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Sample records for monitoring clinical variables

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

    PubMed

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

    2015-02-01

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

  2. Glycemic variability: Clinical implications.

    PubMed

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

    2013-07-01

    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.

  3. Glycemic variability: Clinical implications

    PubMed Central

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

    2013-01-01

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

  4. Evaluation of noncompliance in schizophrenia patients using electronic monitoring (MEMS) and its relationship to sociodemographic, clinical and psychopathological variables.

    PubMed

    Acosta, Francisco J; Bosch, Esperanza; Sarmiento, Gerardo; Juanes, Nuria; Caballero-Hidalgo, Araceli; Mayans, Teresa

    2009-02-01

    Noncompliance is common in patients with schizophrenia and can have serious consequences; therefore research of the variables associated with noncompliance is a priority. Although the MEMS device is regarded as the "reference standard" for evaluating compliance, it has been used in very few published studies. Compliance was evaluated in 102 outpatients diagnosed with schizophrenia according to ICD-10 criteria. Compliance was evaluated with the MEMS device for 3 months in 79 patients who were on oral antipsychotic treatments. Baseline evaluations included sociodemographic, clinical, treatment-related and psychopathological variables. The psychiatrist, patients and relatives also provided compliance estimates. Noncompliant behaviors were observed in 42.3% of patients. Agreement between estimations by the psychiatrist and the MEMS findings was fair, and agreements between those of both patients and relatives and the MEMS findings were slight. Noncompliant patients showed poor insight, conceptual disorganization, stereotyped thinking and poor attention as compared to compliant patients. A large percentage of schizophrenic patients failed to adequately comply with their prescribed treatment. Compliance was overestimated by the psychiatrist, by patients and by relatives. Poorer insight and increased conceptual disorganization were independently associated with noncompliance. Identification of factors associated with noncompliance and strategies to reduce these behaviors would help improve the prognosis of schizophrenia.

  5. 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.

  6. 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.)

  7. 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.

  8. 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.

  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. 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.

  11. 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

  12. 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.

  13. [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.

  14. [Clinical variables of preoperative risk].

    PubMed

    Saad, I A; Zambon, L

    2001-01-01

    To identify risk variables leading to early postoperative pulmonary complication (POPC) in thoracic and upper abdominal surgery. 297 patients submitted to elective surgery were classified as low, moderate and high risk for POPC using PORT scale, following Torrington & Henderson (1988). The patients were followed up for 72 hours postoperative. POPC were defined as atelectasis, pneumonia, tracheobronchitis, wheezing, prolonged intubation and/or prolonged mechanical ventilation. Univariate analysis was applied to study these independent variables: type of surgery, age, nutritional status (BMI), respiratory disease, smoking habit, spirometry and surgical time. Multivariate logistic regression analysis were performed in order to evaluate the relationship between independent and dependent (POPC) variables. POPC incidence was 12.1%. By multivariate logistic regression analysis the variables increasing chance to POPC was cough with yellow mucus (OR= 3.8), thoracic surgery (OR=2.9) compared to abdominal surgery, BMI (OR=1.13), duration of smoking (OR=1.03) and prolonged duration of surgery (OR=1.007). In the thoracic surgery group, multivariate logistic regression analysis showed: wheezing (OR=6.2), BMI (OR=1.15), long time smoking (OR= 1.04) and prolonged duration of surgery (OR= 1.007) related to POPC. The variables occurrence that increased chance to POPC in thoracic and upper abdominal surgery were: cough with yellow mucus, thoracic surgery, BMI, duration of smoking and duration of surgery. Regarding the thoracic surgery group the significance variables were wheezing, BMI, duration of smoking and duration of surgery.

  15. [Clinical classification of variable angle exotrophy].

    PubMed

    Arroyo-Yllanes, María Estela; Osorio-González, Déborah Itzel; Pérez-Pérez, José Fernando

    2007-01-01

    Variable exotropia is determined by a series of mechanisms that provide different clinical characteristics to outline individual therapy. There is no specific categorization that can identify such an entity. A clinical classification is proposed that includes different clinical features in accordance with the mechanisms involved in the variability genesis of such exotropias. Patients with a diagnosis of variable angle exotropia without previous surgery were included. A complete ophthalmic and strabismus exploration was performed. Variability characteristics were studied and grouped by entries in the classification proposed. Ninety patients were examined from the Pediatric Ophthalmology and Strabismus Unit of the General Hospital of Mexico O.D., with a diagnosis of variable angle exotropia. The following forms of presentations were found: secondary variable angle exotropia due to neurological alteration in 32 cases (35.5%), secondary variable angle exotropia due to monocular bad vision in 19 cases (21.2%), dissociated horizontal deviation in 14 cases (15.5%), mixed variable angle exotropia in 22 cases (4.5%) and primary variable angle exotropia in 3 cases (3.33%). This classification allows categorization of all patients of variable angle exotropia into proposed categories. The most common mechanism responsible for variability is neurological alteration. Primary variable angle exotropias are rare and are present in a minimum percentage.

  16. 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.

  17. [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.

  18. What variables can influence clinical reasoning?

    PubMed

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

    2012-12-01

    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. 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. 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) (R(2) chnage = 0.46, P Value = 0.000). 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.

  19. 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

  20. Esophageal Impedance Monitoring: Clinical Pearls and Pitfalls.

    PubMed

    Ravi, Karthik; Katzka, David A

    2016-09-01

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

  1. 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.

  2. 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. © 2016 John Wiley & Sons Ltd.

  3. 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

  4. 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.; hide

    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.

  5. Monitoring in neuroanaesthesia: update of clinical usefulness.

    PubMed

    Fàbregas, N; Gomar, C

    2001-07-01

    The aim of specific monitoring in neuroanaesthesia is to detect, as quickly as possible, intraoperative ischaemic insults so that the brain and the spinal cord may be protected from harmful and frequently inevitable events due to the type of surgery, patient positioning, haemodynamic changes or any intercurrent event. New monitors are being introduced into the operating theatre, but only a few are considered to be an absolute standard of care in neurosurgery, e.g. facial nerve monitoring for surgery of acoustic neuromas and recording of evoked potentials during repair of scoliosis. In the past decade, new monitoring devices have moved from the experimental stage to the operating theatre and although most are still in a phase of technological development and/or definition of their field of applicability they are being used as guides for clinical practice in those instances where cerebral well-being might be impaired. The metabolic consequences of hyperventilation, pharmacological electroencephalogram burst suppression, hypothermia, etc. can now be assessed in the operating theatre. Non-invasive monitoring is being rapidly integrated into our daily work because of its lack of secondary effects. Nevertheless, each new development is regarded as an addition rather than as a substitute for existing equipment. The perfect combination of monitors to provide essential information during an individual surgical procedure to influence a better patient outcome, is still uncertain and needs extensive clinical research.

  6. 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.

  7. Bimodal radio variability in OVRO-40 m-monitored blazars

    NASA Astrophysics Data System (ADS)

    Liodakis, I.; Pavlidou, V.; Hovatta, T.; Max-Moerbeck, W.; Pearson, T. J.; Richards, J. L.; Readhead, A. C. S.

    2017-06-01

    Blazars are known to show periods of quiescence followed by outbursts visible throughout the electromagnetic spectrum. We present a novel maximum likelihood approach to capture this bimodal behaviour by examining blazar radio variability in the flux-density domain. We separate quiescent and flaring components of a source's light curve by modelling its flux-density distribution as a series of 'off'- and 'on'-states. Our modelling allows us to extract information regarding the flaring ratio, duty cycle, and the modulation index in the 'off'-state, in the 'on'-state, as well as throughout the monitoring period of each blazar. We apply our method to a flux-density-limited subsample from the Owens Valley Radio Observatory's 15 GHz blazar monitoring programme, and explore differences in the variability characteristics between BL Lacs and FSRQs as well as between γ-ray detected and non-detected sources. We find that (1) BL Lacs are more variable and have relatively larger outbursts than the FSRQs; (2) unclassified blazar candidates in our sample show similar variability characteristics as the FSRQs and (3) γ-ray detected differ from the γ-ray non-detected sources in all their variability properties, suggesting a link between the production of γ-rays and the mechanism responsible for the radio variability. Finally, we fit distributions for blazar flaring ratios, duty cycles, and on- and off-modulation indices that can be used in population studies of variability-dependent blazar properties.

  8. 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.

  9. Reconfigurable wearable to monitor physiological variables and movement

    NASA Astrophysics Data System (ADS)

    Romero, Francisco J.; Morales, Diego P.; Castillo, Encarnación; García, Antonio; Tahmassebi, Amirhessam; Meyer-Baese, Anke

    2017-05-01

    This article presents a preliminary prototype of a wearable instrument for oxygen saturation and ECG monitoring. The proposed measuring system is based on the light reflection variability of a LED emission on the subject temple. Besides, the system has the capacity to incorporate electrodes to obtain ECG measurements. All measurements are stored and transmitted to a mobile device (tablet or smartphone) through a Bluetooth link.

  10. 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.

  11. 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.

  12. Suicide attempts in schizophrenic patients: clinical variables.

    PubMed

    Mauri, M C; Paletta, S; Maffini, M; Moliterno, D; Altamura, A C

    2013-10-01

    Schizophrenia is associated with a significant risk of suicide: 40-50% of schizophrenic patients report suicidal ideation at some point in their lives, and 4-13% eventually commit suicide. In order to be able to predict and prevent suicide in schizophrenic patients, it is necessary to investigate and characterise suicide victims who meet the criteria for psychotic disorders and risk factors. The aim of this retrospective study was to verify the associations between suicide attempts (SAs) and the demographic and clinical variables of 106 patients who met the DSM-IV-TR criteria for schizophrenia. The patients were divided into two groups on the basis of the presence/absence of lifetime suicide attempts, and their main demographic and clinical characteristics were analysed and compared. The patients with a history of SAs frequently had a duration of untreated psychosis (DUP) of ≥1 year (chi-squared test=9.984, df=1, p=0.0016). They also showed significant associations with the presence of a depressive dimension (chi-squared test=4.439, df=1, p=0.0351), hospitalisations before SAs (chi-squared test=25.515, df=1, p <0.001), and a family history of psychiatric disorders (chi-squared test=12.668, df=2, p=0.0018) or suicidal behaviours (chi-squared test=18.241, df=2, p=0.0001). Finally, they were more frequently prescribed typical antipsychotic agents. The severity of psychiatric symptoms indicates a high risk of suicide in schizophrenic patients. Further prospective studies of larger samples should investigate the role of early interventions and atypical antipsychotic treatment in reducing the risk. Copyright © 2013 Elsevier B.V. All rights reserved.

  13. [Variability in the recommendations for the clinical management of osteoporosis].

    PubMed

    Sanfélix-Genovés, José; Catalá-López, Ferrán; Sanfélix-Gimeno, Gabriel; Hurtado, Isabel; Baixauli, Cristóbal; Peiró, Salvador

    2014-01-07

    Analysis of the variability in the recommendations of the main guidelines and clinical documents for the management of osteoporosis. Searches were carried out in PubMed, Google, web pages of national and international scientific societies related to the management of osteoporosis, and agencies that develop guidelines. We analyzed guidelines and clinical documents that included recommendations for the indication of bone densitometry and/or pharmacological treatment, which could influence the management of osteoporosis in the Spanish National Health System, which have been published between 2006 and 2012. We included 12 documents. Eleven recommend performing bone densitometry upon assessing women risk factors, but the number and type of risk factors vary between documents: 6 recommend its implementation to all women over 65 years, 4 in men aged 65-70 years, and 3 when there is radiological suspicion of osteoporosis. There is agreement on the recommendations on the indication for densitometry to monitor drug response. In primary prevention, all national documents combined risk factors and densitometric osteoporosis and 3 of them recommend individual assessment according to risk factors. Most of the international guidelines require the calculation of risk with the FRAX(®) tool. In secondary prevention, all documents recommend treatment in cases of hip or clinical vertebral fracture; in men, and for the rest of fractures, the recommendations are heterogeneous. Overall there is a high variability in the recommendations of guidelines and other documents for the management of osteoporosis. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  14. 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.

  15. [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.

  16. Monitoring requested on Cepheid variable 1320-02 W Vir

    NASA Astrophysics Data System (ADS)

    Waagen, Elizabeth O.

    2006-01-01

    Longtime AAVSO member and colleague Dr. George Wallerstein, University of Washington, has requested our assistance in monitoring the Cepheid variable W Vir in support of his scheduled observing later this month at Apache Point Observatory in Sunspot, New Mexico. Visual and CCD observations are requested. For PEP observers who can reach magnitude 10 or fainter, PEP-V observations are also requested. Dr. Wallerstein will be observing with the 3.5-meter Astrophysical Research Consortium Telescope for one hour per night for 10 nights, starting January 18. His goal is to observe W Vir from minimum to well after maximum. Visual/CCD observations are essential to know where on the light curve his observations fall. Finder charts with sequence may be created using the AAVSO Variable Star Plotter (https://www.aavso.org/vsp). Observations should be submitted to the AAVSO International Database. See full Alert Notice for more details.

  17. 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.

  18. 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.

  19. Swift X-ray monitoring of stellar coronal variability

    NASA Astrophysics Data System (ADS)

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

    2017-08-01

    We used California Planet Search Ca II H and K core emission measurements to identify and characterize chromospheric activity cycles in a sample of main-sequence FGK stars. About a dozen of these with existing ROSAT archival data were targeted with Swift to obtain a current epoch X-ray flux. We find that coronal variability by a factor of several is common on decade-long timescales (we attempt to link to the chromospheric cycle phase) but can also occur on short timescales between Swift visits to a given target, presumably related to stellar rotation and coronal inhomogeneity or to small flares.Additionally, we present new Swift monitoring 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.

  20. 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

  1. 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).

  2. 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.

  3. 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

  4. Heart rate variability monitoring and assessment system on chip.

    PubMed

    Massagram, Wansuree; Boric-Lubecke, Olga; Macchiarulo, Luca; Chen, Mingqi

    2005-01-01

    This paper describes a system on a chip for heart rate variability monitoring and assessment. The system design applies digital techniques to measure RR intervals from ECG signals, then categorizes and stores HRV measures in an internal memory. The system has been tested for functionality, synthesized and laid out in a 0.5 μm CMOS technology in a 3x3 mm2chip with less than 1.5 μW power dissipation. The chip detects all R peaks with millisecond accuracy after the initial 2 seconds of data, and stores up to 2 minutes of continuous ECG data and up to 4 minutes of HRV histogram. Compact size, low cost, and low power consumption make this chip suitable for employment in modern implantable and portable devices.

  5. 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.

  6. 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.

  7. 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.

  8. 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

  9. Request for regular monitoring of the symbiotic variable RT Cru

    NASA Astrophysics Data System (ADS)

    Waagen, Elizabeth O.

    2014-08-01

    Dr. Margarita Karovska (Harvard-Smithsonian Center for Astrophysics) and colleagues have requested AAVSO observer assistance in their campaign on the symbiotic variable RT Cru (member of a new class of hard X-ray emitting symbiotic binaries). Weekly or more frequent monitoring (B, V, and visual) beginning now is requested in support of upcoming Chandra observations still to be scheduled. "We plan Chandra observations of RT Cru in the near future that will help us understand the characteristics of the accretion onto the white dwarf in this sub-class of symbiotics. This is an important step for determining the precursor conditions for formation of a fraction of asymmetric Planetary Nebulae, and the potential of symbiotic systems as progenitors of at least a fraction of Type Ia supernovae." Finder charts with sequence may be created using the AAVSO Variable Star Plotter (http://www.aavso.org/vsp). Observations should be submitted to the AAVSO International Database. See full Alert Notice for more details and observations.

  10. Monitor Variability of Millimeter Lines in IRC+10216

    NASA Astrophysics Data System (ADS)

    He, J. H.; Dinh-V-Trung; Hasegawa, T. I.

    2017-08-01

    A single dish monitoring of millimeter maser lines SiS J = 14-13 and HCN {ν }2={1}f J = 3-2 and several other rotational lines is reported for the archetypal carbon star IRC+10216. Relative line strength variations of 5% ∼ 30% are found for eight molecular line features with respect to selected reference lines. Definite line-shape variations are found in limited velocity intervals of the SiS and HCN line profiles. The asymmetrical line profiles of the two lines are mainly due to the varying components. The dominant varying components of the line profiles have similar periods and phases to the IR light variation, though both quantities show some degree of velocity dependence; there is also variability asymmetry between the blue and red line wings of both lines. Combining the velocities and amplitudes with a wind velocity model, we suggest that the line profile variations are due to SiS and HCN masing lines emanating from the wind acceleration zone. The possible link of the variabilities to thermal, dynamical, and/or chemical processes within or under this region is also discussed.

  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. [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.

  13. Assessment of heart rate variability in breath holding children by 24 hour Holter monitoring.

    PubMed

    Yilmaz, Osman; Ciftel, Murat; Ozturk, Kezban; Kilic, Omer; Kahveci, Hasan; Laloğlu, Fuat; Ceylan, Ozben

    2015-02-01

    Previous studies have shown that the underlying pathophysiologic mechanism in children with breath holding may be generalised autonomic dysregulation. Thus, we performed cardiac rhythm and heart rate variability analyses using 24-hour Holter monitoring to evaluate the cardiac effects of autonomic dysregulation in children with breath-holding spells. We performed cardiac rhythm and heart rate analyses using 24-hour Holter monitors to evaluate the cardiac effects of autonomic dysregulation in children during a breath-holding spell. Our study group consisted of 68 children with breath-holding spells - 56 cyanotic type and 12 pallid type - and 39 healthy controls. Clinical and heart rate variability results were compared between each spell type - cyanotic or pallid - and the control group; significant differences (p<0.05) in standard deviation of all NN intervals, mean of the standard deviations of all NN intervals for all 5-minute segments, percentage of differences between adjacent RR intervals >50 ms, and square root of the mean of the sum of squares of the differences between adjacent NN intervals values were found between the pallid and cyanotic groups. Holter monitoring for 24 hours and heart rate variability parameters, particularly in children with pallid spells, are crucial for evaluation of cardiac rhythm changes.

  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. Learning temporal weights of clinical events using variable importance.

    PubMed

    Zhao, Jing; Henriksson, Aron

    2016-07-21

    Longitudinal data sources, such as electronic health records (EHRs), are very valuable for monitoring adverse drug events (ADEs). However, ADEs are heavily under-reported in EHRs. Using machine learning algorithms to automatically detect patients that should have had ADEs reported in their health records is an efficient and effective solution. One of the challenges to that end is how to take into account the temporality of clinical events, which are time stamped in EHRs, and providing these as features for machine learning algorithms to exploit. Previous research on this topic suggests that representing EHR data as a bag of temporally weighted clinical events is promising; however, the weights were in that case pre-assigned according to their time stamps, which is limited and potentially less accurate. This study therefore focuses on how to learn weights that effectively take into account the temporality and importance of clinical events for ADE detection. Variable importance obtained from the random forest learning algorithm is used for extracting temporal weights. Two strategies are proposed for applying the learned weights: weighted aggregation and weighted sampling. The first strategy aggregates the weighted clinical events from different time windows to form new features; the second strategy retains the original features but samples them by using their weights as probabilities when building each tree in the forest. The predictive performance of random forest models using the learned weights with the two strategies is compared to using pre-assigned weights. In addition, to assess the sensitivity of the weight-learning procedure, weights from different granularity levels are evaluated and compared. In the weighted sampling strategy, using learned weights significantly improves the predictive performance, in comparison to using pre-assigned weights; however, there is no significant difference between them in the weighted aggregation strategy. Moreover, the

  16. 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

  17. The utility of Bayesian predictive probabilities for interim monitoring of clinical trials.

    PubMed

    Saville, Benjamin R; Connor, Jason T; Ayers, Gregory D; Alvarez, JoAnn

    2014-08-01

    Bayesian predictive probabilities can be used for interim monitoring of clinical trials to estimate the probability of observing a statistically significant treatment effect if the trial were to continue to its predefined maximum sample size. We explore settings in which Bayesian predictive probabilities are advantageous for interim monitoring compared to Bayesian posterior probabilities, p-values, conditional power, or group sequential methods. For interim analyses that address prediction hypotheses, such as futility monitoring and efficacy monitoring with lagged outcomes, only predictive probabilities properly account for the amount of data remaining to be observed in a clinical trial and have the flexibility to incorporate additional information via auxiliary variables. Computational burdens limit the feasibility of predictive probabilities in many clinical trial settings. The specification of prior distributions brings additional challenges for regulatory approval. The use of Bayesian predictive probabilities enables the choice of logical interim stopping rules that closely align with the clinical decision-making process. © The Author(s), 2014.

  18. The utility of Bayesian predictive probabilities for interim monitoring of clinical trials

    PubMed Central

    Connor, Jason T.; Ayers, Gregory D; Alvarez, JoAnn

    2014-01-01

    Background Bayesian predictive probabilities can be used for interim monitoring of clinical trials to estimate the probability of observing a statistically significant treatment effect if the trial were to continue to its predefined maximum sample size. Purpose We explore settings in which Bayesian predictive probabilities are advantageous for interim monitoring compared to Bayesian posterior probabilities, p-values, conditional power, or group sequential methods. Results For interim analyses that address prediction hypotheses, such as futility monitoring and efficacy monitoring with lagged outcomes, only predictive probabilities properly account for the amount of data remaining to be observed in a clinical trial and have the flexibility to incorporate additional information via auxiliary variables. Limitations Computational burdens limit the feasibility of predictive probabilities in many clinical trial settings. The specification of prior distributions brings additional challenges for regulatory approval. Conclusions The use of Bayesian predictive probabilities enables the choice of logical interim stopping rules that closely align with the clinical decision making process. PMID:24872363

  19. [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.

  20. 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.

  1. 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.

  2. 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

  3. 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.

  4. 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

  5. Variable Accuracy of Wearable Heart Rate Monitors during Aerobic Exercise.

    PubMed

    Gillinov, Stephen; Etiwy, Muhammad; Wang, Robert; Blackburn, Gordon; Phelan, Dermot; Gillinov, A Marc; Houghtaling, Penny; Javadikasgari, Hoda; Desai, Milind Y

    2017-08-01

    Athletes and members of the public increasingly rely on wearable HR monitors to guide physical activity and training. The accuracy of newer, optically based monitors is unconfirmed. We sought to assess the accuracy of five optically based HR monitors during various types of aerobic exercise. Fifty healthy adult volunteers (mean ± SD age = 38 ± 12 yr, 54% female) completed exercise protocols on a treadmill, a stationary bicycle, and an elliptical trainer (±arm movement). Each participant underwent HR monitoring with an electrocardiogaphic chest strap monitor (Polar H7), forearm monitor (Scosche Rhythm+), and two randomly assigned wrist-worn HR monitors (Apple Watch, Fitbit Blaze, Garmin Forerunner 235, and TomTom Spark Cardio), one on each wrist. For each exercise type, HR was recorded at rest, light, moderate, and vigorous intensity. Agreement between HR measurements was assessed using Lin's concordance correlation coefficient (rc). Across all exercise conditions, the chest strap monitor (Polar H7) had the best agreement with ECG (rc = 0.996) followed by the Apple Watch (rc = 0.92), the TomTom Spark (rc = 0.83), and the Garmin Forerunner (rc = 0.81). Scosche Rhythm+ and Fitbit Blaze were less accurate (rc = 0.75 and rc = 0.67, respectively). On treadmill, all devices performed well (rc = 0.88-0.93) except the Fitbit Blaze (rc = 0.76). While bicycling, only the Garmin, Apple Watch, and Scosche Rhythm+ had acceptable agreement (rc > 0.80). On the elliptical trainer without arm levers, only the Apple Watch was accurate (rc = 0.94). None of the devices was accurate during elliptical trainer use with arm levers (all rc < 0.80). The accuracy of wearable, optically based HR monitors varies with exercise type and is greatest on the treadmill and lowest on elliptical trainer. Electrode-containing chest monitors should be used when accurate HR measurement is imperative.

  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. 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

  8. Variability of clinical features in attacks of migraine with aura.

    PubMed

    Hansen, Jakob M; Goadsby, Peter J; Charles, Andrew C

    2016-03-01

    There is significant variability in the clinical presentation of migraine, both among patients, and between attacks in an individual patient. We examined clinical features of migraine with aura in a large group of patients enrolled in a clinical trial, and compared retrospective migraine attack characteristics reported upon enrollment in the trial with those recorded prospectively in the trial. Patients with migraine (n = 267) with typical visual aura in more than 30% of their attacks were enrolled from 16 centers for a clinical trial. Upon enrollment, patients provided a detailed retrospective description of the clinical features of their attacks of migraine. During the trial, clinical symptoms in migraine attacks starting with aura were recorded prospectively in 861 attacks. Retrospectively reported visual aura symptoms were variable and often overlapping; the most common symptoms were dots or flashing lights, wavy or jagged lines, blind spots, and tunnel vision. Multiple patients reported more than one visual phenomenon. Approximately half of the patients reported nonvisual aura symptoms, the most common were numbness and tingling, followed by difficulty in recalling or speaking words. A significant percentage of patients also reported a change in olfaction. There were several inconsistencies between the features of prospectively recorded and retrospectively reported attacks. Headache, nausea, photophobia, and phonophobia were all less common in prospectively recorded attacks as compared with retrospective reporting. Nausea was prospectively recorded in only 51% of attacks and mostly with mild intensity. The occurrence and severity of nausea was reduced with advancing patient age. Phonophobia was not consistently recorded in conjunction with photophobia. These findings are consistent with variable involvement of different brain regions during a migraine attack. The variable occurrence of nausea, and phonophobia in conjunction with photophobia, both defining

  9. 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; hide

    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.

  10. 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.

  11. [Current Clinical Variables in Schizophrenia Cases with Suicide Attempt History].

    PubMed

    Sağlam Aykut, Demet; Civil Arslan, Filiz; Özkorumak Karagüzel, Evrim; Karakullukçu, Serdar; Tiryaki, Ahmet

    2017-01-01

    High suicide risk was shown to be related with depression and low quality of life in studies investigating clinical variables related to suicidal behavior. The aim of this study was to investigate the effects of a suicide attempt on clinical presentation by comparing sociodemographic variables, clinical signs, symptoms of depression, quality of life, social functionality, and reported adverse drug reactions in schizophrenic patients with and without suicide. Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale (CDS), Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), Social Functioning Scale (SFS), and Udvalg for Kliniske Undersøgelser Side Effect Rating Scale (UKU) were administered to 115 patients with schizophrenia. 44.3% of patients had at least one suicide attempt. Among sociodemographic variables, a family history of suicide, smoking, and total duration of disease were significantly higher in patients with suicide history than without. Scores of CDS and UKU subscores were significantly higher, and quality of life and social occupation in social functionality were significantly lower in patients with a history of suicide. In correlation analysis, CSD was negatively correlated with Q-LES-Q and independency/performance subscore of SFI, and positively correlated with UKU-Neurological subscore. In line with this data, suicidal behavior may be suggested to affect clinical presentation and course characteristic of schizophrenic patients. Additional treatments towards factors that may impact on the clinical course and social support programs might be suggested for these patients.

  12. A framework for evaluating usability of clinical monitoring technology.

    PubMed

    Daniels, Jeremy; Fels, Sidney; Kushniruk, Andre; Lim, Joanne; Ansermino, J Mark

    2007-10-01

    Technology design is a complex task, and acceptability is enhanced when usability is central to its design. Evaluating usability is a challenge for purchasers and developers of technology. We have developed a framework for testing the usability of clinical monitoring technology through literature review and experience designing clinical monitors. The framework can help designers meet key international usability norms. The framework includes these direct testing methods: thinking aloud, question asking, co-discovery, performance and psychophysiological measurement. Indirect testing methods include: questionnaires and interviews, observation and ethnographic studies, and self-reporting logs. Inspection, a third usability testing method, is also included. The use of these methods is described and practical examples of how they would be used in the development of an innovative monitor are given throughout. This framework is built on a range of methods to ensure harmony between users and new clinical monitoring technology, and have been selected to be practical to use.

  13. 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.

