Alcohol Use Disorders?: Initial Findings From an Expert Round Table Discussion

    PubMed Central

    Gordon, Alan; Jaffe, Adi; McLellan, A. Thomas; Richardson, Gary; Skipper, Gregory; Sucher, Michel; Tirado, Carlos F.; Urschel, Harold C.

    2017-01-01

    Scientific evidence combined with new health insurance coverage now enable a chronic illness management approach to the treatment of alcohol use disorders (AUDs), including regular monitoring of blood alcohol content (BAC), as a useful indicator of disease control. Recent technical advances now permit many different types of remote, real-time monitoring of BAC. However, there is no body of research to empirically guide clinicians in how to maximize the clinical potential of remote BAC monitoring. As an initial step in guiding and supporting such research, the manufacturer of one remote BAC monitoring system sponsored a group of experienced clinicians and clinical researchers to discuss 8 issues that generally affect remote, clinical BAC monitoring of “adults in outpatient AUD treatment.” The expert panel unanimously agreed that remote BAC monitoring for at least 12 months during and after the outpatient treatment of AUD was a clinically viable deterrent to relapse. There was also consensus that positive test results (ie, recent alcohol use) should lead to intensified care and monitoring. However, there was no agreement on specific types of clinical intensification after a positive test. The panel agreed that sharing positive and negative test results with members of the patient support group was helpful in reinforcing abstinence, yet they noted many practical issues regarding information sharing that remain concerning. Significant differences within the panel on several important clinical issues underline the need for more clinical and implementation research to produce empirically-supported guidelines for the use of remote BAC monitoring in AUD treatment. PMID:28157829

  15. GRN deletion in familial frontotemporal dementia showing association with clinical variability in 3 familial cases.

    PubMed

    Milan, Graziella; Napoletano, Sabrina; Pappatà, Sabina; Gentile, Maria Teresa; Colucci-D'Amato, Luca; Della Rocca, Gennaro; Maciag, Anna; Rossetti, Carmen Palermo; Fucci, Laura; Puca, Annibale; Grossi, Dario; Postiglione, Alfredo; Vitale, Emilia

    2017-01-09

    Progranulin (GRN) gene mutations have been genetically associated with frontotemporal dementia (FTD) and are present in about 23% of patients with familial FTD. However, the neurobiology of this secreted glycoprotein remains unclear. Here, we report the identification of 3 pedigrees of Southern Italian extraction in whom FTD segregates with autosomal dominant inheritance patterns. We present evidence that all the available patients in these 3 familial cases are carrying the rare GRN gene exon 6 deletion g10325_10331delCTGCTGT (relative to nt 1 inNG_007886.1), alias Cys157LysfsX97. This mutation was previously described in 2 sporadic cases but was never associated with familial cases. Our patients demonstrate heterogeneous clinical phenotypes, such as the behavioral variant (bv-FTD) in the affected men and the nonfluent/agrammatic variant of primary progressive aphasia (nfvPPA) in the affected woman. Haploinsufficiency was revealed by both quantitative real-time PCR of the gene and protein analyses. These findings provide further support for a previously proposed role for the GRN gene in the genetic etiology of FTD and its phenotypic variability.

  16. Clinical variability in neurohepatic syndrome due to combined mitochondrial DNA depletion and Gaucher disease.

    PubMed

    Harvengt, Julie; Wanty, Catherine; De Paepe, Boel; Sempoux, Christine; Revencu, Nicole; Smet, Joél; Van Coster, Rudy; Lissens, Willy; Seneca, Sara; Weekers, Laurent; Sokal, Etienne; Debray, François-Guillaume

    2014-01-01

    A 1-year-old girl born to consanguineous parents presented with unexplained liver failure, leading to transplantation at 19 months. Subsequent partial splenectomy for persistent cytopenia showed the presence of foamy cells, and Gaucher disease was confirmed by homozygosity for the p.Leu483Pro mutation in the GBA gene. She was treated by enzyme replacement therapy (ERT). Clinical follow-up showed mild developmental delay, strabismus, nystagmus and oculomotor apraxia. Biochemical studies revealed multiple respiratory chain deficiencies and a mosaic pattern of deficient complex IV immunostaining in liver and fibroblast. Molecular analysis identified a mtDNA depletion syndrome due to the homozygous p.Pro98Leu mutation in MPV17. A younger sister unaffected by mtDNA depletion, presented with pancytopenia and hepatosplenomegaly. ERT for Gaucher disease resulted in visceral normalization without any neurological symptom. A third sister, affected by both conditions, had marked developmental delay, strabismus and ophthalmoplegia but no liver cirrhosis. In conclusion, intrafamilal variability occurs in MPV17-related disease. The combined pathological effect of Gaucher and mitochondrial diseases can negatively impact neurological and liver functions and influence the outcome in consanguineous families. The immunocytochemical staining of OXPHOS protein in tissues and cultured cells is a powerful tool revealing mosaic pattern of deficiency pointing to mtDNA-related mitochondrial disorders.

  17. Latent variables underlying the memory beliefs of Chartered Clinical Psychologists, Hypnotherapists and undergraduate students.

    PubMed

    Ost, James; Easton, Simon; Hope, Lorraine; French, Christopher C; Wright, Daniel B

    2017-01-01

    In courts in the United Kingdom, understanding of memory phenomena is often assumed to be a matter of common sense. To test this assumption 337 UK respondents, consisting of 125 Chartered Clinical Psychologists, 88 individuals who advertised their services as Hypnotherapists (HTs) in a classified directory, the Yellow Pages(TM), and 124 first year undergraduate psychology students, completed a questionnaire that assessed their knowledge of 10 memory phenomena about which there is a broad scientific consensus. HTs' responses were the most inconsistent with the scientific consensus, scoring lowest on six of these ten items. Principal Components Analysis indicated two latent variables - reflecting beliefs about memory quality and malleability - underlying respondents' responses. In addition, respondents were asked to rate their own knowledge of the academic memory literature in general. There was no significant relationship between participants' self reported knowledge and their actual knowledge (as measured by their responses to the 10-item questionnaire). There was evidence of beliefs among the HTs that could give rise to some concern (e.g., that early memories from the first year of life are accurately stored and are retrievable).

  18. Thrombocytopenia in common variable immunodeficiency patients - clinical course, management, and effect of immunoglobulins.

    PubMed

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

    2015-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2016-03-01

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

  20. Independent academic Data Monitoring Committees for clinical trials in cardiovascular and cardiometabolic diseases.

    PubMed

    Filippatos, Gerasimos S; de Graeff, Pieter; Bax, Jeroen J; Borg, John-Joseph; Cleland, John G F; Dargie, Henry J; Flather, Marcus; Ford, Ian; Friede, Tim; Greenberg, Barry; Henon-Goburdhun, Cécile; Holcomb, Richard; Horst, Bradley; Lekakis, John; Mueller-Velten, Guenther; Papavassiliou, Athanasios G; Prasad, Krishna; Rosano, Giuseppe M C; Severin, Thomas; Sherman, Warren; Stough, Wendy Gattis; Swedberg, Karl; Tavazzi, Luigi; Tousoulis, Dimitris; Vardas, Panagiotis; Ruschitzka, Frank; Anker, Stefan D

    2017-04-01

    Data Monitoring Committees (DMCs) play a crucial role in the conducting of clinical trials to ensure the safety of study participants and to maintain a trial's scientific integrity. Generally accepted standards exist for DMC composition and operational conduct. However, some relevant issues are not specifically addressed in current guidance documents, resulting in uncertainties regarding optimal approaches for communication between the DMC, steering committee, and sponsors, release of information, and liability protection for DMC members. The Heart Failure Association (HFA) of the European Society of Cardiology (ESC), in collaboration with the Clinical Trials Unit of the European Heart Agency (EHA) of the ESC convened a meeting of international experts in DMCs for cardiovascular and cardiometabolic clinical trials to identify specific issues and develop steps to resolve challenges faced by DMCs.The main recommendations from the meeting relate to methodological consistency, independence, managing conflicts of interest, liability protection, and training of future DMC members. This paper summarizes the key outcomes from this expert meeting, and describes the core set of activities that might be further developed and ultimately implemented by the ESC, HFA, and other interested ESC constituent bodies. The HFA will continue to work with stakeholders in cardiovascular and cardiometabolic clinical research to promote these goals.

  1. Variability of the Black Sea from My Ocean Black Sea Monitoring and Forecasting Center Products

    NASA Astrophysics Data System (ADS)

    Korotaev, G.; Ratner, Yu.; Kholod, A.; Martynov, M.; Ivanchik, M.; Denmyshev, S.; Dorofeev, V.; Knysh, V.; Moiseenko, V.; Kybryakov, A.; Churilova, T.; Suslin, V.

    2012-04-01

    My Ocean project has started provision of the full set of services from 10 January 2012. Regional products in the Black Sea are provided by the Black Sea Marine Forecasting Center (BS MFC). The BS MFC products include operational three-dimensional fields of temperature, salinity, current velocity hindcast, analysis and forecast up to five years (snapshots every three hours or daily averaged fields), reanalysis of the Black Sea dynamics from 1971 to 2002 years, nitrate and phytoplankton daily averaged fields in the upper 200 meter layer and attenuation coefficient analysis. Operational products are simulated by means of assimilation of the sea level anomalies, sea surface temperature and surface chlorophyll concentration, which are products of the Thematic Assembly Centers of My Ocean project, in the models of marine dynamics and ecosystem. Atmospheric forcing for the dynamical model operation is downloaded fro the SKIRON web site. All products are free available in the real-time on the My Ocean project site www.myocean.eu from the My Ocean interactive catalogue in the form of maps on different levels, animations or in digital form. An accuracy of the Black Sea MFC product is estinmated by means fof the comparison of simulations with space remote sensing data or independent in situ measurements by profiling floats or surface drifting buoys. The Black Sea MFC products provide a new insight to the broad range variability of the Black sea dynamics and ecosystem This study is carried out with partial support of the FP6 Sesame project (contract 036949) and FP7 MyOcean project (grant agreement n°218812).

  2. Continuous brain-function monitoring: state of the art in clinical practice.

    PubMed

    Hellström-Westas, Lena; Rosén, Ingmar

    2006-12-01

    Continuous electroencephalographic (EEG) monitoring gives direct information on brain function in newborn infants needing intensive care. To improve the possibilities of long-term monitoring, the EEG is time-compressed and recorded with a reduced number of electrodes. A trend measure of the EEG, the amplitude-integrated EEG (aEEG), has proved capable of giving relevant information in newborn infants of differing levels of maturity. The electrocortical background activity gives information on the level of brain activity, which is associated with outcome in both term asphyxiated infants and in preterm infants. However, the background activity is also affected by several medications, and this must be considered when interpreting the aEEG trace. The aEEG also reveals subclinical epileptic seizure activity, and can be used for evaluation of anti-epileptic treatment. The aEEG should be used as a complement to the standard EEG, and close collaboration between neonatologists and clinical neurophysiologists is necessary for optimal performance of EEG monitoring.

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

    NASA Astrophysics Data System (ADS)

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

    2007-02-01

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

  4. Performance evaluation of sensing fabrics for monitoring physiological and biomechanical variables.

    PubMed

    Scilingo, Enzo Pasquale; Gemignani, Angelo; Paradiso, Rita; Taccini, Nicola; Ghelarducci, Brunello; De Rossi, Danilo

    2005-09-01

    In the last few years, the smart textile area has become increasingly widespread, leading to developments in new wearable sensing systems. Truly wearable instrumented garments capable of recording behavioral and vital signals are crucial for several fields of application. Here we report on results of a careful characterization of the performance of innovative fabric sensors and electrodes able to acquire vital biomechanical and physiological signals, respectively. The sensing function of the fabric sensors relies upon newly developed strain sensors, based on rubber-carbon-coated threads, and mainly depends on the weaving topology, and the composition and deposition process of the conducting rubber-carbon mixture. Fabric sensors are used to acquire the respitrace (RT) and movement sensors (MS). Sensing features of electrodes, instead rely upon metal-based conductive threads, which are instrumental in detecting bioelectrical signals, such as electrocardiogram (ECG) and electromyogram (EMG). Fabric sensors have been tested during some specific tasks of breathing and movement activity, and results have been compared with the responses of a commercial piezoelectric sensor and an electrogoniometer, respectively. The performance of fabric electrodes has been investigated and compared with standard clinical electrodes.

  5. The role of the Data and Safety Monitoring Board in a clinical trial: The CRISIS Study

    PubMed Central

    Holubkov, Richard; Casper, T. Charles; Dean, J. Michael; Anand, K. J. S.; Zimmerman, Jerry; Meert, Kathleen L.; Newth, Christopher J. L.; Berger, John; Harrison, Rick; Willson, Douglas F.; Nicholson, Carol

    2012-01-01

    Objective Randomized clinical trials are commonly overseen by a data and safety monitoring board (DSMB) comprised of experts in medicine, ethics, and biostatistics. DSMB responsibilities include protocol approval, interim review of study enrollment, protocol compliance, safety, and efficacy data. DSMB decisions can affect study design and conduct, as well as reported findings. Researchers must incorporate DSMB oversight into the design, monitoring, and reporting of randomized trials. Design Case study, narrative review. Methods The DSMB’s role during the comparative pediatric Critical Illness Stress-Induced Immune Suppression (CRISIS) Prevention Trial is described. Findings The NIH-appointed CRISIS DSMB was charged with monitoring sample size adequacy and feasibility, safety with respect to adverse events and 28-day mortality, and efficacy with respect to the primary nosocomial infection/sepsis outcome. The Federal Drug Administration also requested DSMB interim review before opening CRISIS to children below one year of age. The first interim analysis found higher 28-day mortality in one treatment arm. The DSMB maintained trial closure to younger children, and requested a second interim data review six months later. At this second meeting, mortality was no longer of concern, while a weak efficacy trend of lower infection/sepsis rates in one study arm emerged. As over 40% of total patients had been enrolled, the DSMB elected to examine conditional power, and unmask treatment arm identities. Upon finding somewhat greater efficacy in the placebo arm, the DSMB recommended stopping CRISIS due to futility. Conclusions The design and operating procedures of a multicenter randomized trial must consider a pivotal DSMB role. Maximum study design flexibility must be allowed, and investigators must be prepared for protocol modifications due to interim findings. The DSMB must have sufficient clinical and statistical expertise to assess potential importance of interim

  6. Operating characteristics of a Simon two-stage phase II clinical trial design incorporating continuous toxicity monitoring.

    PubMed

    Ray, H E; Rai, S N

    2012-01-01

    Phase II clinical trials are usually designed to measure efficacy, but safety is also an important end point. Previous authors recommended a method to monitor toxic events after each patient is enrolled, which is also known as continuously monitoring the toxicity. In this work, we investigate combining the usual Simon two-stage design to monitor response with the continuous toxicity monitoring methodology. Theoretical justification is given for the nominal size, probability of early termination, and average sample size under the null hypothesis of the combined testing procedure. A series of simulations are performed to investigate the performance of the combined procedure.

  7. Relative power of clinical, exercise test, and angiographic variables in predicting clinical outcome after myocardial infarction: the Newham and Tower Hamlets study.

    PubMed Central

    de Belder, M A; Pumphrey, C W; Skehan, J D; Rimington, H; al Wakeel, B; Evans, S J; Rothman, M; Mills, P G

    1988-01-01

    The interrelations of clinical, exercise test, and angiographic variables and their relative values in predicting specific clinical outcomes after myocardial infarction have not been fully established. Of 302 consecutive stable survivors of infarction, 262 performed a predischarge submaximal exercise test. In the first year after infarction patients with a "positive" exercise test were 13 times more likely to die, 2.8 times more likely to have an ischaemic event, and 2.3 times more likely to develop left ventricular failure than patients with negative tests. Patients with positive exercise tests underwent cardiac catheterization. Features of the history, 12 lead electrocardiogram, in-hospital clinical course, exercise test, and left ventricular and coronary angiograms that predicted these clinical end points were identified by univariate analysis. Then multivariable analysis was used to assess the relative powers of all variables in predicting end points. Certain features of the exercise test remained independent predictors of future ischaemic events and the development of overt left ventricular failure, but clinical and angiographic variables were more powerful predictors of mortality. Because the exercise test is also used to select patients for angiography, however, the results of this study strongly support the use of early submaximal exercise testing after infarction. PMID:3203032

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

    NASA Astrophysics Data System (ADS)

    Mielck, Finn; Hass, H. Christian

    2014-05-01

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

  9. Is C2 monitoring or another limited sampling strategy superior to C0 monitoring in improving clinical outcomes in adult liver transplant recipients?

    PubMed

    Marin, Judith Geneviève; Levine, Marc; Ensom, Mary H H

    2006-10-01

    Cyclosporine (CsA) has had a major impact on the process and success of solid organ transplantation. Early in the use of CsA, therapeutic monitoring using the predose (trough, or C0) concentration became the standard of care. However, there are complications with the use of C0 monitoring that have only partly been mitigated with the advent of the micro-emulsion formulation (CsA-ME). More recently, limited sampling strategies (LSSs) for measuring the area under the CsA concentration-time curve (AUC) have been investigated to improve the monitoring of CsA post-transplantation. Many centres now routinely monitor CsA therapy using the concentration at 2 hours postdose (C2). In this paper the strength of the evidence for C2 (or other LSSs) relative to C0 monitoring of CsA-ME for improving clinically important outcomes in liver transplant patients is critically examined. Additionally, gaps in the literature are identified and recommendations are made for clinical research that could be done to provide more definitive evidence for the use of C2 or other LSSs in monitoring liver transplant patients.

  10. Genetic Variability of Beauveria bassiana and a DNA Marker for Environmental Monitoring of a Highly Virulent Isolate Against Cosmopolites sordidus.

    PubMed

    Ferri, D V; Munhoz, C F; Neves, P M O; Ferracin, L M; Sartori, D; Vieira, M L C; Fungaro, M H P

    2012-12-01

    The banana weevil Cosmopolites sordidus (Germar) is one of a number of pests that attack banana crops. The use of the entomopathogenic fungus Beauveria bassiana as a biological control agent for this pest may contribute towards reducing the application of chemical insecticides on banana crops. In this study, the genetic variability of a collection of Brazilian isolates of B. bassiana was evaluated. Samples were obtained from various geographic regions of Brazil, and from different hosts of the Curculionidae family. Based on the DNA fingerprints generated by RAPD and AFLP, we found that 92 and 88 % of the loci were polymorphic, respectively. The B. bassiana isolates were attributed to two genotypic clusters based on the RAPD data, and to three genotypic clusters, when analyzed with AFLP. The nucleotide sequences of nuclear ribosomal DNA intergenic spacers confirmed that all isolates are in fact B. bassiana. Analysis of molecular variance showed that variability among the isolates was not correlated with geographic origin or hosts. A RAPD-specific marker for isolate CG 1024, which is highly virulent to C. sordidus, was cloned and sequenced. Based on the sequences obtained, specific PCR primers BbasCG1024F (5'-TGC GGC TGA GGA GGA CT-3') and BbasCG1024R (5'-TGC GGC TGA GTG TAG AAC-3') were designed for detecting and monitoring this isolate in the field.

  11. Monitoring of microvascular free flaps following oropharyngeal reconstruction using infrared thermography: first clinical experiences.

    PubMed

    Just, Maren; Chalopin, Claire; Unger, Michael; Halama, Dirk; Neumuth, Thomas; Dietz, Andreas; Fischer, Miloš

    2016-09-01

    The aim of this study is to investigate static and dynamic infrared (IR) thermography for intra- and postoperative free-flap monitoring following oropharyngeal reconstruction. Sixteen patients with oropharyngeal reconstruction by free radial forearm flap were included in this prospective, clinical study (05/2013-08/2014). Prior ("intraop_pre") and following ("intraop_post") completion of the microvascular anastomoses, IR thermography was performed for intraoperative flap monitoring. Further IR images were acquired one day ("postop_1") and 10 days ("postop_10") after surgery for postoperative flap monitoring. Of the 16, 15 transferred free radial forearm flaps did not show any perfusion failure. A significant decreasing mean temperature difference (∆T: temperature difference between the flap surface and the surrounding tissue in Kelvin) was measured at all investigation points in comparison with the temperature difference at "intraop_pre" (mean values on all patients: ∆T intraop_pre = -2.64 K; ∆T intraop_post = -1.22 K, p < 0.0015; ∆T postop_1 = -0.54 K, p < 0.0001; ∆T postop_10 = -0.58 K, p < 0.0001). Intraoperative dynamic IR thermography showed typical pattern of non-pathological rewarming due to re-established flap perfusion after completion of the microvascular anastomoses. Static and dynamic IR thermography is a promising, objective method for intraoperative and postoperative monitoring of free-flap reconstructions in head and neck surgery and to detect perfusion failure, before macroscopic changes in the tissue surface are obvious. A lack of significant decrease of the temperature difference compared to surrounding tissue following completion of microvascular anastomoses and an atypical rewarming following a thermal challenge are suggestive of flap perfusion failure.

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

    PubMed

    Pillai, Jagan A; Bonner-Jackson, Aaron

    2015-01-01

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

  13. Chronotypes in patients with nonseasonal depressive disorder: Distribution, stability and association with clinical variables.

    PubMed

    Müller, Matthias Johannes; Cabanel, Nicole; Olschinski, Christiane; Jochim, Dorothee; Kundermann, Bernd

    2015-01-01

    The individual's chronotype is regarded as rather stable trait with substantial heritability and normal distribution of the "morningness-eveningness" dimension in the general population. Eveningness has been related to the risk of developing affective, particularly depressive, disorders. However, age and other sociobiological factors may influence chronotypes. The present study investigated the distribution, stability, and clinical correlates of chronotype and morningness-eveningness in hospitalized patients with affective disorder. Chronotype was assessed with the morningness-eveningness questionnaire (MEQ) in 93 patients with nonseasonal depressive syndrome (85% major depression; 15% depressive adjustment disorder) after admission, and in 19 patients again before discharge. Distribution, stability and correlations of MEQ scores with clinical variables were calculated. Additionally, a literature analysis of chronotype distributions in samples of nondepressed persons and patients with nonseasonal depression was carried out. MEQ scores (mean 49 ± 11, range 23-75, higher scores indicate morningness) in 93 acutely depressed inpatients (age 41 ± 14 years, range 18-75 years; 63% women; hospitalization 48 ± 22 days; BDI-II 32 ± 11) were normally distributed (Shapiro-Wilk test; W = 0.993, p = 0.920) with 59.1% intermediate types, 19.4% evening types, and 21.5% morning types. MEQ change scores from admission to discharge were nonsignificant (-1.3 ± 5.0; paired t-test, t18 = -1.09; p = 0.29) despite significantly improved depression scores (-19.4 ± 7.6; paired t-test, t18 = 11.2, p < 0.001). Age (r = 0.24), and depression scores (r = -0.21) correlated significantly (p < 0.05) with MEQ scores; associations with sex and hospitalization duration were nonsignificant. The present study and literature findings revealed that the frequency of evening types is not clearly elevated in depression, but morning types are

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

    PubMed Central

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

    2008-01-01

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

  15. Using performance indicators to monitor attendance at the Broken Hill blood lead screening clinic.

    PubMed

    Boreland, Frances; Lyle, David

    2009-04-01

    Although the average blood lead level of 1-4-year-old children in Broken Hill has halved since 1991, about 1 in 5 still have blood lead levels higher than the national target (<10 microg/dL). The estimated proportion of children attending the Lead Clinic has declined, to approximately 42% in 2006, raising concern that some children with elevated blood lead levels may not be presenting, thus missing out on appropriate treatment and advice. The aim of this study was to describe patterns of attendance at the clinic as a first step to understanding what factors contribute to clinic attendance and non-attendance. Routinely collected data from the Lead Clinic database were used to describe the impact of factors such as child age, the lead-risk area in which they live, seasonal influences and specific promotional activities on clinic attendance rates from 1999 to June 2007. Estimates of the number of children living in each of the five lead-risk areas were derived from 2001 and 2006 census data and estimates of the number of children born to mothers resident in Broken Hill were derived from the Midwives Data Collection. Attendance rates declined by approximately one-third during the study period. Younger children, and those living closer to the central mining area, were more likely to attend for blood lead screening. Cohort analysis indicated cumulative attendance has declined, with children born in 2005 having a cumulative incidence at 18 months of age 5-10% lower than that for previous birth cohorts. The majority (54%) of children who developed a notifiable blood lead level (15 microg/dL) were first detected at 2 years of age or older, a number of whom (40%) had no recorded tests before the age of 2 years. The analysis has demonstrated the benefits of using an expanded set of performance indicators to monitor the blood lead screening programme. It provides valuable additional information about the reach of the programme. Next steps include seeking additional feedback

  16. Molecular Imaging of Stem Cell Transplantation for Liver Diseases: Monitoring, Clinical Translation, and Theranostics

    PubMed Central

    Petrella, Francesco; Nicosia, Luca

    2016-01-01

    Stem cell transplantation has been investigated to rescue experimental liver failure and is promising to offer an alternative therapy to liver transplantation for liver diseases treatment. Several clinical studies in this field have been carried out, but the therapeutic benefit of this treatment is still controversial. A major obstacle to developing stem cell therapies in clinic is being able to visualize the cells in vivo. Imaging modalities allow optimization of delivery, detecting cell survival and functionality by in vivo monitoring these transplanted graft cells. Moreover, theranostic imaging is a brand new field that utilizes nanometer-scale materials to glean diagnostic insight for simultaneous treatment, which is very promising to improve stem cell-based therapy for treatment of liver diseases. The aim of this review was to summarize the various imaging tools that have been explored with advanced molecular imaging probes. We also outline some recent progress of preclinical and clinical studies of liver stem cells transplantation. Finally, we discuss theranostic imaging for stem cells transplantation for liver dysfunction and future opportunities afforded by theranostic imaging. PMID:28070195

  17. The clinical utility of basophil activation testing in diagnosis and monitoring of allergic disease.

    PubMed

    Hoffmann, H J; Santos, A F; Mayorga, C; Nopp, A; Eberlein, B; Ferrer, M; Rouzaire, P; Ebo, D G; Sabato, V; Sanz, M L; Pecaric-Petkovic, T; Patil, S U; Hausmann, O V; Shreffler, W G; Korosec, P; Knol, E F

    2015-11-01

    The basophil activation test (BAT) has become a pervasive test for allergic response through the development of flow cytometry, discovery of activation markers such as CD63 and unique markers identifying basophil granulocytes. Basophil activation test measures basophil response to allergen cross-linking IgE on between 150 and 2000 basophil granulocytes in <0.1 ml fresh blood. Dichotomous activation is assessed as the fraction of reacting basophils. In addition to clinical history, skin prick test, and specific IgE determination, BAT can be a part of the diagnostic evaluation of patients with food-, insect venom-, and drug allergy and chronic urticaria. It may be helpful in determining the clinically relevant allergen. Basophil sensitivity may be used to monitor patients on allergen immunotherapy, anti-IgE treatment or in the natural resolution of allergy. Basophil activation test may use fewer resources and be more reproducible than challenge testing. As it is less stressful for the patient and avoids severe allergic reactions, BAT ought to precede challenge testing. An important next step is to standardize BAT and make it available in diagnostic laboratories. The nature of basophil activation as an ex vivo challenge makes it a multifaceted and promising tool for the allergist. In this EAACI task force position paper, we provide an overview of the practical and technical details as well as the clinical utility of BAT in diagnosis and management of allergic diseases.

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

    PubMed

    Kiang, Tony K L; Ensom, Mary H H

    2016-03-01

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

  19. Monitoring

    SciTech Connect

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

    2004-11-23

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

  20. Development and Implementation of the Ebola Traveler Monitoring Program and Clinical Outcomes of Monitored Travelers during October – May 2015, Minnesota

    PubMed Central

    DeVries, Aaron; Talley, Pamela; Sweet, Kristin; Kline, Susan; Stinchfield, Patricia; Tosh, Pritish; Danila, Richard

    2016-01-01

    Background In October 2014, the United States began actively monitoring all persons who had traveled from Guinea, Liberia, and Sierra Leone in the previous 21 days. State public health departments were responsible for monitoring all travelers; Minnesota has the largest Liberian population in the United States. The MDH Ebola Clinical Team (ECT) was established to assess travelers with symptoms of concern for Ebola virus disease (EVD), coordinate access to healthcare at appropriate facilities including Ebola Assessment and Treatment Units (EATU), and provide guidance to clinicians. Methods Minnesota Department of Health (MDH) began receiving traveler information collected by U.S. Customs and Border Control and Centers for Disease Control and Prevention staff on October 21, 2014 via encrypted electronic communication. All travelers returning from Liberia, Sierra Leone, and Guinea during 10/21/14–5/15/15 were monitored by MDH staff in the manner recommended by CDC based on the traveler’s risk categorization as “low (but not zero)”, “some” and “high” risk. When a traveler reported symptoms or a temperature ≥100.4° F at any time during their 21-day monitoring period, an ECT member would speak to the traveler and perform a clinical assessment by telephone or via video-chat. Based on the assessment the ECT member would recommend 1) continued clinical monitoring while at home with frequent telephone follow-up by the ECT member, 2) outpatient clinical evaluation at an outpatient site agreed upon by all parties, or 3) inpatient clinical evaluation at one of four Minnesota EATUs. ECT members assessed and approved testing for Ebola virus infection at MDH. Traveler data, calls to the ECT and clinical outcomes were logged on a secure server at MDH. Results During 10/21/14–5/15/15, a total of 783 travelers were monitored; 729 (93%) traveled from Liberia, 30 (4%) Sierra Leone, and 24 (3%) Guinea. The median number monitored per week was 59 (range 45–143). The

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

    PubMed Central

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

    2016-01-01

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

  2. Heart-rate variability (HRV) in the ECG trace of routine EEGs: fast monitoring for the anticholinergic effects of clozapine and olanzapine?

    PubMed

    Eschweiler, G W; Bartels, M; Längle, G; Wild, B; Gaertner, I; Nickola, M

    2002-05-01

    Drug monitoring in psychiatry usually serves psychoactive drug plasma concentration measurement. Anticholinergic properties offer a faster approach to monitoring pharmacodynamic intraindividual effects of the drug by measuring their effects on heart rate variability (HRV), which is sympathetically and parasympathetically controlled via cholinergic synapses. The plasma concentrations of the atypical antipsychotics clozapine and olanzapine correlated with parameters of HRV in 59 patients suffering from schizophrenia or schizoaffective disorder. HRV during 4 minutes at rest was extracted from the ECG trace of a routine digital EEG registration in addition to blood sampling for plasma concentration measurement (HPLC method). We calculated sympathetically and parasympathetically controlled heart frequency bands (low, medium and high frequency) and other HRV parameters, coefficient of variation (CV), and root mean square of successive differences (RMSSD). All HRV parameters were significantly more impaired in clozapine patients (n = 33, mean clozapine plasma concentration 331 +/- 294 ng/ml) than in olanzapine patients (n = 26, mean olanzapine plasma concentration 42 +/- 32 ng/ml) and demonstrated 1.7 - 4.8 times the cardiac anticholinergic properties of clozapine in vivo. 14 out of 14 patients with a CV beyond 3.2 % had clozapine plasma concentrations below the proposed optimal therapeutic concentration of 350 ng/ml. All HRV parameters were inversely and significantly correlated with the clozapine plasma concentrations (such as lgCV: r = - 0.73, p < 0.001) and, to a lesser extent, with the olanzapine plasma concentrations (lgCV r = - 0.44, p < 0.05). These results underline the potential clinical value of HRV parameter extraction from routine ECGs in predicting plasma concentrations and objective individual neurocardiac effects of drugs with anticholinergic properties.

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

    PubMed

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

    2015-09-01

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

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

    PubMed

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

    2013-10-01

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

  5. Supporting work practices, improving patient flow and monitoring performance using a clinical information management system.

    PubMed

    Poulos, Christopher J; Gazibarich, Boris M; Eagar, Kathy

    2007-04-01

    Providing information technology solutions to clinicians to support their work practices benefits clinicians, administrators and patients. We present our 8-year experience with an inexpensive information management system which provides clinical and business process support for clinicians and bed managers. The system has been used by an area rehabilitation and aged care service to manage inpatient consultations and patient flow across nine hospitals. Performance monitoring of the time from referral to consultation, the number, type and outcome of consultations, and the time taken to access a rehabilitation or subacute bed is also provided. Read-only access to the system for clinicians and bed managers outside the rehabilitation and aged care service allows greater transparency.

  6. Doppler standard deviation imaging for clinical monitoring of in vivo human skin blood flow

    SciTech Connect

    Zhao, Yonghua; Chen, Zhongping; Saxer, Christopher; Shen, Qimin; Xiang, Shaohua; Boer, Johannes F. de; Nelson, J. Stuart

    2000-09-15

    We used a novel phase-resolved optical Doppler tomographic (ODT) technique with very high flow-velocity sensitivity (10 {mu}m/s) and high spatial resolution (10 {mu}m) to image blood flow in port-wine stain (PWS) birthmarks in human skin. In addition to the regular ODT velocity and structural images, we use the variance of blood flow velocity to map the PWS vessels. Our device combines ODT and therapeutic systems such that PWS blood flow can be monitored in situ before and after laser treatment. To the authors' knowledge this is the first clinical application of ODT to provide a fast semiquantitative evaluation of the efficacy of PWS laser therapy in situ and in real time. (c) 2000 Optical Society of America.

  7. BK polyomavirus in kidney transplant recipients: screening, monitoring and clinical management.

    PubMed

    Varella, Rafael Brandão; Almeida, Jorge Reis; Lopes, Patrícia de Fátima; Matos, Jorge Paulo Strogoff de; Menezes, Paulo; Lugon, Jocemir Ronaldo

    2014-01-01

    BK polyomavirus (BKPyV) is a causal agent of nephropathy, ureteral stenosis and hemorrhagic cystitis in kidney transplant recipients, and is considered an important emerging disease in transplantation. Regular screening for BKPyV reactivation mainly during the first 2 years posttransplant, with subsequent pre-emptive reduction of immunosuppression is considered the best option to avoid disease progression, since successful clearance or reduction of viremia is achieved in the vast majority of patients within 6 months. The use of drugs with antiviral properties for patients with persistent viremia has been attempted despite unclear benefits. Clinical manifestations of BKPyV nephropathy, current strategies for diagnosis and monitoring of BKPyV infection, management of immunosuppressive regimen after detection of BKPyV reactivation and the use of antiviral drugs are discussed in this review.