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

    PubMed

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

    2016-07-01

    The outcome of treatment with antidepressants varies markedly across people with the same diagnosis. A clinically significant prediction of outcomes could spare the frustration of trial and error approach and improve the outcomes of major depressive disorder through individualized treatment selection. It is likely that a combination of multiple predictors is needed to achieve such prediction. We used elastic net regularized regression to optimize prediction of symptom improvement and remission during treatment with escitalopram or nortriptyline and to identify contributing predictors from a range of demographic and clinical variables in 793 adults with major depressive disorder. A combination of demographic and clinical variables, with strong contributions from symptoms of depressed mood, reduced interest, decreased activity, indecisiveness, pessimism and anxiety significantly predicted treatment outcomes, explaining 5-10% of variance in symptom improvement with escitalopram. Similar combinations of variables predicted remission with area under the curve 0.72, explaining approximately 15% of variance (pseudo R(2)) in who achieves remission, with strong contributions from body mass index, appetite, interest-activity symptom dimension and anxious-somatizing depression subtype. Escitalopram-specific outcome prediction was more accurate than generic outcome prediction, and reached effect sizes that were near or above a previously established benchmark for clinical significance. Outcome prediction on the nortriptyline arm did not significantly differ from chance. These results suggest that easily obtained demographic and clinical variables can predict therapeutic response to escitalopram with clinically meaningful accuracy, suggesting a potential for individualized prescription of this antidepressant drug. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  15. 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

  16. 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.

  17. Ambulatory and home blood pressure monitoring: gaps between clinical guidelines and clinical practice in Singapore

    PubMed Central

    Setia, Sajita; Subramaniam, Kannan; Teo, Boon Wee; Tay, Jam Chin

    2017-01-01

    Purpose Out-of-office blood pressure (BP) measurements (home blood pressure monitoring [HBPM] and ambulatory blood pressure monitoring [ABPM]) provide important additional information for effective hypertension detection and management decisions. Therefore, out-of-office BP measurement is now recommended by several international guidelines. This study evaluated the practice and uptake of HBPM and ABPM among physicians from Singapore. Materials and methods A sample of physicians from Singapore was surveyed between 8 September and 5 October 2016. Those included were in public or private practice had been practicing for ≥3 years, directly cared for patients ≥70% of the time, and treated ≥30 patients for hypertension per month. The questionnaire covered six main categories: general BP management, BP variability (BPV) awareness/diagnosis, HBPM, ABPM, BPV management, and associated training needs. Results Sixty physicians (30 general practitioners, 20 cardiologists, and 10 nephrologists) were included (77% male, 85% aged 31–60 years, and mean 22-year practice). Physicians recommended HBPM and ABPM to 81% and 27% of hypertensive patients, respectively. HBPM was most often used to monitor antihypertensive therapy (88% of physicians) and 97% thought that ABPM was useful for providing information on BPV. HBPM instructions often differed from current guideline recommendations in terms of frequency, number of measurements, and timing. The proportion of consultation time devoted to discussing HBPM and BPV was one-quarter or less for 73% of physicians, and only 55% said that they had the ability to provide education on HBPM and BPV. Patient inertia, poor patient compliance, lack of medical consultation time, and poor patient access to a BP machine were the most common challenges for implementing out-of-office BP monitoring. Conclusion Although physicians from Singapore do recommend out-of-office BP measurement to patients with hypertension, this survey identified several

  18. Ambulatory and home blood pressure monitoring: gaps between clinical guidelines and clinical practice in Singapore.

    PubMed

    Setia, Sajita; Subramaniam, Kannan; Teo, Boon Wee; Tay, Jam Chin

    2017-01-01

    Out-of-office blood pressure (BP) measurements (home blood pressure monitoring [HBPM] and ambulatory blood pressure monitoring [ABPM]) provide important additional information for effective hypertension detection and management decisions. Therefore, out-of-office BP measurement is now recommended by several international guidelines. This study evaluated the practice and uptake of HBPM and ABPM among physicians from Singapore. A sample of physicians from Singapore was surveyed between 8 September and 5 October 2016. Those included were in public or private practice had been practicing for ≥3 years, directly cared for patients ≥70% of the time, and treated ≥30 patients for hypertension per month. The questionnaire covered six main categories: general BP management, BP variability (BPV) awareness/diagnosis, HBPM, ABPM, BPV management, and associated training needs. Sixty physicians (30 general practitioners, 20 cardiologists, and 10 nephrologists) were included (77% male, 85% aged 31-60 years, and mean 22-year practice). Physicians recommended HBPM and ABPM to 81% and 27% of hypertensive patients, respectively. HBPM was most often used to monitor antihypertensive therapy (88% of physicians) and 97% thought that ABPM was useful for providing information on BPV. HBPM instructions often differed from current guideline recommendations in terms of frequency, number of measurements, and timing. The proportion of consultation time devoted to discussing HBPM and BPV was one-quarter or less for 73% of physicians, and only 55% said that they had the ability to provide education on HBPM and BPV. Patient inertia, poor patient compliance, lack of medical consultation time, and poor patient access to a BP machine were the most common challenges for implementing out-of-office BP monitoring. Although physicians from Singapore do recommend out-of-office BP measurement to patients with hypertension, this survey identified several important gaps in knowledge and clinical practice.

  19. 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.

  20. [Clinical variability and diagnosis steps in childhood mitochondrial disease].

    PubMed

    Mercier, S; Josselin de Wasch, M; Labarthe, F; Jardel, C; Lombès, A; Munnich, A; Toutain, A; Nivet, H; Saliba, E; Chantepie, A; Castelnau, P

    2009-04-01

    Mitochondrial respiratory chain deficiencies are known for their high clinical variability. Difficult to diagnose, the prevalence of these diseases is probably underestimated. We report 18 children diagnosed with respiratory chain deficiency at the Tours University Hospital over the past 10 years. Three clinical profiles can be distinguished depending on the age at onset of the first symptoms: the neonatal period (4 cases), between 1 month and 2 years of age (10 cases), and after 10 years (4 cases). However, no clinical feature appears specific of any age group. In contrast, respiratory chain analysis on liver biopsy was very informative for all our patients at any age and with any clinical presentation, even with predominant neurological symptoms. These biochemical analyses support the diagnosis of mitochondrial disorders in view of molecular analysis, which nevertheless frequently remains inconclusive. These investigations should benefit from the new molecular screening technologies based on DNA chips that can identify the genomic mutations responsible for these severe and relatively frequent diseases.

  1. [Analysing heart rate variability to improve the monitoring of pain].

    PubMed

    Butruille, Laura; De Jonckheere, Julien; Jeanne, Mathieu; Tavernier, Benoît; Logier, Régis

    2016-12-01

    An innovative technique based on the analysis of instantaneous heart rate variability helps to improve the prevention and management of pain and discomfort. Simple to implement, this non-invasive technique is based on the continuous recording of the electrocardiograph signal. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  2. 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,…

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

    PubMed Central

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

    2011-01-01

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

  4. Variability of clinical functional MR imaging results: a multicenter study.

    PubMed

    Wurnig, Moritz C; Rath, Jakob; Klinger, Nicolaus; Höllinger, Ilse; Geissler, Alexander; Fischmeister, Florian P; Aichhorn, Markus; Foki, Thomas; Kronbichler, Martin; Nickel, Janpeter; Siedentopf, Christian; Staffen, Wolfgang; Verius, Michael; Golaszewski, Stefan; Koppelstätter, Florian; Knosp, Engelbert; Auff, Eduard; Felber, Stephan; Seitz, Rüdiger J; Beisteiner, Roland

    2013-08-01

    To investigate intersite variability of clinical functional magnetic resonance (MR) imaging, including influence of task standardization on variability and use of various parameters to inform the clinician whether the reliability of a given functional localization is high or low. Local ethics committees approved the study; all participants gave written informed consent. Eight women and seven men (mean age, 40 years) were prospectively investigated at three experienced functional MR sites with 1.5- (two sites) or 3-T (one site) MR. Nonstandardized motor and highly standardized somatosensory versions of a frequently requested clinical task (localization of the primary sensorimotor cortex) were used. Perirolandic functional MR variability was assessed (peak activation variability, center of mass [COM] variability, intraclass correlation values, overlap ratio [OR], activation size ratio). Data quality measures for functional MR images included percentage signal change (PSC), contrast-to-noise ratio (CNR), and head motion parameters. Data were analyzed with analysis of variance and a correlation analysis. Localization of perirolandic functional MR activity differed by 8 mm (peak activity) and 6 mm (COM activity) among sites. Peak activation varied up to 16.5 mm (COM range, 0.4-16.5 mm) and 45.5 mm (peak activity range, 1.8-45.5 mm). Signal strength (PSC, CNR) was significantly lower for the somatosensory task (mean PSC, 1.0% ± 0.5 [standard deviation]; mean CNR, 1.2 ± 0.4) than for the motor task (mean PSC, 2.4% ± 0.8; mean CNR, 2.9 ± 0.9) (P < .001, both). Intersite variability was larger with low signal strength (negative correlations between signal strength and peak activation variability) even if the task was highly standardized (mean OR, 22.0% ± 18.9 [somatosensory task] and 50.1% ± 18.8 [motor task]). Clinical practice and clinical functional MR biomarker studies should consider that the center of task-specific brain activation may vary up to 16.5 mm, with

  5. Childhood Depression: Relation to Adaptive, Clinical and Predictor Variables

    PubMed Central

    Garaigordobil, Maite; Bernarás, Elena; Jaureguizar, Joana; Machimbarrena, Juan M.

    2017-01-01

    The study had two goals: (1) to explore the relations between self-assessed childhood depression and other adaptive and clinical variables (2) to identify predictor variables of childhood depression. Participants were 420 students aged 7–10 years old (53.3% boys, 46.7% girls). Results revealed: (1) positive correlations between depression and clinical maladjustment, school maladjustment, emotional symptoms, internalizing and externalizing problems, problem behaviors, emotional reactivity, and childhood stress; and (2) negative correlations between depression and personal adaptation, global self-concept, social skills, and resilience (sense of competence and affiliation). Linear regression analysis including the global dimensions revealed 4 predictors of childhood depression that explained 50.6% of the variance: high clinical maladjustment, low global self-concept, high level of stress, and poor social skills. However, upon introducing the sub-dimensions, 9 predictor variables emerged that explained 56.4% of the variance: many internalizing problems, low family self-concept, high anxiety, low responsibility, low personal self-assessment, high social stress, few aggressive behaviors toward peers, many health/psychosomatic problems, and external locus of control. The discussion addresses the importance of implementing prevention programs for childhood depression at early ages. PMID:28572787

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

    PubMed

    Galli, Alessio; Ambrosini, Francesco; Lombardi, Federico

    2016-08-01

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

  7. 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.

  8. Monitoring variability and changes of the Indonesian Throughflow

    NASA Astrophysics Data System (ADS)

    Feng, Ming; Wijffels, Susan

    2017-04-01

    The Indonesian Throughflow (ITF) is an important component of the upper cell of the global overturning circulation that provides a low-latitude pathway for warm, fresh waters from the Pacific to enter the Indian Ocean. The IX1 XBT line between the coasts of Australia and Indonesia, initially championed by Gary Meyers, crosses the ITF and has now been in operation for more than 30 years. In this presentation, we review research progresses on the variability and changes of the ITF based on the IX1 XBT data, in memory of Gary's contribution to the Indian Ocean research. The ITF passes across a region that comprises the intersection of two ocean waveguides - those of the equatorial Pacific and equatorial Indian Ocean. The ITF geostrophic transport is stronger during La Niñas and weaker during El Niños. The Indian Ocean wind variability associated with the Indian Ocean Dipole (IOD) in many years offsets the Pacific ENSO influences on the ITF geostrophic transport during the developing and mature phases of El Niño and La Niña, due to the covarying IOD variability with ENSO. The IX1 line reveals the geostrophic ITF decadal and multi-decadal changes: there was a weakening change from the mid-1970s climate regime shift followed by a strengthening trend of about 1 Sv every 10 years over the recent decades. These decadal changes appear mostly due to the ITF responses to decadal variations of the trade winds in the Pacific. Climate models project a weakening trend of the ITF under the global warming, due to the slowdown of the global overturning circulation. The consistent and now multidecadal sampling along IX1 is a precious resource for the climate community and is a testament to the vision and commitment of Gary Meyers to use observations to drive insight into earth's climate variability.

  9. 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.

  10. 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."

  11. 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...

  12. 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...

  13. 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...

  14. 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...

  15. 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.

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

    ERIC Educational Resources Information Center

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

    2010-01-01

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

  17. 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.

  18. 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.

  19. 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

  20. 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.

  1. Ultrasound monitoring of the treatment of clinically significant knee osteoarthritis.

    PubMed

    Vojtassak, J; Vojtassak, J

    2014-01-01

    The study presented an ultrasound (US) monitoring of treatment as a new imaging US method with the results of therapy of clinically significant knee osteoarthritis. X-ray is widely used for knee osteoarthritis classification, which does not involve the evaluation of the soft tissue. High frequency and high resolution US of joints (arthrosonography, echoarthrography) assess not only morphologic but also functional changes in the knee joint. In the prospective study, 110 patients with clinically significant knee osteoarthritis were treated non-operative. US examination and US monitoring of therapy was performed during 24 weeks therapy period. A remission of pathomorphologic (marginal osteofytes) and pathophysiologic (effusion in anterior knee and Baker´s cyst) attributes were evaluated according the US classification. Pathomorphologic attributes changes showed a static state, without remission or progression. Pathophysiologic attributes changes showed a remission during the study period. The highest remission was in the first three weeks, 60 % anterior knee effusion and 62 % Baker´s cyst. At the end of study, no changes from the initial US grade was observed in 16 % of effusion in anterior knee and 22 % of Baker´s cyst. Therapeutic resistant Baker´s cyst was present at the end of study in 36 %. We demonstrated a new method - US monitoring of therapy, which can objectivize the efficiency of treatment of clinically significant knee osteoarthritis. We would recommend US monitoring of therapy for the routine use in orthopedic clinical praxis (Tab. 6, Graph 3, Fig. 3, Ref. 15).

  2. 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.

  3. Pedigree and marker information requirements to monitor genetic variability

    PubMed Central

    Roswitha, Baumung; Johann, Sölkner

    2003-01-01

    There are several measures available to describe the genetic variability of populations. The average inbreeding coefficient of a population based on pedigree information is a frequently chosen option. Due to the developments in molecular genetics it is also possible to calculate inbreeding coefficients based on genetic marker information. A simulation study was carried out involving ten sires and 50 dams. The animals were mated over a period of 20 discrete generations. The population size was kept constant. Different situations with regard to the level of polymorphism and initial allele frequencies and mating scheme (random mating, avoidance of full sib mating, avoidance of full sib and half sib mating) were considered. Pedigree inbreeding coefficients of the last generation using full pedigree or 10, 5 and 2 generations of the pedigree were calculated. Marker inbreeding coefficients based on different sets of microsatellite loci were also investigated. Under random mating, pedigree-inbreeding coefficients are clearly more closely related to true autozygosity (i.e., the actual proportion of loci with alleles identical by descent) than marker-inbreeding coefficients. If mating is not random, the demands on the quality and quantity of pedigree records increase. Greater attention must be paid to the correct parentage of the animals. PMID:12927072

  4. 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.

  5. 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.

  6. Variability in the clinical expression of Parkinson's disease.

    PubMed

    Wolters, Erik Ch

    2008-03-15

    Parkinsonism is a clinical syndrome characterized by bradykinesia, hypo-/akinesia, muscular rigidity, and resting tremor, mainly caused by Parkinson's disease (PD). Symptoms of PD are due to a progressive loss of nigral neurons causing striatal dopaminergic denervation. However, nigral degeneration is only a part of the underlying synucleinopathy, and clinical symptoms go far beyond motor parkinsonism. Olfactory disturbances, fatigue, pain, autonomic dysfunction, sleep fragmentation, depression, and dementia with or without psychosis are frequently seen. The variability in the expression of these signs and symptoms, as discussed in this paper, might be explained by the specific topographical sequence of the pathology, depending on the extent and progression of the degenerative process at defined sites. Better insight in the clinicopathological correlations of this disease may help to further develop early diagnosis and adequate therapeutic strategies.

  7. 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

  8. 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.

  9. 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.

  10. Recommendations for Responsible Monitoring and Regulation of Clinical Software Systems

    PubMed Central

    Miller, Randolph A.; Gardner, Reed M.

    1997-01-01

    Abstract In mid-1996, the FDA called for discussions on regulation of clinical software programs as medical devices. In response, a consortium of organizations dedicated to improving health care through information technology has developed recommendations for the responsible regulation and monitoring of clinical software systems by users, vendors, and regulatory agencies. Organizations assisting in development of recommendations, or endorsing the consortium position include the American Medical Informatics Association, the Computer-based Patient Record Institute, the Medical Library Association, the Association of Academic Health Sciences Libraries, the American Health Information Management Association, the American Nurses Association, the Center for Healthcare Information Management, and the American College of Physicians. The consortium proposes four categories of clinical system risks and four classes of measured monitoring and regulatory actions that can be applied strategically based on the level of risk in a given setting. The consortium recommends local oversight of clinical software systems, and adoption by healthcare information system developers of a code of good business practices. Budgetary and other constraints limit the type and number of systems that the FDA can regulate effectively. FDA regulation should exempt most clinical software systems and focus on those systems posing highest clinical risk, with limited opportunities for competent human intervention. PMID:9391932

  11. 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

  12. 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

  13. Clinical benefits of remote versus transtelephonic monitoring of implanted pacemakers.

    PubMed

    Crossley, George H; Chen, Jane; Choucair, Wassim; Cohen, Todd J; Gohn, Douglas C; Johnson, W Ben; Kennedy, Eleanor E; Mongeon, Luc R; Serwer, Gerald A; Qiao, Hongyan; Wilkoff, Bruce L

    2009-11-24

    The purpose of this study was to evaluate remote pacemaker interrogation for the earlier diagnosis of clinically actionable events compared with traditional transtelephonic monitoring and routine in-person evaluation. Pacemaker patient follow-up procedures have evolved from evaluating devices with little programmability and diagnostic information solely in person to transtelephonic rhythm strip recordings that allow monitoring of basic device function. More recently developed remote monitoring technology leverages expanded device capabilities, augmenting traditional transtelephonic monitoring to evaluate patients via full device interrogation. The time to first diagnosis of a clinically actionable event was compared in patients who were followed by remote interrogation (Remote) and those who were followed per standard of care with office visits augmented by transtelephonic monitoring (Control). Patients were randomized 2:1. Remote arm patients transmitted pacemaker information at 3-month intervals. Control arm patients with a single-chamber pacemaker transmitted at 2-month intervals. Control arm patients with dual-chamber devices transmitted at 2-month intervals with an office visit at 6 months. All patients were seen in office at 12 months. The mean time to first diagnosis of clinically actionable events was earlier in the Remote arm (5.7 months) than in the Control arm (7.7 months). Three (2%) of the 190 events in the Control arm and 446 (66%) of 676 events in the Remote arm were identified remotely. The strategic use of remote pacemaker interrogation follow-up detects actionable events that are potentially important more quickly and more frequently than transtelephonic rhythm strip recordings. The use of transtelephonic rhythm strips for pacemaker follow-up is of little value except for battery status determinations. (PREFER [Pacemaker Remote Follow-up Evaluation and Review]; NCT00294645).

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

    PubMed Central

    Viera, Anthony J.; Shimbo, Daichi

    2016-01-01

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

  15. Spatial and temporal variability and monitoring of hydrophysical fields of the Black Sea

    NASA Astrophysics Data System (ADS)

    Ivanov, V. A.

    2014-01-01

    As part of the Russian-Ukrainian program "The Black Sea as a Simulation Model of the Ocean," the monitoring of the marine environment is considered using modern measuring systems. On the basis of historical and contemporary observation data, we estimate the spatial and temporal scales of dominant processes in the Black Sea. We describe the main measuring systems used to monitor the structure and variability of the hydrophysical fields. Examples characterizing the specific features of the Black Sea processes are presented.

  16. Holter monitoring in clinically healthy Cavalier King Charles Spaniels, Wire-haired Dachshunds, and Cairn Terriers.

    PubMed

    Rasmussen, C E; Vesterholm, S; Ludvigsen, T P; Häggström, J; Pedersen, H D; Moesgaard, S G; Olsen, L H

    2011-01-01

    Few reported studies describe normal values from 24-hour ECG (Holter) recordings of small breed dogs. To investigate influence of breed, age, sex, body weight, degree of recording artifact, and mitral valve prolapse (MVP) on Holter recordings of 3 breeds of small dogs that have differing predispositions for myxomatous mitral valve disease. The study also assessed if heart rate (HR) at clinical examination (HRex) was associated with HR during Holter monitoring and evaluated the reproducibility of Holter variables. Fifty clinically healthy, privately owned dogs of the breeds Cavalier King Charles Spaniel (CKCS), Wire-haired Dachshund (wD), or Cairn Terrier (CT). Prospective, longitudinal observational study. Dogs were recruited for clinical examination, echocardiography, and Holter monitoring. In 8 CKCS, Holter recordings were performed twice with a 7-day interval. Arrhythmia and heart rate variability (HRV) analysis (time and frequency domain analysis) were performed on Holter recordings. Fifteen out of 27 Holter derived variables were significantly associated with breed (P < .03), but not with age (P > .7), sex (P > .2), body weight (P > .7), degree of recording artifact (P > .4), or MVP (P > .6). During Holter recording, minimum (P = .0001) and mean HR (P = .0001) were higher in CKCS compared with wD. CKCS had significantly lower values than wD, CT, or both in 10 out of 13 HRV variables (P < .03). Minimum and mean HR during Holter recording were correlated with HRex (r = 0.55, P = .0003). HR and time domain variables had a coefficient of variation <10%. There is an influence of breed on Holter-derived variables in 3 breeds of small dogs. Arrhythmia and HRV analysis can be performed on 24-hour ambulatory ECG (Holter) recordings. Arrhythmia analysis includes HR measurements and identification of arrhythmias. Copyright © 2011 by the American College of Veterinary Internal Medicine.

  17. 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

  18. 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.

  19. 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

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

    NASA Astrophysics Data System (ADS)

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

    2015-09-01

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

  1. Pulmonary function in ankylosing spondylitis: association with clinical variables.

    PubMed

    Brambila-Tapia, A J L; Rocha-Muñoz, A D; Gonzalez-Lopez, L; Vázquez-Del-Mercado, M; Salazar-Páramo, M; Dávalos-Rodríguez, I P; De la Cerda-Trujillo, L; Diaz-Toscano, M L; Hernandez-Cuervo, P; Diaz-Rizo, V; Sanchez-Mosco, D; Vazquez-Jimenez, J C; Cardona-Muñoz, E G; Gamez-Nava, J I

    2013-09-01

    To evaluate the association between pulmonary function and clinical variables in ankylosing spondylitis (AS) and to compare the pulmonary function of patients with AS with that of healthy controls, 61 AS patients and 74 healthy controls were included. In AS, we assessed clinical disease indices (BASDAI, BASFI, BASG), morning stiffness, number of hypersensitive entheses, metrology measures, 6-min walking test, acute phase reactants, radiological presence of "bamboo spine," and severity of radiological involvement in sacroiliac and vertebral joints. AS and healthy controls had similar age and gender. All the parameters of pulmonary function were significantly diminished in AS than in healthy controls (p < 0.001), with a higher proportion of restrictive pattern (57.4 vs. 5.4 %). In AS, pulmonary function correlated negatively with BASDAI, BASFI, BASG, morning stiffness, number of hypersensitive entheses, occiput-wall distance, and ESR, and positively with 6-min walking test. There was no association between pulmonary function with radiological stage of vertebral joints and sacroiliac joints, "bamboo spine," disease duration, or chest expansion. A higher frequency of AS patients had a decreased pulmonary function and results of the 6-min walking test. These abnormalities in AS were more related with disease activity than with mobility limitation.

  2. [Predictive variables for mental retardation in a Pediatric Epilepsy Monitoring Unit. Neuropsychological assessment].

    PubMed

    López-Sala, A; Palacio-Navarro, A; Donaire, A; García, G; Colomé, R; Boix, C; Sans, A; Campistol, J; Sanmartí, F X

    2010-03-03

    We sought to describe the epidemiological and clinical data from our patients in the Pediatric Epilepsy Monitoring Unit (PEMU) of the Sant Joan de Deu Hospital of Barcelona, and determine the variables of risk for mental retardation. A retrospective review of PEMU reports and hospital discharge summaries from March 2005 to December 2008 was conducted. The data from patients with intelligence quotient (IQ) estimated, older than 3 years of age and with epileptic electroencephalography (EEG) activity was analyzed in 158 patients (8.8 +/- 5.2 years; 55.1% boys). Of those pediatric patients, 63 had IQ less than 70 and 47 an IQ greater than or equal to 70. Intractable epilepsy was present in all of them. The percentage of the patients with mental retardation is significantly higher in patients with onset of epilepsy before 24 months (68.3%) than patients with later onset (27.7%). Onset of seizures, EEG findings and epilepsy etiology are significant risk factors for mental retardation. Early age at seizure, multifocal epilepsy and cryptogenic etiology are factors of worse prognosis to normal development of cognitive functions in pediatric intractable epilepsy.

  3. [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.

  4. 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

  5. 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.

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

    PubMed

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

    2016-10-01

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

  7. Ambulatory blood pressure monitoring-derived short-term blood pressure variability in primary hyperparathyroidism.

    PubMed

    Concistrè, A; Grillo, A; La Torre, G; Carretta, R; Fabris, B; Petramala, L; Marinelli, C; Rebellato, A; Fallo, F; Letizia, C

    2017-07-12

    Primary hyperparathyroidism is associated with a cluster of cardiovascular manifestations, including hypertension, leading to increased cardiovascular risk. The aim of our study was to investigate the ambulatory blood pressure monitoring-derived short-term blood pressure variability in patients with primary hyperparathyroidism, in comparison with patients with essential hypertension and normotensive controls. Twenty-five patients with primary hyperparathyroidism (7 normotensive,18 hypertensive) underwent ambulatory blood pressure monitoring at diagnosis, and fifteen out of them were re-evaluated after parathyroidectomy. Short-term-blood pressure variability was derived from ambulatory blood pressure monitoring and calculated as the following: 1) Standard Deviation of 24-h, day-time and night-time-BP; 2) the average of day-time and night-time-Standard Deviation, weighted for the duration of the day and night periods (24-h "weighted" Standard Deviation of BP); 3) average real variability, i.e., the average of the absolute differences between all consecutive BP measurements. Baseline data of normotensive and essential hypertension patients were matched for age, sex, BMI and 24-h ambulatory blood pressure monitoring values with normotensive and hypertensive-primary hyperparathyroidism patients, respectively. Normotensive-primary hyperparathyroidism patients showed a 24-h weighted Standard Deviation (P < 0.01) and average real variability (P < 0.05) of systolic blood pressure higher than that of 12 normotensive controls. 24-h average real variability of systolic BP, as well as serum calcium and parathyroid hormone levels, were reduced in operated patients (P < 0.001). A positive correlation of serum calcium and parathyroid hormone with 24-h-average real variability of systolic BP was observed in the entire primary hyperparathyroidism patients group (P = 0.04, P  = 0.02; respectively). Systolic blood pressure variability is increased in normotensive

  8. [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.

  9. 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.

  10. Monitoring trends in bird populations: addressing background levels of annual variability in counts

    Treesearch

    Jared Verner; Kathryn L. Purcell; Jennifer G. Turner

    1996-01-01

    Point counting has been widely accepted as a method for monitoring trends in bird populations. Using a rigorously standardized protocol at 210 counting stations at the San Joaquin Experimental Range, Madera Co., California, we have been studying sources of variability in point counts of birds. Vegetation types in the study area have not changed during the 11 years of...

  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. 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

  14. 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

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

    PubMed Central

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

    2015-01-01

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

  16. Implications of climate variability for monitoring the effectiveness of global mercury policy

    NASA Astrophysics Data System (ADS)

    Giang, A.; Monier, E.; Couzo, E. A.; Pike-thackray, C.; Selin, N. E.