  8. Intracranial Pressure Monitoring as a Part of Multimodal Monitoring Management of Patients with Critical Polytrauma: Correlation between Optimised Intensive Therapy According to Intracranial Pressure Parameters and Clinical Picture

    PubMed Central

    Luca, Loredana; Rogobete, Alexandru Florin; Bedreag, Ovidiu Horea; Sarandan, Mirela; Cradigati, Carmen Alina; Papurica, Marius; Gruneantu, Anelore; Patrut, Raluca; Vernic, Corina; Dumbuleu, Corina Maria; Sandesc, Dorel

    2015-01-01

    Objective Trauma patient requires a complex therapeutic management because of multiple severe injuries or secondary complications. The most significant injury found in patients with trauma is head injury, which has the greatest impact on mortality. Intracranial pressure (ICP) monitoring is required in severe traumatic head injury because it optimises treatment based on ICP values and cerebral perfusion pressure (CPP). Methods From a total of 64 patients admitted in the intensive care unit (ICU) ‘Casa Austria’, from the Polytraumatology Clinic of the Emergency County Hospital “Pius Brinzeu” Timisoara, Romania, between January 2014 and December 2014; only patients who underwent ICP monitoring (n=10) were analysed. The study population was divided into several categories depending on the time passed since trauma to the time of installation of ICP monitoring (<18 h, 19–24 h and >24 h). Comparisons were made in terms of the number of days admitted in the ICU and mortality between patients with head injury who benefited and those who did not benefit from ICP monitoring. Results The results show the positive influence of ICP monitoring on the number of admission days in ICU because of the possibility that the number of admission days to augment therapeutic effects in patients who benefited from ICP monitoring reduces by 1.93 days compared with those who did not undergo ICP monitoring. Conclusion ICP monitoring and optimizing therapy according to the ICP and CPP has significant influence on the rate of survival. ICP monitoring is necessary in all patients with head trauma injury according to recent guidelines. The main therapeutic goal in the management of the trauma patient with head injury is to minimize the destructive effects of the associated side effects. PMID:27366538

  9. Clinical Factors Underlying the Inter-individual Variability of the Resting Motor Threshold in Navigated Transcranial Magnetic Stimulation Motor Mapping.

    PubMed

    Sollmann, Nico; Tanigawa, Noriko; Bulubas, Lucia; Sabih, Jamil; Zimmer, Claus; Ringel, Florian; Meyer, Bernhard; Krieg, Sandro M

    2017-01-01

    Correctly determining individual's resting motor threshold (rMT) is crucial for accurate and reliable mapping by navigated transcranial magnetic stimulation (nTMS), which is especially true for preoperative motor mapping in brain tumor patients. However, systematic data analysis on clinical factors underlying inter-individual rMT variability in neurosurgical motor mapping is sparse. The present study examined 14 preselected clinical factors that may underlie inter-individual rMT variability by performing multiple regression analysis (backward, followed by forward model comparisons) on the nTMS motor mapping data of 100 brain tumor patients. Data were collected from preoperative motor mapping of abductor pollicis brevis (APB), abductor digiti minimi (ADM), and flexor carpi radialis (FCR) muscle representations among these patients. While edema and age at exam in the ADM model only jointly reduced the unexplained variance significantly, the other factors kept in the ADM model (gender, antiepileptic drug intake, and motor deficit) and each of the factors kept in the APB and FCR models independently significantly reduced the unexplained variance. Hence, several clinical parameters contribute to inter-individual rMT variability and should be taken into account during initial and follow-up motor mappings. Thus, the present study adds basic evidence on inter-individual rMT variability, whereby some of the parameters are specific to brain tumor patients.

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

    PubMed Central

    Dunphy, Mark PS.; Lewis, Jason S.

    2010-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

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

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

    PubMed Central

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

    2015-01-01

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

  13. [Biological risk in the operating room: microbiological monitoring of the environment and analysis of the associated variables].

    PubMed

    Liguori, G; Spagnoli, G; Agozzino, E; Marinelli, A; Signoriello, G; Lucariello, A; Albano, L; Di Onofrio, V; Cammarota, B; Capozza, G; Lombardi, R; Marinelli, P

    2005-01-01

    The authors present an environmental microbiological monitoring programme carried out over a period of 15 months in 16 operating theatres performing specific types of surgery. The levels of microbial contamination of the air and of four of the most representative surfaces of the clean area were determined at 3 different times for each theatre, both before and during surgery. For the air assessment, the results obtained with three different samplers, Sed-3 Unit, SAS and RCS, were compared. The results were on the whole acceptable, but some poor conditions were detected during the theatres in use, especially in general surgery theatres; in some of these the floors showed levels of contamination consistently exceeding the reference limits. As the monitoring programme proceeded, the microbiological quality of the air and of the surfaces in the theatres notably improved. The three air samplers showed different conditions expressed with units of measure not always readily comparable. For active samplers, the bacterial load determined by RCS, although less variable, were always higher (even 2-3 fold) than those obtained with the SAS. Passive sampling takes longer but determines the real risk of infection for the patients; contemporary determination of the fall-out and the CFU/m3 helps to identify the occupational risks. Since the limit values established by the ISPESL guidelines for the operating theatres have been defined only for active samplers, there is urgent need for more exhaustive national guidelines to define similar values also for passive sampling. The Authors conclude stressing the importance of promoting continuing information-education programmes to heighten the awareness of all those involved in operating theatre activities.

  14. Passive acoustic monitoring of the temporal variability of odontocete tonal sounds from a long-term marine observatory.

    PubMed

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

    2015-01-01

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

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

    PubMed Central

    Barnouin, J; Chassagne, M

    2001-01-01

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

  16. Monitoring Atlantic overturning circulation and transport variability with GRACE-type ocean bottom pressure observations - a sensitivity study

    NASA Astrophysics Data System (ADS)

    Bentel, K.; Landerer, F. W.; Boening, C.

    2015-12-01

    The Atlantic Meridional Overturning Circulation (AMOC) is a key mechanism for large-scale northward heat transport and thus plays an important role for global climate. Relatively warm water is transported northward in the upper layers of the North Atlantic Ocean and, after cooling at subpolar latitudes, sinks down and is transported back south in the deeper limb of the AMOC. The utility of in situ ocean bottom pressure (OBP) observations to infer AMOC changes at single latitudes has been characterized in the recent literature using output from ocean models. We extend the analysis and examine the utility of space-based observations of time-variable gravity and the inversion for ocean bottom pressure to monitor AMOC changes and variability between 20 and 60° N. Consistent with previous results, we find a strong correlation between the AMOC signal and OBP variations, mainly along the western slope of the Atlantic Basin. We then use synthetic OBP data - smoothed and filtered to resemble the resolution of the GRACE (Gravity Recovery and Climate Experiment) gravity mission, but without errors - and reconstruct geostrophic AMOC transport. Due to the coarse resolution of GRACE-like OBP fields, we find that leakage of signal across the step slopes of the ocean basin is a significant challenge at certain latitudes. Transport signal rms is of a similar order of magnitude as error rms for the reconstructed time series. However, the interannual AMOC anomaly time series can be recovered from 20 years of monthly GRACE-like OBP fields with errors less than 1 sverdrup in many locations.

  17. Determination of Voriconazole Serum Concentration by Bioassay, a Valid Method for Therapeutic Drug Monitoring for Clinical Laboratories

    PubMed Central

    Cendejas-Bueno, Emilio; Cuenca-Estrella, Manuel

    2013-01-01

    We describe here a simple, fast, and reliable bioassay method for therapeutic drug monitoring of voriconazole. Fifty-eight clinical and external quality control samples were evaluated with this microbiological assay, and results were compared with those obtained with a previously validated chromatographic method. A good correlation between both assays was observed. This particular microbiological method was demonstrated to be simple and offers enough precision and accuracy to perform voriconazole therapeutic drug monitoring in laboratories without specialized equipment. PMID:23650161

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

    PubMed Central

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

    2014-01-01

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

  19. Clinical implication of blood glucose monitoring in general dental offices: the Ehime Dental Diabetes Study

    PubMed Central

    Harase, Tadahiro; Nishida, Wataru; Hamakawa, Tomohiro; Hino, Satoshi; Shigematsu, Kenji; Kobayashi, Satoru; Sako, Hirofumi; Ito, Shirou; Murakami, Hajime; Nishida, Kei; Inoue, Hiroshi; Fujisawa, Masahito; Yoshizu, Hiroshi; Kawamura, Ryoichi; Takata, Yasunori; Onuma, Hiroshi; Shimizu, Keita; Hamakawa, Hiroyuki; Osawa, Haruhiko

    2015-01-01

    Objective We examined whether general dentists can contribute to the detection of patients with undiagnosed diabetes and prediabetes by monitoring blood glucose in dental clinics. Research design and methods A total of 716 patients who visited clinics for dental treatment were enrolled and classified into 3 groups (mild, moderate, and severe) according to Kornman's criteria for periodontitis. The correlations between the casual blood glucose level, presence or absence of the history of diabetes, and/or severity of periodontitis were evaluated. Results 68 patients (9.5%) had hyperglycemia (blood glucose ≥200 mg/dL). Of these patients, 20 (29.4%) did not have a history of diabetes. Blood glucose tended to be higher with greater periodontitis severity. Of the 3 groups, the severe periodontitis group had the highest proportion of patients with hyperglycemia (p<0.0001). Conclusions Patients with dental problems could be screened for diabetes, especially undiagnosed diabetes. General dentists could function as practitioners to screen for diabetes. Trial registration number UMIN-CTR 000014877. PMID:26629348

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

    PubMed Central

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

    2016-01-01

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

  1. Clinical applications of squamous cell carcinoma antigen-immunoglobulins M to monitor chronic hepatitis C

    PubMed Central

    Martini, Andrea; Gallotta, Andrea; Pontisso, Patrizia; Fassina, Giorgio

    2015-01-01

    Hepatitis C virus (HCV) is the main cause of chronic liver disease and cirrhosis in Western countries. Over time, the majority of cirrhotic patients develop hepatocellular carcinoma (HCC), one of the most common fatal cancers worldwide - fourth for incidence rate. A high public health priority need is the development of biomarkers to screen for liver disease progression and for early diagnosis of HCC development, particularly in the high risk population represented by HCV-positive patients with cirrhosis. Several studies have shown that serological determination of a novel biomarker, squamous cell carcinoma antigen-immunoglobulins M (SCCA-IgM), might be useful to identify patients with progressive liver disease. In the initial part of this review we summarize the main clinical studies that have investigated this new circulating biomarker on HCV-infected patients, providing evidence that in chronic hepatitis C SCCA-IgM may be used to monitor progression of liver disease, and also to assess the virological response to antiviral treatment. In the last part of this review we address other, not less important, clinical applications of this biomarker in hepatology. PMID:26689503

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

    SciTech Connect

    Radigan, Jacqueline

    2014-12-20

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

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

    NASA Astrophysics Data System (ADS)

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

    2016-04-01

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

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

    SciTech Connect

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

    2012-12-01

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

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

    PubMed Central

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

    2016-01-01

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

  6. How many clinic BP readings are needed to predict cardiovascular events as accurately as ambulatory BP monitoring?

    PubMed

    Eguchi, K; Hoshide, S; Shimada, K; Kario, K

    2014-12-01

    We tested the hypothesis that multiple clinic blood pressure (BP) readings over an extended baseline period would be as predictive as ambulatory BP (ABP) for cardiovascular disease (CVD). Clinic and ABP monitoring were performed in 457 hypertensive patients at baseline. Clinic BP was measured monthly and the means of the first 3, 5 and 10 clinic BP readings were taken as the multiple clinic BP readings. The subjects were followed up, and stroke, HARD CVD, and ALL CVD events were determined as outcomes. In multivariate Cox regression analyses, ambulatory systolic BP (SBP) best predicted three outcomes independently of baseline and multiple clinic SBP readings. The mean of 10 clinic SBP readings predicted stroke (hazards ratio (HR)=1.39, 95% confidence interval (CI)=1.02-1.90, P=0.04) and ALL CVD (HR=1.41, 95% CI=1.13-1.74, P=0.002) independently of baseline clinic SBP. Clinic SBPs by three and five readings were not associated with any CVD events, except that clinic SBP by three readings was associated with ALL CVD (P=0.015). Besides ABP values, the mean of the first 10 clinic SBP values was a significant predictor of stroke and ALL CVD events. It is important to take more than several clinic BP readings early after the baseline period for the risk stratification of future CVD events.

  7. Electrical Cell-Substrate Impedance Spectroscopy Can Monitor Age-Grouped Human Adipose Stem Cell Variability During Osteogenic Differentiation.

    PubMed

    Nordberg, Rachel C; Zhang, Jianlei; Griffith, Emily H; Frank, Matthew W; Starly, Binil; Loboa, Elizabeth G

    2017-02-01

    Human adipose stem cells (hASCs) are an attractive cell source for bone tissue engineering applications. However, a critical issue to be addressed before widespread hASC clinical translation is the dramatic variability in proliferative capacity and osteogenic potential among hASCs isolated from different donors. The goal of this study was to test our hypothesis that electrical cell-substrate impedance spectroscopy (ECIS) could track complex bioimpedance patterns of hASCs throughout proliferation and osteogenic differentiation to better understand and predict variability among hASC populations. Superlots composed of hASCs from young (aged 24-36 years), middle-aged (aged 48-55 years), and elderly (aged 60-81 years) donors were seeded on gold electrode arrays. Complex impedance measurements were taken throughout proliferation and osteogenic differentiation. During osteogenic differentiation, four impedance phases were identified: increase, primary stabilization, drop phase, and secondary stabilization. Matrix deposition was first observed 48-96 hours after the impedance maximum, indicating, for the first time, that ECIS can identify morphological changes that correspond to late-stage osteogenic differentiation. The impedance maximum was observed at day 10.0 in young, day 6.1 in middle-aged, and day 1.3 in elderly hASCs, suggesting that hASCs from younger donors require a longer time to differentiate than do hASCs from older donors, but young hASCs proliferated more and accreted more calcium long-term. This is the first study to use ECIS to predict osteogenic potential of multiple hASC populations and to show that donor age may temporally control onset of osteogenesis. These findings could be critical for development of patient-specific bone tissue engineering and regenerative medicine therapies. Stem Cells Translational Medicine 2017;6:502-511.

  8. Clinical Applicability of Cone-Beam Computed Tomography in Monitoring Seroma Volume Change During Breast Irradiation

    SciTech Connect

    Yang, Tzu-I; Minkema, Danny; Elkhuizen, Paula; Heemsbergen, Wilma; Mourik, Anke M. van; Vliet-Vroegindeweij, Corine van

    2010-09-01

    Purpose: To determine whether cone-beam CT (CBCT) is effective in monitoring seroma reduction during breast irradiation when compared with conventional CT. Patients and Methods: This study included 19 women with Stage T1-2 breast cancer treated with breast-conserving therapy. Each patient underwent two to four CT and multiple CBCT scans (mean, 8; range, 7-13 scans) at various time intervals during radiotherapy. Seroma were contoured by two observers on all scans and checked by one radiation oncologist. Seroma clarity was determined according to The British Columbia Cancer Agency Seroma Clarity Score scale, and conformity index (CI) of the two observers was evaluated. Correlations in seroma contours and seroma characteristics between CBCT and CT, as well as interobserver variation, were examined. Results: The mean differences in seroma volume between CT and CBCT (3%, p = 0.3) and between the two observers (6%, p = 0.2) were not statistically significant. Seroma clarity correlated significantly with CI for both CT and CBCT (p = 0.02 and p = 0.001, respectively), indicating the higher the seroma clarity score, the greater the CI between the observers. With seroma clarity 3 or higher for CT and CBCT, a high level of observer concordance was shown (all CI of these scans were {>=}50%). Conclusion: Volume discrepancy between CBCT and CT and between the two observers was not statistically significant. Seroma clarity influenced observers' ability to contour on CT or CBCT equally. Therefore, CBCT is a good clinical surrogate for CT in monitoring seroma reduction during breast radiotherapy, especially for patients with seroma clarity score 3 or higher.