    2016-12-01

    We investigate how climate variability affects ability to detect policy-related anthropogenic changes in mercury emissions in wet deposition monitoring data using earth system and atmospheric chemistry modeling. The Minamata Convention, a multilateral environmental agreement that aims to protect human health and the environment from anthropogenic emissions and releases of mercury, includes provisions for monitoring treaty effectiveness. Because meteorology can affect mercury chemistry and transport, internal variability is an important contributor to uncertainty in how effective policy may be in reducing the amount of mercury entering ecosystems through wet deposition. We simulate mercury chemistry using the GEOS-Chem global transport model to assess the influence of meteorology in the context of other uncertainties in mercury cycling and policy. In these simulations, we find that interannual variability in meteorology may be a dominant contributor to the spatial pattern and magnitude of historical regional wet deposition trends. To further assess the influence of climate variability in the GEOS-Chem mercury simulation, we use a 5-member ensemble of meteorological fields from the MIT Integrated Global System Model under present and future climate. Each member involves randomly initialized 20 year simulations centered around 2000 and 2050 (under a no-policy and a climate stabilization scenario). Building on previous efforts to understand climate-air quality interactions for ground-level O3 and particulate matter, we estimate from the ensemble the range of trends in mercury wet deposition given natural variability, and, to extend our previous results on regions that are sensitive to near-source vs. remote anthropogenic signals, we identify geographic regions where mercury wet deposition is most sensitive to this variability. We discuss how an improved understanding of natural variability can inform the Conference of Parties on monitoring strategy and policy ambition.

  17. [Blood pressure variability: clinical interest or simple curiosity?].

    PubMed

    Ciaroni, Stefano

    2007-03-14

    Blood pressure variability is a physiological phenomenon influenced by many internal and external factors. This variability could be also influenced by pathological conditions such as arterial hypertension. Two forms must be mainly distinguished: the blood pressure variability at long and short-term. The latter could only be studied by continuous recordings. In this article will be analysed the interest of measuring blood pressure variability, its cardiovascular prognosis and the therapeutic tools when it is increased.

  18. 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.

  19. 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.

  20. Clinical Trial of an Educational Program to Decrease Monitor Alarms in a Medical Intensive Care Unit.

    PubMed

    Brantley, Arian; Collins-Brown, Sandra; Kirkland, Jasmine; Knapp, Meghan; Pressley, Jackie; Higgins, Melinda; McMurtry, James P

    2016-07-01

    Clinical research to identify effective interventions for decreasing nonactionable alarms has been limited. The objective of this study was to determine if a staff educational program on customizing alarm settings on bedside monitors decreased alarms in a medical intensive care unit (MICU). A preintervention, postintervention, nonequivalent group design was used to evaluate an educational program on alarm management in a convenience sample of MICU nurses. A 15-minute session was provided in a 1-week period. The outcome variable (number of alarms for low oxygen saturation via pulse oximetry [SpO2]) was determined from monitor log files adjusted by patient census. Data were collected for 15 days before and after the intervention. χ(2) analysis was used, with P less than .05 considered significant. After 1 week of education, low SpO2 alarms decreased from 502 to 306 alarms per patient monitored per day, a 39% reduction (P < .001). Instructions for nurses in the medical intensive care unit on individualizing alarm settings to patients' clinical condition decreased common monitor alarms by 39%. ©2016 American Association of Critical-Care Nurses.

  1. Clinical Insight Into Latent Variables of Psychiatric Questionnaires for Mood Symptom Self-Assessment.

    PubMed

    Tsanas, Athanasios; Saunders, Kate; Bilderbeck, Amy; Palmius, Niclas; Goodwin, Guy; De Vos, Maarten

    2017-05-25

    We recently described a new questionnaire to monitor mood called mood zoom (MZ). MZ comprises 6 items assessing mood symptoms on a 7-point Likert scale; we had previously used standard principal component analysis (PCA) to tentatively understand its properties, but the presence of multiple nonzero loadings obstructed the interpretation of its latent variables. The aim of this study was to rigorously investigate the internal properties and latent variables of MZ using an algorithmic approach which may lead to more interpretable results than PCA. Additionally, we explored three other widely used psychiatric questionnaires to investigate latent variable structure similarities with MZ: (1) Altman self-rating mania scale (ASRM), assessing mania; (2) quick inventory of depressive symptomatology (QIDS) self-report, assessing depression; and (3) generalized anxiety disorder (7-item) (GAD-7), assessing anxiety. We elicited responses from 131 participants: 48 bipolar disorder (BD), 32 borderline personality disorder (BPD), and 51 healthy controls (HC), collected longitudinally (median [interquartile range, IQR]: 363 [276] days). Participants were requested to complete ASRM, QIDS, and GAD-7 weekly (all 3 questionnaires were completed on the Web) and MZ daily (using a custom-based smartphone app). We applied sparse PCA (SPCA) to determine the latent variables for the four questionnaires, where a small subset of the original items contributes toward each latent variable. We found that MZ had great consistency across the three cohorts studied. Three main principal components were derived using SPCA, which can be tentatively interpreted as (1) anxiety and sadness, (2) positive affect, and (3) irritability. The MZ principal component comprising anxiety and sadness explains most of the variance in BD and BPD, whereas the positive affect of MZ explains most of the variance in HC. The latent variables in ASRM were identical for the patient groups but different for HC; nevertheless

  2. Clinical Insight Into Latent Variables of Psychiatric Questionnaires for Mood Symptom Self-Assessment

    PubMed Central

    Saunders, Kate; Bilderbeck, Amy; Palmius, Niclas; Goodwin, Guy; De Vos, Maarten

    2017-01-01

    Background We recently described a new questionnaire to monitor mood called mood zoom (MZ). MZ comprises 6 items assessing mood symptoms on a 7-point Likert scale; we had previously used standard principal component analysis (PCA) to tentatively understand its properties, but the presence of multiple nonzero loadings obstructed the interpretation of its latent variables. Objective The aim of this study was to rigorously investigate the internal properties and latent variables of MZ using an algorithmic approach which may lead to more interpretable results than PCA. Additionally, we explored three other widely used psychiatric questionnaires to investigate latent variable structure similarities with MZ: (1) Altman self-rating mania scale (ASRM), assessing mania; (2) quick inventory of depressive symptomatology (QIDS) self-report, assessing depression; and (3) generalized anxiety disorder (7-item) (GAD-7), assessing anxiety. Methods We elicited responses from 131 participants: 48 bipolar disorder (BD), 32 borderline personality disorder (BPD), and 51 healthy controls (HC), collected longitudinally (median [interquartile range, IQR]: 363 [276] days). Participants were requested to complete ASRM, QIDS, and GAD-7 weekly (all 3 questionnaires were completed on the Web) and MZ daily (using a custom-based smartphone app). We applied sparse PCA (SPCA) to determine the latent variables for the four questionnaires, where a small subset of the original items contributes toward each latent variable. Results We found that MZ had great consistency across the three cohorts studied. Three main principal components were derived using SPCA, which can be tentatively interpreted as (1) anxiety and sadness, (2) positive affect, and (3) irritability. The MZ principal component comprising anxiety and sadness explains most of the variance in BD and BPD, whereas the positive affect of MZ explains most of the variance in HC. The latent variables in ASRM were identical for the patient groups

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

    PubMed Central

    2010-01-01

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

  4. 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.

  5. 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.

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

    PubMed

    Briner, Matthias; Kessler, Oliver; Pfeiffer, Yvonne; Wehner, Theo; Manser, Tanja

    2010-12-13

    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. 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. 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. 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.

  7. 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

  8. Clinical Performance and Admission Variables as Predictors of Passage of the National Physical Therapy Examination.

    PubMed

    Meiners, Kelly M; Rush, Douglas K

    2017-01-01

    Prior studies have explored variables that had predictive relationships with National Physical Therapy Examination (NPTE) score or NPTE failure. The purpose of this study was to explore whether certain variables were predictive of test-takers' first-time score on the NPTE. The population consisted of 134 students who graduated from the university's Professional DPT Program in 2012 to 2014. This quantitative study used a retrospective design. Two separate data analyses were conducted. First, hierarchical linear multiple regression (HMR) analysis was performed to determine which variables were predictive of first-time NPTE score. Second, a correlation analysis was performed on all 18 Physical Therapy Clinical Performance Instrument (PT CPI) 2006 category scores obtained during the first long-term clinical rotation, overall PT CPI 2006 score, and NPTE passage. With all variables entered, the HMR model predicted 39% of the variance seen in NPTE scores. The HMR results showed that physical therapy program first-year GPA (1PTGPA) was the strongest predictor and explained 24% of the variance in NPTE scores (b=0.572, p<0.001). The correlational analysis found no statistically significant correlation between the 18 PT CPI 2006 category scores, overall PT CPI 2006 score, and NPTE passage. As 1PTGPA had the most significant contribution to prediction of NPTE scores, programs need to monitor first-year students who display academic difficulty. PT CPI version 2006 scores were significantly correlated with each other, but not with NPTE score or NPTE passage. Both tools measure many of the same professional requirements but use different modes of assessment, and they may be considered complementary tools to gain a full picture of both the student's ability and skills.

  9. 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

  10. 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.

  11. 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

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

    PubMed

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

    2013-01-01

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

  13. The future of monitoring in clinical research – a holistic approach: Linking risk-based monitoring with quality management principles

    PubMed Central

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

    2013-01-01

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

  14. Monitoring Optical Variability of Quasars and Stars at a Small Campus Observatory

    NASA Astrophysics Data System (ADS)

    Balonek, T. J.

    2005-12-01

    Colgate University's Foggy Bottom Observatory on-campus 16-inch telescope (equipped with a CCD) has been utilized by faculty and undergraduate students for seventeen years to study the optical variability of quasars and stars. The observatory is used for research projects on more than one hundred nights per year, despite being located in a region (central New York) with poor climatic conditions and quickly changing sky conditions. The observatory's location, at the edge of and above the campus and small town, provides an easily accessible dark site. We devote most of the observing time to imaging the fields of variable objects for photometric monitoring, with the aim of achieving both good time resolution and long term coverage of program objects. With a flexible observing program, we can quickly respond to requests for supporting observations of any object brighter than about 17th magnitude. The major photometry projects have included: monitoring two dozen blazars on timescales ranging from minutes to years, detection and monitoring of variable stars in the fields of blazars, transits of the extrasolar planet TrES-1, determining times of minimum and light curve shapes of eclipsing binary stars, rotation curves and astrometry of asteroids, and light curves of extragalactic supernovae. The observing and image calibration - reduction techniques, and problems which we have encountered, will be discussed.

  15. 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.

  16. 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.

  17. Treatment success in neck pain: The added predictive value of psychosocial variables in addition to clinical variables.

    PubMed

    Groeneweg, Ruud; Haanstra, Tsjitske; Bolman, Catherine A W; Oostendorp, Rob A B; van Tulder, Maurits W; Ostelo, Raymond W J G

    2017-01-01

    Identification of psychosocial variables may influence treatment outcome. The objective of this study was to prospectively examine whether psychosocial variables, in addition to clinical variables (pain, functioning, general health, previous neck pain, comorbidity), are predictive factors for treatment outcome (i.e. global perceived effect, functioning and pain) in patients with sub-acute and chronic non-specific neck pain undergoing physical therapy or manual therapy. Psychosocial factors included treatment outcome expectancy and treatment credibility, health locus of control, and fear avoidance beliefs. This study reports a secondary analysis of a primary care-based pragmatic randomized controlled trial. Potential predictors were measured at baseline and outcomes, in 181 patients, at 7 weeks and 26 weeks. Hierarchical logistic regression models showed that treatment outcome expectancy predicted outcome success, in addition to clinical and demographic variables. Expectancy explained additional variance, ranging from 6% (pain) to 17% (functioning) at 7 weeks, and 8% (pain) to 16% (functioning) at 26 weeks. Locus of control and fear avoidance beliefs did not add significantly to predicting outcome. Based on the results of this study we conclude that outcome expectancy, in patients with non-specific sub-acute and chronic neck pain, has additional predictive value for treatment success above and beyond clinical and demographic variables. Psychological processes, health perceptions and how these factors relate to clinical variables may be important for treatment decision making regarding therapeutic options for individual patients. Copyright © 2016 Scandinavian Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  18. Square(2) - A Web Application for Data Monitoring in Epidemiological and Clinical Studies

    PubMed

    Schmidt, Carsten Oliver; Krabbe, Christine; Schössow, Janka; Albers, Martin; Radke, Dörte; Henke, Jörg

    2017-01-01

    Valid scientific inferences from epidemiological and clinical studies require high data quality. Data generating departments therefore aim to detect data irregularities as early as possible in order to guide quality management processes. In addition, after the completion of data collections the obtained data quality must be evaluated. This can be challenging in complex studies due to a wide scope of examinations, numerous study variables, multiple examiners, devices, and examination centers. This paper describes a Java EE web application used to monitor and evaluate data quality in institutions with complex and multiple studies, named Square(2). It uses the Java libraries Apache MyFaces 2, extended by BootsFaces for layout and style. RServe and REngine manage calls to R server processes. All study data and metadata are stored in PostgreSQL. R is the statistics backend and LaTeX is used for the generation of print ready PDF reports. A GUI manages the entire workflow. Square(2) covers all steps in the data monitoring workflow, including the setup of studies and their structure, the handling of metadata for data monitoring purposes, selection of variables, upload of data, statistical analyses, and the generation as well as inspection of quality reports. To take into account data protection issues, Square(2) comprises an extensive user rights and roles concept.

  19. [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.

  20. 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.

  1. Role of Continuous Glucose Monitoring in Clinical Trials: Recommendations on Reporting.

    PubMed

    Schnell, Oliver; Barnard, Katharine; Bergenstal, Richard; Bosi, Emanuele; Garg, Satish; Guerci, Bruno; Haak, Thomas; Hirsch, Irl B; Ji, Linong; Joshi, Shashank R; Kamp, Maarten; Laffel, Lori; Mathieu, Chantal; Polonsky, William H; Snoek, Frank; Home, Philip

    2017-07-01

    Thanks to significant improvements in the precision, accuracy, and usability of continuous glucose monitoring (CGM), its relevance in both ambulatory diabetes care and clinical research is increasing. In this study, we address the latter perspective and derive provisional reporting recommendations. CGM systems have been available since around the year 2000 and used primarily in people with type 1 diabetes. In contrast to self-measured glucose, CGM can provide continuous real-time measurement of glucose levels, alerts for hypoglycemia and hyperglycemia, and a detailed assessment of glycemic variability. Through a broad spectrum of derived glucose data, CGM should be a useful tool for clinical evaluation of new glucose-lowering medications and strategies. It is the only technology that can measure hyperglycemic and hypoglycemic exposure in ambulatory care, or provide data for comprehensive assessment of glucose variability. Other advantages of current CGM systems include the opportunity for improved self-management of glycemic control, with particular relevance to those at higher risk of or from hypoglycemia. We therefore summarize the current status and limitations of CGM from the perspective of clinical trials and derive suggested recommendations for how these should facilitate optimal CGM use and reporting of data in clinical research.

  2. 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.

  3. Simultaneous Monitoring of X-Ray and Radio Variability in Sagittarius A*

    NASA Astrophysics Data System (ADS)

    Capellupo, Daniel M.; Haggard, Daryl; Choux, Nicolas; Baganoff, Fred; Bower, Geoffrey C.; Cotton, Bill; Degenaar, Nathalie; Dexter, Jason; Falcke, Heino; Fragile, P. Chris; Heinke, Craig O.; Law, Casey J.; Markoff, Sera; Neilsen, Joey; Ponti, Gabriele; Rea, Nanda; Yusef-Zadeh, Farhad

    2017-08-01

    Monitoring of Sagittarius A* from X-ray to radio wavelengths has revealed structured variability—including X-ray flares—but it is challenging to establish correlations between them. Most studies have focused on variability in the X-ray and infrared, where variations are often simultaneous, and because long time series at submillimeter and radio wavelengths are limited. Previous work on submillimeter and radio variability hints at a lag between X-ray flares and their candidate submillimeter or radio counterparts, with the long wavelength data lagging the X-ray. However, there is only one published time lag between an X-ray flare and a possible radio counterpart. Here we report nine contemporaneous X-ray and radio observations of Sgr A*. We detect significant radio variability peaking ≳ 176 minutes after the brightest X-ray flare ever detected from Sgr A*. We also report other potentially associated X-ray and radio variability, with the radio peaks appearing ≲ 80 minutes after these weaker X-ray flares. Taken at face value, these results suggest that stronger X-ray flares lead to longer time lags in the radio. However, we also test the possibility that the variability at X-ray and radio wavelengths is not temporally correlated. We cross-correlate data from mismatched X-ray and radio epochs and obtain comparable correlations to the matched data. Hence, we find no overall statistical evidence that X-ray flares and radio variability are correlated, underscoring a need for more simultaneous, long duration X-ray-radio monitoring of Sgr A*.

  4. Simple clinical variables predict liver histology in hepatitis C: prospective validation of a clinical prediction model.

    PubMed

    Romagnuolo, Joseph; Andrews, Christopher N; Bain, Vincent G; Bonacini, Maurizio; Cotler, Scott J; Ma, Mang; Sherman, Morris

    2005-11-01

    A recent single-center multivariate analysis of hepatitis C (HCV) patients showed that having any two criteria: 1) ferritin > or =200 microg/l and 2) spider nevi and/or albumin < or = 35 g/l predicted grade 2 or greater histological inflammation; the presence of any two of the following criteria: spider nevi, platelets < or =150 x 109/l, palpable splenomegaly and/or albumin < or =35 g/l predicted stage 2 or greater histological fibrosis. Absence of predictors also predicted a lack of inflammation and fibrosis. Our aim was prospectively to validate this clinical prediction model using an independent multicenter sample. Eighty-one patients with previously untreated active chronic HCV underwent physical examination, laboratory investigation, and liver biopsy. Biopsies were read, in blinded fashion, by a single pathologist, using a modified Hytiroglou (1995) scale. The clinical scoring system was correlated with histology; likelihood ratios (LRs), Fisher's exact p-values, and receiver operating characteristics (ROCs) were calculated. Data recording was complete in 77 and 38 patients regarding fibrotic stage and inflammatory grade, respectively. For fibrosis, 3/3 patients with any three criteria (LR 17, positive predictive value (PPV) 100%), 4/5 patients with any two criteria (LR 5.1), and 15/47 with no criteria (LR 0.6, negative predictive value (NPV) 68%) had stage 2 or greater fibrosis on biopsy (p=0.01). For inflammation, 5/5 patients with both criteria (LR 15, PPV 100%), and 8/19 patients with no criteria (LR 0.5, NPV 58%) had moderate-severe inflammation on liver biopsy (p=0.036). When missing variables were assumed to be normal, recalculated LRs were almost identical. An alanine aminotransferase (ALAT) level <60 U/l may increase the NPVs. This independent multicenter data set has validated our published model which uses simple clinical variables accurately and significantly to predict hepatic fibrosis and inflammation in HCV patients.

  5. 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.

  6. The intermedius nerve as a confounding variable for monitoring of the free-running electromyogram.

    PubMed

    Prell, Julian; Strauss, Christian; Rachinger, Jens; Scheller, Christian; Alfieri, Alex; Herfurth, Kirsten; Rampp, Stefan

    2015-09-01

    A-trains, a facial nerve EMG-pattern, are correlated with postoperative functional impairment. However, an unknown confounder is suspected to cause false positive monitoring results. The intermedius nerve contains motor fibers targeting lower facial muscles; their significance for facial nerve monitoring is yet unknown. Intraoperative videotapes and free-running 9-channel facial nerve EMG assessed from 87 patients undergoing surgery for vestibular schwannoma were evaluated, and presence/absence of an identifiable intermedius nerve was determined. The prognostic value of train time, a quantitative measure for A-train activity, was evaluated for both the groups with and without an identifiable intermedius nerve. Correlation between traintime and outcome (Spearman's Rho) rose to 0.73 (p<0.001) when only patients without an identified intermedius nerve were considered, and fell to 0.43 (p<0.05) with the other patient group. This difference was statistically significant (p=0.036), was more prominent in the channels monitoring perioral facial muscles, and resulted from additional A-train activity in patients with an identifiable intermedius nerve. A separate intermedius nerve may be more prone to manipulation, leading to A-train activity without clinical correlate, thus causing false positive monitoring results. For interpretation of the free-running EMG, the intermedius nerve needs to be taken into account as a confounder. Copyright © 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

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

    SciTech Connect

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

    2009-11-01

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

  8. Quantification of topographic changes in the surface of back of young patients monitored for idiopathic scoliosis: correlation with radiographic variables

    NASA Astrophysics Data System (ADS)

    Pino-Almero, Laura; Mínguez-Rey, María Fe; Sentamans-Segarra, Salvador; Salvador-Palmer, María Rosario; Anda, Rosa María Cibrián-Ortiz de; La O, Javier López-de

    2016-11-01

    Idiopathic scoliosis requires a close follow-up while the patient is skeletally immature to detect early progression. Patients who are monitored by radiographs are exposed to high doses of ionizing radiation. The purpose of this study is to evaluate if an optic noninvasive method of back surface topography based on structured light would be clinically useful in the follow-up of young patients with idiopathic scoliosis. This could reduce the number of radiographs made on these children. Thirty-one patients with idiopathic scoliosis were submitted twice to radiograph and our topographic method at intervals of 6 months to 1 year. Three topographical variables were applied horizontal plane deformity index (DHOPI), posterior trunk symmetry index (POTSI), and columnar profile (PC). A statistically significant correlation was found between variations of Cobb angle with DHOPI (r=0.720, p<0.01) and POTSI (r=0.753, p<0.01) during the monitoring period. Hence, this topographic method could be useful in clinical practice as an objective adjuvant tool in routine follow-up of scoliosis.

  9. 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.

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

    ERIC Educational Resources Information Center

    Hall, Gordon C. Nagayama

    1988-01-01

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

  11. 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.

  12. 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

    Sowan, Azizeh Khaled; Reed, Charles Calhoun; Staggers, Nancy

    2016-09-30

    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. 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. 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. 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. 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.

  13. Variability of N-terminal probrain natriuretic peptide in stable chronic heart failure and its relation to changes in clinical variables.

    PubMed

    Frankenstein, Lutz; Remppis, Andrew; Frankenstein, Joerdis; Hess, Georg; Zdunek, Dietmar; Slottje, Karen; Katus, Hugo A; Zugck, Christian

    2009-05-01

    We investigated the variability of N-terminal probrain natriuretic peptide (NT-proBNP) and its relation to known confounding variables in patients with stable chronic heart failure who were on a stable optimized medication regimen. At 4 sampling intervals (14-day, 1-month, 2-month, and 3-month) the results for NT-proBNP measurements and several clinical variables were measured in samples from 41 patients with chronic systolic dysfunction who met 21 prespecified criteria for stability. Mean within-person NT-proBNP variabilities expressed as percentage CV were 17.6%, 18.9%, 15.5%, and 16.2% at 14-day, 1-month, 2-month, and 3-month follow-up, respectively, and the corresponding reference change values were 34.6%, 52.5%, 43.1%, and 45.0%, respectively. Within-person variability of NT-proBNP was not found to be associated with renal function, weight, or waist circumference. Likewise, age, sex, baseline NT-proBNP, New York Heart Association functional class, and ejection fraction did not influence variability of NT-proBNP. The index of individuality ranged from 0.07-0.15 depending on the time interval between test results. Although other reported studies have revealed variations in the range of 80%, in this prespecified stable heart-failure population variation of NT-proBNP at 14-day, 1-month, 2-month, and 3-month follow-up was lower and was not related to renal function or weight. In view of the low index of individuality we observed, within-person variation is quite low compared to between-person variation. Consideration of these facts is important for the interpretation of clinical trials and the use of NT-proBNP in monitoring patients with heart failure.

  14. An update on insertable cardiac monitors: examining the latest clinical evidence and technology for arrhythmia management.

    PubMed

    Olsen, Flemming J; Biering-Sørensen, Tor; Krieger, Derk W

    2015-05-01

    Continuous cardiac rhythm monitoring has undergone compelling progress over the past decades. Cardiac monitoring has emerged from 12-lead electrocardiograms being performed at the discretion of the treating physician to in-hospital telemetry, Holter monitoring, prolonged external event monitoring and most recently toward insertable device monitoring for several years. Significant advantages and disadvantages pertaining to these monitoring options will be addressed in this review. Insertable cardiac monitors have several advantages over external monitoring techniques and may signify a clinical turning point in the field of arrhythmia management. However, their role in the detection of paroxysmal atrial fibrillation after cryptogenic strokes has yet to evolve. This will be the main focus of this review. Issues surrounding patient selection, clinical relevance and determination of cost-effectiveness for prolonged cardiac monitoring require further studies. Furthermore, insertable cardiac monitoring has not only the potential to augment diagnostic capabilities but also to improve the management of paroxysmal atrial fibrillation.

  15. Clinical variables of preoperative risk in thoracic surgery.

    PubMed

    Saad, Ivete Alonso Bredda; De Capitani, Eduardo Mello; Toro, Ivan Felizardo Contrera; Zambon, Lair

    2003-05-05

    Pulmonary complications are the most common forms of postoperative morbidity in thoracic surgery, especially atelectasis and pneumonia. The first step in avoiding these complications during the postoperative period is to detect the patients that may develop them. To identify risk variables leading to early postoperative pulmonary complications in thoracic surgery. Prospective study. Hospital das Clínicas, Faculdade de Ciências Médicas, Universidade Estadual de Campinas. 145 patients submitted to elective surgery were classified as low, moderate and high risk for postoperative pulmonary complications using a risk assessment scale. The patients were followed up for 72 hours after the operation. Postoperative pulmonary complications were defined as atelectasis, pneumonia, tracheobronchitis, wheezing, prolonged intubation and/or prolonged mechanical ventilation. Univariate analysis was applied in order to study these independent variables: age, nutritional status, body mass index, respiratory disease, smoking habit, spirometry and surgery duration. Multivariate logistic regression analysis was performed in order to evaluate the relationship between independent and dependent variables. The incidence of postoperative complications was 18.6%. Multivariate logistic regression analysis showed that the variables increasing the chances of postoperative pulmonary complications were wheezing (odds ratio, OR = 6.2), body mass index (OR = 1.15), smoking (OR = 1.04) and surgery duration (OR = 1.007). Wheezing, body mass index, smoking and surgery duration increase the chances of postoperative pulmonary complications in thoracic surgery

  16. Clinical and ultrastructural analysis of variable speed corneal trephination.

    PubMed

    Schanzlin, D J; Robin, J B; Spence, D J

    1983-09-01

    An automated, variable speed trephine was utilized to study the effects of rotation velocity on corneal trephination. Scanning electron microscopy revealed that the higher velocity (800 RPM) specimens had less stromal lamellar disruption, producing a smoother interface than either the lower velocity (100 RPM) automated trephinations or manual trephinations.

  17. 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.

  18. 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.

  19. 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.

  20. [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.

  1. The balanced mind: the variability of task-unrelated thoughts predicts error monitoring.

    PubMed

    Allen, Micah; Smallwood, Jonathan; Christensen, Joanna; Gramm, Daniel; Rasmussen, Beinta; Jensen, Christian Gaden; Roepstorff, Andreas; Lutz, Antoine

    2013-01-01

    Self-generated thoughts unrelated to ongoing activities, also known as "mind-wandering," make up a substantial portion of our daily lives. Reports of such task-unrelated thoughts (TUTs) predict both poor performance on demanding cognitive tasks and blood-oxygen-level-dependent (BOLD) activity in the default mode network (DMN). However, recent findings suggest that TUTs and the DMN can also facilitate metacognitive abilities and related behaviors. To further understand these relationships, we examined the influence of subjective intensity, ruminative quality, and variability of mind-wandering on response inhibition and monitoring, using the Error Awareness Task (EAT). We expected to replicate links between TUT and reduced inhibition, and explored whether variance in TUT would predict improved error monitoring, reflecting a capacity to balance between internal and external cognition. By analyzing BOLD responses to subjective probes and the EAT, we dissociated contributions of the DMN, executive, and salience networks to task performance. While both response inhibition and online TUT ratings modulated BOLD activity in the medial prefrontal cortex (mPFC) of the DMN, the former recruited a more dorsal area implying functional segregation. We further found that individual differences in mean TUTs strongly predicted EAT stop accuracy, while TUT variability specifically predicted levels of error awareness. Interestingly, we also observed co-activation of salience and default mode regions during error awareness, supporting a link between monitoring and TUTs. Altogether our results suggest that although TUT is detrimental to task performance, fluctuations in attention between self-generated and external task-related thought is a characteristic of individuals with greater metacognitive monitoring capacity. Achieving a balance between internally and externally oriented thought may thus aid individuals in optimizing their task performance.