  9. Glider monitoring reveals high sub-seasonal variability at a key 'choke' point in the thermohaline circulation of the Western Mediterranean

    NASA Astrophysics Data System (ADS)

    Heslop, Emma; Ruiz, Simón; Allen, John; Luís López-Jurado, José; Tintoré, Joaquín

    2013-04-01

    It is becoming increasingly important to understand sub-seasonal variability in our ocean circulation, in order to place historical observations in context and detect the signature of climatic oscillations and change, and to improve the biogeochemical modelling of our ocean system. Flow variability and dynamic processes at inter-basin 'choke' points in the circulation system, such as Drake Passage in the Southern Ocean and the Fram Straits between the Arctic Sea and the North Atlantic Ocean, have an influential role in the patterns of heat, salt and watermass exchange between ocean basins and are particularly important locations to monitor variability at a variety of scales. The Ibiza Channel in the Western Mediterranean is one such 'choke' point in the basin scale circulation of the Mediterranean Sea, where an important north south exchange of water masses is known to influence the spawning grounds of commercially important fish stocks. Here autonomous underwater gliders are proving particularly effective at capturing the signature of sub-seasonal variability and the dynamics of an sub-basin exchange, previously only monitored at a seasonal level through ships surveys or at a coarse resolution with sparse moorings. Here we show the results of monthly glider monitoring of the Ibiza Channel in 2011- 2012, although due to technical issues the glider timeseries is not continuous for the whole period, we are nevertheless able to see days-weeks variability in the transport of different watermasses, on a scale comparable to that of the previously identified seasonal cycle. With the high spatial and temporal resolution of glider data, potential 'modes' of circulation are also identified with the aim of simplifying the complex pattern of flows previously observed at this dynamically complex location. This high variability is placed in the context of historical observations from the Instituto Español de Oceanografía (IEO-COB) program of seasonal ship surveys, to

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

    PubMed Central

    Matoušková, Ivanka; Holy, Ondřej

    2014-01-01

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

  11. A new mathematical model based on clinical and laboratory variables for the diagnosis of Sjögren's syndrome.

    PubMed

    Martin-Martin, L S; Latini, A; Pagano, A; Ragno, A; Stasi, R; Coppè, A; Davoli, G; Crescenzi, A; Alimonti, A; Migliore, A

    2003-05-01

    Sjögren's syndrome (SS) is a systemic autoimmune disease that mainly affects exocrine glands. A diagnosis of SS in its early stages has a potential clinical relevance, but it is difficult and cannot be made solely on clinical grounds. Several sets of diagnostic criteria have been proposed, but none has met with a general consensus. Minor salivary gland has been judged to be the "gold standard" for the diagnosis of SS. However, it is a painful procedure and has a small but significant proportion of both false positive and false negative results. The aim of our study was to develop a simple mathematical score that uses clinical and laboratory variables for diagnosing SS, thereby reducing the need of minor salivary gland. The following variables were included in the model: ANA, SS-A/SS-B, Schirmer's Test/BUT, C3/C4, serum gammaglobulin levels. One hundred consecutive individuals reporting clinical syndromes consistent with a sicca syndrome were included in the study. The application of our multifactorial mathematical model has shown a high predictive value for SS vs controls or vs patients with other autoimmune disorders (Sensitivity 93%, Specificity 100%), with an estimated minor salivary gland reduction of 77%. We conclude that our mathematical model can be considered a useful non-invasive approach for diagnosing Sjogren's Syndrome and recommend its validation on a larger scale.

  12. 78 FR 48173 - Guidance for Industry on Oversight of Clinical Investigations-A Risk-Based Approach to Monitoring...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-07

    ...] [FR Doc No: 2013-19004] DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket... is to enhance human subject protection and the quality of clinical trial data by focusing sponsor... Approach to Monitoring; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice....

  13. Monitoring weekly heart rate variability in futsal players during the preseason: the importance of maintaining high vagal activity.

    PubMed

    Nakamura, Fabio Y; Pereira, Lucas A; Rabelo, Felipe N; Flatt, Andrew A; Esco, Michael R; Bertollo, Maurizio; Loturco, Irineu

    2016-12-01

    This study aimed to compare the weekly natural log of the root-mean-square difference of successive normal inter-beat (RR) intervals (ln RMSSDWeekly) and its coefficient of variation (ln RMSSDCV) in response to 5 weeks of preseason training in professional male futsal players. A secondary aim was to assess the relationship between ln RMSSDWeekly and ln RMSSDCV. The ln RMSSD is a measure of cardiac-vagal activity, and ln RMSSDCV represents the perturbations of cardiac autonomic homeostasis, which may be useful for assessing how athletes are coping with training. Ten futsal players had their resting ln RMSSD recorded prior to the first daily training session on four out of approximately five regular training days · week(-1). Session rating of perceived exertion (sRPE) was quantified for all training sessions. Despite weekly sRPE varying between 3455 ± 300 and 5243 ± 463 arbitrary units (a.u.), the group changes in ln RMSSDWeekly were rated as unclear (using magnitude-based inference), although large inter-individual variability in ln RMSSD responses was observed. The ln RMSSDCV in weeks 4 and 5 were likely lower than the previous weeks. A large and significant negative correlation (r = -0.53; CI 90%: -0.36; -0.67) was found between ln RMSSD and ln RMSSDCV. Therefore, monitoring individual ln RMSSD responses is suggested since large inter-individual variations may exist in response to futsal training. In addition, higher values of ln RMSSD are associated with lower oscillations of cardiac autonomic activity.

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

    PubMed Central

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

    2015-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2008-09-01

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

  16. Sentence Comprehension in Agrammatic Aphasia: History and Variability to Clinical Implications

    ERIC Educational Resources Information Center

    Johnson, Danielle; Cannizzaro, Michael S.

    2009-01-01

    Individuals with Broca's aphasia often present with deficits in their ability to comprehend non-canonical sentences. This has been contrastingly characterized as a systematic loss of specific grammatical abilities or as individual variability in the dynamics between processing load and resource availability. The present study investigated sentence…

  17. Continuous safety monitoring for randomized controlled clinical trials with blinded treatment information. Part 2: Statistical considerations.

    PubMed

    Ball, Greg; Piller, Linda B

    2011-09-01

    If the primary objective of a trial is to learn about the ability of a new treatment to help future patients without sacrificing the safe and effective treatment of the current patients, then a Bayesian design with frequent assessments of the accumulating data should be considered. Unfortunately, Bayesian analyses typically do not have standard approaches, and because of the subjectivity of prior probabilities and the possibility for introducing bias, statisticians have developed other methods for statistical inference that only depend on deductive probabilities. However, these frequentist probabilities are just theories about how certain relative frequencies will develop over time. They have no real meaning in a single experiment. Designed to work well in the long run, p-values become hard to explain for individual experiments. Fortunately, the controversy surrounding Bayes' theorem comes, not from the representation of evidence, but from the use of probabilities to measure belief. A prior distribution is not necessary. The likelihood function contains all of the information in a trial relevant for making inferences about the parameters. Monitoring clinical trials is a dynamic process which requires flexibility to respond to unforeseen developments. Likelihood ratios allow the data to speak for themselves, without regard for the probability of observing weak or misleading evidence, and decisions to stop, or continue, a trial can be made at any time, with all of the available information. A likelihood based method is needed.

  18. Clinical characteristics of resistant hypertension evaluated by ambulatory blood pressure monitoring.

    PubMed

    Kansui, Yasuo; Matsumura, Kiyoshi; Kida, Haruko; Sakata, Satoko; Ohtsubo, Toshio; Ibaraki, Ai; Kitazono, Takanari

    2014-01-01

    Strict control of blood pressure is important to prevent cardiovascular disease, although it is sometimes difficult to decrease blood pressure to target levels. The aim of this study was to investigate the clinical characteristics of resistant hypertension evaluated by ambulatory blood pressure monitoring. One hundred in-hospital patients, whose 24-hour average blood pressure was higher than 130/80 mmHg even after treatment with more than three antihypertensive drugs, were included in the present analysis. Circadian variation of blood pressure was evaluated by nocturnal fall in systolic blood pressure. Average blood pressures of all patients were high in both daytime and nighttime, 150.0/82.9 and 143.8/78.2 mmHg, respectively. Twenty patients had been treated with hemodialysis or peritoneal dialysis. In 63 patients out of the other 80 patients (79%), estimated glomerular filtration rate (eGFR) was also decreased (<60 mL/min/1.73 m²). The patients classified into dipper, non-dipper, riser and extreme-dipper were 20%, 43%, 34% and 3%, respectively. In addition, in 17 patients whose eGFR was preserved, 12 patients showed a non-dipper or riser pattern, suggesting that it was difficult to account for this altered circadian blood pressure variation only by renal dysfunction. These results show that a large number of the patients with resistant hypertension suffered from renal dysfunction, although it was difficult to explain altered circadian blood pressure variation based on renal dysfunction alone.

  19. An intensive drug monitoring study suggesting possible clinical irrelevance of impaired drug disposition in liver disease.

    PubMed Central

    Naranjo, C A; Busto, U; Janecek, E; Ruiz, I; Roach, C A; Kaplan, K

    1983-01-01

    1 Liver disease can alter the disposition and clinical effects of drugs. However, even though altered drug disposition occurs, there is no clinical evidence relating it to an increased susceptibility to adverse drug reactions (ADRs). 2 An intensive prospective drug monitoring study of 2,582 hospitalized patients was conducted. The adverse drug reactions probability scale (APS) was used to assess ADRs. Only non-mild, definite or probable ADRs (APS greater than or equal to 5) were included. Severity of liver dysfunction was assessed by a composite clinical and laboratory index (CCLI). 3 The frequency of ADRs was higher in 402 patients with cirrhosis (27.4%) than in 661 with renal dysfunction (22.8%) and in 249 with other parenchymatous liver diseases (13.7%) or in 1,270 patients with neither liver diseases nor renal dysfunction (10.9%) (chi 2 3 = 85.53, P less than 0.001). The frequency of ADRs in cirrhotics was highly correlated with the severity of the liver dysfunction measured by CCLI (r = 0.82, P less than 0.001). 4 Drugs predominantly eliminated by liver metabolism were not among those most commonly inducing ADRs or those causing severe reactions in cirrhotics. Thus, frusemide caused the most common and the most severe ADRs, whereas reactions induced by sedatives were uncommon. Drug-induced hepatic encephalopathy was more common in cirrhotics receiving diuretics (13.3%) than in those receiving sedatives (1.8%) (chi 2 y.c. = 5.29, P less than 0.025). Patients with alcoholic liver disease had more drug-induced hepatic encephalopathy (7.7%) than those with non-alcoholic liver disease (1.2%) (chi 2 y.c. = 11.86, P less than 0.001). 5 These results indicate that susceptibility to ADRs is increased only in severe cirrhosis and that the most common and severe ADRs seem more likely related to enhanced pharmacodynamic action than to impaired drug disposition. PMID:6849781

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

    SciTech Connect

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

    2015-01-15

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

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

    PubMed

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

    2013-07-15

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

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

    PubMed

    Bersimis, S; Sachlas, A; Papaioannou, T

    2015-01-30

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

  3. Unexpected Genomic Variability in Clinical and Environmental Strains of the Pathogenic Yeast Candida parapsilosis

    PubMed Central

    Pryszcz, Leszek P.; Németh, Tibor; Gácser, Attila; Gabaldón, Toni

    2013-01-01

    Invasive candidiasis is the most commonly reported invasive fungal infection worldwide. Although Candida albicans remains the main cause, the incidence of emerging Candida species, such as C. parapsilosis is increasing. It has been postulated that C. parapsilosis clinical isolates result from a recent global expansion of a virulent clone. However, the availability of a single genome for this species has so far prevented testing this hypothesis at genomic scales. We present here the sequence of three additional strains from clinical and environmental samples. Our analyses reveal unexpected patterns of genomic variation, shared among distant strains, that argue against the clonal expansion hypothesis. All strains carry independent expansions involving an arsenite transporter homolog, pointing to the existence of directional selection in the environment, and independent origins of the two clinical isolates. Furthermore, we report the first evidence for the existence of recombination in this species. Altogether, our results shed new light onto the dynamics of genome evolution in C. parapsilosis. PMID:24259314

  4. Phenotypic variability of the kyphoscoliotic type of Ehlers-Danlos syndrome (EDS VIA): clinical, molecular and biochemical delineation

    PubMed Central

    2011-01-01

    Background The kyphoscoliotic type of Ehlers-Danlos syndrome (EDS VIA) (OMIM 225400) is a rare inheritable connective tissue disorder characterized by a deficiency of collagen lysyl hydroxylase 1 (LH1; EC 1.14.11.4) due to mutations in PLOD1. Biochemically this results in underhydroxylation of collagen lysyl residues and, hence, an abnormal pattern of lysyl pyridinoline (LP) and hydroxylysyl pyridinoline (HP) crosslinks excreted in the urine. Clinically the disorder is characterized by hypotonia and kyphoscoliosis at birth, joint hypermobility, and skin hyperelasticity and fragility. Severe hypotonia usually leads to delay in gross motor development, whereas cognitive development is reported to be normal. Methods We describe the clinical, biochemical and molecular characterisation, as well as electron microscopy findings of skin, in 15 patients newly diagnosed with this rare type of Ehlers-Danlos syndrome. Results Age at diagnosis ranged from 5 months to 27 years, with only 1/3 of the patients been diagnosed correctly in the first year of life. A similar disease frequency was found in females and males, however a broad disease severity spectrum (intra- and interfamilial), independent of molecular background or biochemical phenotype, was observed. Kyphoscoliosis, one of the main clinical features was not present at birth in 4 patients. Importantly we also noted the occurrence of vascular rupture antenatally and postnatally, as well as developmental delay in 5 patients. Conclusion In view of these findings we propose that EDS VIA is a highly variable clinical entity, presenting with a broad clinical spectrum, which may also be associated with cognitive delay and an increased risk for vascular events. Genotype/phenotype association studies and additional molecular investigations in more extended EDS VIA populations will be necessary to further elucidate the cause of the variability of the disease severity. PMID:21699693

  5. Logic Learning Machine and standard supervised methods for Hodgkin's lymphoma prognosis using gene expression data and clinical variables.

    PubMed

    Parodi, Stefano; Manneschi, Chiara; Verda, Damiano; Ferrari, Enrico; Muselli, Marco

    2016-06-27

    This study evaluates the performance of a set of machine learning techniques in predicting the prognosis of Hodgkin's lymphoma using clinical factors and gene expression data. Analysed samples from 130 Hodgkin's lymphoma patients included a small set of clinical variables and more than 54,000 gene features. Machine learning classifiers included three black-box algorithms (k-nearest neighbour, Artificial Neural Network, and Support Vector Machine) and two methods based on intelligible rules (Decision Tree and the innovative Logic Learning Machine method). Support Vector Machine clearly outperformed any of the other methods. Among the two rule-based algorithms, Logic Learning Machine performed better and identified a set of simple intelligible rules based on a combination of clinical variables and gene expressions. Decision Tree identified a non-coding gene (XIST) involved in the early phases of X chromosome inactivation that was overexpressed in females and in non-relapsed patients. XIST expression might be responsible for the better prognosis of female Hodgkin's lymphoma patients.

  6. Improvement in latent variable indirect response joint modeling of a continuous and a categorical clinical endpoint in rheumatoid arthritis.

    PubMed

    Hu, Chuanpu; Zhou, Honghui

    2016-02-01

    Improving the quality of exposure-response modeling is important in clinical drug development. The general joint modeling of multiple endpoints is made possible in part by recent progress on the latent variable indirect response (IDR) modeling for ordered categorical endpoints. This manuscript aims to investigate, when modeling a continuous and a categorical clinical endpoint, the level of improvement achievable by joint modeling in the latent variable IDR modeling framework through the sharing of model parameters for the individual endpoints, guided by the appropriate representation of drug and placebo mechanism. This was illustrated with data from two phase III clinical trials of intravenously administered mAb X for the treatment of rheumatoid arthritis, with the 28-joint disease activity score (DAS28) and 20, 50, and 70% improvement in the American College of Rheumatology (ACR20, ACR50, and ACR70) disease severity criteria were used as efficacy endpoints. The joint modeling framework led to a parsimonious final model with reasonable performance, evaluated by visual predictive check. The results showed that, compared with the more common approach of separately modeling the endpoints, it is possible for the joint model to be more parsimonious and yet better describe the individual endpoints. In particular, the joint model may better describe one endpoint through subject-specific random effects that would not have been estimable from data of this endpoint alone.