  2. The balanced mind: the variability of task-unrelated thoughts predicts error monitoring

    PubMed Central

    Allen, Micah; Smallwood, Jonathan; Christensen, Joanna; Gramm, Daniel; Rasmussen, Beinta; Jensen, Christian Gaden; Roepstorff, Andreas; Lutz, Antoine

    2013-01-01

    Self-generated thoughts unrelated to ongoing activities, also known as “mind-wandering,” make up a substantial portion of our daily lives. Reports of such task-unrelated thoughts (TUTs) predict both poor performance on demanding cognitive tasks and blood-oxygen-level-dependent (BOLD) activity in the default mode network (DMN). However, recent findings suggest that TUTs and the DMN can also facilitate metacognitive abilities and related behaviors. To further understand these relationships, we examined the influence of subjective intensity, ruminative quality, and variability of mind-wandering on response inhibition and monitoring, using the Error Awareness Task (EAT). We expected to replicate links between TUT and reduced inhibition, and explored whether variance in TUT would predict improved error monitoring, reflecting a capacity to balance between internal and external cognition. By analyzing BOLD responses to subjective probes and the EAT, we dissociated contributions of the DMN, executive, and salience networks to task performance. While both response inhibition and online TUT ratings modulated BOLD activity in the medial prefrontal cortex (mPFC) of the DMN, the former recruited a more dorsal area implying functional segregation. We further found that individual differences in mean TUTs strongly predicted EAT stop accuracy, while TUT variability specifically predicted levels of error awareness. Interestingly, we also observed co-activation of salience and default mode regions during error awareness, supporting a link between monitoring and TUTs. Altogether our results suggest that although TUT is detrimental to task performance, fluctuations in attention between self-generated and external task-related thought is a characteristic of individuals with greater metacognitive monitoring capacity. Achieving a balance between internally and externally oriented thought may thus aid individuals in optimizing their task performance. PMID:24223545

  3. Koroaps - System for a Large Scale Monitoring and Variable Stars Searching

    NASA Astrophysics Data System (ADS)

    Parimucha, S.; Baludansky, D.; Vadila, M.

    We give an introduction information about the KOROAPS (KO·sice ROztoky Automatic Photometry System). It is a system for a large scale automatic multicolor monitoring and variable stars searching. It is in a development at Safarik University in Kosice in cooperation with Roztoky Observatory. The system is now in a test operation at Roztoky Observatory. System consists of Nikkor photolense 2/200 equipped with SBIG ST8 CCD camera and set of the standard VRI photometric filters. It is placed on Celestron's CG-5 Advanced mount. We give description of the basic properties of the instrument, data reduction pipeline and operational modes of the instrument.

  4. 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.

  5. 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

  6. 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

  7. 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.

  8. Psychosocial Variables Contribute to Length of Stay and Discharge Destination after Lumbar Surgery Independent of Demographic and Clinical Variables.

    PubMed

    Mancuso, Carol A; Duculan, Roland; Craig, Chad M; Girardi, Federico P

    2017-07-03

    Prospective analysis of resource utilization (RU) after lumbar surgery. To determine contributions of patient psychosocial variables to RU, specifically length of stay (LOS) and discharge destination. Associations between demographic/clinical variables and RU are well-established; less is known about associations between psychosocial variables, such as social support and depressive/anxiety symptoms, and RU. Preoperatively 532 patients provided standard ratings of depressive and anxiety symptoms and amount of social support. Clinical variables included calculation of a composite score reflecting invasiveness of surgery. Two outcomes were considered: LOS ≤ 3 or > 3 days; and discharged home without external services or discharged with external services. Independent variables in multivariable logistic models were demographic/clinical and psychosocial variables. Mean age was 56 years, 55% were men, 87% had degenerative conditions, 40% had a positive depression screen, 62% had anxiety greater than population norms, and 77% reported as much social support as wanted. Variables that remained associated with a LOS > 3 days (53%) in multivariable analysis were: older age (OR 1.8, CI 1.2-2.8); female gender (OR 1.9, CI 1.2-2.9), less social support (OR1.4, CI 1.1-1.7); obesity (OR1.8, CI 1.1-2.8), worse functional status (OR 1.0, CI 1.0-1.0) and more invasive surgery (OR 3.0, CI 2.4-3.7). Variables that remained associated with discharged with external services (17%) in multivariable analysis were: older age (OR 3.3, CI 1.9-5.9); less social support (OR 1.3, CI 1.0-1.7); positive depression screen (OR 1.9, CI 1.1-3.4); more anxiety (OR 2.4, CI 1.3-4.2); major comorbidity (OR 1.7, CI 1.0-2.8); and more invasive surgery (OR 1.9, CI 1.5-2.5). This study confirms the importance of demographic/clinical variables as predictors of greater RU after lumbar surgery and provides preliminary evidence for the importance of concurrent psychosocial variables, particularly less social

  9. Measurement of heart rate variability: a clinical tool or a research toy?

    PubMed

    Huikuri, H V; Mäkikallio, T; Airaksinen, K E; Mitrani, R; Castellanos, A; Myerburg, R J

    1999-12-01

    The objectives of this review are to discuss the diversity of mechanisms that may explain the association between heart rate (HR) variability and mortality, to appraise the clinical applicability of traditional and new measures of HR variability and to propose future directions in this field of research. There is a large body of data demonstrating that abnormal HR variability measured over a 24-h period provides information on the risk of subsequent death in subjects with and without structural heart disease. However, the mechanisms responsible for this association are not completely established. Therefore, no specific therapy is currently available to improve the prognosis for patients with abnormal HR variability. Reduced HR variability has been most commonly associated with a risk of arrhythmic death, but recent data suggest that abnormal variability also predicts vascular causes of death, progression of coronary atherosclerosis and death due to heart failure. A consensus is also lacking on the best HR variability measure for clinical purposes. Time and frequency domain measures of HR variability have been most commonly used, but recent studies show that new analysis methods based on nonlinear dynamics may be more powerful in terms of risk stratification. Before the measurement of HR variability can be applied to clinical practice and used to direct therapy, more precise insight into the pathophysiological link between HR variability and mortality are needed. Further studies should also address the issue of which of the HR variability indexes, including the new nonlinear measures, is best for clinical purposes in various patient populations.

  10. Complement in clinical medicine: Clinical trials, case reports and therapy monitoring.

    PubMed

    Ricklin, Daniel; Barratt-Due, Andreas; Mollnes, Tom Eirik

    2017-09-01

    Research during past decades made it evident that complement is involved in more tasks than fighting infections, but has important roles in other immune surveillance and housekeeping functions. If the balance between complement activation and regulation is out of tune, however, complement can quickly turn against the host and contribute to adverse processes that result in various clinical conditions. Whereas clinical awareness was initially focused on complement deficiencies, excessive activation and insufficient regulation are frequently the dominant factors in complement-related disorders. The individual complement profile of a patient often determines the course and severity of the disease, and the pathophysiological involvement of complement may be highly diverse. As a consequence, complement assays have evolved as essential tools not only in initial diagnosis but also for following disease progression and for monitoring complement-targeted therapies, which become increasingly available in routine clinical use. We herein review the current state of complement-directed drug candidates in clinical evaluation and provide an overview of extended indications considered for the FDA-approved inhibitor eculizumab. Furthermore we review the literature describing cases reports and case series where eculizumab has been used "off-label". Finally, we give a summary of the currently available tests to measure complement profiles and discuss their suitability in diagnostics and treatment monitoring. With complement finally entering the clinical arena, there are intriguing opportunities for treating complement-mediated diseases. However, this progress also requires a new awareness about complement pathophysiology, adequate diagnostic tools and suitable treatment options among clinicians treating patients with such disorders. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  11. Simultaneous Monitoring of X-ray and Radio Variability in Sagittarius A*

    NASA Astrophysics Data System (ADS)

    Haggard, Daryl; Capellupo, Daniel M.; Choux, Nicolas; Baganoff, Frederick K.; Bower, Geoffrey C.; Cotton, William D.; Degenaar, Nathalie; Dexter, Jason; Falcke, Heino; Fragile, P. Christopher Christopher; Heinke, Craig O.; Law, Casey J.; Markoff, Sera; Neilsen, Joseph; Ponti, Gabriele; Rea, Nanda; Yusef-Zadeh, Farhad

    2017-08-01

    We report on joint X-ray/radio campaigns targeting Sagittarius A*, including 9 contemporaneous Chandra and VLA observations. These campaigns are the most extensive of their kind and have allowed us to test whether the black hole’s variations in different parts of the electromagnetic spectrum are due to the same physical processes. We detect significant radio variability peaking >176 minutes after the brightest X-ray flare ever detected from Sgr A*. We also identify other potentially associated X-ray and radio variability, with radio peaks appearing <80 minutes after weaker X-ray flares. These results suggest that stronger X-ray flares lead to longer time lags in the radio. However, we also test the possibility that the variability at X-ray and at radio wavelengths are not temporally correlated, and show that the radio variations occurring around the time of X-ray flaring are not significantly greater than the overall radio flux variations. We also cross-correlate data from mismatched X-ray and radio epochs and obtain comparable correlations to the matched data. Hence, we find no overall statistical evidence that X-ray flares and radio variability are correlated, underscoring a need for more simultaneous, long duration X-ray-radio monitoring of Sgr A*.

  12. A clinically relevant wound assessment method to monitor healing progression.

    PubMed

    Barber, Sharon

    2008-03-01

    One of the most important principles of wound management is periodic assessment and documentation of wound healing. Documentation of healing progress over time allows providers to assess the effectiveness of care to maximize healing. Several methods to determine wound healing progress currently exist and include dimensional, visual, and physiological assessments. However, because existing tools often require correlation of subjective assessments, are time-consuming, and may not consider that wound healing occurs from the "bottom up," a more objective and quicker approach to monitor healing progression was pursued. The purpose of this case study is to describe a once pen-and-paper tool that has now been computerized (the Barber Measuring Tool) that builds a graphical representation of a patient's individual wound healing progress to facilitate clinical decisions regarding the patient's plan of care. The tool, which is currently used for all wound patients in the author's facility, calculates wound volume using a simple formula and tracks this measurement as a percent of baseline over time in the patient's chart. Although formal research to establish validity and reliability of this tool has yet to be conducted, the tool has been used with more than 400 patients and has provided an accurate representation of healing progress. Studies to support proliferating use of this tool are warranted.

  13. Development and Feasibility Testing of a Critical Care EEG Monitoring Database for Standardized Clinical Reporting and Multicenter Collaborative Research.

    PubMed

    Lee, Jong Woo; LaRoche, Suzette; Choi, Hyunmi; Rodriguez Ruiz, Andres A; Fertig, Evan; Politsky, Jeffrey M; Herman, Susan T; Loddenkemper, Tobias; Sansevere, Arnold J; Korb, Pearce J; Abend, Nicholas S; Goldstein, Joshua L; Sinha, Saurabh R; Dombrowski, Keith E; Ritzl, Eva K; Westover, Michael B; Gavvala, Jay R; Gerard, Elizabeth E; Schmitt, Sarah E; Szaflarski, Jerzy P; Ding, Kan; Haas, Kevin F; Buchsbaum, Richard; Hirsch, Lawrence J; Wusthoff, Courtney J; Hopp, Jennifer L; Hahn, Cecil D

    2016-04-01

    The rapid expansion of the use of continuous critical care electroencephalogram (cEEG) monitoring and resulting multicenter research studies through the Critical Care EEG Monitoring Research Consortium has created the need for a collaborative data sharing mechanism and repository. The authors describe the development of a research database incorporating the American Clinical Neurophysiology Society standardized terminology for critical care EEG monitoring. The database includes flexible report generation tools that allow for daily clinical use. Key clinical and research variables were incorporated into a Microsoft Access database. To assess its utility for multicenter research data collection, the authors performed a 21-center feasibility study in which each center entered data from 12 consecutive intensive care unit monitoring patients. To assess its utility as a clinical report generating tool, three large volume centers used it to generate daily clinical critical care EEG reports. A total of 280 subjects were enrolled in the multicenter feasibility study. The duration of recording (median, 25.5 hours) varied significantly between the centers. The incidence of seizure (17.6%), periodic/rhythmic discharges (35.7%), and interictal epileptiform discharges (11.8%) was similar to previous studies. The database was used as a clinical reporting tool by 3 centers that entered a total of 3,144 unique patients covering 6,665 recording days. The Critical Care EEG Monitoring Research Consortium database has been successfully developed and implemented with a dual role as a collaborative research platform and a clinical reporting tool. It is now available for public download to be used as a clinical data repository and report generating tool.

  14. Social Class and Diagnostic Suggestion as Variables in Clinical Judgment

    ERIC Educational Resources Information Center

    Di Nardo, Peter A.

    1975-01-01

    Sixty graduate students in clinical psychology made diagnostic assessments of one of two staged interviews identical in content but enacted to convey either a middle- or lower-class impression. The results indicate the existence of a class bias and suggest a status differential between psychologists and psychiatrists. (Author)

  15. 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

  16. 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

  17. Monitoring-Based Model for Personalizing the Clinical Process of Crohn’s Disease

    PubMed Central

    de Ramón-Fernández, Alberto; Ruiz-Fernández, Daniel; Vives-Boix, Víctor

    2017-01-01

    Crohn’s disease is a chronic pathology belonging to the group of inflammatory bowel diseases. Patients suffering from Crohn’s disease must be supervised by a medical specialist for the rest of their lives; furthermore, each patient has its own characteristics and is affected by the disease in a different way, so health recommendations and treatments cannot be generalized and should be individualized for a specific patient. To achieve this personalization in a cost-effective way using technology, we propose a model based on different information flows: control, personalization, and monitoring. As a result of the model and to perform a functional validation, an architecture based on services and a prototype of the system has been defined. In this prototype, a set of different devices and technologies to monitor variables from patients and their environment has been integrated. Artificial intelligence algorithms are also included to reduce the workload related to the review and analysis of the information gathered. Due to the continuous and automated monitoring of the Crohn’s patient, this proposal can help in the personalization of the Crohn’s disease clinical process. PMID:28678162

  18. 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

  19. 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.

  20. 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

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

    PubMed Central

    Goldman, Sylvie; Greene, Paul E.

    2012-01-01

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

  2. 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. Copyright © 2014 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

  3. How novice, skilled and advanced clinical researchers include variables in a case report form for clinical research: a qualitative study.

    PubMed

    Chu, Hongling; Zeng, Lin; Fetters, Micheal D; Li, Nan; Tao, Liyuan; Shi, Yanyan; Zhang, Hua; Wang, Xiaoxiao; Li, Fengwei; Zhao, Yiming

    2017-09-18

    Despite varying degrees in research training, most academic clinicians are expected to conduct clinical research. The objective of this research was to understand how clinical researchers of different skill levels include variables in a case report form for their clinical research. The setting for this research was a major academic institution in Beijing, China. The target population was clinical researchers with three levels of experience, namely, limited clinical research experience, clinicians with rich clinical research experience and clinical research experts. Using a qualitative approach, we conducted 13 individual interviews (face to face) and one group interview (n=4) with clinical researchers from June to September 2016. Based on maximum variation sampling to identify researchers with three levels of research experience: eight clinicians with limited clinical research experience, five clinicians with rich clinical research experience and four clinical research experts. These 17 researchers had diverse hospital-based medical specialties and or specialisation in clinical research. Our analysis yields a typology of three processes developing a case report form that varies according to research experience level. Novice clinician researchers often have an incomplete protocol or none at all, and conduct data collection and publication based on a general framework. Experienced clinician researchers include variables in the case report form based on previous experience with attention to including domains or items at risk for omission and by eliminating unnecessary variables. Expert researchers consider comprehensively in advance data collection and implementation needs and plan accordingly. These results illustrate increasing levels of sophistication in research planning that increase sophistication in selection for variables in the case report form. These findings suggest that novice and intermediate-level researchers could benefit by emulating the comprehensive

  4. 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.

  5. Recent Advances in Climate Monitoring with GNSS Radio Occultation: Capturing Atmospheric Variability and Trends

    NASA Astrophysics Data System (ADS)

    Steiner, A. K.

    2016-12-01

    Monitoring atmospheric variability and climate change requires observations of high quality. Climate data records need to be homogeneous, long-term stable, and traceable to standards of the international system of units (SI). The uncertainty in observing essential climate variables (ECVs), such as temperature and water vapor, must be smaller than the signals expected from long-term change. Conventional observations generally agree on a long-term warming of the troposphere and a cooling of the stratosphere. Nevertheless, there exists considerable uncertainty in trend rates and their vertical structure, particularly in the upper troposphere and stratosphere. This is stated as a key issue in the recent world climate report implying the need for data with better accuracy. Radio Occultation (RO) based on Global Navigation Satellite System (GNSS) signals now provides 15 years of observations. This is still a short record from a climate perspective, but the traceability to fundamental time standards with precise atomic clocks enables a long-term stable and consistent data record with global coverage. Basic error characteristics are well understood and advances are ongoing towards establishing RO as a reference record of ECVs with integrated uncertainty estimation. We give an overview on recent accomplishments in monitoring climate variability and change with RO. Based on the recently reprocessed Wegener Center RO record over 2001-2016, version OPSv5.6, we demonstrate the ability of RO to capture the El Niño-Southern Oscillation (ENSO), the Quasi-Biennial Oscillation (QBO), tropopause dynamics, atmospheric waves, subtropical and polar jet streams, mid-latitude blocking events, and signatures from volcanic eruptions. We present climate change diagnostics and discuss vertically resolved atmospheric change signals in the troposphere and lower stratosphere. We find RO of high utility for resolving the atmospheric structure and detecting climate change, emphasizing its key

  6. Simultaneous monitoring of maternal and fetal heart rate variability during labor in relation with fetal gender.

    PubMed

    Gonçalves, Hernâni; Fernandes, Diana; Pinto, Paula; Ayres-de-Campos, Diogo; Bernardes, João

    2017-08-21

    Male gender is considered a risk factor for several adverse perinatal outcomes. Fetal gender effect on fetal heart rate (FHR) has been subject of several studies with contradictory results. The importance of maternal heart rate (MHR) monitoring during labor has also been investigated, but less is known about the effect of fetal gender on MHR. The aim of this study is to simultaneously assess maternal and FHR variability during labor in relation with fetal gender. Simultaneous MHR and FHR recordings were obtained from 44 singleton term pregnancies during the last 2 hr of labor (H1, H2 ). Heart rate tracings were analyzed using linear (time- and frequency-domain) and nonlinear indices. Both linear and nonlinear components were considered in assessing FHR and MHR interaction, including cross-sample entropy (cross-SampEn). Mothers carrying male fetuses (n = 22) had significantly higher values for linear indices related with MHR average and variability and sympatho-vagal balance, while the opposite occurred in the high-frequency component and most nonlinear indices. Significant differences in FHR were only observed in H1 with higher entropy values in female fetuses. Assessing the differences between FHR and MHR, statistically significant differences were obtained in most nonlinear indices between genders. A significantly higher cross-SampEn was observed in mothers carrying female fetuses (n = 22), denoting lower synchrony or similarity between MHR and FHR. The variability of MHR and the synchrony/similarity between MHR and FHR vary with respect to fetal gender during labor. These findings suggest that fetal gender needs to be taken into account when simultaneously monitoring MHR and FHR. © 2017 Wiley Periodicals, Inc.

  7. 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].

  8. 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.

  9. Monitoring of dual-energy X-ray absorptiometry measurement in clinical practice.

    PubMed

    El Maghraoui, Abdellah; Achemlal, Lahsen; Bezza, Ahmed

    2006-01-01

    Bone densitometry has become the "gold standard" in osteoporosis diagnosis and treatment evaluation. It has also become more and more common to perform a second dual-energy X-ray absorptiometry (DXA) measurement to monitor bone mineral density (BMD) status or the effect of therapeutic intervention. When a second measurement is performed on a patient, the clinician needs to distinguish between a true change in BMD and a random fluctuation related to variability in the measurement procedure. The reproducibility of DXA measurements is claimed to be good. Such variability is due to multiple causes, such as device errors, technician variability, patients' movements, and variation due to other unpredictable sources. The precision error is usually expressed as the coefficient of variation (CV). However, several other statistics to express reproducibility exist such as the smallest detectable difference (SDD) or the least significant change (LSC). The SDD represents a cut-off that can be measured in an individual and is usually considered more useful than the CV in clinical practice. Indeed, the use of the SDD is preferable to the use of the CV and LSC because of its independence from BMD level and its expression in absolute units (g/cm2). At each measurement center, the SDD must be calculated from in vivo reproducibility data. The choice of the optimum time and site for performing follow-up scans depends on the ratio of the expected BMD treatment effect to the precision of the measurements.

  10. 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

  11. 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

  12. 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

  13. Definition of variables required for comprehensive description of drug dosage and clinical pharmacokinetics.

    PubMed

    Medem, Anna V; Seidling, Hanna M; Eichler, Hans-Georg; Kaltschmidt, Jens; Metzner, Michael; Hubert, Carina M; Czock, David; Haefeli, Walter E

    2017-05-01

    Electronic clinical decision support systems (CDSS) require drug information that can be processed by computers. The goal of this project was to determine and evaluate a compilation of variables that comprehensively capture the information contained in the summary of product characteristic (SmPC) and unequivocally describe the drug, its dosage options, and clinical pharmacokinetics. An expert panel defined and structured a set of variables and drafted a guideline to extract and enter information on dosage and clinical pharmacokinetics from textual SmPCs as published by the European Medicines Agency (EMA). The set of variables was iteratively revised and evaluated by data extraction and variable allocation of roughly 7% of all centrally approved drugs. The information contained in the SmPC was allocated to three information clusters consisting of 260 variables. The cluster "drug characterization" specifies the nature of the drug. The cluster "dosage" provides information on approved drug dosages and defines corresponding specific conditions. The cluster "clinical pharmacokinetics" includes pharmacokinetic parameters of relevance for dosing in clinical practice. A first evaluation demonstrated that, despite the complexity of the current free text SmPCs, dosage and pharmacokinetic information can be reliably extracted from the SmPCs and comprehensively described by a limited set of variables. By proposing a compilation of variables well describing drug dosage and clinical pharmacokinetics, the project represents a step forward towards the development of a comprehensive database system serving as information source for sophisticated CDSS.

  14. Therapeutic drug monitoring of atazanavir: surveillance of pharmacotherapy in the clinic

    PubMed Central

    Ray, John E; Marriott, Debbie; Bloch, Mark T; McLachlan, Andrew J

    2005-01-01

    Background Therapeutic failure with antiretroviral therapy (ART) is a substantial issue where viral rebound, viral resistance and drug-related toxicity remain serious concerns. Drug exposure-response relationships have been described for the protease inhibitors, pharmacokinetic variability is substantial for this class of drugs and drug interactions can also alter ART exposure. Given this background we established a therapeutic drug monitoring (TDM) service to monitor atazanavir (ATV) plasma concentrations early after the therapy was made available to treatment-experienced people infected with HIV who were managed in a clinical setting. Methods This was a prospective observational study which evaluated plasma samples from 110 highly treatment-experienced people with HIV using TDM and applied pharmacokinetic analysis over a five month period. Results ATV trough concentrations exhibited substantial intersubject variability (<25–2108 µg l−1). A substantial number of subjects (50%,13/26) who received ATV400 mg daily had low exposure to ATV. Serum bilirubin concentrations correlated significantly with higher ATV trough concentrations (ρ = 0.803; P < 0.001) and 55% (29/53) of subjects who received ATV300/100 mg RTV daily had plasma concentrations above a proposed target concentration associated with elevated bilirubin concentrations. This study confirmed low ATV exposure in eight subjects with HIV receiving ATV 400 mg daily. Reasons for low ATV exposure in this cohort include administration of interacting drugs, including a possible interaction with ritonavir, fluticasone and ATV, impaired ATV absorption secondary to suspected achlorhydria and potential interactions with colchicine and nandrolone. Viral load remained undetectable in most of these subjects with low ATV exposure. Conclusions TDM and targeted pharmacokinetic studies should be viewed as fundamental tools in the development and clinical application of ART, to improve pharmacotherapy for people with HIV

  15. 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.

  16. 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.…

  17. 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.…

  18. Comparison of two systems for long-term heart rate variability monitoring in free-living conditions - a pilot study

    PubMed Central

    2011-01-01

    Objective A number of small portable systems that can measure HRV are available to address questions related to autonomic regulation in free-living subjects. However, ambulatory HRV measurements obtained through use of these systems have not previously been validated against standard clinical measurements such as Holter recordings. The objective of this study was to validate HRV obtained using a commonly used system, Actiheart, during occupational and leisure-time activities. Method Full-day ambulatory electrocardiography (ECG) signals were recorded from 8 females simultaneously using Actiheart and Holter recorders, and signals were processed to RR-interval time series. Segments of 5-minute duration were sampled every 30 minutes, and spectral components of the heart rate variability were calculated. Actiheart and Holter values were compared using Deming regression analysis and Bland-Altman plots. Results In total, 489 segments were available with an HRV value from both Actiheart and Holter recordings after filtering out segments with >10% interpolated beats. No systematic differences between Actiheart and Holter HRV were found. The random deviations between Actiheart and Holter were comparable to the repeatability standard deviation between consecutive Holter measurements. Discussion The results show that Actiheart is suited as a stand-alone ambulatory method for heart rate variability monitoring during occupational and leisure-time activities. PMID:21481282

  19. 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.

  20. 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.

  1. Clinical and Immunological Spectrum of Common Variable Immunodeficiency (CVID).

    PubMed

    Webster, Anthony David B

    2004-09-01

    We have analysed data from 150 patients initially classified as having CVID. About 10% had laboratory abnormalities suggesting known single gene disorders (eg: hyper-IgM syndrome), and in a few a genetic defect has been confirmed. We have attempted to sub-classify the remaining patients by analysis of their circulating lymphocytes. B lymphocyte markers have been used to estimate the numbers of circulating immature and class switched B cells; there is an association between the presence of high relative numbers of immature circulating B cells, splenomegaly and autoimmune disease. About 25% of CVID patients have a moderate CD4+ T lymphopenia, sometimes with a relative expansion of CD8+ T cells. About 30% of CVID patients have persistent relatively high levels of circulating CD8+ T cells binding immunogenic peptides from EBV or CMV. Many of these patients also have high relative numbers of circulating CD8+ perforin positive T cells, and there is evidence that these cells may be responsible for neutropenia or inflammatory bowel disease in some patients. The clinical spectrum of CVID is diverse, with some patients suffering from few infections, and over 50% have evidence of structural lung damage. About 25% of UK patients have chronic inflammation in various organs, particularly the lungs, liver and spleen, often with granulomatous changes. Steroids are used to treat many of the patients with chronic inflammatory complications, although trials are in progress with anti-TNF agents. The incidence of these inflammatory complications is different between countries, being rare in Sweden. Attempts to correlate clinical phenotypes with the laboratory abnormalities described above have been disappointing, suggesting that unknown genetic factors unrelated to the cause of the immunodeficiency determine the complications; attempts to identify some of these factors will be discussed. Finally a provisional scheme to sub classify CVID patients according to lymphocyte abnormalities

  2. 3D.07: CORRELATION BETWEEN THE ARTERIAL PRESSURE VARIABILITY ESTIMATED AT CLINICS, MAPA AND AMPA.