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

    NASA Astrophysics Data System (ADS)

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

    2009-02-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2014-12-01

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

  9. Variability in Clinical Presentation of Neonatal Stroke: Report of Four Cases

    PubMed Central

    Joseph, Sonia; Bennett, Robert; Kola, Bhargavi; Hughes, Amanda

    2017-01-01

    Neonatal stroke can be a cause of long term neurodevelopmental disability, seizures, and impaired cognitive function. We present four cases of neonatal stroke, associated with different risk factors and clinical presentations. Two of these newborns were born to mothers with no prenatal care. PMID:28194288

  10. Correlation between the Lactate Dehydrogenase Levels with Laboratory Variables in the Clinical Severity of Sickle Cell Anemia in Congolese Patients

    PubMed Central

    Mikobi, Tite Minga; Lukusa Tshilobo, Prosper; Aloni, Michel Ntetani; Mvumbi Lelo, Georges; Akilimali, Pierre Zalagile; Muyembe-Tamfum, Jean Jacques; Race, Valérie; Matthijs, Gert; Mbuyi Mwamba, Jean Marie

    2015-01-01

    Background Sickle cell anemia is an inflammatory disease and is characterized by chronic hemolysis. We sought to evaluate the association of lactate dehydrogenase levels with specific clinical phenotypes and laboratory variables in patients with sickle cell anemia. Methods The present cross-sectional study was conducted in Sickle Cell Centre of Yolo in Kinshasa, the Democratic Republic of Congo. Two hundred and eleven patients with Sickle Cell Anemia in steady state were recruited. Seventy-four participants with normal Hb (Hb-AA) were selected as a control group. Results The average rates of hemoglobin, hematocrit, and red blood cells tended to be significantly lower in subjects with Hb-SS (p<0.001). The average rates of white blood cells, platelets, reticulocytes and serum LDH were significantly higher in subjects with Hb-SS (p<0.001). The average rates of Hb, HbF, hematocrit and red blood cells of Hb-SS patients with asymptomatic clinical phenotype were significantly higher than those of the two other phenotypes. However, the average rates of white blood cells, platelets, reticulocytes, and LDH of Hb-SS patients with the severe clinical phenotype are higher than those of two other clinical phenotypes. Significant correlations were observed between Hb and white blood cell in severe clinical phenotype (r3 = -0.37 *) between Hb and red blood cells in the three phenotypes (r1 = 0.69 * r2 * = 0.69, r3 = 0.83 *), and finally between Hb and reticulocytes in the asymptomatic clinical phenotype and severe clinical phenotype (r1 = -0.50 * r3 = 0.45 *). A significant increase in LDH was observed in patients with leg ulcer, cholelithiasis and aseptic necrosis of the femoral head. Conclusion The increase in serum LDH is accompanied by changes in hematological parameters. In our midst, serum LDH may be considered as an indicator of the severity of the disease. PMID:25946088

  11. Molecular method for the characterization of Coxiella burnetii from clinical and environmental samples: variability of genotypes in Spain

    PubMed Central

    2012-01-01

    Background Coxiella burnetii is a highly clonal microorganism which is difficult to culture, requiring BSL3 conditions for its propagation. This leads to a scarce availability of isolates worldwide. On the other hand, published methods of characterization have delineated up to 8 different genomic groups and 36 genotypes. However, all these methodologies, with the exception of one that exhibited limited discriminatory power (3 genotypes), rely on performing between 10 and 20 PCR amplifications or sequencing long fragments of DNA, which make their direct application to clinical samples impracticable and leads to a scarce accessibility of data on the circulation of C. burnetii genotypes. Results To assess the variability of this organism in Spain, we have developed a novel method that consists of a multiplex (8 targets) PCR and hybridization with specific probes that reproduce the previous classification of this organism into 8 genomic groups, and up to 16 genotypes. It allows for a direct characterization from clinical and environmental samples in a single run, which will help in the study of the different genotypes circulating in wild and domestic cycles as well as from sporadic human cases and outbreaks. The method has been validated with reference isolates. A high variability of C. burnetii has been found in Spain among 90 samples tested, detecting 10 different genotypes, being those adaA negative associated with acute Q fever cases presenting as fever of intermediate duration with liver involvement and with chronic cases. Genotypes infecting humans are also found in sheep, goats, rats, wild boar and ticks, and the only genotype found in cattle has never been found among our clinical samples. Conclusions This newly developed methodology has permitted to demonstrate that C. burnetii is highly variable in Spain. With the data presented here, cattle seem not to participate in the transmission of C. burnetii to humans in the samples studied, while sheep, goats, wild

  12. [The design and clinical application of an apparatus for monitoring neuromuscular transmission function during operation under general anaesthesia].

    PubMed

    Lin, S; Zhou, W; Yang, J; Li, Y; Wang, Y; Wang, Q

    1998-06-01

    This paper introduces a monitoring system of musle relaxant in action during the operation under general anaesthesia. The design of the monitor is based on measurement of acceleration. It consists of an acceleration transducer, a nerve stimulator and a microcomputer unit. The transducer can be fastened to the thumb, and the signal of the thumb movement in response to ulnar nerve stimulation is measured and registered in the computing unit. In clinical practice, it has been proved that this new apparatus can achieve reliable evaluation of nuromuscular transmission function and improve the quality of anesthesia in patients care during surgical operation.

  13. Monitoring of clinical and laboratory data in two cases of imported Lassa fever.

    PubMed

    Schmitz, Herbert; Köhler, Bernhard; Laue, Thomas; Drosten, Christian; Veldkamp, Peter J; Günther, Stephan; Emmerich, Petra; Geisen, Hans P; Fleischer, Klaus; Beersma, Matthias F C; Hoerauf, Achim

    2002-01-01

    During 2000, four cases of fatal Lassa fever were imported from Africa to Europe. In two patients, consecutive serum samples were available for monitoring of virus load and cytokine levels in addition to standard laboratory data. Both patients had non-specific early clinical symptoms including high fever. Patient 1 developed multi-organ failure and died of hemorrhagic shock on day 15 of illness, while patient 2 died of respiratory failure due to aspiration without hemorrhage on day 16. Ribavirin was administered to both patients beginning only on day 11. High serum aspartate aminotransferase and lactate dehydrogenase (LDH) levels were remarkable in both patients. Patient 1 had an initial virus load of 10(6) S RNA copies/ml as measured by real-time RT-PCR. Viremia increased steadily and reached a plateau of approximately 10(8)-10(9) copies/ml 4 days before death, while IFN-gamma and TNF-alpha rose to extremely high levels only shortly before death. In contrast, in patient 2 the virus load decreased from 10(7) to 10(6) copies/ml during the late stage of illness which was paralleled by a decrease in the IFN-gamma and TNF-alpha levels. The IL-10 level increased when specific IgM and IgG appeared. These data suggest that a high virus load and high levels of pro-inflammatory cytokines in the late stage of Lassa fever play an important role in the pathogenesis of hemorrhage, multi-organ failure, and shock in Lassa fever.

  14. Using instrumental variables to disentangle treatment and placebo effects in blinded and unblinded randomized clinical trials influenced by unmeasured confounders

    PubMed Central

    Chaibub Neto, Elias

    2016-01-01

    Clinical trials traditionally employ blinding as a design mechanism to reduce the influence of placebo effects. In practice, however, it can be difficult or impossible to blind study participants and unblinded trials are common in medical research. Here we show how instrumental variables can be used to quantify and disentangle treatment and placebo effects in randomized clinical trials comparing control and active treatments in the presence of confounders. The key idea is to use randomization to separately manipulate treatment assignment and psychological encouragement conversations/interactions that increase the participants’ desire for improved symptoms. The proposed approach is able to improve the estimation of treatment effects in blinded studies and, most importantly, opens the doors to account for placebo effects in unblinded trials. PMID:27869205

  15. Using instrumental variables to disentangle treatment and placebo effects in blinded and unblinded randomized clinical trials influenced by unmeasured confounders

    NASA Astrophysics Data System (ADS)

    Chaibub Neto, Elias

    2016-11-01

    Clinical trials traditionally employ blinding as a design mechanism to reduce the influence of placebo effects. In practice, however, it can be difficult or impossible to blind study participants and unblinded trials are common in medical research. Here we show how instrumental variables can be used to quantify and disentangle treatment and placebo effects in randomized clinical trials comparing control and active treatments in the presence of confounders. The key idea is to use randomization to separately manipulate treatment assignment and psychological encouragement conversations/interactions that increase the participants’ desire for improved symptoms. The proposed approach is able to improve the estimation of treatment effects in blinded studies and, most importantly, opens the doors to account for placebo effects in unblinded trials.

  16. Identifying Signs of Tinea Pedis: A Key to Understanding Clinical Variables.

    PubMed

    Canavan, Theresa N; Elewski, Boni E

    2015-10-01

    Tinea pedis is a frequently encountered dermatophytosis affecting the superficial skin of the feet, primarily of adults. The prevalence of tinea pedis has increased over the last several decades due to an increase in multiple risk factors. Infection from dermatophytes is most common, but infection from other fungi can also result in tinea pedis. Four distinct clinical presentations occur: interdigital, moccasin, vesicular, and acute ulcerative types. A variety of physical exam findings can help the clinician identify patients with tinea pedis.

  17. Relationship of Clinical and Microbiological Variables in Patients with Type 1 Diabetes Mellitus and Periodontitis

    PubMed Central

    Sakalauskiene, Jurgina; Kubilius, Ricardas; Gleiznys, Alvydas; Vitkauskiene, Astra; Ivanauskiene, Egle; Šaferis, Viktoras

    2014-01-01

    Background The aim of the study was to analyze how metabolic control of type 1 diabetes is related to clinical and microbiological periodontal parameters. Material/Methods The study involved 56 subjects aged from 19 to 50 years divided into 2 groups: healthy subjects (the H group), and diabetic (type 1 diabetes) patients with chronic untreated generalized periodontitis (the DM group). The glycosylated hemoglobin value (HbA1c) was determined using the UniCel DxC 800 SYNCHRON System (Beckman Coulter, USA), and the concentration in blood was measured by the turbidimetric immunoinhibition method. A molecular genetic assay (Micro-IDent plus, Germany) was used to detect periodontopathogenic bacteria in plaque samples. Periodontitis was confirmed by clinical and radiological examination. Results Fusobacterium nucleatum, Capnocytophaga species, and Eikenella corrodens were the most frequently found bacteria in dental plaque samples (77.8%, 66.7%, and 33.4%, respectively), whereas Aggregatibacter actinomycetemcomitans was identified 40.7% less frequently in the DM group than in the H group. The strongest relationship was observed between the presence of 2 periodontal pathogens – F. nucleatum and Capnocytophaga spp. – and poorer metabolic control in type 1 diabetes patients (HbA1c) and all clinical parameters of periodontal pathology. Conclusions Periodontal disease was more evident in type 1 diabetic patients, and the prevalence of periodontitis was greatly increased in subjects with poorer metabolic control. PMID:25294115

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

    PubMed

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

    2008-05-01

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

  19. Monitoring in microvascular surgery.

    PubMed

    Furnas, H; Rosen, J M

    1991-03-01

    The importance of monitoring in microvascular surgery is underscored by the high reported salvage rates of failing free flaps and replants. In this overview, we begin by defining the physiology of ischemic tissue with emphasis given to the no-reflow phenomenon and the secondary critical ischemia times. Based on the physiological changes accompanying ischemia, several variables are defined that can be monitored to reflect the vascular state of a free flap or replant. Multifarious monitoring systems are then reviewed, including clinical observation, temperature, isotope clearance, ultrasonic Doppler, laser Doppler, transcutaneous oxygen tension, reflection plethysmography, dermofluorometry, pH, electromagnetic flowmetry, serial hematocrits, interstitial fluid pressure, and magnetic resonance imaging.

  20. A longitudinal study on emotional adjustment of sarcoma patients: the determinant role of demographic, clinical and coping variables.

    PubMed

    Paredes, T; Pereira, M; Simões, M R; Canavarro, M C

    2012-01-01

    The present study examined change on emotional distress of sarcoma patients from the diagnostic to treatment phases, the distinct trajectories of adjustment and the influence of demographic, clinical and coping variables on anxiety and depression. Thirty-six sarcoma patients completed questionnaires on emotional distress (Hospital Anxiety and Depression Scale) and coping strategies (Brief Cope) at time of diagnosis, and again during treatment. No significant change in emotional distress levels was found from diagnostic to treatment phase, with mean anxiety and depression scores remaining below the clinical range. Over time, 52.8% and 66.7% of patients maintained non-clinical anxious and depressive symptoms respectively, and 25% and 11.1% remained with clinical anxiety and depression. Living with partner, less use of humour and more denial were associated with high emotional distress at time of diagnosis and during treatments, and high levels of distress at baseline were predictive of poorer emotional adjustment during treatments. Although sarcoma patients, in general, seem to exhibit good psychological adjustment, there is a significant minority that requires mental health services in order to help decrease their emotional distress following the diagnosis, and prevent psychological difficulties during treatments. Our findings are an important contribution to understanding the psychological adjustment of patients with a specific and rare type of cancer.

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

    PubMed

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

    2016-07-07

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

  2. The Rett condition--broad clinical variability--a case report over three decades.

    PubMed

    Hagberg, B

    1995-04-01

    A forme fruste Rett variant female with partially preserved speech remnants is described. She was first seen by the author at an age of 4 years. She then presented with an unspecific syndrome of moderate mental retardation. At follow-up when aged 32 she had successively through the years developed a number of Rett characteristic abnormal behavioural patterns and neurologic deviations, together convincingly indicating a Rett syndrome. However, this has been discrete and atypical in original presentation and first apparent in the long term clinical profile. It is underlined that a whole battery of Rett peculiarities appearing with age should be present to allow diagnostic accuracy.

  3. Clinical and immunological overlap between autoimmune lymphoproliferative syndrome and common variable immunodeficiency.

    PubMed

    Rensing-Ehl, A; Warnatz, K; Fuchs, S; Schlesier, M; Salzer, U; Draeger, R; Bondzio, I; Joos, Y; Janda, A; Gomes, M; Abinun, M; Hambleton, S; Cant, A; Shackley, F; Flood, T; Waruiru, C; Beutel, K; Siepermann, K; Dueckers, G; Niehues, T; Wiesel, T; Schuster, V; Seidel, M G; Minkov, M; Sirkiä, K; Kopp, M V; Korhonen, M; Schwarz, K; Ehl, S; Speckmann, C

    2010-12-01

    Autoimmune lymphoproliferative syndrome (ALPS) is mainly caused by defects in the CD95 pathway. Raised CD3+TCRαβ+CD4-CD8- double negative T cells and impaired T cell apoptosis are hallmarks of the disease. In contrast, the B cell compartment has been less well studied. We found an altered distribution of B cell subsets with raised transitional B cells and reduced marginal zone B cells, switched memory B cells and plasma blasts in most of 22 analyzed ALPS patients. Moreover, 5 out of 66 ALPS patients presented with low IgG and susceptibility to infection revealing a significant overlap between ALPS and common variable immunodeficiency (CVID). In patients presenting with lymphoproliferation, cytopenia, hypogammaglobulinemia and impaired B cell differentiation, serum biomarkers were helpful in addition to apoptosis tests for the identification of ALPS patients. Our observations may indicate a role for apoptosis defects in some diseases currently classified as CVID.

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

    PubMed

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

    2016-04-01

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

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

    ERIC Educational Resources Information Center

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

    2008-01-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2015-10-01

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

  8. Genetic variability among Chlamydia trachomatis reference and clinical strains analyzed by pulsed-field gel electrophoresis.

    PubMed Central

    Rodriguez, P; Allardet-Servent, A; de Barbeyrac, B; Ramuz, M; Bebear, C

    1994-01-01

    Pulsed-field gel electrophoresis (PFGE) was applied to Chlamydia trachomatis reference strains representing each of the 18 serovars and to 29 clinical isolates from genital specimens collected in Bordeaux, France, or Malmö, Sweden. Comparison of the fingerprint patterns of the reference strains revealed a high level of polymorphism of the total DNA when SmaI was used (14 profiles), whereas the other enzymes, Sse8387I and ApaI, showed fewer differences. Some serovars, considered to be closely related on the basis of their antigenic determinants located on the major outer membrane protein (MOMP), such as D and Da or I and Ia, were shown to be different after PFGE of their genomic DNAs. However, serovars B and Ba and serovars L2 and L2a had identical patterns after analysis with the three endonucleases. When applied to clinical isolates, which were typed by restriction fragment length polymorphism analysis of the MOMP gene, PFGE allowed the detection of intragenotype polymorphisms and showed the identity of two strains successively isolated from the same patient. This technique seems to be an efficient tool for epidemiological studies when used in addition to serotyping or genotyping by restriction fragment length polymorphism analysis of the MOMP gene. Images PMID:7883878

  9. Phenotypic variability in gap junction syndromic skin disorders: experience from KID and Clouston syndromes' clinical diagnostics.

    PubMed

    Kutkowska-Kaźmierczak, Anna; Niepokój, Katarzyna; Wertheim-Tysarowska, Katarzyna; Giza, Aleksandra; Mordasewicz-Goliszewska, Maria; Bal, Jerzy; Obersztyn, Ewa

    2015-08-01

    Connexins belong to the family of gap junction proteins which enable direct cell-to-cell communication by forming channels in adjacent cells. Mutations in connexin genes cause a variety of human diseases and, in a few cases, result in skin disorders. There are significant differences in the clinical picture of two rare autosomal dominant syndromes: keratitis-ichthyosis-deafness (KID) syndrome and hidrotic ectodermal dysplasia (Clouston syndrome), which are caused by GJB2 and GJB6 mutations, respectively. This is despite the fact that, in both cases, malfunctioning of the same family proteins and some overlapping clinical features (nail dystrophy, hair loss, and palmoplantar keratoderma) is observed. KID syndrome is characterized by progressive vascularizing keratitis, ichthyosiform erythrokeratoderma, and neurosensory hearing loss, whereas Clouston syndrome is characterized by nail dystrophy, hypotrichosis, and palmoplantar keratoderma. The present paper presents a Polish patient with sporadic KID syndrome caused by the mutation of p.Asp50Asn in GJB2. The patient encountered difficulties in obtaining a correct diagnosis. The other case presented is that of a family with Clouston syndrome (caused by p.Gly11Arg mutation in GJB6), who are the first reported patients of Polish origin suffering from this disorder. Phenotype diversity among patients with the same genotypes reported to date is also summarized. The conclusion is that proper diagnosis of these syndromes is still challenging and should always be followed by molecular verification.

  10. Problematic sexual behavior in young adults: Associations across clinical, behavioral, and neurocognitive variables

    PubMed Central

    Leppink, EW; Chamberlain, SR; Redden, SA; Grant, JE

    2017-01-01

    Objective A notable number of young adults struggle to control impulsive behavior, resulting in impairment and distress. Assessments of problematic sexual behavior (PSB) have noted clinical differences relative to other populations, but neurocognitive findings have varied. This analysis assesses the clinical presentation and neurocognitive profile of patients with PSB relative to participants evident PSB symptoms. Methods 492 participants (18-29) were recruited for a study on impulsivity in young adults. Participants completed diagnostic, self-report, and neurocognitive measures which assessed several cognitive domains. PSB was defined as endorsing fantasies, urges, or sexual behavior that felt out of control or was causing distress. Results 54 (11%) participants reported current PSB. This group was older, reported earlier sexual experiences and alcohol use, and lower quality of life and self-esteem. Comorbidity was greater in the PSB group, particularly for depression and alcohol dependence. The PSB group also showed differences in impulsivity, decision making, spatial working memory, problem solving, and emotional dysregulation. Conclusion Results suggest that PSB is associated with psychosocial dysfunction, greater comorbidity, and neurocognitive differences. These associations suggest a more salient impact than typical sexual behavior. Furthermore, this study demonstrated several neurocognitive deficits in the PSB group which have found more mixed support previously. PMID:27723520

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

    PubMed Central

    Carroll, KJ; Jones, B; Benet, LZ

    2016-01-01

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

  12. Intra-host viral variability in children clinically infected with H1N1 (2009) pandemic influenza.

    PubMed

    Bourret, Vincent; Croville, Guillaume; Mansuy, Jean-Michel; Mengelle, Catherine; Mariette, Jérôme; Klopp, Christophe; Genthon, Clémence; Izopet, Jacques; Guérin, Jean-Luc

    2015-07-01

    Recent in-depth genetic analyses of influenza A virus samples have revealed patterns of intra-host viral genetic variability in a variety of relevant systems. These have included laboratory infected poultry, horses, pigs, chicken eggs and swine respiratory cells, as well as naturally infected poultry and horses. In humans, next generation sequencing techniques have enabled the study of genetic variability at specific positions of the viral genome. The present study investigated how 454 pyrosequencing could help unravel intra-host genetic diversity patterns on the full-length viral hæmagglutinin and neuraminidase genes from human H1N1 (2009) pandemic influenza clinical cases. This approach revealed unexpected patterns of co-infection in a 3-week old toddler, arising from rapid and complex reassortment phenomena on a local epidemiological scale. It also suggested the possible existence of very low frequency mutants resistant to neuraminidase inhibitors in two untreated patients. As well as revealing patterns of intra-host viral variability, this report highlights technical challenges in the appraisal of scientifically and medically relevant topics such as the natural occurrence of homologous recombination or very low frequency drug-resistant variants in influenza virus populations.

  13. Self-Monitoring as a Mediator of Weight Loss in the SMART Randomized Clinical Trial

    PubMed Central

    Turk, Melanie Warziski; Elci, Okan U.; Wang, Jing; Sereika, Susan M.; Ewing, Linda J.; Acharya, Sushama D.; Glanz, Karen; Burke, Lora E.

    2012-01-01

    Background Integral components of behavioral weight-loss treatment include self-monitoring of diet and physical activity along with feedback to participants regarding their behaviors. While providing feedback has been associated with weight loss, no studies have examined the impact of feedback frequency on weight loss, or the mediating role of self-monitoring adherence in this relationship. Purpose This study examined the effect of participant feedback frequency on weight loss and determined if this effect was mediated by adherence to self-monitoring in a behavioral weight-loss trial conducted in the United States. Method Participants (N=210) were randomly assigned to one of three self-monitoring methods with either no daily feedback messages or daily feedback messages: 1) paper diary (PD)- no daily feedback, 2) personal digital assistant (PDA)- no daily feedback, and 3) PDA- daily, tailored feedback messages (PDA+FB). The Sobel test via bootstrapping examined the direct effect of feedback frequency on weight loss and the indirect effect through self-monitoring adherence. Results Receiving daily feedback messages significantly increased participants’ self-monitoring adherence. A significant effect of feedback frequency on weight loss was noted; however, after adjusting for self-monitoring adherence, the effect of feedback frequency on weight loss was no longer significant. Feedback frequency had a significant indirect effect on weight loss through self-monitoring adherence. Conclusion Self-monitoring adherence mediated the effect of feedback frequency on weight loss. Increasing the frequency with which participants receive feedback could enhance self-monitoring adherence, a critical component of behavioral weight-loss treatment. PMID:22936524

  14. A Computer-Aided Analysis Method of SPECT Brain Images for Quantitative Treatment Monitoring: Performance Evaluations and Clinical Applications

    PubMed Central

    Wei, Wentao; Huang, Qiu; Wan, Jieqing; Huang, Gang

    2017-01-01

    The objective and quantitative analysis of longitudinal single photon emission computed tomography (SPECT) images are significant for the treatment monitoring of brain disorders. Therefore, a computer aided analysis (CAA) method is introduced to extract a change-rate map (CRM) as a parametric image for quantifying the changes of regional cerebral blood flow (rCBF) in longitudinal SPECT brain images. The performances of the CAA-CRM approach in treatment monitoring are evaluated by the computer simulations and clinical applications. The results of computer simulations show that the derived CRMs have high similarities with their ground truths when the lesion size is larger than system spatial resolution and the change rate is higher than 20%. In clinical applications, the CAA-CRM approach is used to assess the treatment of 50 patients with brain ischemia. The results demonstrate that CAA-CRM approach has a 93.4% accuracy of recovered region's localization. Moreover, the quantitative indexes of recovered regions derived from CRM are all significantly different among the groups and highly correlated with the experienced clinical diagnosis. In conclusion, the proposed CAA-CRM approach provides a convenient solution to generate a parametric image and derive the quantitative indexes from the longitudinal SPECT brain images for treatment monitoring. PMID:28251150

  15. A Computer-Aided Analysis Method of SPECT Brain Images for Quantitative Treatment Monitoring: Performance Evaluations and Clinical Applications.

    PubMed

    Zheng, Xiujuan; Wei, Wentao; Huang, Qiu; Song, Shaoli; Wan, Jieqing; Huang, Gang

    2017-01-01

    The objective and quantitative analysis of longitudinal single photon emission computed tomography (SPECT) images are significant for the treatment monitoring of brain disorders. Therefore, a computer aided analysis (CAA) method is introduced to extract a change-rate map (CRM) as a parametric image for quantifying the changes of regional cerebral blood flow (rCBF) in longitudinal SPECT brain images. The performances of the CAA-CRM approach in treatment monitoring are evaluated by the computer simulations and clinical applications. The results of computer simulations show that the derived CRMs have high similarities with their ground truths when the lesion size is larger than system spatial resolution and the change rate is higher than 20%. In clinical applications, the CAA-CRM approach is used to assess the treatment of 50 patients with brain ischemia. The results demonstrate that CAA-CRM approach has a 93.4% accuracy of recovered region's localization. Moreover, the quantitative indexes of recovered regions derived from CRM are all significantly different among the groups and highly correlated with the experienced clinical diagnosis. In conclusion, the proposed CAA-CRM approach provides a convenient solution to generate a parametric image and derive the quantitative indexes from the longitudinal SPECT brain images for treatment monitoring.

  16. Vasculitis and vasculopathy in Lupus Nephritis: Clinical variability, outcome, and new insight into treatment.

    PubMed

    Kaul, A; Agrawal, V; Bhaduaria, D; Agrawal, Vikas; Prasad, Narayan; Gupta, Amit; Sharma, R K

    2017-01-01

    More than 50% of patients with systemic lupus erythematosus (SLE) have renal involvement at presentation or during their illness. Lupus nephritis (LN) encompasses several patterns of renal disease, including glomerular, tubulointerstitial, and vascular pathologies. The presence and significance of renal vascular lesions (VLs) are often overlooked. VLs in LN are not rare with an incidence of 10%-40% on renal biopsies from various studies and their presence is often labeled as poor prognostic markers. The current treatment protocol for LN is mainly based on the glomerular pathology, and no guidelines/consensus exists for treatment of LN with VLs. We describe the clinical presentation, course, response to therapy, and outcomes in five patients with SLE with histological evidence of renal VLs.

  17. L-sulpiride in young and elderly negative schizophrenics: clinical and pharmacokinetic variables.

    PubMed

    Mauri, M C; Leva, P; Coppola, M T; Altamura, C A

    1994-03-01

    1. Clinical activity, tolerability and kinetic profile of L-sulpiride (200-300 mg/die p.o.) in relation to age, in 14 chronic schizophrenic in patients diagnosed according to DSM III-R, typed as negative forms, were studied. 2. The drug showed its efficacy in negative forms of schizophrenia, without any significant difference between negative and positive symptoms even if productive symptom scores were quite low already in pre-treatment condition. 3. No more side effects (anticholinergic and extrapyramidal) in elderly patients compared to young/adult ones were reported. 4. No significant differences between young/adult and elderly patients for the various pharmacokinetic parameters (t1/2, AUC, Cmax, Tmax, Vd and Cl), after acute and multiple dosing, were observed.

  18. Proliferating cell nuclear antigen immunostaining in breast carcinoma and its relationship to clinical and pathological variables.

    PubMed

    Agarwal, S; Jain, R; Rusia, U; Gupta, R L

    1997-01-01

    Tumour proliferative activity of 74 breast lesions was assessed by determining mitotic index and immunostaining for proliferative cell nuclear antigen using Peroxidase antiperoxidase method. The indices were correlated with histomorphology and clinical stage of the disease. Positively stained nuclei and mitotic figures were counted per 1000 cells to calculate Proliferating Cell Nuclear Antigen (PCNA) and mitotic index respectively. Sixty four cases stained positive for PCNA. The index ranged between 0 to 98. PCNA index was significantly low in benign lesions as compared to malignant lesions (p < 0.0002). There was a linear correlation between the mitotic index and PCNA index. PCNA index also showed significant correlation with tumour size and histologic grade; however, it had no correlation with axillary lymph node status.

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

    PubMed

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

    2016-05-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2014-10-01

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

  1. Sleep Quality in Parkinson’s Disease: An Examination of Clinical Variables

    PubMed Central

    Stavitsky, Karina; Cronin-Golomb, Alice

    2011-01-01

    The etiology of sleep problems in PD is not well understood, as they may arise from the pathology of the disease or from other disease related-factors such as motor dysfunction, dopaminergic medication, and mood disturbances. The aim of this study was to investigate factors associated with sleep including disease-related variables such as motor symptom severity, dose of medication and mood and disease subtypes. Thirty-five non-demented patients with PD were included. Sleep was measured using 24-hour wrist actigraphy over a seven-day period, during which time participants kept a sleep diary. Subjective sleep and arousal questionnaires included the Parkinson’s Disease Sleep Scale and Epworth Sleepiness Scale. Motor symptom severity and dopaminergic medication were significantly related to measures of sleep quality. Gender differences in sleep were found, with men having worse sleep quality and more excessive daytime sleepiness than women. We also found that actigraphy may serve as a useful tool for identifying individuals with possible REM behavior disorder, a sleep disorder that has important implications in early detection of PD. PMID:21537164

  2. Epidermal growth factor receptor mutation in adenocarcinoma lung in a North Indian population: Prevalence and relation with different clinical variables

    PubMed Central

    Kasana, Basharat Ahmad; Dar, Waseem Raja; Aziz, Sheikh Aijaz; Lone, Abdul Rashid; Sofi, Najeeb Ullah; Dar, Imtiyaz Ahmad; Latief, Muzamil; Arshad, Faheem; Hussain, Moomin; Hussain, Mir

    2016-01-01

    Introduction: Lung cancer is one of the most common causes of cancer deaths worldwide. Adenocarcinoma is taking over squamous cell lung cancer as the predominant histological subtype. Several cytotoxic drugs are available for the treatment of lung cancer, but side effects limit their use. Recently, targeted therapies for cancers have come into clinical practice. Aims and Objectives: To determine the prevalence of epidermal growth factor receptor (EGFR) mutation in adenocarcinoma lung in a North Indian population and its relation with different clinical variables. Materials and Methods: A total of 57 patients who met inclusion criteria were recruited into the study. Relevant history, clinical examination and investigations were done. EGFR mutation was done in all patients. Results: A total of twenty patients tested positive for EGFR mutation. EGFR was more frequently detected in female patients (53.8%), while as only 19.4% of the male patients expressed EGFR mutation, which was statistically very significant (P = 0.007). EGFR mutation was more frequently detected in nonsmokers (52%) as compared to smokers (21.9%) which also was statistically significant (P value of 0.018). EGFR mutation was more common in Stage III and IV adenocarcinomas (48%) as compared to Stage I and II (21.4%) which was statistically significant (P value 0.034). Conclusion: EGFR mutation should be routinely done in all patients of adenocarcinoma lung particularly non-smoker females with Stage III and IV disease. PMID:27688613

  3. Clinical and sociodemographic variables associated with diabetes-related distress in patients with type 2 diabetes mellitus

    PubMed Central

    Zanchetta, Flávia Cristina; Trevisan, Danilo Donizetti; Apolinario, Priscila Peruzzo; da Silva, Juliana Bastoni; Lima, Maria Helena de Melo

    2016-01-01

    ABSTRACT Objective: To evaluate the relation between diabetes-related distress and the clinical and sociodemographic characteristics of type 2 diabetes mellitus patients. Methods: A cross-sectional study based on a secondary analysis of data collected at a specialized care outpatient center in Brazil. Participants completed a questionnaire on sociodemographic and clinical characteristics and the Brazilian version of the Diabetes Distress Scale (B-DDS). Results: About 31% of the 130 eligible patients reported diabetes distress, and the mean B-DDS score was 2.6. Multiple regression analysis showed the B-DDS score was positively correlated with marital status (p=0.0230), use of diet and physical activities for diabetes management (p=0.0180), and use of insulin therapy (p=0.0030). The “emotional burden”, “regimen-related distress”, and “interpersonal distress” domains from B-DDS were associated with the use of insulin therapy (p=0.0010), marital status (p=0.0110), and the presence of three or more comorbidities (p=0.0175). Conclusion: These findings suggest the clinical and sociodemographic variables are relatively weak predictors of diabetes-related distress. The highest scores in the B-DDS were observed in the emotional burden domain, indicating the presence of diabetes distress among the participants of the study. PMID:27759822

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

    PubMed

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

    2016-01-01

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

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

    PubMed Central

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

    2016-01-01

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

  6. Remote physiological monitoring: clinical, financial, and behavioral outcomes in a heart failure population.

    PubMed

    Hudson, Laurel R; Hamar, G Brent; Orr, Patty; Johnson, Jeffrey H; Neftzger, Amy; Chung, Richard S; Williams, Myra L; Gandy, William M; Crawford, Albert; Clarke, Janice; Goldfarb, Neil I

    2005-12-01

    This article reports on the outcomes associated with remote physiological monitoring (RPM) conducted as part of a heart failure disease management program. Claims data, medical records, data transmission records, and survey results for 91 individuals ages 50-92 (mean 74 years) successfully completing a heart failure RPM program were analyzed for time periods before, during, and after the monitoring intervention. The program was associated with significant reductions in per member per month costs and emergency room and hospital utilization. More detailed analyses were performed for specific gender and age subgroups. Participant surveys indicated high levels of satisfaction, and improvements in self-perceived health status, self-efficacy, and self-management behaviors. This study is the first to assess the impact of a RPM program following removal of the monitoring equipment. The results indicate that RPM, as a component of a traditional disease management program, has a sustained, beneficial effect on participants' lifestyles after the monitoring period has ended.

  7. Mean Platelet Volume and Arterial Stiffness – Clinical Relationship and Common Genetic Variability

    PubMed Central

    Panova-Noeva, Marina; Arnold, Natalie; Hermanns, M. Iris; Prochaska, Jürgen H.; Schulz, Andreas; Spronk, Henri M.; Binder, Harald; Pfeiffer, Norbert; Beutel, Manfred; Blankenberg, Stefan; Zeller, Tanja; Lotz, Johannes; Münzel, Thomas; Lackner, Karl J.; ten Cate, Hugo; Wild, Philipp S.