    PubMed

    Abellan-Huerta, J; García-Escribano, I A; Soto, R M; Leal, M; Torres, A; Guerrero, B; Melgar, A C; Soto, M; Soria, F; Abellan-Aleman, J

    2015-06-01

    To measure the variability (VB) of the arterial pressure (AP) with the use of serial measurements at the clinics (VBCLIN), with 24 h ambulatory monitoring (MAPA) (VBMAPA) and home automonitoring -AMPA- (VBAMPA) and to estimate a relationship among each method. This is an observational, descriptive and transversal study assessed with 91 hypertensive patients in treatment and stable with AP < 160/100 mmHg for the last 3 months. Patients between 50-80 years old were included. The VB of the AP was defined as the standard deviation for both, diastolic and systolic pressures. The different VB were determined with the use of tensiometers and validated AP monitors. VBCLIN was estimated from 8 measurements per week in the clinics. A 24 h MAPA was assessed to all the patients included in the study in order to obtain the VBMAPA and an AMPA in two non-consecutive weeks to obtain the VBAMPA (total of 54 measurements). 91 patients with 66 ± 7.7 years old and 58.2% males were recruited. AP values were 134 ± 14/82 ± 10 mmHg for systolic and diastolic APCLIN, respectively. AP values were 122 ± 17 / 68 ± 12 mmHg for systolic and diastolic APMAPA, respectively. AP values were 125 ± 13/75 ± 7 mmHg for systolic and diastolic APAMPA, respectively. The systolic VB for the three above methods was significantly correlated being maximal between VBCLIN and VBAMPA (r = 0.45; 0 < 0.001) and lower for VBCLIN and VBMAPA (r = 0.25; p = 0.015) and VBMAPA and VBAMPA (r = 0.32; p = 0.002). Means of the systolic AP between each method were statistically different except for VBCLIN and VBAMPA. Corresponding to diastolic AP VB, we could only found a significant relationship between VBCLIN and VBAMPA (r = 0.243; p = 0.021). The correlation between VB of AP measured in the clinics, with AMPA and MAPA methods is weak. This observation suggests that these are not interchangeable methodologies. Future studies focused on the

  3. Whole Body Magnetic Resonance Imaging Features in Diffuse Idiopathic Skeletal Hyperostosis in Conjunction with Clinical Variables to Whole Body MRI and Clinical Variables in Ankylosing Spondylitis.

    PubMed

    Weiss, Bettina G; Bachmann, Lucas M; Pfirrmann, Christian W A; Kissling, Rudolf O; Zubler, Veronika

    2016-02-01

    Discrimination of diffuse idiopathic skeletal hyperostosis (DISH) and ankylosing spondylitis (AS) can be challenging. Usefulness of whole-body magnetic resonance imaging (WB-MRI) in diagnosing spondyloarthritis has been recently proved. We assessed the value of clinical variables alone and in combination with WB-MRI to distinguish between DISH and AS. Diagnostic case-control study: 33 patients with AS and 15 patients with DISH were included. All patients underwent 1.5 Tesla WB-MRI scanning. MR scans were read by a blinded radiologist using the Canadian-Danish Working Group's recommendation. Imaging and clinical variables were identified using the bootstrap. The most important variables from MR and clinical history were assessed in a multivariate fashion resulting in 3 diagnostic models (MRI, clinical, and combined). The discriminative capacity was quantified using the area under the receiver-operating characteristic (ROC) curve. The strength of diagnostic variables was quantified with OR. Forty-eight patients provided 1545 positive findings (193 DISH/1352 AS). The final MR model contained upper anterior corner fat infiltration (32 DISH/181 AS), ankylosis on the vertebral endplate (4 DISH/60 AS), facet joint ankylosis (4 DISH/49 AS), sacroiliac joint edema (11 DISH/91 AS), sacroiliac joint fat infiltration (2 DISH/114 AS), sacroiliac joint ankylosis (2 DISH/119 AS); area under the ROC curve was 0.71, 95% CI 0.64-0.78. The final clinical model contained patient's age and body mass index (area under the ROC curve 0.90, 95% CI 0.89-0.91). The full diagnostic model containing clinical and MR information had an area under the ROC curve of 0.93 (95% CI 0.92-0.95). WB-MRI features can contribute to the correct diagnosis after a thorough conventional workup of patients with DISH and AS.

  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. Variability in pathogenicity prediction programs: impact on clinical diagnostics

    PubMed Central

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

    2015-01-01

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

  6. 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. 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.

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

    PubMed

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

    2016-06-01

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

  9. Variability in clinical assessment of neuroimaging in temporal lobe epilepsy.

    PubMed

    Struck, Aaron F; Westover, Michael B

    2015-08-01

    Neuroimaging is critical in deciding candidacy for epilepsy surgery. Currently imaging is primarily assessed qualitatively, which may affect patient selection and outcomes. The epilepsy surgery database at MGH was reviewed for temporal lobectomy patients from the last 10 years. Radiology reports for MRI and FDG-PET were compared to the epilepsy conference consensus. First, specific findings of ipsi/contra hippocampal atrophy and T2 signal changes were directly compared. Next the overall impression of presence of hippocampal sclerosis (HS) for MRI and temporal hypometabolism for PET was used for sensitivity/specificity analysis. To assess predictive power of imaging findings logistic regression was used. 104 subjects were identified. 70% of subjects were ILAE class I at 1-year. Radiology reports and the conference consensus differed in 31% of FDG-PET studies and 41% of MRIs. For PET most disagreement (50%) stemmed for discrepancy regarding contralateral temporal hypometabolism. For MRI discrepancy in ipsilateral hippocampal atrophy/T2 signal accounted for 59% of disagreements. When overall impression of the image was used the overall reliability between groups was high with only MRI sensitivity to detect HS (0.75 radiology, 0.91 conference, p=0.02) was significantly different between groups. On logistic regression MRI was a significant predictor of HS, but still 36% of patients with normal MRI as read by both groups had HS on pathology. Despite some difference in specific radiologic findings, overall accuracy for MRI and PET is similar in clinical practice between radiology and conference; nonetheless there are still cases of hippocampal pathology not detected by standard imaging methods. Copyright © 2015 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  10. Linear variable filter based oil condition monitoring systems for offshore windturbines

    NASA Astrophysics Data System (ADS)

    Wiesent, Benjamin R.; Dorigo, Daniel G.; Şimşek, Özlem; Koch, Alexander W.

    2011-10-01

    A major part of future renewable energy will be generated in offshore wind farms. The used turbines of the 5 MW class and beyond, often feature a planetary gear with 1000 liters lubricating oil or even more. Monitoring the oil aging process provides early indication of necessary maintenance and oil change. Thus maintenance is no longer time-scheduled but becomes wear dependent providing ecological and economical benefits. This paper describes two approaches based on a linear variable filter (LVF) as dispersive element in a setup of a cost effective infrared miniature spectrometer for oil condition monitoring purposes. Spectra and design criteria of a static multi-element detector and a scanning single element detector system are compared and rated. Both LVF miniature spectrometers are appropriately designed for the suggested measurements but have certain restrictions. LVF multi-channel sensors combined with sophisticated multivariate data processing offer the possibility to use the sensor for a broad range of lubricants just by a software update of the calibration set. An all-purpose oil sensor may be obtained.

  11. Monitoring of Spectral Variations of Mira-Type and Semiregular Variable Stars

    NASA Astrophysics Data System (ADS)

    Rudnitskij, G. M.

    The results of monitoring of a sample of late-type variable stars (Mira Ceti-type and semiregulars) are reported. Since 1980 a sample of 60 stars has been observed in the maser line of the H2O molecule at a wavelength of 1.35 cm. These observations are performed on the RT-22 radio telescope of the Pushchino Radio Astronomy Observatory (Moscow Region). Since 1994 optical spectra of some of these stars have also been monitored on the 1.25-meter telescope of the Crimean Laboratory of the Sternberg Astronomical Institute. Regularities in the spectral behavior of the stars are discussed. Variations of the circumstellar H2O masers correlate with the visual light curves (AFOEV and AAVSO data) with a time lag of 0.3--0.4P (P is the star's period). Flares of the Hα emission noted in R Leo, U Aur, R Cas, and R LMi were followed 1.5--2 years later by corresponding flares of the H2O masers. These phenomena are interpreted as a consequence of propagation of a shock wave driven by stellar pulsation. Alternatively, the shock can be produced by motion of a low-mass satellite (a planet or a brown dwarf) in the inner layer of the circumstellar envelope. The effects of such a satellite on the spectrum and light curve of the primary star are discussed.

  12. Wearable wireless heart rate monitor for continuous long-term variability studies.

    PubMed

    Augustyniak, Piotr

    2011-01-01

    Prototyping of a home care system for activity surveillance and sleep assessment targeted to elderly people involves the compromise of wearing comfort and measurement performance. We propose a wearable heart rate variability monitor connected via wireless digital link to a home-embedded infrastructure of multimodal health surveillance system. The coin-size wearable recorder acquires and processes the electrocardiogram and sends annotated tachogram data accordingly to the subject's status and programed schedule. Thanks to remote programmability, in case of predefined thresholds excess, the recorder response is immediate, whereas the regular reports are organized in packets and delivered in bulk in short transmission sessions. This approach significantly reduces the data rate and the energy required to supply the communication module. The prototype weighting 11.2 g is based on the ARM7 (Atmel Corporate Headquarters 2325 Orchard Parkway San Jose, CA, USA) processor running at 18 MHz and with a 300-mA h rechargeable battery allows for up to 10 days of seamless tachogram monitoring. Copyright © 2011 Elsevier Inc. All rights reserved.

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

    PubMed

    Varouchakis, Epsilon A; Hristopulos, D T

    2013-01-01

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

  14. 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.

  15. 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.

  16. Optical and Radio Monitoring of a Sample of Late-Type Variables

    NASA Astrophysics Data System (ADS)

    Esipov, V. F.; Lekht, E. E.; Pashchenko, M. I.; Rudnitskij, G. M.

    Results of regular observations of about 20 Miras and semiregular variables (o Cet, R Leo, R Aql, U Her, χ Cyg, R Tri, and others) in 1994-1999 are presented. The monitoring includes optical spectroscopy, optical (UBV) and infrared (JHKLM) photometry, high-resolution radio spectroscopy in the 1.35-cm water-vapour maser line (on the 22-m radio telescope in Pushchino). Optical spectroscopy shows that the appearance of strong Balmer emission lines in Miras may be a rare event, and the presumed shock waves are thus weak. The H2O maser flux generally correlates with visual light curves of the stars with some delay Δϕ=0.1-0.4P (P is the variability period). For R Leo, R Cas, and U Aur strong flares in the Hα line, observed in 1997-1998, were followed by corresponding outbursts of the H2O maser emission about 2P later. This sequence of events is probably caused by a shock wave propagating outward in the stellar atmosphere and consecutively initiating the Hα emission and, later, the maser flare at a larger distance from the stellar surface.

  17. 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.

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

    PubMed

    Guidi, Gabriele; Pollonini, Luca; Dacso, Clifford C; Iadanza, Ernesto

    2015-01-01

    Congestive Heart Failure (CHF) is a serious cardiac condition that brings high risks of urgent hospitalization and death. Remote monitoring systems are well-suited to managing patients suffering from CHF, and can reduce deaths and re-hospitalizations, as shown by the literature, including multiple systematic reviews. The monitoring system proposed in this paper aims at helping CHF stakeholders make appropriate decisions in managing the disease and preventing cardiac events, such as decompensation, which can lead to hospitalization or death. Monitoring activities are stratified into three layers: scheduled visits to a hospital following up on a cardiac event, home monitoring visits by nurses, and patient's self-monitoring performed at home using specialized equipment. Appropriate hardware, desktop and mobile software applications were developed to enable a patient's monitoring by all stakeholders. For the first two layers, we designed and implemented a Decision Support System (DSS) using machine learning (Random Forest algorithm) to predict the number of decompensations per year and to assess the heart failure severity based on a variety of clinical data. For the third layer, custom-designed sensors (the Blue Scale system) for electrocardiogram (EKG), pulse transit times, bio-impedance and weight allowed frequent collection of CHF-related data in the comfort of the patient's home. We also performed a short-term Heart Rate Variability (HRV) analysis on electrocardiograms self-acquired by 15 healthy volunteers and compared the obtained parameters with those of 15 CHF patients from PhysioNet's PhysioBank archives. We report numerical performances of the DSS, calculated as multiclass accuracy, sensitivity and specificity in a 10-fold cross-validation. The obtained average accuracies are: 71.9% in predicting the number of decompensations and 81.3% in severity assessment. The most serious class in severity assessment is detected with good sensitivity and specificity (0

  19. [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.

  20. 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

  1. 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.

  2. 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.

  3. Coordinated Broadband Monitoring of Variable X-Ray Sources in NGC 1313

    NASA Technical Reports Server (NTRS)

    Boettcher, Markus

    2005-01-01

    The nearby (3.7 Mpc) late-type barred spiral galaxy NGC 1313 contains three ultraluminous X-ray sources (ULXs) that are offset from the center of the galaxy. Two of these have been associated with optical ionized nebulae, and their spectral and variability properties indicate that they contain black holes. The third ULX is SN 1978K, which was the second supernova to be detected and recognized as a supernova from its radio emission, and the first from its X-rays. In this project, we have started a long-term program of X-ray (XMM-Newton), optical (VLT), and radio (ATCA) observations of these and other sources in NGC 1313. This program has been continued through Cycle 3. XMM-Newton observations in cycle 2 consisted of eight 10 ksec priority A monitoring observations between 2003 November 25 and 2004 January 16. The data obtained from these observations have been fully analyzed, and the results have been published in Smith et al. (2004). The results included the identification of the optical counterpart of ULX X-2, and firm upper limits for the radio counterparts of ULXs X-1 and X-2. Previously unknown X-ray spectral variability has been detected in ULXs X-1 and X-2. For SNR 1978K, we were able to extend and refine the X-ray decay light curve. In tandem, we developed a semi-analytical model for the spectral variability of microquasar jets, which will be refined and applied to the combined results from our cycle 2 + 3 observations after the cycle-3 data have been fully analyzed.

  4. A continental phenology model for monitoring vegetation responses to interannual climatic variability

    NASA Astrophysics Data System (ADS)

    White, Michael A.; Thornton, Peter E.; Running, Steven W.

    1997-06-01

    Regional phenology is important in ecosystem simulation models and coupled biosphere/atmosphere models. In the continental United States, the timing of the onset of greenness in the spring (leaf expansion, grass green-up) and offset of greenness in the fall (leaf abscission, cessation of height growth, grass brown-off) are strongly influenced by meteorological and climatological conditions. We developed predictive phenology models based on traditional phenology research using commonly available meteorological and climatological data. Predictions were compared with satellite phenology observations at numerous 20 km × 20 km contiguous landcover sites. Onset mean absolute error was 7.2 days in the deciduous broadleaf forest (DBF) biome and 6.1 days in the grassland biome. Offset mean absolute error was 5.3 days in the DBF biome and 6.3 days in the grassland biome. Maximum expected errors at a 95% probability level ranged from 10 to 14 days. Onset was strongly associated with temperature summations in both grassland and DBF biomes; DBF offset was best predicted with a photoperiod function, while grassland offset required a combination of precipitation and temperature controls. A long-term regional test of the DBF onset model captured field-measured interannual variability trends in lilac phenology. Continental application of the phenology models for 1990-1992 revealed extensive interannual variability in onset and offset. Median continental growing season length ranged from a low of 129 days in 1991 to a high of 146 days in 1992. Potential uses of the models include regulation of the timing and length of the growing season in large-scale biogeochemical models and monitoring vegetation response to interannual climatic variability.

  5. 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

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

    PubMed

    Cleophas, Ton J

    2016-01-01

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

  7. 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.

  8. Automatic blood pressure monitors. A clinical evaluation of five models in adults.

    PubMed

    Johnson, C J; Kerr, J H

    1985-05-01

    Five automatic blood pressure monitors were evaluated by comparing their values with almost simultaneous blood pressure readings from radial artery catheters. A total of 583 comparisons were made on 48 patients. Statistical analysis was performed on the pooled comparisons of systolic and diastolic pressure for each monitor. Agreement between the pressure measurements was variable between both patients and machines. For systolic pressure, two machines (Copal and Sentron) had correlation coefficients of over 0.9 while for the other machines (Dinamap 845XT, Narco and Vitastat 9001S) the values lay between 0.7 and 0.8. The steepest regression lines were also found with the Copal (0.93) and Sentron (0.86) data, but the other machines had considerably flatter slopes (0.55 to 0.67). The intercepts on the Y axes ranged from +14.1 (Copa) to +50.1 (Dinamap). In clinical use, popularity of the different machines reflected the degree to which the machine reproduced the behaviour of the direct pressure measurement.

  9. Risk-proportionate clinical trial monitoring: an example approach from a non-commercial trials unit.

    PubMed

    Tudur Smith, Catrin; Williamson, Paula; Jones, Ashley; Smyth, Alan; Hewer, Simon Langton; Gamble, Carrol

    2014-04-16

    Some level of monitoring is usually required during a clinical trial to protect the rights and safety of trial participants and to safeguard the quality and reliability of trial results. Although there is increasing support for the use of risk-proportionate approaches to achieve these aims, the variety of methods and lack of an empirical evidence base can present challenges for clinical trial practitioners. This paper describes the monitoring methods and procedures that are utilised by a non-commercial clinical trials unit which coordinates a range of clinical trials across a variety of clinical areas with different associated risks. Monitoring activities and approaches should be selected to be proportionate to the risks identified within a trial. A risk-proportionate approach to monitoring is described giving details of methods that may be considered by clinical trial practitioners during the development of a trial monitoring plan. An example risk assessment and corresponding monitoring plan for a low risk (type A in the Medicines and Healthcare Products Regulatory Agency (MHRA) classification system) pediatric trial is provided for illustration. We present ideas for developing a monitoring plan for a clinical trial of an investigational medicinal product based on our experience. Alternative approaches may be relevant or preferable in other settings based on inherent risk.

  10. Risk-proportionate clinical trial monitoring: an example approach from a non-commercial trials unit

    PubMed Central

    2014-01-01

    Background Some level of monitoring is usually required during a clinical trial to protect the rights and safety of trial participants and to safeguard the quality and reliability of trial results. Although there is increasing support for the use of risk-proportionate approaches to achieve these aims, the variety of methods and lack of an empirical evidence base can present challenges for clinical trial practitioners. Methods This paper describes the monitoring methods and procedures that are utilised by a non-commercial clinical trials unit which coordinates a range of clinical trials across a variety of clinical areas with different associated risks. Results Monitoring activities and approaches should be selected to be proportionate to the risks identified within a trial. A risk-proportionate approach to monitoring is described giving details of methods that may be considered by clinical trial practitioners during the development of a trial monitoring plan. An example risk assessment and corresponding monitoring plan for a low risk (type A in the Medicines and Healthcare Products Regulatory Agency (MHRA) classification system) pediatric trial is provided for illustration. Conclusion We present ideas for developing a monitoring plan for a clinical trial of an investigational medicinal product based on our experience. Alternative approaches may be relevant or preferable in other settings based on inherent risk. PMID:24739398

  11. 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

  12. Formant Frequencies and Bandwidths in Relation to Clinical Variables in an Obstructive Sleep Apnea Population.

    PubMed

    Montero Benavides, Ana; Blanco Murillo, José Luis; Fernández Pozo, Rubén; Espinoza Cuadros, Fernando; Torre Toledano, Doroteo; Alcázar-Ramírez, José D; Hernández Gómez, Luis A

    2016-01-01

    We investigated whether differences in formants and their bandwidths, previously reported comparing small sample population of healthy individuals and patients with obstructive sleep apnea (OSA), are detected on a larger population representative of a clinical practice scenario. We examine possible indirect or mediated effects of clinical variables, which may shed some light on the connection between speech and OSA. In a retrospective study, 241 male subjects suspected to suffer from OSA were examined. The apnea-hypopnea index (AHI) was obtained for every subject using overnight polysomnography. Furthermore, the clinical variables usually reported as predictors of OSA, body mass index (BMI), cervical perimeter, height, weight, and age, were collected. Voice samples of sustained phonations of the vowels /a/, /e/, /i/, /o/, and /u/ were recorded. Formant frequencies F1, F2, and F3 and bandwidths BW1, BW2, and BW3 of the sustained vowels were determined using spectrographic analysis. Correlations among AHI, clinical parameters, and formants and bandwidths were determined. Correlations between AHI and clinical variables were stronger than those between AHI and voice features. AHI only correlates poorly with BW2 of /a/ and BW3 of /e/. A number of further weak but significant correlations have been detected between voice and clinical variables. Most of them were for height and age, with two higher values for age and F2 of /o/ and F2 of /u/. Only few very weak correlations were detected between voice and BMI, weight and cervical perimeter, wich are the clinical variables more correlated with AHI. No significant correlations were detected between AHI and formant frequencies and bandwidths. Correlations between voice and other clinical factors characterizing OSA are weak but highlight the importance of considering indirect or mediated effects of such clinical variables in any research on speech and OSA. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All

  13. Technical implementation and clinical findings/results of monitoring oxygen saturation in patients referred for long-term EEG monitoring.

    PubMed

    Ives, J R; Mainwaring, N R; Krishnamurthy, K B; Blum, A S; Drislane, F W; Schachter, S C; Schomer, D L

    1996-11-01

    Recent technical developments allow the recording of a patient's oxygen saturation (SpO2) simultaneously with intensive long-term EEG monitoring (LTM). Clinically significant information from this enhanced multi-system physiological monitoring device can contribute to more accurate diagnoses in patients referred for LTM. This report covers the technical usage of combined SpO2/EEG recordings in a small group of patients. Clinically, the findings on the SpO2 monitor helped to define the diagnosis in many of these patients. In a few, the SpO2 changes were diagnostic in their own right and prompted referral to our Sleep Disorders Laboratory. From a research aspect, the details of the morphology and timing of the oxygen desaturations and EEG show several interesting relationships with respect to the dynamics of seizure semiology and respiratory physiology.

  14. 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.

  15. 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 be...

  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 be...

  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 be...

  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 be...

  19. 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

  20. 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.

  1. High-resolution ultrasound imaging and noninvasive optoacoustic monitoring of blood variables in peripheral blood vessels

    NASA Astrophysics Data System (ADS)

    Petrov, Irene Y.; Petrov, Yuriy; Prough, Donald S.; Esenaliev, Rinat O.

    2011-03-01

    Ultrasound imaging is being widely used in clinics to obtain diagnostic information non-invasively and in real time. A high-resolution ultrasound imaging platform, Vevo (VisualSonics, Inc.) provides in vivo, real-time images with exceptional resolution (up to 30 microns) using high-frequency transducers (up to 80 MHz). Recently, we built optoacoustic systems for probing radial artery and peripheral veins that can be used for noninvasive monitoring of total hemoglobin concentration, oxyhemoglobin saturation, and concentration of important endogenous and exogenous chromophores (such as ICG). In this work we used the high-resolution ultrasound imaging system Vevo 770 for visualization of the radial artery and peripheral veins and acquired corresponding optoacoustic signals from them using the optoacoustic systems. Analysis of the optoacoustic data with a specially developed algorithm allowed for measurement of blood oxygenation in the blood vessels as well as for continuous, real-time monitoring of arterial and venous blood oxygenation. Our results indicate that: 1) the optoacoustic technique (unlike pure optical approaches and other noninvasive techniques) is capable of accurate peripheral venous oxygenation measurement; and 2) peripheral venous oxygenation is dependent on skin temperature and local hemodynamics. Moreover, we performed for the first time (to the best of our knowledge) a comparative study of optoacoustic arterial oximetry and a standard pulse oximeter in humans and demonstrated superior performance of the optoacoustic arterial oximeter, in particular at low blood flow.

  2. 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

  3. Consideration of clinical variables for choosing new anticoagulant alternatives to warfarin for the management of non-valvular atrial fibrillation.

    PubMed

    Lu, Y; Branstad, R; Karim, R M; Asinger, R W

    2014-12-01

    Patients with non-valvular atrial fibrillation (NVAF) are at risk for stroke and systemic embolism (SSE), and this risk can be decreased with adjusted-dose warfarin. Warfarin, however, is cumbersome to use and requires at least monthly laboratory monitoring. Three new oral anticoagulants (NOACs) that are less cumbersome have been approved as alternatives to warfarin for SSE prevention in NVAF. Selecting a patient-specific alternative to warfarin can be confusing for pharmacists and clinicians. This review details clinical parameters to consider when choosing an alternative to warfarin for a specific patient and summarizes them in a Comparison Table. Using available clinical evidence from pivotal trials, US FDA- and Health Canada-approved prescribing information and post-marketing observations, this review provides a summary of important clinical variables for clinicians to consider when choosing patient-centred anticoagulant alternatives to warfarin for prevention of SSE in NVAF. Dabigatran, rivaroxaban and apixaban are approved alternatives to warfarin for primary and secondary prevention of SSE in patients with NVAF. Additionally, apixaban has also been compared to aspirin in patients with NVAF that were considered unsuitable for vitamin K antagonist therapy. Prospective consideration of age, weight, hepatic function, renal function and drug interactions are important clinical parameters to consider when selecting patient-centred alternatives to adjusted-dose warfarin. Several NOACs are now alternatives to warfarin for SSE prevention in NVAF but require providers to make a shift in strategy from tailoring anticoagulant dose based on anticoagulant effect to selection of the anticoagulant based on clinical variables that affect anticoagulant exposure. These variables and their interactions should be considered in choosing an alternative to warfarin and are summarized in a simple table comparing the new anticoagulants. © 2014 John Wiley & Sons Ltd.

  4. Diabetes and Prediabetes Classification Using Glycemic Variability Indices From Continuous Glucose Monitoring Data.

    PubMed

    Acciaroli, Giada; Sparacino, Giovanni; Hakaste, Liisa; Facchinetti, Andrea; Di Nunzio, Giorgio Maria; Palombit, Alessandro; Tuomi, Tiinamaija; Gabriel, Rafael; Aranda, Jaime; Vega, Saturio; Cobelli, Claudio

    2017-05-01

    Tens of glycemic variability (GV) indices are available in the literature to characterize the dynamic properties of glucose concentration profiles from continuous glucose monitoring (CGM) sensors. However, how to exploit the plethora of GV indices for classifying subjects is still controversial. For instance, the basic problem of using GV indices to automatically determine if the subject is healthy rather than affected by impaired glucose tolerance (IGT) or type 2 diabetes (T2D), is still unaddressed. Here, we analyzed the feasibility of using CGM-based GV indices to distinguish healthy from IGT&T2D and IGT from T2D subjects by means of a machine-learning approach. The data set consists of 102 subjects belonging to three different classes: 34 healthy, 39 IGT, and 29 T2D subjects. Each subject was monitored for a few days by a CGM sensor that produced a glucose profile from which we extracted 25 GV indices. We used a two-step binary logistic regression model to classify subjects. The first step distinguishes healthy subjects from IGT&T2D, the second step classifies subjects into either IGT or T2D. Healthy subjects are distinguished from subjects with diabetes (IGT&T2D) with 91.4% accuracy. Subjects are further subdivided into IGT or T2D classes with 79.5% accuracy. Globally, the classification into the three classes shows 86.6% accuracy. Even with a basic classification strategy, CGM-based GV indices show good accuracy in classifying healthy and subjects with diabetes. The classification into IGT or T2D seems, not surprisingly, more critical, but results encourage further investigation of the present research.

  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. 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.

  7. Development and Implementation of the Ebola Traveler Monitoring Program and Clinical Outcomes of Monitored Travelers during October - May 2015, Minnesota.

    PubMed

    DeVries, Aaron; Talley, Pamela; Sweet, Kristin; Kline, Susan; Stinchfield, Patricia; Tosh, Pritish; Danila, Richard

    2016-01-01

    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. 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. 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 median age was 35 years; 136 (17%) were aged

  8. 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.