    2017-01-01

    Vessel wall stiffening is an important clinical parameter, but it is unknown whether platelets, key elements in the pathogenesis of arterial thrombosis, are associated with arterial stiffness. The present studies sought to determine whether mean platelet volume (MPV), a potential marker of platelet activation, is linked to vascular elasticity as assessed by the augmentation index (AIx), in 15,010 individuals from the population-based Gutenberg Health Study. Multivariable analysis showed that MPV in both males (β 0.776; 95thCI [0.250;1.16]; p = 0.0024) and females (β 0.881[0.328;1.43]; p = 0.0018) is strongly associated with AIx. Individuals with MPV and AIx above the sex-specific medians had worse survival. Association analysis between MPV-related genetic variants and arterial stiffness identified four genetic variants in males and one in females related with AIx. Cox regression analysis for mortality identified one of these joint genetic variants close to ring finger protein 145 gene (RNF145, rs10076782) linked with increased mortality (hazard ratio 2.02; 95thCI [1.35;3.02]; p = 0.00061). Thus, these population-based data demonstrate a close relation between platelet volume as a potential marker of platelet activation and arterial stiffness in both sexes. Further research is warranted to further elucidate the mechanisms underlying larger platelets‘ role in arterial stiffening including the role of shared common genetics. PMID:28059166

  8. The Correlation of Muscle Biopsy Scores with the Clinical Variables in Idiopathic Inflammatory Myopathies

    PubMed Central

    Wangkaew, Suparaporn; Suwansirikul, Songkiet; Aroonrungwichian, Kantawut; Kasitanon, Nuntana; Louthrenoo, Worawit

    2016-01-01

    Objectives: To compare the muscle pathology findings among subgroups of idiopathic inflammatory myopathies (IIM) patients, and to determine the correlations of muscle biopsy scores with muscle power and creatine kinase (CK). Methods: The medical records of IIM patients consisting of the demographic data, clinical parameters and laboratory conducted were retrospectively reviewed. Their initial muscle biopsies were reviewed, and four domains were scored: inflammation, vascular, muscle, and connective tissue. Results: Ninety-five IIM patients (28 patients with idiopathic polymyositis (PM) 9 idiopathic dermatomyositis (DM), 5 DM associated with malignancy, and 53 PM/DM associated with connective tissue disease) with median (IQR: Q1, Q3) disease duration of 1.2 (0.5, 3.1) months were included. No significant differences in initial muscle pathology findings and muscle pathology score among the subgroups were found. Muscle degeneration and endomysial fibrosis scores were negatively correlated with muscle power (r=-0.23 and-0.24, respectively, p<0.05) and positively correlated with CK (r=0.27 and 0.39, respectively, p<0.01). No significant correlation was detected either inflammation or vasculitis scores with muscle power and CK levels. Conclusion: In this study, muscle biopsy cannot be used to differentiate among subgroups of IIM patients. In addition, we found only modest correlation of muscle biopsy scores with muscle power and CK. Further study is necessary to confirm our findings. PMID:28144368

  9. [Development of a portable ECG monitor with diagnostic & therapeutic functions and its clinical applications].

    PubMed

    Fan, Shou-nian; Jiang, Chen-xi; Cai, Yun-chang; Liu, Jun-shi; Fan, Yuan-yuan; Liu, Zhi-qin; Zhao, Ning; Wu, Qiang

    2005-01-01

    A portable ECG monitor is introduced in the paper, which has a temporary intravenous and transesophageal fixable rate pacing function. During the PSVT attack, the tachyarrythmia can be stopped by the transesophageal cardiac pacing while the ECG signals are monitored. The instrument has some advantages such as small size, low price and good practicality. It is worth while introducing and popularizing it to all hospitals.

  10. Area-under-the-curve versus trough level monitoring of cyclosporine concentration: critical assessment of dosage adjustment practices and measurement of clinical outcome.

    PubMed

    Grevel, J

    1993-12-01

    Cyclosporine (CsA) immunosuppressive therapy is confounded by a narrow therapeutic window and large intersubject variability. Trough-level monitoring cannot prevent the frequent occurrence of toxic side effects and graft rejection. Area-under-the-curve (AUC) monitoring affords better control of exposure of an individual patient to CsA, which is compensated for by a moderate increase in the number of blood samples. A linear pharmacokinetic model for CsA dosage adjustment using AUC measurements as feedback information decreased the incidence of delayed graft loss during the first month. This strategy failed, however, to lower the frequency of acute graft rejection despite a significant relationship between the probability of rejection and exposure to CsA (measured as average steady-state concentration). A nonlinear Michaelis-Menten model describes the relationship between oral dose rate and average steady-state concentration better than does a linear clearance model. Clinical utility of the nonlinear model remains to be proven.

  11. Relationship between HRV measurements and demographic and clinical variables in a population of patients with atrial fibrillation.

    PubMed

    Buttà, Carmelo; Tuttolomondo, Antonino; Casuccio, Alessandra; Petrantoni, Rossella; Miceli, Giuseppe; Cuttitta, Francesco; Pinto, Antonio

    2016-12-01

    Little is known about the role of HRV in atrial fibrillation (AF) patients. Aim of our study was to assess the relationship between HRV measurements and demographic and clinical variables in a population of 274 AF patients. We selected all consecutive patients with persistent/permanent AF among whom had performed a Holter ECG in our Department from April 2010 to April 2015. Time-domain analysis of HRV was evaluated. Demographic and clinical variables were collected for each patient. At multivariable logistic regression, a higher pNN50 was associated with ACE inhibitors/ARBs (p = 0.016) and a lower pNN50 with obesity (p = 0.037) and higher heart rate (HR) (p < 0.0005). A higher RMSSD was associated with ACE inhibitors/ARBs (p = 0.001), digitalis (p < 0.0005) and beta-blockers (p = 0.002) and a lower RMSSD with a higher HR (p < 0.0005). A higher SDNNi was associated with ACE inhibitors/ARBs (p < 0.0005), digitalis (p < 0.0005) and beta-blockers (p = 0.002) and a lower SDNNi with dysthyroidism (p = 0.048) and higher HR (p < 0.0005). A higher SDANN was associated with non-dihydropyiridine calcium-channel-blockers (p = 0.002) and ACE inhibitors/ARBs (p = 0.002) and a lower SDANN with hypertension (p = 0.034), obesity (p = 0.011), stroke (p = 0.031), pneumonia (p = 0.005) and higher HR (p < 0.0005). A higher SDNN was associated with ACE inhibitors/ARBs (p < 0.0005), digitalis (p < 0.0005) and beta-blockers (p = 0.022) and a lower SDNN with obesity (p = 0.012), pneumonia (p = 0.049) and higher HR (p < 0.0005). Our study showed that, in AF patients, there is a direct relationship between some clinical variables and HRV measurements; as for patients with sinus rhythm, even in AF patients this relationship seemed to reflect the autonomic nervous system activity.

  12. Clinical variability in cardiovascular disease risk factor screening and management in adolescent and young adult women with polycystic ovary syndrome

    PubMed Central

    Baer, Tamara E.; Milliren, Carly E.; Walls, Courtney; DiVasta, Amy D.

    2014-01-01

    Study Objectives To review the clinical presentation, evaluation and management of normal-weight, overweight and obese adolescent and young adult women with PCOS over 2-year follow-up. Design Retrospective chart review Participants 173 adolescent and young adult women, aged 12–22 years, diagnosed with PCOS Interventions Demographic, health data, and laboratory measures were abstracted from 3 clinic visits: baseline and 1- and 2- year follow-up. Subjects were classified as normal-weight (NW), overweight (OW) or obese (OB). Longitudinal data were analyzed using repeated measures ANOVA. Main Outcome Measures BMI, self-reported concerns, lifestyle changes. Results Most patients (73%) were OW or OB. Family history of type II diabetes was greater in OW (38%) and OB (53%) as compared to NW (22%) patients (p=0.002). Acanthosis nigricans was identified in OW (62%) and OB (21%) patients, but not NW patients (0%; p <0.001). OW and OB patients had higher fasting insulin (p<0.001) and lower HDL cholesterol (p=0.005) than NW patients, although screening rates were low. BMI Z-scores decreased in both OW and OB patients over time (0.07 units/year; p<0.001). Conclusions Most patients with PCOS were OW/OB. Substantial clinical variability existed in CVD screening; among those screened, OW and OB patients had greater CVD risk factors. Despite self-reported concerns about weight and diabetes risk among OW/OB patients, no clinically significant change in BMI percentile occurred. Evidence-based interventions and recommendations for screening tests are needed to address CVD risk in adolescents and young adults with PCOS. PMID:26081478

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

    SciTech Connect

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

    2013-11-20

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

  14. How Variable Is Our Delivery of Information? Approaches to Patient Education About Oral Chemotherapy in the Pediatric Oncology Clinic.

    PubMed

    Kahn, Justine M; Athale, Uma H; Clavell, Luis A; Cole, Peter D; Leclerc, Jean-Marie; Laverdiere, Caroline; Michon, Bruno; Schorin, Marshall A; Welch, Jennifer J G; Sallan, Stephen E; Silverman, Lewis B; Kelly, Kara M

    In pediatric patients with acute lymphoblastic leukemia, adherence to oral chemotherapy relies largely on a parent's comprehension of the drug's indication and administration guidelines. We assessed how pediatric oncology providers educate families about oral chemotherapy. We conducted a cross-sectional survey of 68 physicians and nurses from 9 institutions in the Dana-Farber Cancer Institute Acute Lymphoblastic Leukemia Consortium. The inter-individual approach to patient education is variable and may consist of handouts, treatment calendars, and discussions. The extent of teaching often varies depending on a provider's subjective assessment of a family's needs. Twenty-five percent of providers suggested standardizing patient teaching. When developing educational models, care teams should consider approaches that (a) objectively identify families in need of extensive teaching, (b) designate allotted teaching time by nursing staff during clinic visits, and (c) maintain the variation and dynamism that informs a successful provider-patient relationship.

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

    NASA Astrophysics Data System (ADS)

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

    2015-10-01

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

  16. Feasibility of using Clinical Element Models (CEM) to standardize phenotype variables in the database of genotypes and phenotypes (dbGaP).

    PubMed

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

    2013-01-01

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

  17. Complex regional pain syndrome: medical and legal ramifications of clinical variability and experience and perspective of a practicing clinician

    PubMed Central

    Lazaro, RP

    2017-01-01

    Objective The aim of this study was to demonstrate the ramifications of clinical variability of complex regional pain syndrome (CRPS) and how they can affect the various aspects of this condition, favorably or unfavorably, for both patients and participating medical and legal professionals. Methods Twelve patients diagnosed with CRPS at different times in the past 25 years were followed up, and their signs and symptoms were reviewed for variability. None had preexisting or ongoing medical disorders and prior injury to the peripheral nerves or musculoskeletal tissues. None had been involved in litigation. Physical traumas that triggered CRPS were job-related, vehicular accidents, and personal injuries. The presence of vasomotor symptoms (eg, swelling, skin discoloration, and temperature changes) and allodynia in the affected extremity was the basis for clinical diagnosis in all the patients. The need for imaging studies was precluded in some patients owing to the presence of vasomotor symptoms, which either fluctuated or were steady. Seven of the patients had type 1 CRPS, and five patients had type 2 CRPS. Results Most patients encountered delay in diagnosis and treatment and legal obstacles owing to the lack of “typical” objective signs of CRPS. The patients’ symptoms fluctuated at different times of the day. Eight patients experienced spread of vasomotor symptoms and varying degree of allodynia in the opposite extremity. One patient, who developed signs and symptoms of rheumatoid arthritis, 2 months after the injury, continued to have CRPS symptoms in the injured hand. Treatment modalities administered in all the patients were essentially ineffective. All the patients, except one, were unable to return to their original line of work, and their symptoms persisted regardless of the outcome of their legal claims. Conclusion It is likely that patients who continue to complain of pain and vasomotor symptoms followed by a physical injury have CRPS. The complex

  18. The application of clinical variables and models to predict pulmonary embolism in cancer patients: a comprehensive single cancer center experience

    PubMed Central

    Mansour, Asem; Ismael, Yousef; Abunasser, Mahmoud; Hammode, Emad; Turfa, Rim; Abdel-Razeq, Hikmat

    2013-01-01

    Introduction Prompt diagnosis and treatment of pulmonary embolism (PE) can help reduce its associated morbidity and mortality. Computed tomography chest angiography (CTA) scanning is the most widely used diagnostic modality. In noncancer patients, only 10% of such studies are positive for PE. Clinical variables, individual or in combination, that can predict test positivity are highly needed. Materials and methods All CTAs requested to confirm or exclude a diagnosis of PE in a single comprehensive cancer center were reviewed. In addition to the Wells score, other clinical variables known to increase the risk of PE were analyzed. Results A total of 778 adult cancer patients were treated at King Hussein Cancer Center (Amman, Jordan) and were included in this study; the majority of patients (64.2%) had stage 4 disease. Overall, 129 (16.6%) patients had positive scans for PE, while alternative diagnoses were made in 308 (39.6%) patients. Cancer stage and anticancer treatment had no impact on positive PE rates. However, Wells criteria classified patients into three risk groups with PE rates of 10.2%, 16.1%, and 62.5% among the patients with low, moderate, and high risk, respectively (P < 0.0001). Duration of cancer diagnosis (<12 months versus >12 months) had a significant impact on positive PE studies (22.0% versus 12.4%, respectively, P = 0.007). Conclusion The rate of positive PE studies in cancer patients is higher than previously reported in noncancer patients. Positivity for PE was higher during the first 12 months of cancer diagnosis and in those with high probability score according to the Wells criteria. Factors like primary tumor stage and anticancer therapy had no significant impact on PE-positive studies. PMID:24187488

  19. Study of skin vasomotion in type 1 diabetic patients and of its possible relationship with clinical and laboratory variables.

    PubMed

    Rossi, Marco; Matteucci, Elena; Pesce, Margherita; Consani, Cristina; Galetta, Fabio; Giampietro, Ottavio; Santoro, Gino

    2013-01-01

    Vascular oscillation (vasomotion) occurs in the microcirculation and is thought to be a significant contributor to tissue perfusion. Our aim was to assess skin vasomotion (SV) of type 1 diabetic patients (T1D-pts) and its relationship with clinical or laboratory variables of the studied T1D-pts. Forearm endothelial-, sympathetic- and myogenic-dependent SV were assessed basally and after 3 min of forearm ischemia in 40 T1D-pts and 50 healthy controls, by spectral analysis of laser-Doppler (LD) signal at the frequency ranges of 0.009-0.02 Hz, 0.021-0.06 Hz and 0.061-0.2 Hz, respectively. Post-ischemic per cent increase (PI%-increase) in power spectral density (PSD) of skin endothelial- and sympathetic-dependent VS was significantly reduced in T1D-pts compared to controls (p < 0.0005, p < 0.0001, respectively). Linear regression analysis showed a significant positive relationship between PI%-increase of endothelial-dependent SV and heart rate variation during laying-standing test (R = 0.65, p = 0.00001), and a negative relationship between PI%-increase in PSD of skin LD signal 0.009-1.6 Hz spectrum and glycated haemoglobin serum levels (R = 0.44, p = 0.0036) in T1D-pts. These results are consistent with reduced skin endothelial- and sympathetic-dependent stimulated SV and with relationships between some clinical or laboratory variables and SV parameters in the T1D-pts studied.

  20. Temperature-Dependent Growth Modeling of Environmental and Clinical Legionella pneumophila Multilocus Variable-Number Tandem-Repeat Analysis (MLVA) Genotypes.

    PubMed

    Sharaby, Yehonatan; Rodríguez-Martínez, Sarah; Oks, Olga; Pecellin, Marina; Mizrahi, Hila; Peretz, Avi; Brettar, Ingrid; Höfle, Manfred G; Halpern, Malka

    2017-04-15

    Legionella pneumophila causes waterborne infections resulting in severe pneumonia. High-resolution genotyping of L. pneumophila isolates can be achieved by multiple-locus variable-number tandem-repeat analysis (MLVA). Recently, we found that different MLVA genotypes of L. pneumophila dominated different sites in a small drinking-water network, with a genotype-related temperature and abundance regime. The present study focuses on understanding the temperature-dependent growth kinetics of the genotypes that dominated the water network. Our aim was to model mathematically the influence of temperature on the growth kinetics of different environmental and clinical L. pneumophila genotypes and to compare it with the influence of their ecological niches. Environmental strains showed a distinct temperature preference, with significant differences among the growth kinetics of the three studied genotypes (Gt4, Gt6, and Gt15). Gt4 strains exhibited superior growth at lower temperatures (25 and 30°C), while Gt15 strains appeared to be best adapted to relatively higher temperatures (42 and 45°C). The temperature-dependent growth traits of the environmental genotypes were consistent with their distribution and temperature preferences in the water network. Clinical isolates exhibited significantly higher growth rates and reached higher maximal cell densities at 37°C and 42°C than the environmental strains. Further research on the growth preferences of L. pneumophila clinical and environmental genotypes will result in a better understanding of their ecological niches in drinking-water systems as well as in the human body.IMPORTANCELegionella pneumophila is a waterborne pathogen that threatens humans in developed countries. The bacteria inhabit natural and man-made freshwater environments. Here we demonstrate that different environmental L. pneumophila genotypes have different temperature-dependent growth kinetics. Moreover, Legionella strains that belong to the same species

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

    PubMed Central

    2016-01-01

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

  2. Improving Clinical Laboratory Efficiency: Introduction of Systems for the Diagnosis and Monitoring of HIV Infection.

    PubMed

    Alvarez, Marta; Chueca, Natalia; Guillot, Vicente; Bernal, María Del Carmen; García, Federico

    2012-01-01

    Since the first tests for identifying individuals with suspected human immunodeficiency virus (HIV) infection were introduced in the mid-1980s, diagnostic virology testing has greatly evolved. The technological advances, automating in the laboratories and the advances in molecular biology techniques have helped introduce invaluable laboratory methods for managing HIV patients. Tests for diagnosis, specially for screening HIV antibodies, are now fully automated; in the same way, tests for monitoring HIV viral load (HIV RNA copies/ml of plasma), which is used for monitoring infection and response to antiretroviral treatment, are also fully automated; however, resistance testing, tropism determination and minor variant detection, which are used to make decisions for changing antiretroviral treatment regimens in patients failing therapy, still remain highly laborious and time consuming. This chapter will review the main aspects relating to the automating of the methods available for laboratory diagnosis as well as for monitoring of the HIV infection and determination of resistance to antiretrovirals and viral tropism.