  9. Clinical evaluation of a new epidural pressure monitor.

    PubMed

    Czech, T; Korn, A; Reinprecht, A; Schramm, W; Kimla, T; Spiss, C K

    1993-01-01

    Comparative measuring of epidural pressure using the Spiegelberg probe 1 and ventricular fluid pressure was carried out in 15 neurosurgical intensive-care patients. Deviations in both directions were established, with a trend toward overestimating ventricular pressure in epidural pressure measuring (r = 0.77). Individual pulsations, spontaneous wave courses and therapy-induced pressure changes were reflected without delays. There were no complications observed with probe implantation periods for up to 6 days. The system has been shown to be mechanically stable and easy to implant. We believe the device to be fit for trend monitoring of intracranial pressure. As with other epidural pressure monitoring systems, false assessments of ventricular pressure may lead to wrong decisions as to required therapy.

  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. 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…

  12. Using hydrophones as a surrogate monitoring technique to detect temporal and spatial variability in bedload transport

    USGS Publications Warehouse

    Marineau, Mathieu D.; Minear, J. Toby; Wright, Scott A.

    2015-01-01

    Collecting physical bedload measurements is an expensive and time-consuming endeavor that rarely captures the spatial and temporal variability of sediment transport. Technological advances can improve monitoring of sediment transport by filling in temporal gaps between physical sampling periods. We have developed a low-cost hydrophone recording system designed to record the sediment-generated noise (SGN) resulting from collisions of coarse particles (generally larger than 4 mm) in gravel-bedded rivers. The sound level of the signal recorded by the hydrophone is assumed to be proportional to the magnitude of bedload transport as long as the acoustic frequency of the SGN is known, the grain-size distribution of the bedload is assumed constant, and the frequency band of the ambient noise is known and can be excluded from the analysis. Each system has two hydrophone heads and samples at half-hour intervals. Ten systems were deployed on the San Joaquin River, California, and its tributaries for ten months during water year 2014, and two systems were deployed during a flood event on the Gunnison River, Colorado in 2014. A mobile hydrophone system was also tested at both locations to collect longitudinal profiles of SGN. Physical samples of bedload were not collected in this study. In lieu of physical measurements, several audio recordings from each site were aurally reviewed to confirm the presence or absence of SGN, and hydraulic data were compared to historical measurements of bedload transport or transport capacity estimates to verify if hydraulic conditions during the study would likely produce bedload transport. At one site on the San Joaquin River, the threshold of movement was estimated to have occurred around 30 m 3 /s based on SGN data. During the Gunnison River flood event, continuous data showed clockwise hysteresis, indicating that bedload transport was generally less at any given streamflow discharge during the recession limb of the hydrograph. Spatial

  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. [ECG monitoring in full-term infants. Analysis of the rhythm and variability of heart rate].

    PubMed

    Pandolfi, M; Falsini, G; Lazzerini, S; Giani, I; Rosati, C; Mantini, G; Grazzini, M

    1993-01-01

    Heart Rate (HR) and Heart Rate Variability (HRV) depend on the neural control to the heart. HRV can be measured from 24-hours function. Little information is available on cardiac rhythm and on autonomic nervous control to the heart at birth. The aims of the study weew: 1) to study the cardiac rhythm in healthy newborn babies; 2) to asses the normal values for HRV at birth. We studied 20 full term healthy newborn babies. Newborns underwent 24-hours ECG-Holter monitoring. Analysis was performed by a 750 A Del Mar Avionics Analyzer. We determined: Heart Rate (HR), number of extrasystoles, Standard Deviation of all R-R intervals over 24 hours (SDNN) and mean hourly HRV (HRVM). Results about HRV were matched with those of 50 healthy adults. 1) Average HR in the newborn babies was 108 (range: 55-198); we found high prevalence of supraventricular extrasystoles. 2) We determined reference value for HRV. SDNN was 55 +/- 17 ms in newborns. SDNN of adults was 132 +/- 25 ms (44% higher than in newborns; p < 0.001). HRVM was 46 +/- 14 ms in newborns and 76 +/- 14 ms (p < 0.001). 1) Larger intervals of HR in newborn babies compared to literature data and an high prevalence of supraventricular arrhythmias in full term healthy newborn babies. 2) Reference values for HRV in newborn babies. The low values of HRV confirm the immaturity of autonomic cardiac control.

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

    NASA Astrophysics Data System (ADS)

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

    2015-11-01

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

  17. Sub-daily variability of suspended sediment fluxes in small mountainous catchments - implications for community-based river monitoring

    NASA Astrophysics Data System (ADS)

    Duvert, C.; Gratiot, N.; Némery, J.; Burgos, A.; Navratil, O.

    2010-10-01

    Accurate estimates of suspended sediment yields depend on effective monitoring strategies. In mountainous environments undergoing intense seasonal precipitation, the implementation of such monitoring programs relies primarily on a rigorous study of the temporal variability of fine sediment transport. This investigation focuses on seasonal and short-term sediment variability in a subhumid region of the Mexican Volcanic Belt. Intensive hydrosedimentary monitoring was conducted during one year on four contrasting catchments (3 to 630 km2). Analyses revealed significant temporal variability in suspended sediment export over various time scales, with between 63 and 97% of the annual load exported in as little as 2% of the time. Statistical techniques were used to evaluate the sampling frequency required to get reliable annual sediment yield estimates at the four sites. A bi-daily sampling would be required at the outlet of the 630-km2 catchment, whereas in the three smaller catchments (3-12 km2), the achievement of accurate estimates would inevitably require hourly monitoring. At the larger catchment scale, analysis of the sub-daily variability of fine sediment fluxes showed that the frequency of sampling could be lowered by up to 100% (i.e. from bi-daily to daily) if considering a specific and regular sampling time in the day. In contrast, conducting a similar sampling strategy at the three smaller catchments could lead to serious misinterpretation (i.e. up to 1000% error). Our findings emphasise the importance of an analysis of the sub-daily variability of sediment fluxes in mountainous catchments. Characterising this variability may offer useful insights for improving the effectiveness of community-based monitoring strategies in rural areas of developing countries. In regions where historical records based on discrete sampling are available, it may also help assessing the quality of past flux estimates. Finally, the study confirms the global necessity of acquiring

  18. Sub-daily variability of suspended sediment fluxes in small mountainous catchments &ndash implications for community-based river monitoring

    NASA Astrophysics Data System (ADS)

    Duvert, C.; Gratiot, N.; Némery, J.; Burgos, A.; Navratil, O.

    2011-03-01

    Accurate estimates of suspended sediment yields depend on effective monitoring strategies. In mountainous environments undergoing intense seasonal precipitation, the implementation of such monitoring programs relies primarily on a rigorous study of the temporal variability of fine sediment transport. This investigation focuses on seasonal and short-term variability in suspended sediment flux in a subhumid region of the Mexican Volcanic Belt. Intensive monitoring was conducted during one year in four contrasting catchments (3 to 630 km2). Analyses revealed significant temporal variability in suspended sediment export over various time scales, with between 63 and 97% of the annual load exported in as little as 2% of the time. Statistical techniques were used to evaluate the sampling frequency required to get reliable estimates of annual sediment yield at the four sites. A bi-daily sampling scheme would be required at the outlet of the 630 km2 catchment, whereas in the three smaller catchments (3-12 km2), accurate estimates would inevitably require hourly monitoring. At the larger catchment scale, analysis of the sub-daily variability of fine sediment fluxes showed that the frequency of sampling could be lowered by up to 100% (i.e. from bi-daily to daily) if a specific and regular sampling time in the day was considered. In contrast, conducting a similar sampling strategy at the three smaller catchments could lead to serious misinterpretation (i.e. up to 1000% error). Our findings emphasise the importance of an analysis of the sub-daily variability of sediment fluxes in mountainous catchments. Characterising this variability may offer useful insights for improving the effectiveness of community-based monitoring strategies in rural areas of developing countries. In regions where historical records based on discrete sampling are available, it may also help assessing the quality of past flux estimates. Finally, the study confirms the global necessity of acquiring more

  19. 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

  20. Medication monitoring for people with dementia in care homes: the feasibility and clinical impact of nurse-led monitoring.

    PubMed

    Jordan, Sue; Gabe, Marie; Newson, Louise; Snelgrove, Sherrill; Panes, Gerwyn; Picek, Aldo; Russell, Ian T; Dennis, Michael

    2014-01-01

    People with dementia are susceptible to adverse effects of medicines. However, they are not always closely monitored. We explored (1) feasibility and (2) clinical impact of nurse-led medication monitoring. Feasibility "before-and-after" intervention study. Three care homes in Wales. Eleven service users diagnosed with dementia, taking at least one antipsychotic, antidepressant, or antiepileptic medicine. West Wales Adverse Drug Reaction (ADR) Profile for Mental Health Medicines. (1) Feasibility: recruitment, retention, and implementation. (2) Clinical impact: previously undocumented problems identified and ameliorated, as recorded in participants' records before and after introduction of the profile, and one month later. Nurses recruited and retained 11 of 29 eligible service users. The profile took 20-25 minutes to implement, caused no harm, and supplemented usual care. Initially, the profile identified previously undocumented problems for all participants (mean 12.7 (SD 4.7)). One month later, some problems had been ameliorated (mean 4.9 (3.6)). Clinical gains included new prescriptions to manage pain (2 participants), psoriasis (1), Parkinsonian symptoms (1), rash (1), dose reduction of benzodiazepines (1), new care plans for oral hygiene, skin problems, and constipation. Participants benefited from structured nurse-led medication monitoring. Clinical trials of our ADR Profile are feasible and necessary.

  1. Variable clinical presentations of secondary delusional infestation: an experience of six cases from a psychodermatology clinic.

    PubMed

    Altunay, Ilknur K; Ates, Bilge; Mercan, Sibel; Demirci, Gulsen Tukenmez; Kayaoglu, Semra

    2012-01-01

    Delusional Infestation (DI) is a relatively rare condition with a fixed belief of being infested with living organisms, despite a lack of medical evidence of such infestation. Although it seems to be a psychiatric disease, patients commonly are admitted to dermatology clinics because of skin findings. Psychiatrists can underestimate its prevalance, whereas dermatologists can miss the diagnosis. It should be managed as a psychodermatological disease. Our aim in the study was to evaluate six patients with different clinical presentations of DI and to emphasize some clinical features. All patients were internalized in the psychodermatology clinic for this study. Medical history and clinical data from dermatologic and psychiatric examinations were noted; Mini International Neuropsychiatric Interview (MINI-Plus) and laboratory investigations including blood and urine analyses, microscopic analysis of so-called pathogens, and skin biopsy if needed, were performed. The diagnosis was made based on detailed history, dermatologic and psychiatric examinations, and laboratory investigations. All patients had symptoms of itching, burning, or crawling sensations dermatologically and thus were admitted to dermatology clinic. They were all considered secondary DI to another medical condition or to psychiatric illness. Vitamin B12 deficiency, diabetes, and hypothyroidism were the underlying medical conditions. Related psychiatric illnesses were trichotillomania and schizoaffective disorder, schizophrenia, shared pychotic disorder, and brief psychotic disorder. Two patients had delusions of inanimate materials; four patients had partial and complete remissions; and two patients have dropped out. Each patient had different clinical characteristics creating diagnostic challenges. All complaints were related to the infestation of the skin. The presence of different psychiatric comorbidities is remarkable. It seems that both psychiatrists and dermatologists can face diagnostic and

  2. Intra- and Interobserver Variability of Cochlear Length Measurements in Clinical CT.

    PubMed

    Iyaniwura, John E; Elfarnawany, Mai; Riyahi-Alam, Sadegh; Sharma, Manas; Kassam, Zahra; Bureau, Yves; Parnes, Lorne S; Ladak, Hanif M; Agrawal, Sumit K

    2017-07-01

    The cochlear A-value measurement exhibits significant inter- and intraobserver variability, and its accuracy is dependent on the visualization method in clinical computed tomography (CT) images of the cochlea. An accurate estimate of the cochlear duct length (CDL) can be used to determine electrode choice, and frequency map the cochlea based on the Greenwood equation. Studies have described estimating the CDL using a single A-value measurement, however the observer variability has not been assessed. Clinical and micro-CT images of 20 cadaveric cochleae were acquired. Four specialists measured A-values on clinical CT images using both standard views and multiplanar reconstructed (MPR) views. Measurements were repeated to assess for intraobserver variability. Observer variabilities were evaluated using intra-class correlation and absolute differences. Accuracy was evaluated by comparison to the gold standard micro-CT images of the same specimens. Interobserver variability was good (average absolute difference: 0.77 ± 0.42 mm) using standard views and fair (average absolute difference: 0.90 ± 0.31 mm) using MPR views. Intraobserver variability had an average absolute difference of 0.31 ± 0.09 mm for the standard views and 0.38 ± 0.17 mm for the MPR views. MPR view measurements were more accurate than standard views, with average relative errors of 9.5 and 14.5%, respectively. There was significant observer variability in A-value measurements using both the standard and MPR views. Creating the MPR views increased variability between experts, however MPR views yielded more accurate results. Automated A-value measurement algorithms may help to reduce variability and increase accuracy in the future.

  3. 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.

  4. 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

  5. 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

  6. Understanding Blood Pressure Variation and Variability: Biological Importance and Clinical Significance.

    PubMed

    James, Gary D

    2017-01-01

    Variability is a normative property of blood pressure necessary for survival which likely contributes to morbidity and mortality through allostatic load. Because of its allostatic and adaptive properties blood pressure responses to peculiar situations like the visit to the clinic can lead to the misdiagnosis of hypertension. Cuff methods of blood pressure measurement can also create blood pressure variation when there really is none. There are also physiological differences between populations related to their evolutionary history that likely further affect the extent of population differences in 24-h blood pressure variability. Quantifying the sources and extent of blood pressure variability can be done using natural experimental models and through the evaluation of ecological momentary data. It is very likely that the results of population studies of blood pressure variability and morbidity and mortality risk are inconclusive because the parameters used to assess blood pressure variability do not reflect the actual nature of blood pressure allostasis.

  7. Clinical testing of contrast thresholds using a commercial television monitor system.

    PubMed

    Vingrys, Algis J; Anderson, Andrew J

    1998-01-01

    Background: The Medmont AT-20 has incorporated a contrast threshold test using a predetermined letter size that can be applied in clinical settings. This paper describes a pilot study that evaluates this technology and the effects of certain parameters on test outcomes. Methods: A photometric calibration of the test was performed to define the relationship between the AT-20 scale and Weber contrast (W%). We determined the effects of repeated measures (precision), target size (6/6 to 6/96), viewing duration (50 to 1,000 msec), defocus (+0.50 to +1.50 DS) and a macula scotoma on thresholds. The accuracy of the staircase (PEST) procedure was evaluated with and without false-negative responses. Results: The AT-20 scale has an almost linear relationship to a logarithmic transformation of W% and provides a suitable measure of contrast threshold. In the absence of monitor calibration, threshold uncertainty could be as great as 0.22 log units (W%) compared with published norms. We found that threshold variability averaged +/- 7.1 AT-20 scale units (95 per cent limits of agreement) and was proportional to threshold magnitude. One dioptre of defocus decreased thresholds by about one log unit (W%) for a 6/24 target. We propose that a 6/24 letter shown for 500 msec should provide a useful target for most clinical settings. The PEST procedure can yield endpoints in 47 (+/-12) seconds, is robust to false negative (FN) responses and gives abnormal thresholds in the presence of a macula scotoma. Conclusions: The Medmont AT-20 contrast test provides a useful clinical measure of contrast threshold. With calibration, the test could also be applied to research projects.

  8. [Clinical characteristics of bone disease in multiple myeloma and clinical significance of monitoring bone metabolic markers].

    PubMed

    Chu, B; Lu, M Q; Wu, M Q; Shi, L; Fu, L N; Gao, S; Fang, L J; Xiang, Q Q; Bao, L

    2016-05-17

    To observe the clinical characteristics of bone disease in patients with multiple myeloma (MM) and the clinical significance of monitoring bone metabolic markers. The data of 178 MM cases newly diagnosed in Beijing Ji Shui Tan Hospital from January 2009 to June 2014 were reviewed to analysis the types and classification of bone disease and to observe the clinical characteristics of patients with different grades of bone disease. The levels of bone metabolic markers total procollagen type Ⅰ N-terminal peptide (tPINP) and β C-terminal telopeptide of type Ⅰ collagen (β-CTX) were monitored regularly in the two years following treatment in 66 cases. (1) Among the 178 newly diagnosed MM cases, 167 cases complained of pain in bones on first visit, 35 cases combined with hypercalcemia, 83 cases combined with osteoporosis, 154 cases combined with osteolytic bone destruction, and 73 cases combined with pathologic fracture. The most common osteolytic location was the spine. The most common fracture sites was the spine. (2) According to bone disease grading, the 178 cases were divided into group A (bone grade 0-2, n=51) and group B(bone grade 3-4, n=127). There were no significant differences between group A and group B in gender, median age, therapeutic effect/ineffec, median overall survival, median progress-free survival, mean serum lactic dehydrogenase, mean albumin, urine light chains and serum creatinine(all P>0.05). Compared with group A, group B had lower hemoglobin level[(99.78±29.93)vs (108.84±29.30) g/L], and higher blood calcium level[(2.47±0.40)vs (2.30±0.29) mmol/L], serum β2-microglobuin level[(6.04±4.84)vs (4.12±3.97)mg/L], and bone marrow plasma cells percentage(33.30%±24.87% vs 23.51%±22.67%)(all P<0.05). (3) Before treatment, the levels of β-CTX and tPINP in patients of group B(n=47) were higher than those in group A(n=19)(median 0.78 vs 0.42 μg/L, 60.95 vs 43.47 μg/L, both P<0.05). The ratio of β-CTX /tPINP in group B was higher than that

  9. Post-Surgical Clinical Monitoring of Soft Tissue Wound Healing in Periodontal and Implant Surgery.

    PubMed

    Pippi, Roberto

    2017-01-01

    Clinical features of surgical soft tissue wound healing in dentistry have been rarely discussed in the international literature. The aim of the present paper is to highlight both the main clinical findings of surgical wound healing, especially in periodontal and implant dentistry, and the wound healing monitoring procedures which should be followed. Wound inspection after careful food and plaque debridement is the essential part of wound healing monitoring. Periodontal and peri-implant probing should be performed only after tissue healing has been completed and not on a weekly basis in peri-implant tissue monitoring. Telephone follow-up and patient self-assessment scales can also be used the days following surgery to monitor the most common surgical complications such as pain, swelling, bleeding, and bruising. Wound healing monitoring is an important concern in all surgical procedures since it allows to identify signs or/and symptoms possibly related to surgical complications.

  10. 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.

  11. 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

  12. [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.

  13. Heart rate variability to monitor performance in elite athletes: Criticalities and avoidable pitfalls.

    PubMed

    Lucini, Daniela; Marchetti, Ilaria; Spataro, Antonio; Malacarne, Mara; Benzi, Manuela; Tamorri, Stefano; Sala, Roberto; Pagani, Massimo

    2017-08-01

    Spectral analysis of Heart Rate Variability (HRV) is a simple, non-invasive technique that is widely used in sport to assess sympatho-vagal regulation of the heart. Its employment is increasing partly due to the rising usage of wearable devices. However data acquisition using these devices may be suboptimal because they cannot discriminate between sinus and non-sinus beats and do not record any data regarding respiratory frequency. This information is mandatory for a correct clinical interpretation. This study involved 974 elite athletes, all of them underwent a complete autonomic assessment, by way of Autoregressive HRV analysis. In 91 subjects (9% of the total population) we observed criticalities of either cardiac rhythm or respiration. Through perusal of one-lead ECG analysis we observed that 77 subjects had atrial or ventricular ectopy, i.e. conditions which impair stationarity and sinus rhythm. Running anyway autonomic nervous system analysis in this population, we observed that RR variance and raw values of LF and HF regions are significantly higher in arrhythmic subjects. In addition 14 subjects had slow (about 6 breath/min, 0.1Hz) respiration. This condition clouds the separation between LF from HF spectral regions of RR interval variability, respectively markers of the prevalent sympathetic and vagal modulation of SA node and of their synergistic interaction. Caution must be payed when assessing HRV with non-ECG wearable devices. Recording ECG signal and ensuring that respiratory rate is higher than 10 breath/min are both prerequisites for a more reliable analysis of HRV particularly in athletes. Copyright © 2017 Elsevier B.V. All rights reserved.

  14. 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

  15. Identifying variables associated with inaccurate self-monitoring of blood glucose: proposed guidelines to improve accuracy.

    PubMed

    Bergenstal, R; Pearson, J; Cembrowski, G S; Bina, D; Davidson, J; List, S

    2000-01-01

    This study was conducted to evaluate patients' proficiency in self-monitoring of blood glucose (SMBG). Diabetes nurse educators in 4 suburban Minneapolis clinic sites surveyed the SMBG training/cure practices of 280 patients with type 1 and type 2 diabetes. Participant SMBG technique was measured by direct observation. Participants performed a finger puncture and used their own meters to measure the first blood sample. A second sample was measured on the HemoCue B Glucose analyzer, and a third sample was used to measure hemoglobin. The series of tests were then repeated. If either of the 2 glucose tests was more than 15% from the HemoCue value, participants were reeducated about the manufacturer's suggested procedure. Of the 280 participants, 19% had blood glucose test results greater than the 15% limit for meter accuracy. After reeducation, 69% of those who had initially failed achieved acceptable results. The most significant problems were lack of periodic meter technique evaluation, difficulty using wipe meters, incorrect use of control solutions, lack of hand washing even when observed, and unclean meters. As a result of the study, guidelines were subsequently developed to evaluate meter accuracy in an outpatient setting. Further effort is needed to establish standards for evaluating SMBG.

  16. 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

  17. 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.

  18. 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.

  19. 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

  20. Potential analytical interferences and seasonal variability in diethyltoluamide environmental monitoring programs.

    PubMed

    Merel, Sylvain; Nikiforov, Andrey I; Snyder, Shane A

    2015-05-01

    N,N-diethyl-m-toluamide (DEET), the active component of many insect repellents, is among the most frequently detected compounds in aqueous environments with concentrations reported in the ng L(-1) to μg L(-1) range. However, DEET is often detected in blanks and reported concentrations differ significantly depending on the analytical technique employed. In addition, relatively sparse data are available regarding the seasonal variability of DEET concentrations in water and there are apparent inconsistencies with expected use patterns. Therefore, the present study investigates potential interferences affecting the detection and quantification of DEET then the geographical and seasonal variations of DEET concentrations. To examine potential analytical interferences, DEET was analyzed in five geographically-diverse wastewater effluents using both gas chromatography and liquid chromatography coupled to mass spectrometric detectors. At times, the concentrations quantified by the employed analytical methods varied significantly. Five compounds with similar molecular weights and structures as DEET were investigated as potential mimics and some were shown to induce an overestimation of DEET. Further experimentation suggested that the solvents used in sample preparation and HPLC analysis are another possible source of interference. Besides potential interferences, the seven-month weekly monitoring of DEET in the primary effluent of a wastewater treatment plant demonstrated a clear seasonal trend with decreasing concentration from summer to winter. These data collectively demonstrate that there are many challenges in the quantification of DEET in complex environmental samples and that co-occurrence of similarly structured substances present in the water sample and/or the solvents used for the analysis could induce analytical bias. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. Monitoring the results of cardiac surgery by variable life-adjusted display.

    PubMed

    Lovegrove, J; Valencia, O; Treasure, T; Sherlaw-Johnson, C; Gallivan, S

    1997-10-18

    Conventional assessment of the outcome of cardiac surgery usually takes the form of retrospective mortality figures and, at best, indicates an average performance over time. Summary tables conceal good and bad runs, and without risk adjustment they are difficult to interpret. We developed a refinement of the cumulative sum method that weights death and survival by each patient's risk status and provides a display of surgical performance over time. The variable life-adjusted (VLAD) plot shows the difference between expected and actual cumulative mortality. VLAD shows whether a surgeon's performance is above or below what might be expected. This mortality-scoring system accumulates penalties for each death and rewards for every survivor, based on the inherent risk of perioperative death of each case concerned. We illustrate the results of three performance reviews, displayed as VLADs. The first shows the results of an individual surgeon for 547 consecutive cardiac-surgical cases. The overall mortality was 36% less than that predicted by the Parsonnet scoring system. The second displays the results for 5000 consecutive patients who underwent cardiopulmonary bypass between 1992 and 1996, divided into six contemporaneous series. The predicted mortality was 9% compared with 6% actual mortality. The third is a plot for a trainee surgeon and clearly shows how a period of poor performance was identified and then substantially improved, which would not have been revealed by conventional tables of summary statistics. VLAD provides a graphical display of risk-adjusted survival figures for individual surgeons or units over time and could be modified to monitor performance over a range of treatments and outcomes.

  2. 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%).

  3. 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.

  4. Self-monitoring of blood pressure should be used in clinical trials.

    PubMed

    Baguet, Jean-Philippe; Mallion, Jean-Michel

    2002-02-01

    The number of studies of the efficacy of drugs in hypertension and of their effects on morbidity and mortality continues to be large. Traditionally such studies were carried out by measuring the blood pressure (BP) in the office. Recently, there has been an increasing use of other approaches, such as self-measurement. The advantages of this technique may be the achievement of greater precision of measurement, explained by elimination of the white-coat effect, reduction in placebo effect and reduction in variability of BP. Some have even noted a greater reproducibility than using ambulatory BP monitoring. We now have available reference values and normal ranges for self-BP monitoring. The feasibility and the limitations of self-BP measurement are also known. Self-measurement allows multiple recordings of BP over the short term as well as over the long term. Moreover, the compliance of this technique is satisfying. The analysis of the data requires precise recommendations. One cannot refer to trough : peak ratio, which is used in ambulatory recordings. However, other methods of analysis such as evening BP : morning BP ratio or measures taken after taking treatment are useful. The number of subjects needed for a study is much smaller than in a study performed using office measurements for a similar or better statistical power. Such a method has a higher predictive value than clinic measurement both for study of end organ damage and for morbidity and mortality. Finally home measurement is much less costly. In conclusion, provided one uses validated equipment and if one follows recommendations for each measurement and for the succession of measurements, then self-measurement of BP at home seems a useful and practical tool for therapeutic trials.

  5. Brief Experimental Analysis of Antecedent Variables Related to Noncompliance in Young Children in an Outpatient Clinic

    ERIC Educational Resources Information Center

    Stephens, Tracy J.; Wacker, David P.; Cooper, Linda; Richman, David; Kayser, Krista

    2003-01-01

    The purpose of this investigation was to evaluate a methodology for analyzing the interactive effects of two different antecedent variables on child noncompliance in an outpatient clinic. Phase 1 of this study consisted of antecedent manipulations to identify situations that occasioned problematic behaviors (i.e., presence or absence of the…

  6. [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.

  7. Optoacoustic monitoring of blood hemoglobin concentration: a pilot clinical study

    NASA Astrophysics Data System (ADS)

    Petrova, Irina Y.; Esenaliev, Rinat O.; Petrov, Yuriy Y.; Brecht, Hans-Peter F.; Svensen, Christer H.; Olsson, Joel; Deyo, Donald J.; Prough, Donald S.

    2005-07-01

    The optoacoustic technique is noninvasive, has high spatial resolution, and potentially can be used to measure the total hemoglobin concentration ([THb]) continuously and accurately. We performed in vitro measurements in blood and in vivo tests in healthy volunteers. Our clinical protocol included rapid infusion of intravenous saline to simulate rapid change in the [THb] during fluid therapy or surgery. Optoacoustic measurements were made from the wrist area overlying the radial artery for more than 1 h. The amplitude of the optoacoustic signal generated in the radial artery closely followed the [THb] measured directly in concurrently collected blood samples.