  3. 21 CFR 312.87 - Active monitoring of conduct and evaluation of clinical trials.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... clinical trials. 312.87 Section 312.87 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS FOR HUMAN USE INVESTIGATIONAL NEW DRUG APPLICATION Drugs Intended... and evaluation of clinical trials. For drugs covered under this section, the Commissioner and...

  4. Evaluation of Commercial Self-Monitoring Devices for Clinical Purposes: Results from the Future Patient Trial, Phase I

    PubMed Central

    Leth, Soren; Hansen, John; Nielsen, Olav W.; Dinesen, Birthe

    2017-01-01

    Commercial self-monitoring devices are becoming increasingly popular, and over the last decade, the use of self-monitoring technology has spread widely in both consumer and medical markets. The purpose of this study was to evaluate five commercially available self-monitoring devices for further testing in clinical applications. Four activity trackers and one sleep tracker were evaluated based on step count validity and heart rate validity. Methods: The study enrolled 22 healthy volunteers in a walking test. Volunteers walked a 100 m track at 2 km/h and 3.5 km/h. Steps were measured by four activity trackers and compared to gyroscope readings. Two trackers were also tested on nine subjects by comparing pulse readings to Holter monitoring. Results: The lowest average systematic error in the walking tests was −0.2%, recorded on the Garmin Vivofit 2 at 3.5 km/h; the highest error was the Fitbit Charge HR at 2 km/h with an error margin of 26.8%. Comparisons of pulse measurements from the Fitbit Charge HR revealed a margin error of −3.42% ± 7.99% compared to the electrocardiogram. The Beddit sleep tracker measured a systematic error of −3.27% ± 4.60%. Conclusion: The measured results revealed the current functionality and limitations of the five self-tracking devices, and point towards a need for future research in this area. PMID:28117736

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

    NASA Astrophysics Data System (ADS)

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

    2015-12-01

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

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

    SciTech Connect

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

    2011-11-29

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

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

    PubMed

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

    2015-03-01

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

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

    PubMed

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

    2014-10-01

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

  9. Serial Liver Stiffness Measurements and Monitoring of Liver-Transplanted Patients in a Real-Life Clinical Practice

    PubMed Central

    Rinaldi, Luca; Valente, Giovanna; Piai, Guido

    2016-01-01

    Background Liver transplanted patients need close surveillance for early signs of graft disease. Objectives Transient elastography can safely be repeated over time, offering serial liver stiffness measurement values. Serial stiffness measurements were compared to single baseline stiffness measurements in predicting the appearance of liver-related clinical events and guiding subsequent clinical decisions. Methods One hundred and sixty liver transplanted patients were observed for three years in our real-life practice. Results Liver stiffness measurements were stable in 75% of patients, decreased in 4% of patients, and increased in 21% of patients. The pattern of increased stiffness measurements was associated with both HCV-RNA positive status and the presence of an active biliary complication of liver transplantation and was more predictive of a clinically significant event resulting from any disease of the transplanted liver when compared to a stable pattern or to a single liver stiffness measurement. The procedures that were consequently performed were often diagnostic for unexpected situations, both in HCV-RNA positive and HCV-RNA negative patients. Conclusions The pattern of longitudinally increased liver stiffness measurements efficiently supported clinical decisions for individualized management strategies. Repeated transient elastography in real-life clinical practice appears to have a practical role in monitoring liver transplanted patients. PMID:28123442

  10. Clinical applicability of in vivo fluorescence confocal microscopy for noninvasive diagnosis and therapeutic monitoring of nonmelanoma skin cancer.

    PubMed

    Astner, Susanne; Dietterle, Susanne; Otberg, Nina; Röwert-Huber, Hans-Joachim; Stockfleth, Eggert; Lademann, Jürgen

    2008-01-01

    Excisional biopsies and routine histology remains the gold standard for the histomorphologic evaluation of normal and diseased skin. However, there is increasing interest in the development of noninvasive optical technologies for evaluation, diagnosis, and monitoring of skin disease in vivo. Fluorescent confocal microscopy is an innovative optical technology that has previously been used for morphologic evaluation of live human tissue. We evaluate the clinical applicability of a fluorescent confocal laser scanning microscope (FLSM) for a systematic evaluation of normal and diseased skin in vivo and in correlation with routine histology. A total of 40 patients were recruited to participate in the study. Skin sites of 10 participants with no prior history of skin disease served as controls and to evaluate topographic variations of normal skin in vivo. Thirty patients with a suspected diagnosis of nonmelanoma skin cancer were evaluated, whereby FLSM features of actinic keratoses (AK) and basal cell carcinoma (BCC) were recorded in an observational analysis. Selected BCCs were monitored for their skin response to topical therapy using Imiquimod as an immune-response modifier. A commercially available fluorescence microscope (OptiScan Ltd., Melbourne, Australia) was used to carry out all FLSM evaluations. Common FLSM features to AK and BCC included nuclear pleomorphism at the level of the granular and spinous layer and increased vascularity in the superficial dermal compartment. Even though the presence of superficial disruption and mere atypia of epidermal keratinocytes was more indicative of AK, the nesting of atypical basal cells, increased blood vessel tortuosity, and nuclear polarization were more typical for BCC. All diagnoses were confirmed by histology. FLSM allowed a monitoring of the local immune response following therapy with Imiquimod and demonstrated a continuous normalization of diseased skin on repeated evaluations over time. This study illustrates

  11. Clinical course and interstage monitoring after the Norwood and hybrid procedures for hypoplastic left heart syndrome.

    PubMed

    Knirsch, Walter; Bertholdt, Sonia; Stoffel, Gaby; Stiasny, Brian; Weber, Roland; Dave, Hitendu; Prêtre, Rene; von Rhein, Michael; Kretschmar, Oliver

    2014-06-01

    Infants with hypoplastic left heart syndrome (HLHS) are at risk for interstage morbidity and mortality, especially between the first and second surgical stages after the Norwood and hybrid procedures. This study compared the morbidity and mortality of patients treated by either the Norwood or the hybrid procedure for HLHS between the first and second stages who were undergoing interstage monitoring. Between October 2008 and December 2011, 26 infants (14 boys) with HLHS (n = 16) and other univentricular heart malformations with aortic arch anomaly (n = 10) were scheduled for interstage monitoring after Norwood I (n = 12) and hybrid (n = 14) procedures. Three infants (11.5 %) died after first-stage palliation (one hybrid patient and two Norwood patients), and three infants (11.5 %) died after second-stage palliation (two hybrid patients and one Norwood patient) (p = 0.83), all after early second-stage surgery (<90 days). The Norwood I and hybrid procedures did not differ in terms of overall mortality (23 %) (three hybrid and three Norwood patients; p = 1.00). Seven infants (26.9 %) could not be discharged from the hospital due to hemodynamic instability and were referred for early second-stage surgery (<90 days). After the first stage, the invasive reevaluation rate before discharge was high (53.8 %), with cardiac catheterizations for 8 of 14 patients after the hybrid procedure and for 6 of 12 patients after the Norwood procedure (p = 0.69). A total of 11 reinterventions were performed (eight by catheter and three by surgery). Of the eight catheter reinterventions, five were performed for hybrid patients (p = 0.22). For 14 infants, 89 days (range 10-177 days) of interstage monitoring were scheduled. One infant (3.9 %) died during the interstage monitoring. The findings showed a breach of the physiologic criteria for interstage monitoring in seven infants (50 %) after 10 days (range 4-68 days) (five hybrid and two Norwood patients), leading to rehospitalization and

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

    PubMed

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

    2015-01-01

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

  13. Nine years of multi-frequency monitoring of the blazar PKS 0048-097: spectral and temporal variability

    NASA Astrophysics Data System (ADS)

    Wierzcholska, Alicja

    2015-08-01

    Context. Blazars are highly variable, radio-loud active galactic nuclei with jets oriented at a small angle to the line of sight. The observed emission of these sources covers the whole electromagnetic spectrum from radio frequencies up to the high or even very high energy gamma-ray range. To understand the complex physics of these objects, multi-wavelength observations and studies on the variability and correlations between different wavelengths are therefore essential. Aims: The long-term multi-frequency observations of PKS 0048-097 are analysed here to investigate its spectral and temporal features. The studies includes nine years of observations of the blazar, which is well studied in the optical and radio domain, but not in the other frequencies. Methods: Multi-wavelength data collected with OVRO, KAIT, Catalina, Swift/UVOT, Swift/XRT, and Fermi/LAT were studied. Results: The performed analysis revealed strong variability in all wavelengths that is most clearly manifested in the X-ray range. The correlation studies do not exhibit any relation between different wavelengths, except for the very strong positive correlation between the optical emission in V and R bands.

  14. Physical Conditions and Variability Processes in AGN Jets through Multi-Frequency Linear and Circular Radio Polarization Monitoring

    NASA Astrophysics Data System (ADS)

    Myserlis, Ioannis; Angelakis, Emmanouil; Kraus, Alex; Fuhrmann, Lars; Karamanavis, Vassilis; Zensus, J.

    2016-11-01

    Radio polarimetry is an invaluable tool to investigate the physical conditions and variability processes in active galactic nuclei (AGN) jets. However, detecting their linear and circular polarization properties is a challenging endeavor due to their low levels and possible depolarization effects. We have developed an end-to-end data analysis methodology to recover the polarization properties of unresolved sources with high accuracy. It has been applied to recover the linear and circular polarization of 87 AGNs measured by the F-GAMMA program from July 2010 to January 2015 with a mean cadence of 1.3 months. Their linear polarization was recovered at four frequencies between 2.64 and 10.45 GHz and the circular polarization at 4.85 and 8.35 GHz. The physical conditions required to reproduce the observed polarization properties and the processes which induce their variability were investigated with a full-Stokes radiative transfer code which emulates the synchrotron emission of modeled jets. The model was used to investigate the conditions needed to reproduce the observed polarization behavior for the blazar 3C 454.3, assuming that the observed variability is attributed to evolving internal shocks propagating downstream.

  15. Variability at the Edge: Optical Near/IR Rapid-cadence Monitoring of Newly Outbursting FU Orionis Object HBC 722

    NASA Astrophysics Data System (ADS)

    Green, Joel D.; Robertson, Paul; Baek, Giseon; Pooley, David; Pak, Soojong; Im, Myungshin; Lee, Jeong-Eun; Jeon, Yiseul; Choi, Changsu; Meschiari, Stefano

    2013-02-01

    We present the detection of day-timescale periodic variability in the r-band lightcurve of newly outbursting FU Orionis-type object HBC 722, taken from >42 nights of observation with the CQUEAN instrument on the McDonald Observatory 2.1 m telescope. The optical/near-IR lightcurve of HBC 722 shows a complex array of periodic variability, clustering around 5.8-day (0.044 mag amplitude) and 1.28-day (0.016 mag amplitude) periods, after removal of overall baseline variation. We attribute the unusual number of comparable strength signals to a phenomenon related to the temporary increase in accretion rate associated with FUors. We consider semi-random "flickering," magnetic braking/field compression and rotational asymmetries in the disk instability region as potential sources of variability. Assuming that the 5.8-day period is due to stellar rotation and the 1.28-day period is indicative of Keplerian rotation at the inner radius of the accretion disk (at 2 R sstarf), we derive a B-field strength of 2.2-2.7 kG, slightly larger than typical T Tauri stars. If instead the 5.8-day signal is from a disk asymmetry, the instability region has an outer radius of 5.4 R sstarf, consistent with models of FUor disks. Further exploration of the time domain in this complicated source and related objects will be key to understanding accretion processes.

  16. VARIABILITY AT THE EDGE: OPTICAL NEAR/IR RAPID-CADENCE MONITORING OF NEWLY OUTBURSTING FU ORIONIS OBJECT HBC 722

    SciTech Connect

    Green, Joel D.; Robertson, Paul; Pak, Soojong; Meschiari, Stefano; Baek, Giseon; Lee, Jeong-Eun; Pooley, David; Im, Myungshin; Jeon, Yiseul; Choi, Changsu

    2013-02-10

    We present the detection of day-timescale periodic variability in the r-band lightcurve of newly outbursting FU Orionis-type object HBC 722, taken from >42 nights of observation with the CQUEAN instrument on the McDonald Observatory 2.1 m telescope. The optical/near-IR lightcurve of HBC 722 shows a complex array of periodic variability, clustering around 5.8-day (0.044 mag amplitude) and 1.28-day (0.016 mag amplitude) periods, after removal of overall baseline variation. We attribute the unusual number of comparable strength signals to a phenomenon related to the temporary increase in accretion rate associated with FUors. We consider semi-random 'flickering', magnetic braking/field compression and rotational asymmetries in the disk instability region as potential sources of variability. Assuming that the 5.8-day period is due to stellar rotation and the 1.28-day period is indicative of Keplerian rotation at the inner radius of the accretion disk (at 2 R {sub *}), we derive a B-field strength of 2.2-2.7 kG, slightly larger than typical T Tauri stars. If instead the 5.8-day signal is from a disk asymmetry, the instability region has an outer radius of 5.4 R {sub *}, consistent with models of FUor disks. Further exploration of the time domain in this complicated source and related objects will be key to understanding accretion processes.

  17. Long term photometric monitoring with the Mercator telescope. Frequencies and mode identification of variable O-B stars

    NASA Astrophysics Data System (ADS)

    De Cat, P.; Briquet, M.; Aerts, C.; Goossens, K.; Saesen, S.; Cuypers, J.; Yakut, K.; Scuflaire, R.; Dupret, M.-A.; Uytterhoeven, K.; van Winckel, H.; Raskin, G.; Davignon, G.; Le Guillou, L.; van Malderen, R.; Reyniers, M.; Acke, B.; De Meester, W.; Vanautgaerden, J.; Vandenbussche, B.; Verhoelst, T.; Waelkens, C.; Deroo, P.; Reyniers, K.; Ausseloos, M.; Broeders, E.; Daszyńska-Daszkiewicz, J.; Debosscher, J.; De Ruyter, S.; Lefever, K.; Decin, G.; Kolenberg, K.; Mazumdar, A.; van Kerckhoven, C.; De Ridder, J.; Drummond, R.; Barban, C.; Vanhollebeke, E.; Maas, T.; Decin, L.

    2007-02-01

    Aims: We selected a large sample of O-B stars that were considered as (candidate) slowly pulsating B, β Cep, and Maia stars after the analysis of their hipparcos data. We analysed our new seven passband geneva data collected for these stars during the first three years of scientific operations of the mercator telescope. We performed a frequency analysis for 28 targets with more than 50 high-quality measurements to improve their variability classification. For the pulsating stars, we tried both to identify the modes and to search for rotationally split modes. Methods: We searched for frequencies in all the geneva passbands and colours by using two independent frequency analysis methods and we applied a 3.6 S/N-level criterion to locate the significant peaks in the periodograms. The modes were identified by applying the method of photometric amplitudes for which we calculated a large, homogeneous grid of equilibrium models to perform a pulsational stability analysis. When both the radius and the projected rotational velocity of an object are known, we determined a lower limit for the rotation frequency to estimate the expected frequency spacings in rotationally split pulsation modes. Results: We detected 61 frequencies, among which 33 are new. We classified 21 objects as pulsating variables (7 new confirmed pulsating stars, including 2 hybrid β Cep/SPB stars), 6 as non-pulsating variables (binaries or spotted stars), and 1 as photometrically constant. All the Maia candidates were reclassified into other variability classes. We performed mode identification for the pulsating variables for the first time. The most probable ℓ value is 0, 1, 2, and 4 for 1, 31, 9, and 5 modes, respectively, including only 4 unambiguous identifications. For 7 stars we cannot rule out that some of the observed frequencies belong to the same rotationally split mode. For 4 targets we may begin to resolve close frequency multiplets. Based on observations collected with the p7 photometer

  18. A study of familial MELAS: evaluation of A3243G mutation, clinical phenotype, and magnetic resonance spectroscopy-monitored progression.

    PubMed

    Chen, Chunnuan; Xiong, Nian; Wang, Yuhui; Xiong, Jing; Huang, Jinsha; Zhang, Zhentao; Wang, Tao

    2012-01-01

    The clinical manifestations of mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes syndrome (MELAS syndrome) are nonspecific and can easily be misdiagnosed. Magnetic resonance spectroscopy (MRS)-based detection of lactate in the brain has been found to be of diagnostic help in MELAS syndrome, however, the issue of whether MRS features vary by stage remains unresolved. We assessed the causative mutation and radiological features of a family of MELAS. Four of the family members harbored the A3243G mutation, probably of maternal inheritance. However, the clinical phenotypic expression was different in these patients. MRS showed a lactate peak, decreased N-acetylaspartate, choline, and creatine, which became more pronounced with progression of the disease, demonstrating that brain-MRS-based detection of lactate may be a suitable way to monitor the progression and treatment of MELAS.

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

    NASA Astrophysics Data System (ADS)

    Bieroza, Magdalena; Heathwaite, Louise

    2013-04-01

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

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

    PubMed

    Martin, Colin J

    2016-06-01

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