  8. Next-Generation Sequencing to Help Monitor Patients Infected with HIV: Ready for Clinical Use?

    PubMed

    Gibson, Richard M; Schmotzer, Christine L; Quiñones-Mateu, Miguel E

    2014-04-01

    Given the extreme variability of the human immunodeficiency virus (HIV) and its ability to replicate as complex viral populations, HIV variants with reduced susceptibility to antiretroviral drugs or with specific coreceptor tropism (CCR5 and/or CXCR4) may be present as minority members of the viral quasispecies. The sensitivity of current HIV genotypic or phenotypic assays is limited, and thus, these tests usually fail to detect low-abundance viral variants. Next-generation (deep) sequencing (NGS) produces an enormous amount of information that allows the detection of minority HIV variants at levels unimaginable using standard Sanger sequencing. NGS technologies continue to evolve, opening new and more affordable opportunities to implement this methodology in clinical laboratories, and HIV is not an exception. The ample use of a battery of more effective antiretroviral drugs, together with careful patient monitoring based on HIV resistance testing, has resulted in HIV-infected patients whose disease is usually well-controlled. The vast majority of adherent patients without detectable resistance become virologically suppressed; however, a subset of these patients with undetectable resistance by standard methods may fail antiretroviral therapy, perhaps due to the presence of minority HIV-resistant variants. Novel NGS-based HIV assays with increased sensitivity for identifying low-level drug resistance and/or coreceptor tropism may play an important role in the success of antiretroviral treatments.

  9. 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. Copyright © 2015 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

  10. Impact of menstruation on select hematology and clinical chemistry variables in cynomolgus macaques.

    PubMed

    Perigard, Christopher J; Parrula, M Cecilia M; Larkin, Matthew H; Gleason, Carol R

    2016-06-01

    In preclinical studies with cynomolgus macaques, it is common to have one or more females presenting with menses. Published literature indicates that the blood lost during menses causes decreases in red blood cell mass variables (RBC, HGB, and HCT), which would be a confounding factor in the interpretation of drug-related effects on clinical pathology data, but no scientific data have been published to support this claim. This investigation was conducted to determine if the amount of blood lost during menses in cynomolgus macaques has an effect on routine hematology and serum chemistry variables. Ten female cynomolgus macaques (Macaca fascicularis), 5 to 6.5 years old, were observed daily during approximately 3 months (97 days) for the presence of menses. Hematology and serum chemistry variables were evaluated twice weekly. The results indicated that menstruation affects the erythrogram including RBC, HGB, HCT, MCHC, MCV, reticulocyte count, RDW, the leukogram including neutrophil, lymphocyte, and monocyte counts, and chemistry variables, including GGT activity, and the concentrations of total proteins, albumin, globulins, and calcium. The magnitude of the effect of menstruation on susceptible variables is dependent on the duration of the menstrual phase. Macaques with menstrual phases lasting ≥ 7 days are more likely to develop changes in variables related to chronic blood loss. In preclinical toxicology studies with cynomolgus macaques, interpretation of changes in several commonly evaluated hematology and serum chemistry variables requires adequate clinical observation and documentation concerning presence and duration of menses. There is a concern that macaques with long menstrual cycles can develop iron deficiency anemia due to chronic menstrual blood loss. © 2016 American Society for Veterinary Clinical Pathology.

  11. Classification models for neurocognitive impairment in HIV infection based on demographic and clinical variables.

    PubMed

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

    2014-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  13. 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

  14. 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.

  15. Commonality and Variability Analysis for Xenon Family of Separation Virtual Machine Monitors (CVAX)

    DTIC Science & Technology

    2017-07-18

    Machine Monitors (CVAX) July 18, 2017 Approved for public release; distribution is unlimited. James Kirby Jr. John mcDermott Center for High...Analysis for Xenon Family of Separation Virtual Machine Monitors (CVAX) James Kirby Jr., John McDermott, and Grady H. Campbell Jr.* Naval Research...Kirby Jr. (202) 767-3107 The objective of this document is to define the composition of the Xenon Family of Separation Virtual Machine Monitors. This

  16. [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.

  17. Vital signs monitoring on general wards: clinical staff perceptions of current practices and the planned introduction of continuous monitoring technology.

    PubMed

    Prgomet, Mirela; Cardona-Morrell, Magnolia; Nicholson, Margaret; Lake, Rebecca; Long, Janet; Westbrook, Johanna; Braithwaite, Jeffrey; Hillman, Ken

    2016-09-01

    Early detection of patient deterioration and prevention of adverse events are key challenges to patient safety. This study investigated clinical staff perceptions of current monitoring practices and the planned introduction of continuous monitoring devices on general wards. Multi-method study comprising structured surveys, in-depth interviews and device trial with log book feedback. Two general wards in a large urban teaching hospital in Sydney, Australia. Respiratory and neurosurgery nursing staff and two doctors. Nurses were confident about their abilities to identify patients at risk of deterioration, using a combination of vital signs and visual assessment. There were concerns about the accuracy of current vital signs monitoring equipment and frequency of intermittent observation. Both the nurses and the doctors were enthusiastic about the prospect of continuous monitoring and perceived it would allow earlier identification of patient deterioration; provide reassurance to patients; and support interdisciplinary communication. There were also reservations about continuous monitoring, including potential decrease in bedside nurse-patient interactions; increase in inappropriate escalations of patient care; and discomfort to patients. While continuous monitoring devices were seen as a potentially positive tool to support the identification of patient deterioration, drawbacks, such as the potential for reduced patient contact, revealed key areas that will require close surveillance following the implementation of devices. Training and improved interdisciplinary communication were identified as key requisites for successful implementation. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  18. 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

    group has implemented closer, invasive intra-operative monitoring of blood pressure through the placement of an intraarterial line in the femoral...Standardize Clinical Monitoring of Restorative Transplantation PRINCIPAL INVESTIGATOR: W. P. Andrew Lee, MD CONTRACTING ORGANIZATION: Johns Hopkins...Approach to Advance Translational Science and Standardize Clinical Monitoring of Restorative Transplantation 5a. CONTRACT NUMBER 5b. GRANT NUMBER

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

    NASA Astrophysics Data System (ADS)

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

    2004-12-01

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

  20. 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

  1. 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

  2. Clinical implications of household food security: definitions, monitoring, and policy.

    PubMed

    Cook, John T

    2002-01-01

    Poverty-related food insecurity is a reality that many clinicians in nutrition and health care encounter either directly or indirectly. It is associated with both overnutrition and undernutrition, but it is not congruent with malnutrition. Food insecurity affects human development and health throughout the lifecycle, but can be particularly harmful during critical or vulnerable stages early and late in life. Understanding the causes and consequences of food insecurity and knowing how to identify them can improve the quality and effectiveness of clinical care, and facilitate prevention and treatment of many kinds of health problems. Numerous public policies and programs exist to ameliorate and prevent poverty-related food insecurity. However, the resources to support them ebb and flow with the politics of annual state and federal budgetary cycles. Support and need for these social-safety-net programs also vary with business cycles. Unfortunately, need often expands as support shrinks along with employment and government revenues during recessions, and shrinks as support expands along with employment and government revenues during expansions.

  3. 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.

  4. 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…

  5. 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…

  6. 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

  7. Minor methane emissions from an Alpine hydropower reservoir based on monitoring of diel and seasonal variability.

    PubMed

    Sollberger, Sébastien; Wehrli, Bernhard; Schubert, Carsten J; DelSontro, Tonya; Eugster, Werner

    2017-08-25

    We monitored CH4 emissions during the ice-free period of an Alpine hydropower reservoir in the Swiss Alps, Lake Klöntal, to investigate mechanisms responsible for CH4 variability and to estimate overall emissions to the atmosphere. A floating eddy-covariance platform yielded total CH4 and CO2 emission rates at high temporal resolution, while hydroacoustic surveys provided no indication of CH4 ebullition. Higher CH4 fluxes (2.9 ± 0.1 mg CH4 per m(2) per day) occurred during the day when surface water temperatures were warmer and wind speeds higher than at night. Piston velocity estimates (k600) showed an upper limit at high wind speeds that may be more generally valid also for other lakes and reservoirs with limited CH4 dissolved in the water body: above 2.0 m s(-1) a further increase in wind speed did not lead to higher CH4 fluxes, because under such conditions it is not the turbulent mixing and transport that limits effluxes, but the resupply of CH4 to the lake surface. Increasing CH4 fluxes during the warm season showed a clear spatial gradient once the reservoir started to fill up and flood additional surface area. The warm period contributed 27% of the total CH4 emissions (2.6 t CH4 per year) estimated for the full year and CH4 accounted for 63% of carbonic greenhouse gas emissions. Overall, the average CH4 emissions (1.7 to 2.2 mg CH4 per m(2) per day determined independently from surface water samplings and eddy covariance, respectively) were small compared to most tropical and some temperate reservoirs. The resulting greenhouse gas (GHG) emissions in CO2-equivalents revealed that electricity produced in the Lake Klöntal power plant was relatively climate-friendly with a low GHG-to-power output ratio of 1.24 kg CO2,eq per MW h compared to 6.5 and 8.1 kg CO2,eq per MW h associated with the operation of solar photovoltaics and wind energy, respectively, or about 980 kg CO2,eq per MW h for coal-fired power plants.

  8. Impact of a clinical pharmacy anemia management service on adherence to monitoring guidelines, clinical outcomes, and medication utilization.

    PubMed

    Debenito, Jenny M; Billups, Sarah J; Tran, Thu S; Price, Lea C

    2014-07-01

    Anemia management clinics have demonstrated favorable impacts on clinical and economic outcomes and patient satisfaction. Clinical pharmacists are uniquely qualified to manage complex drug therapies requiring intensive monitoring. The complexity, risks associated with inappropriate treatment, and high cost of erythropoietin-stimulating agents (ESAs) make patients on these medications excellent candidates for clinical pharmacist-based management. Integrating ESA management into a clinical pharmacist-managed service has the potential to improve anemia management not only by improving patient outcomes and patient safety, but also by decreasing medication costs. To (a) assess adherence to monitoring guidelines, efficacy, and safety outcomes and (b) quantify medication utilization expenditures among patients using ESA therapy managed by a clinical pharmacy service compared with usual care. This is a retrospective longitudinal cohort study of patients with anemia caused by chronic kidney disease who were on ESA treatment for at least 6 months between January 2008 and December 2010. Adherence to monitoring guidelines, efficacy, safety, and drug utilization outcomes were compared between the 2 groups. A total of 101 patients were included in the study. Of that number, 31 were managed by the pharmacist-managed anemia service, and 70 were in the usual care group. The pharmacist-managed patients had improved adherence to guidelines for hemoglobin monitoring (32.3% vs. 14.3%, P = 0.049) and iron monitoring (61.3% vs. 30.0%, P = 0.005) compared with similar patients receiving usual care. Time to achievement of hemoglobin target was 28 days in the pharmacist-managed group compared with 41 days in the usual care group (P = 0.135), while the proportion of patients achieving target hemoglobin was 96.8% compared with 95.7%, respectively (P = 0.654). Patients in the pharmacist-managed group used less epoetin alfa during the 6-month period, leading to an annualized

  9. 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.

  10. Monitoring physicians' prescription patterns on electronic health record: the prescription pattern around clinical event (PACE) algorithm.

    PubMed

    Yoon, Dukyong; Park, Inwhee; Park, Man Young; Hong, Seung Kwon; Park, Rae Woong

    2013-01-01

    Electronic health records (EHRs) have gained attention as a valuable data source for medical research, as its adoption rate continues to rise. However, no method for the monitoring of physicians' prescription patterns has been established. Since EHR maintain all prescription data as well as clinical events that occur during the care of patients, we hypothesized that a physician's prescription pattern can be monitored from EHR. In this study, we developed a novel algorithm named PACE, Prescription pattern Around Clinical Event. This algorithm analyzes distribution of the prescription of specific drugs around the time of a clinical event. In the proof of concept study, prescription changes with regard to hyperkalemia were well represented by the algorithm, and the observed patterns well correlated with the physician's knowledge on hyperkalemia (Cohen's kappa, 0.457-0.653). We expect that this algorithm can be used to monitor the guideline adherence of physicians.

  11. 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.

  12. 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. © 2013 Movement Disorder Society.

  13. Utility of Gene Expression Profiling Score Variability to Predict Clinical Events in Heart Transplant Recipients.

    PubMed

    Deng, Mario C; Elashoff, Barbara; Pham, Michael X; Teuteberg, Jeffrey J; Kfoury, Abdallah G; Starling, Randall C; Cappola, Thomas P; Kao, Andrew; Anderson, Allen S; Cotts, William G; Ewald, Gregory A; Baran, David A; Bogaev, Roberta C; Shahzad, Khurram; Hiller, David; Yee, James; Valantine, Hannah A

    2014-01-31

    Gene expression profiling test scores have primarily been used to identify heart transplant recipients who have a low probability of rejection at the time of surveillance testing. We hypothesized that the variability of gene expression profiling test scores within a patient may predict risk of future events of allograft dysfunction or death. Patients from the IMAGE study with rejection surveillance gene expression profiling tests performed at 1- to 6-month intervals were selected for this cohort study. Gene expression profiling score variability was defined as the standard deviation of an individual's cumulative test scores. Gene expression profiling ordinal score (range, 0-39), threshold score (binary value=1 if ordinal score ≥34), and score variability were studied in multivariate Cox regression models to predict future clinical events. Race, age at time of transplantation, and time posttransplantation were significantly associated with future events in the univariate analysis. In the multivariate analyses, gene expression profiling score variability, but not ordinal scores or scores over threshold, was independently associated with future clinical events. The regression coefficient P values were <0.001, 0.46, and 0.773, for gene expression profiling variability, ordinal, and threshold scores, respectively. The hazard ratio for a 1 unit increase in variability was 1.76 (95% CI, 1.4-2.3). The variability of a heart recipient's gene expression profiling test scores over time may provide prognostic utility. This information is independent of the probability of acute cellular rejection at the time of testing that is rendered from a single ordinal gene-expression profiling test score.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

  14. Utility of gene expression profiling score variability to predict clinical events in heart transplant recipients.

    PubMed

    Deng, Mario C; Elashoff, Barbara; Pham, Michael X; Teuteberg, Jeffrey J; Kfoury, Abdallah G; Starling, Randall C; Cappola, Thomas P; Kao, Andrew; Anderson, Allen S; Cotts, William G; Ewald, Gregory A; Baran, David A; Bogaev, Roberta C; Shahzad, Khurram; Hiller, David; Yee, James; Valantine, Hannah A

    2014-03-27

    Gene expression profiling test scores have primarily been used to identify heart transplant recipients who have a low probability of rejection at the time of surveillance testing. We hypothesized that the variability of gene expression profiling test scores within a patient may predict risk of future events of allograft dysfunction or death. Patients from the IMAGE study with rejection surveillance gene expression profiling tests performed at 1- to 6-month intervals were selected for this cohort study. Gene expression profiling score variability was defined as the standard deviation of an individual's cumulative test scores. Gene expression profiling ordinal score (range, 0-39), threshold score (binary value=1 if ordinal score ≥ 34), and score variability were studied in multivariate Cox regression models to predict future clinical events. Race, age at time of transplantation, and time posttransplantation were significantly associated with future events in the univariate analysis. In the multivariate analyses, gene expression profiling score variability, but not ordinal scores or scores over threshold, was independently associated with future clinical events. The regression coefficient P values were <0.001, 0.46, and 0.773, for gene expression profiling variability, ordinal, and threshold scores, respectively. The hazard ratio for a 1 unit increase in variability was 1.76 (95% CI, 1.4-2.3). The variability of a heart recipient's gene expression profiling test scores over time may provide prognostic utility. This information is independent of the probability of acute cellular rejection at the time of testing that is rendered from a single ordinal gene-expression profiling test score.

  15. Utility of Gene Expression Profiling Score Variability to Predict Clinical Events in Heart Transplant Recipients

    PubMed Central

    Deng, Mario C.; Elashoff, Barbara; Pham, Michael X.; Teuteberg, Jeffrey J.; Kfoury, Abdallah G.; Starling, Randall C.; Cappola, Thomas P.; Kao, Andrew; Anderson, Allen S.; Cotts, William G.; Ewald, Gregory A.; Baran, David A.; Bogaev, Roberta C.; Shahzad, Khurram; Hiller, David; Yee, James; Valantine, Hannah A.

    2014-01-01

    Background Gene expression profiling test scores have primarily been used to identify heart transplant recipients who have a low probability of rejection at the time of surveillance testing. We hypothesized that the variability of gene expression profiling test scores within a patient may predict risk of future events of allograft dysfunction or death. Method Patients from the IMAGE study with rejection surveillance gene expression profiling tests performed at 1- to 6-month intervals were selected for this cohort study. Gene expression profiling score variability was defined as the standard deviation of an individual’s cumulative test scores. Gene expression profiling ordinal score (range, 0–39), threshold score (binary value=1 if ordinal score ≥34), and score variability were studied in multivariate Cox regression models to predict future clinical events. Results Race, age at time of transplantation, and time posttransplantation were significantly associated with future events in the univariate analysis. In the multivariate analyses, gene expression profiling score variability, but not ordinal scores or scores over threshold, was independently associated with future clinical events. The regression coefficient P values were <0.001, 0.46, and 0.773, for gene expression profiling variability, ordinal, and threshold scores, respectively. The hazard ratio for a 1 unit increase in variability was 1.76 (95% CI, 1.4–2.3). Discussion The variability of a heart recipient’s gene expression profiling test scores over time may provide prognostic utility. This information is independent of the probability of acute cellular rejection at the time of testing that is rendered from a single ordinal gene-expression profiling test score. PMID:24637869

  16. 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. Copyright © 2014 John Wiley & Sons

  17. Clinical management of multiple sclerosis through home telehealth monitoring: results of a pilot project.

    PubMed

    Turner, Aaron P; Wallin, Mitchell T; Sloan, Alicia; Maloni, Heidi; Kane, Robert; Martz, Lore; Haselkorn, Jodie K

    2013-01-01

    This study examined the feasibility of using home telehealth monitoring to improve clinical care and promote symptom self-management among veterans with multiple sclerosis (MS). This was a longitudinal cohort study linking mailed survey data at baseline and 6-month follow-up with information from home telehealth monitors. The study was conducted in two large Department of Veterans Affairs (VA) MS clinics in Seattle, Washington, and Washington, DC, and involved 41 veterans with MS. The measures were demographic information and data from a standardized question set using a home telehealth monitor. Participants reported moderate levels of disability (median Expanded Disability Status Scale [EDSS] score, 6.5) and substantial distance from the nearest VA MS clinic (mean distance, 93.6 miles). Of the participants, 61.0% reported current use of MS disease-modifying treatments. A total of 85.4% of participants provided consistent data from home monitoring. Overall satisfaction with home telehealth monitoring was high, with 87.5% of participants rating their experience as good or better. The most frequently reported symptoms at month 1 were fatigue (95.1%), depression (78.0%), and pain (70.7%). All symptoms were reported less frequently by month 6, with the greatest reduction in depression (change of 23.2 percentage points), although these changes were not statistically significant. Home telehealth monitoring is a promising tool for the management of chronic disease, although substantial practical barriers to efficient implementation remain.

  18. Reducing Clinical Trial Monitoring Resource Allocation and Costs Through Remote Access to Electronic Medical Records

    PubMed Central

    Uren, Shannon C.; Kirkman, Mitchell B.; Dalton, Brad S.; Zalcberg, John R.

    2013-01-01

    Purpose: With electronic medical records (eMRs), the option now exists for clinical trial monitors to perform source data verification (SDV) remotely. We report on a feasibility study of remote access to eMRs for SDV and the potential advantages of such a process in terms of resource allocation and cost. Methods: The Clinical Trials Unit at the Peter MacCallum Cancer Centre, in collaboration with Novartis Pharmaceuticals Australia, conducted a 6-month feasibility study of remote SDV. A Novartis monitor was granted dedicated software and restricted remote access to the eMR portal of the cancer center, thereby providing an avenue through which perform SDV. Results: Six monitoring visits were conducted during the study period, four of which were performed remotely. The ability to conduct two thirds of the monitoring visits remotely in this complex phase III study resulted in an overall cost saving to Novartis. Similarly, remote monitoring eased the strain on internal resources, particularly monitoring space and hospital computer terminal access, at the cancer center. Conclusion: Remote access to patient eMRs for SDV is feasible and is potentially an avenue through which resources can be more efficiently used. Although this feasibility study involved limited numbers, there is no limit to scaling these processes to any number of patients enrolled onto large clinical trials. PMID:23633977

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

    PubMed

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

    2015-10-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2016-03-01

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

  1. Wearable sweat detector device design for health monitoring and clinical diagnosis

    NASA Astrophysics Data System (ADS)

    Wu, Qiuchen; Zhang, Xiaodong; Tian, Bihao; Zhang, Hongyan; Yu, Yang; Wang, Ming

    2017-06-01

    Miniaturized sensor is necessary part for wearable detector for biomedical applications. Wearable detector device is indispensable for online health care. This paper presents a concept of an wearable digital health monitoring device design for sweat analysis. The flexible sensor is developed to quantify the amount of hydrogen ions in sweat and skin temperature in real time. The detection system includes pH sensor, temperature sensor, signal processing module, power source, microprocessor, display module and so on. The sweat monitoring device is designed for sport monitoring or clinical diagnosis.

  2. 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.

  3. 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.

  4. 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

  5. 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.

  6. 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.

  7. [Common variable immunodeficiency: Clinical and immunological characterization of patients and homogeneous subgroup definition by means of B lymphocyte subpopulation typing].

    PubMed

    Vélez, Alejandra Catalina; Castaño, Diana María; Gómez, Rubén Darío; Orrego, Julio César; Moncada, Marcela; Franco, José Luis

    2015-01-01

    Common variable immunodeficiency is a heterogeneous syndrome characterized by recurrent infections, hypogammaglobulinemia and defective production of specific antibodies. Abnormalities in peripheral blood lymphocyte subpopulations, in particular of B lymphocytes, allow the classification of patients into homogeneous groups. To perform a clinical and immunological characterization and to evaluate lymphocyte subpopulations of twelve Colombian patients with common variable immunodeficiency in order to define homogeneous groups. We reviewed medical records and evaluated serum immunoglobulins (Ig), lymphoproliferation, delayed hypersensitivity and used flow cytometry to quantify peripheral blood total lymphocyte and B cell populations. All patients had recurrent respiratory and/or gastrointestinal infections, while some also had infections affecting other systems. All patients had abnormally low serum IgG levels, while IgA and IgM levels were reduced in nine and ten patients, respectively. Lymphoproliferation to mitogen was lower in patients than in healthy controls but lymphoproliferation to specific antigen was normal in all. Flow cytometry revealed high numbers of T cells in three patients, while seven had a low CD4+/CD8+ ratio and four had reduced NK cells . Eleven patients had normal B cell counts, and eight of them also showed decreased memory B lymphocytes, and four had increased transitional or CD21 low B lymphocytes. Lymphocyte typing allowed assigning all but one patient to homogeneous groups according to international classification schemes, indicating the necessity of including more criteria until an ideal classification is achieved. This study will lead to a better medical monitoring of common variable immunodeficiency patients in groups at high risk of developing clinical complications.

  8. Clinical picture and treatment of 2212 patients with common variable immunodeficiency.

    PubMed

    Gathmann, Benjamin; Mahlaoui, Nizar; Gérard, Laurence; Oksenhendler, Eric; Warnatz, Klaus; Schulze, Ilka; Kindle, Gerhard; Kuijpers, Taco W; van Beem, Rachel T; Guzman, David; Workman, Sarita; Soler-Palacín, Pere; De Gracia, Javier; Witte, Torsten; Schmidt, Reinhold E; Litzman, Jiri; Hlavackova, Eva; Thon, Vojtech; Borte, Michael; Borte, Stephan; Kumararatne, Dinakantha; Feighery, Conleth; Longhurst, Hilary; Helbert, Matthew; Szaflarska, Anna; Sediva, Anna; Belohradsky, Bernd H; Jones, Alison; Baumann, Ulrich; Meyts, Isabelle; Kutukculer, Necil; Wågström, Per; Galal, Nermeen Mouftah; Roesler, Joachim; Farmaki, Evangelia; Zinovieva, Natalia; Ciznar, Peter; Papadopoulou-Alataki, Efimia; Bienemann, Kirsten; Velbri, Sirje; Panahloo, Zoya; Grimbacher, Bodo

    2014-07-01

    Common variable immunodeficiency (CVID) is an antibody deficiency with an equal sex distribution and a high variability in clinical presentation. The main features include respiratory tract infections and their associated complications, enteropathy, autoimmunity, and lymphoproliferative disorders. This study analyzes the clinical presentation, association between clinical features, and differences and effects of immunoglobulin treatment in Europe. Data on 2212 patients with CVID from 28 medical centers contributing to the European Society for Immunodeficiencies Database were analyzed retrospectively. Early disease onset (<10 years) was very frequent in our cohort (33.7%), especially in male subjects (39.8%). Male subjects with early-onset CVID were more prone to pneumonia and less prone to other complications suggesting a distinct disease entity. The diagnostic delay of CVID ranges between 4 and 5 years in many countries and is particularly high in subjects with early-onset CVID. Enteropathy, autoimmunity, granulomas, and splenomegaly formed a set of interrelated features, whereas bronchiectasis was not associated with any other clinical feature. Patient survival in this cohort was associated with age at onset and age at diagnosis only. There were different treatment strategies in Europe, with considerable differences in immunoglobulin dosing, ranging from 130 up to 750 mg/kg/mo. Patients with very low trough levels of less than 4 g/L had poor clinical outcomes, whereas higher trough levels were associated with a reduced frequency of serious bacterial infections. Patients with CVID are being managed differently throughout Europe, affecting various outcome measures. Clinically, CVID is a truly variable antibody deficiency syndrome. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.

  9. The role of the Data and Safety Monitoring Board in a clinical trial: the CRISIS study.

    PubMed

    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

    2013-05-01

    Randomized clinical trials are commonly overseen by a Data and Safety Monitoring Board comprised of experts in medicine, ethics, and biostatistics. Data and Safety Monitoring Board responsibilities include protocol approval, interim review of study enrollment, protocol compliance, safety, and efficacy data. Data and Safety Monitoring Board decisions can affect study design and conduct, as well as reported findings. Researchers must incorporate Data and Safety Monitoring Board oversight into the design, monitoring, and reporting of randomized trials. Case study, narrative review. The Data and Safety Monitoring Board's role during the comparative pediatric Critical Illness Stress-Induced Immune Suppression (CRISIS) Prevention Trial is described. The National Institutes of Health-appointed CRISIS Data and Safety Monitoring Board 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 Data and Safety Monitoring Board interim review before opening CRISIS to children below 1 yr of age. The first interim analysis found higher 28-day mortality in one treatment arm. The Data and Safety Monitoring Board maintained trial closure to younger children and requested a second interim data review 6 months later. At this second meeting, mortality was no longer of concern, whereas a weak efficacy trend of lower infection/sepsis rates in one study arm emerged. As over 40% of total patients had been enrolled, the Data and Safety Monitoring Board elected to examine conditional power and unmask treatment arm identities. On finding somewhat greater efficacy in the placebo arm, the Data and Safety Monitoring Board recommended stopping CRISIS due to futility. The design and operating procedures of a multicenter randomized trial must consider a pivotal Data and Safety Monitoring Board role. Maximum

  10. Update on prescription monitoring in clinical practice: a survey study of prescription monitoring program administrators.

    PubMed

    Katz, Nathaniel; Houle, Brian; Fernandez, Kathrine C; Kreiner, Peter; Thomas, Cindy Parks; Kim, MeeLee; Carrow, Grant M; Audet, Adele; Brushwood, David

    2008-01-01

    Prescription drug abuse and undertreatment of pain are public health priorities in the United States. Few options to manage these problems are balanced, in simultaneously supporting pain relief and deterring prescription drug abuse. Prescription monitoring programs (PMPs) potentially offer a balanced approach; however, the medical/scientific communities are not well informed about their current status and potential risks/benefits. The purpose of this study was to provide a benchmark of the current status of PMPs for healthcare providers upon which to engage PMP administrators. A Web survey of current PMP directors with a telephone follow-up conducted in June-July 2006 regarding goals, data captured, data sharing procedures, healthcare provider training, and evaluation efforts. Eighteen of 23 states with operating PMPs at that time participated. Eleven programs allowed physician access to PMP data. Data were delivered by mail (N = 6), fax (N = 8), e-mail (N = 1), and Websites (N = 8). Eight programs provided data to providers within 1 hour. Three states have developed provider PMP usage guidelines. Eight states developed or are developing educational programs. Two states completed or are conducting evaluations of the public health impact of PMP implementation. Five states have begun utilizing PMP data as an epidemiological tool. Initial public safety orientation of PMPs is evolving to include improving public health and patient care. Beginning with efforts to engage healthcare providers through data sharing and education, and progressively including program evaluation on public health and patient care, our results suggest a rapid movement in the direction of utilization of PMPs to improve health care.

  11. 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

  12. Beat-to-beat variability of cardiac action potential duration: underlying mechanism and clinical implications.

    PubMed

    Nánási, Péter P; Magyar, János; Varró, András; Ördög, Balázs

    2017-07-26

    Beat-to-beat variability of cardiac action potential duration (short-term variability, SV) is a common feature of various cardiac preparations, including the human heart. Although it is believed to be one of the best arrhythmia predictors, the underlying mechanisms are not fully understood at present. The magnitude of SV is basically determined by the intensity of cell-to-cell coupling in multicellular preparations and by the duration of the action potential (APD). To compensate for the APD-dependent nature of SV, the concept of relative SV (RSV) has been introduced by normalizing the changes of SV to the concomitant changes in APD. RSV is reduced by ICa, IKr, and IKs while increased by INa, suggesting that ion currents involved in the negative feedback regulation of APD tend to keep RSV at a low level. RSV is also influenced by intracellular calcium concentration and tissue redox potential. The clinical implications of APD variability is discussed in detail.

  13. 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.

  14. [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.

  15. 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.

  16. 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.

  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. Variability of word discrimination scores in clinical practice and consequences on their sensitivity to hearing loss.

    PubMed

    Moulin, Annie; Bernard, André; Tordella, Laurent; Vergne, Judith; Gisbert, Annie; Martin, Christian; Richard, Céline

    2017-05-01

    Speech perception scores are widely used to assess patient's functional hearing, yet most linguistic material used in these audiometric tests dates to before the availability of large computerized linguistic databases. In an ENT clinic population of 120 patients with median hearing loss of 43-dB HL, we quantified the variability and the sensitivity of speech perception scores to hearing loss, measured using disyllabic word lists, as a function of both the number of ten-word lists and type of scoring used (word, syllables or phonemes). The mean word recognition scores varied significantly across lists from 54 to 68%. The median of the variability of the word recognition score ranged from 30% for one ten-word list down to 20% for three ten-word lists. Syllabic and phonemic scores showed much less variability with standard deviations decreasing by 1.15 with the use of syllabic scores and by 1.45 with phonemic scores. The sensitivity of each list to hearing loss and distortions varied significantly. There was an increase in the minimum effect size that could be seen for syllabic scores compared to word scores, with no significant further improvement with phonemic scores. The use of at least two ten-word lists, quoted in syllables rather than in whole words, contributed to a large decrease in variability and an increase in sensitivity to hearing loss. However, those results emphasize the need of using updated linguistic material for clinical speech score assessments.

  19. Changes in clinical and physiologic variables predict survival in idiopathic pulmonary fibrosis.

    PubMed

    Collard, Harold R; King, Talmadge E; Bartelson, Becki Bucher; Vourlekis, Jason S; Schwarz, Marvin I; Brown, Kevin K

    2003-09-01

    There is significant heterogeneity in survival time among patients with idiopathic pulmonary fibrosis. Studies of baseline clinical and physiologic variables as predictors of survival time have reported inconsistent results. We evaluated the predictive value of changes in clinical and physiologic variables over time for survival time in 81 patients with biopsy-proven idiopathic pulmonary fibrosis. Six-month changes in dyspnea score, total lung capacity, thoracic gas volume, FVC, FEV1, diffusing capacity of carbon monoxide, partial pressure of arterial oxygen, oxygen saturation, and alveolar-arterial oxygen gradient were predictive of survival time even after adjustment for baseline values. Analyses were repeated on 51 patients with 12-month change data. Twelve-month changes in dyspnea score, total lung capacity, FVC, partial pressure of arterial oxygen, oxygen saturation, and alveolar-arterial oxygen gradient were predictive of survival time after adjustment for baseline values. Evaluation of changes in clinical and physiological variables over 6 and 12 months may provide clinicians with more accurate prognostic information than baseline values alone.

  20. Prediction of 6-yr symptom course trajectories of anxiety disorders by diagnostic, clinical and psychological variables.

    PubMed

    Spinhoven, Philip; Batelaan, Neeltje; Rhebergen, Didi; van Balkom, Anton; Schoevers, Robert; Penninx, Brenda W

    2016-12-01

    This study aimed to identify course trajectories of anxiety disorder using a data-driven method and to determine the incremental predictive value of clinical and psychological variables over and above diagnostic categories. 703 patients with DSM-IV panic disorder with or without agoraphobia, agoraphobia, social phobia, or generalized anxiety disorder were selected from a prospective cohort study. Latent Growth Mixture Modeling was conducted, based on symptoms of anxiety and avoidance as assessed with the Life Chart Interview covering a 6-year time period. In 44% of the participants symptoms of anxiety and avoidance improved, in 24% remained stable, in 25% slightly increased, and in 7% severely increased. Identified course trajectories were predicted by baseline DSM-IV anxiety categories, clinical variables (i.e., severity and duration and level of disability) and psychological predictors (i.e., neuroticism, extraversion, anxiety sensitivity, worry, and rumination). Clinical variables better predicted unfavorable course trajectories than psychological predictors, over and above diagnostic categories. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Clinical Evaluation of a Novel System for Monitoring Surgical Hemoglobin Loss

    PubMed Central

    Holmes, Allen A.; Konig, Gerhardt; Ting, Vicki; Philip, Bridget; Puzio, Thomas; Satish, Siddarth; Waters, Jonathan H.

    2014-01-01

    Background Accurate measurement of intraoperative blood loss is an important clinical variable in managing fluid resuscitation and avoiding unnecessary transfusion of blood products. In this study, blood lost onto laparotomy sponges during surgical cases was measured using a tablet computer programmed with a unique algorithm modeled after facial recognition technology. In this study we assessed the accuracy and performance of the system in surgical cases. Methods In this prospective, multicenter study, 46 patients undergoing surgery with anticipated significant blood loss contributed laparotomy sponges for hemoglobin (Hb) loss measurement using the Triton System with Feature Extraction Technology (Gauss Surgical, Inc., Los Altos, USA). The Hb loss measured by the new system was compared to Hb loss measured by manual rinsing of the sponges. Accuracy was evaluated using linear regression and Bland-Altman analysis. In addition, the new system’s calculation of blood volume loss was compared with the gravimetric method of estimating blood loss from intraoperative sponge weights. Results A significant positive linear correlation was noted between the new system’s measurements and the rinsed Hb mass (r = 0.93, p < 0.0001). Bland-Altman analysis revealed a bias of 9.0 g and narrow limits of agreement (−7.5 g to 25.5 g) between the new system’s measures and the rinsed Hb mass. These limits were within the clinically relevant difference of +/−30 g, which is approximately half of the Hb content of a unit of allogeneic whole blood. Bland-Altman analysis of the estimated blood loss on sponges using the gravimetric method demonstrated a bias of 466 ml (overestimation) with limits of agreement of −171 ml and 1103 ml, due to the presence of contaminants other than blood on the laparotomy sponges. Conclusion The novel mobile monitoring system provides an accurate measurement of Hb mass on surgical sponges as compared with manual rinsing measurements and is significantly

  2. Comparison of two scoring systems used to monitor diets in outpatient clinical trials.

    PubMed

    Harris, W S; Held, S J; Dujovne, C A

    1995-08-01

    Dietary stability and compliance are crucial to the proper interpretation of the results of clinical trials evaluating the efficacy of lipid-lowering drugs since dietary variations can obscure the true effects of the drugs being tested. Documentation of compliance to National Cholesterol Education Program (NCEP) dietary guidelines can be difficult to obtain, however, especially since many diets may meet one or two but not all the criteria for a Step 1 or 2 classification. The purpose of this study was to compare the ability of two diet scoring systems (the Food Record Rating [FRR] and the Ratio of Ingested Saturated fat and Cholesterol to Calories [RISCC]) to classify these ambiguous diets. Three-day diet diaries (n = 622) were obtained from patients participating in a multicenter, clinical trial testing the lipid-lowering effects of a fiber supplement. The FRR score of each diary was calculated; the diary was then computer analyzed for nutrient composition, and the RISCC score was calculated. Based upon the NCEP dietary criteria for total fat, saturated fat, and cholesterol each diet was classified as either Step 1 or Step 2. Diets exceeding Step 1 criteria were classified as typical American (Step 0). Diets not meeting all 3 criteria for any given Step were considered 'NCEP unclassifiable'. Using the FRR and RISCC scores of only the NCEP-classifiable diets, the optimal RISCC and FRR cutoff points to distinguish between Step 0 and 1 diets and Step 1 and 2 diets were determined. Only 50% of the diets were NCEP-classifiable. Using these diets, a RISCC of 20 best distinguished a Step 0 from a Step 1 diet, and 13 segregated Step 1 from 2 diets. The FRR cutoff points were 14 and 8, respectively. Using these values, the RISCC was able correctly to classify 92-97% of the diets, whereas the FRR correctly classified only 73-80%. Variability of scores within each Step was twice as high for the FRR as for the RISCC. The FRR was more biased by total kilocalories than was the

  3. 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.

  4. The preliminary study on the clinical application of the WHAM (Wearable Heart Activity Monitor).

    PubMed

    Shin, Kunsoo; Kim, Youn Ho; Kim, Jong Pal; Park, Jae Chan

    2006-01-01

    In this paper, we investigated the validity of the WHAM (wearable heart activity monitor) in the clinical applications, which has been implemented as a wearable ambulatory device for continuously and long-term monitoring user's cardiac conditions. To this end, using the WHAM and the conventional Holter monitor the ECG signals over 24 hours were recorded during daily activities. The signal from the WHAM was compared with that from the conventional Holter monitor in terms of the readability of the signal, the quality of the signal, and the accuracy of arrhythmia detection. The performance of the WHAM was a little lower as compared with the conventional Holter monitor, although showing no significant difference (the readability of the signal: 97.2% vs 99.3%; the quality of the signal: 0.97 vs 0.98; the accuracy of arrhythmia detection: 96.2% vs 98.1%). From these results, it is likely that the WHAM shows the performance enough to be used in the clinical application as a wearable ambulatory monitoring device.

  5. Clinical and non-clinical depression and anxiety in young people: A scoping review on heart rate variability.

    PubMed

    Paniccia, Melissa; Paniccia, David; Thomas, Scott; Taha, Tim; Reed, Nick

    2017-08-26

    Heart rate variability (HRV), a measure of cardiac autonomic nervous system functioning, has emerged as a physiological indicator for emotional regulation and psychological well-being. HRV is understudied in the context of depression and anxiety in young people (10-24years old). Main objectives: (1) describe the nature and breadth of reviewed studies; and (2) synthesize main findings in the context of clinical and non-clinical populations of young people with depression and/or anxiety. The Arksey and O'Malley methodology was utilized for this scoping review. CINHAL, EMBASE, Medline, PsychInfo, Scopus, Web of Science, as well as grey literature, were searched. Two reviewers screened titles, abstracts and full papers for inclusion. A total of 20 citations were included in the final review (19 citations peer-reviewed journal articles, 1 journal abstract). Numerical and thematic analysis was used to summarize study findings. In clinical populations of either depression or anxiety, HRV was lower compared to controls. In non-clinical populations of either depression or anxiety, HRV was found to be lower in those who reported more depression or anxiety symptoms. The quality of the reviewed articles was not assessed which limits the ability to generate conclusions regarding study findings. Changes in HRV were found across the spectrum of clinical and non-clinical populations of young people with depression or anxiety. Neurophysiological research on depression and anxiety in young people can act as a first step to understanding how physiological flexibility (i.e. HRV) is related to psychological flexibility (i.e. adaptive or maladaptive responses to life events). Copyright © 2017 Elsevier B.V. All rights reserved.

  6. 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.

  7. Variability of measurements of visual acuity in a large eye clinic.

    PubMed

    Siderov, J; Tiu, A L

    1999-12-01

    The aim of this study was to determine the variability of visual acuity in a large eye clinic. A cross-sectional study using 50, consecutively presenting adult patients with visual acuity of at least 6/60 and aged between 18 and 75 years was performed. Measurements of visual acuity obtained under normal clinical conditions were compared to measurements obtained using standard clinical research protocols. The variability of visual acuity was assessed by determining the 95% limits of agreement between test and retest measures. There were no significant differences between test-retest measurements of visual acuity, either aided or unaided. Pearson r correlation coefficients between test and retest measurements were high for both aided and unaided visual acuity. The 95% limits of agreement revealed repeatability of about +/-1.5 logMAR or 1.5 lines on a standard logMAR chart. In large eye clinics, in order to be confident that a real change in visual acuity has occurred between measurements, a difference of at least 0.15 logMAR (8 letters on a standard logMAR visual acuity chart) is required.

  8. 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.

  9. 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.

  10. F-GAMMA: variability Doppler factors of blazars from multiwavelength monitoring

    NASA Astrophysics Data System (ADS)

    Liodakis, I.; Marchili, N.; Angelakis, E.; Fuhrmann, L.; Nestoras, I.; Myserlis, I.; Karamanavis, V.; Krichbaum, T. P.; Sievers, A.; Ungerechts, H.; Zensus, J. A.

    2017-04-01

    Recent population studies have shown that variability Doppler factors can describe blazars as a population adequately. We use the flux-density variations found within the extensive radio multiwavelength data sets of the F-GAMMA programme, a total of 10 frequencies from 2.64 up to 142.33 GHz, in order to estimate the variability Doppler factors for 58 γ-ray bright sources, for 20 of which no variability Doppler factor has been estimated before. We employ specifically designed algorithms in order to obtain a model for each flare at each frequency. We then identify each event and track its evolution through all the available frequencies for each source. This approach allows us to distinguish significant events producing flares from stochastic variability in blazar jets. It also allows us to constrain effectively the variability brightness temperature and hence the variability Doppler factor, as well as error estimates. Our method can produce the most accurate (16 per cent error, on average) estimates in the literature to date.

  11. 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

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

    PubMed

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

    2016-01-01

    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. The aim was to evaluate the clinical utility of VITOM as a learning tool for neuroendoscopy. 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. 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. Video telescopic operating monitor is found useful to reduce initial learning curve of neuroendoscopy.

  13. Sibling teenage pregnancy and clinic-referred girls’ condom use: The protective role of maternal monitoring

    PubMed Central

    Nichols, Sara; Javdani, Shabnam; Rodriguez, Erin; Emerson, Erin; Donenberg, Geri

    2016-01-01

    Younger sisters of teenage parents have elevated rates of engaging in unprotected sex. This may result from changes in parenting behavior after a sibling becomes pregnant or impregnates a partner, and be particularly pronounced for girls seeking mental health treatment. The current study examines condom use over time in 211 African-American girls recruited from outpatient psychiatric clinics. Findings indicate that having a sibling with a teenage pregnancy history predicts less consistent condom use two years later. After accounting for earlier condom use and mental health problems, maternal monitoring moderates condom use such that for girls with a sibling with a pregnancy history, more vigilant maternal monitoring is associated with increased condom use, while for girls with no sibling pregnancy history, maternal monitoring is unrelated to adolescents’ condom use two years later. Findings suggest that targeted interventions to increase maternal monitoring of high-risk teens may be beneficial for girls with a sibling history of teenage pregnancy. PMID:27172111

  14. 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

  15. 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

  16. 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

  17. Hybrid approaches to clinical trial monitoring: Practical alternatives to 100% source data verification

    PubMed Central

    De, Sourabh

    2011-01-01

    For years, a vast majority of clinical trial industry has followed the tenet of 100% source data verification (SDV). This has been driven partly by the overcautious approach to linking quality of data to the extent of monitoring and SDV and partly by being on the safer side of regulations. The regulations however, do not state any upper or lower limits of SDV. What it expects from researchers and the sponsors is methodologies which ensure data quality. How the industry does it is open to innovation and application of statistical methods, targeted and remote monitoring, real time reporting, adaptive monitoring schedules, etc. In short, hybrid approaches to monitoring. Coupled with concepts of optimum monitoring and SDV at site and off-site monitoring techniques, it should be possible to save time required to conduct SDV leading to more available time for other productive activities. Organizations stand to gain directly or indirectly from such savings, whether by diverting the funds back to the R&D pipeline; investing more in technology infrastructure to support large trials; or simply increasing sample size of trials. Whether it also affects the work-life balance of monitors who may then need to travel with a less hectic schedule for the same level of quality and productivity can be predicted only when there is more evidence from field. PMID:21897885

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

    PubMed

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

    2015-09-01

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

  19. 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.

  20. Evaluation of clinical usefulness of a medical monitor equipped with an organic electroluminescence panel in comparison with liquid crystal display monitors.

    PubMed

    Kataoka, Fumio; Nomura, Hiroyuki; Nogami, Yuya; Arima, Hirokazu; Sawano, Yoshiko; Banno, Kouji; Fujii, Takuma; Aoki, Daisuke

    2013-01-01

    The medical liquid crystal display (LCD) monitor is a conventionally used imaging device for diagnosis and during endoscopic surgery. Recently, a medical organic electroluminescence panel, the organic light-emitting diode (OLED) monitor, was made available commercially. The advantages of the OLED monitor include good color reproducibility, high contrast, and high video responsiveness. In this nonclinical study, we compared the clinical usefulness and image quality of the OLED monitor and those of the LCD monitor using videos of gynecologic endoscopic surgeries. Monitors were set for blind evaluation. Five evaluators with varying experience in endoscopic surgery evaluated 21 surgery videos played simultaneously on an OLED monitor and two LCD monitors for 2 to 3 minutes twice. Evaluators judged 13 clinical usefulness indices and 11 image quality indices using a 5-point scale (1, very good; 5, very poor) for each video. The mean scores of clinical usefulness indices of the OLED monitor and the LCD monitors 1 and 2 were 2.2 to 2.7, 2.1 to 3.3, and 3.0 to 3.2, respectively. Of seven indices measured, five including motion response, the ability to differentiate organs, recognize lesions, and reproduce actual images, and the general impression of picture quality were statistically superior with use of the OLED monitor compared with the LCD monitor 1, and two including ability to distinguish blood vessels and the ureters were statistically superior with use of the LCD monitor 1 compared with the OLED monitor. The mean scores of image quality indices of the OLED monitor and the LCD monitors 1 and 2 were 1.8 to 3.2, 2.6 to 3.6, and 2.8 to 4.0, respectively. Each index of the OLED monitor was superior to or comparable with those of the LCD monitors. We conclude that the OLED monitor is superior to the LCD monitors insofar as several video presentation characteristics required in gynecologic endoscopic surgery. These findings suggest that the OLED monitor is expected to

  1. Methods for Minimization and Management of Variability in Long Term Groundwater Monitoring Results

    DTIC Science & Technology

    2015-06-01

    Term Groundwater Monitoring Results June 2015 This report was prepared under contract to the Department of Defense Strategic Environmental Research...used in demonstration program.......................... 13  Figure 2. Use of SNAP sampler to collect groundwater samples...Julia M. Small ( groundwater sampling and data analysis); and Ben T. Medina ( groundwater sampling). This page left blank intentionally. ES-1

  2. 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.

  3. Methods for Minimization and Management of Variability in Long-Term Groundwater Monitoring Results

    DTIC Science & Technology

    2015-12-01

    technologies that are increasing in popularity. 1.3 REGULATORY DRIVERS As part of the regulatory clean-up process , monitoring of site contaminants ...13 4.1.3 Contaminant Distribution and Selected Wells ............................................................... 13 4.2...14 iii 4.2.3 Contaminant Distribution and Selected Wells

  4. 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...

  5. 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...

  6. 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.

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

    NASA Astrophysics Data System (ADS)

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

    2016-05-01

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

  8. Clinical Activity Monitoring System (CATS): An automatic system to quantify bedside clinical activities in the intensive care unit.

    PubMed

    Guo, Peng; Chiew, Yeong Shiong; Shaw, Geoffrey M; Shao, Lei; Green, Richard; Clark, Adrian; Chase, J Geoffrey

    2016-12-01

    Monitoring clinical activity at the bedside in the intensive care unit (ICU) can provide useful information to evaluate nursing care and patient recovery. However, it is labour intensive to quantify these activities and there is a need for an automated method to record and quantify these activities. This paper presents an automated system, Clinical Activity Tracking System (CATS), to monitor and evaluate clinical activity at the patient's bedside. The CATS uses four Microsoft Kinect infrared sensors to track bedside nursing interventions. The system was tested in a simulated environment where test candidates performed different motion paths in the detection area. Two metrics, 'Distance' and 'Dwell time', were developed to evaluate interventions or workload in the detection area. Results showed that the system can accurately track the intervention performed by individual or multiple subjects. The results of a 30-day, 24-hour preliminary study in an ICU bed space matched clinical expectations. It was found that the average 24-hour intervention is 22.0minutes/hour. The average intervention during the day time (7am-11pm) is 23.6minutes/hour, 1.4 times higher than 11pm-7am, 16.8minutes/hour. This system provides a unique approach to automatically collect and evaluate nursing interventions that can be used to evaluate patient acuity and workload demand. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

    PubMed

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

    1990-03-01

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

  10. [Cognitive impairment in patients with coronary disease: relationship with clinical variables].

    PubMed

    Pérez-Belmonte, Luis M; Lara, J Pablo; Olalla-Mercadé, Eduardo; Gutiérrez de Loma, Julio; Barbancho, Miguel A; San Román-Terán, Carlos M

    2014-08-04

    Coronary disease has been associated with cognitive disorders. We studied the presence of dysexecutive mild cognitive impairment in patients scheduled for coronary surgery. The executive function of 35 patients was evaluated (Trail Making Test). They were classified into 2 groups: normal performance or cognitive impairment, and we assessed the relationship with others variables (Mann-Whitney, chi-square and multiple regression analysis). The dysexecutive cognitive impairment group (n=7; 20%) showed greater degree of angina (odds ratio [OR] 1.4, 95% confidence interval [95% CI] 1.1-2.6; P=.04), 3-vessels coronary artery disease (OR 1.3, 95% CI 1.08-3.6; P=.04) and body mass index (OR 1.56, 95% CI 1.16-3.65; P=.03) and lower diastolic blood pressure (OR 1.56, 95% CI 1.2-2.98; P=.02), hemoglobin (OR 2.03, 95% CI 1.18-4.05; P=.02) and hematocrit (OR 2.45, 95% CI 1.67-3.99; P<.001); these variables proved to be significant in the test performance considered as a dependent variable (R(2)=0.62). We found a significant prevalence of dysexecutive mild cognitive impairment, which was associated with cardiovascular risk factors. We recommend assessment and monitoring of cognitive performance for probable neurological complications after cardiac surgery. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  11. Monitors.

    ERIC Educational Resources Information Center

    Powell, David

    1984-01-01

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

  12. 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

  13. Coefficient of variation of R-R interval closely correlates with glycemic variability assessed by continuous glucose monitoring in insulin-depleted patients with type 1 diabetes.

    PubMed

    Iwasaki, Shingo; Kozawa, Junji; Fukui, Kenji; Iwahashi, Hiromi; Imagawa, Akihisa; Shimomura, Iichiro

    2015-08-01

    In type 1 diabetic patients, insulin secretory capacity, meals and physical activity correlate with glycemic variability. Autonomic function associated with gastrointestinal motility and counterregulatory hormone secretion is another candidate which correlates with glucose variability. The aim of this study is to clarify a new clinical parameter associated with glycemic variability in insulin-depleted patients with type 1 diabetes. We studied 31 inpatients with type 1 diabetes. We evaluated glycemic variability calculated by continuous glucose monitoring, clinical parameters and the coefficient of variation of R-R interval (CVR-R). Glycemic variability was also assessed during the daytime and nighttime. The CVR-R showed a significant negative correlation with the whole-day standard deviation (SD) (r = -0.50, p = 0.007), mean amplitude of glycemic excursions (MAGE) (r = -0.47, p=0.011), M-value (r = -0.38, p = 0.048) and mean of daily differences (MODD) (r = -0.59, p = 0.001). The CVR-R also showed a significant negative correlation with the nighttime SD (r = -0.59, p = 0.001), MAGE (r = -0.47, p=0.011), M-value (r = -0.53, p = 0.004) and MODD (r = -0.65, p = 0.0003). And furthermore, the CVR-R also showed a significant negative correlation with the daytime SD (r = -0.44, p = 0.019) and MAGE (r = -0.50, p = 0.006), but not with the daytime M-value or MODD. The nighttime SD was significantly higher in patients with diabetic polyneuropathy than in patients without it (p = 0.016), while the CVR-R was significantly lower in patients with polyneuropathy than in patients without it (p = 0.009). CVR-R is closely correlated with glycemic variability, especially during nighttime, in insulin-depleted patients with type 1 diabetes. Measuring CVR-R may help us to presume the degree of glycemic variability in those patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  14. 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.

  15. 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

  16. 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

  17. 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.

  18. 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.

  19. Variables associated with nonadherence in clinically stable patients with bipolar disorder.

    PubMed

    Navarro, Santiago; Rodríguez, Fernando; Acosta, Francisco J; García-Bello, Miguel

    2016-09-01

    Nonadherence is an important and highly prevalent issue in bipolar disorder, which may have serious consequences. Surprisingly, few studies have been carried out in patients with clinical stability to explore risk factors for nonadherence. Adherence was assessed in 76 bipolar disorder patients with clinical stability using objective and subjective methods, both with a cross-sectional approach and a 3-year retrospective period. Possible associations between nonadherence and sociodemographic, clinical, treatment-related, psychopathological, psychological-subjective and result variables were also assessed. 36.8% of patients were nonadherent. These patients showed greater concerns about medicines, worse functionality, a greater number of episodes and depressive episodes, higher prevalence of psychiatric comorbidities, present and/or past substance use or abuse and a history of depressive episodes with psychotic symptoms. A multivariate analysis revealed that concern about medicines, present and/or past substance use or abuse and psychiatric comorbidities were independently associated with nonadherence. Nonadherence is a frequent phenomenon in bipolar disorder, even in patients with clinical stability. Clinicians should assess patients’ beliefs and attitudes towards medicines and help them reevaluate those issues with a more realistic perspective. Clinicians should also take actions to prevent substance use or abuse. Identification of nonadherence risk profile in bipolar disorder patients in clinical stability, adds complementary information to the identified risk profile in acute phases of the disease.

  20. 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.

  1. 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.

  2. 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.

  3. Identifying emotional intelligence skills of Turkish clinical nurses according to sociodemographic and professional variables.

    PubMed

    Kahraman, Nilgün; Hiçdurmaz, Duygu

    2016-04-01

    This study aimed to identify the emotional intelligence skills of Turkish clinical nurses according to sociodemographic and professional variables. Emotional intelligence is "the ability of a person to comprehend self-emotions, to show empathy towards the feelings of others, and to control self-emotions in a way that enriches life." Nurses with a higher emotional intelligence level offer more efficient and professional care, and they accomplish more in their social and professional lives. We designed a descriptive cross-sectional study. The Introductory Information Form and the Bar-On emotional intelligence Inventory were used to collect data between 20th June and 20th August 2012. The study was conducted with 312 nurses from 37 hospitals located within the borders of the metropolitan municipality in Ankara. There were no significant differences between emotional intelligence scores of the nurses according to demographic variables such as age, gender, marital status, having children. Thus, sociodemographic factors did not appear to be key factors, but some professional variables did. Higher total emotional intelligence scores were observed in those who had 10 years or longer experience, who found oneself successful in professional life, who stated that emotional intelligence is an improvable skill and who previously received self-improvement training. Interpersonal skills were higher in those with a graduate degree and in nurses working in polyclinics and paediatric units. These findings indicate which groups require improvement in emotional intelligence skills and which skills need improvement. Additionally, these results provide knowledge and create awareness about emotional intelligence skills of nurses and the distribution of these skills according to sociodemographic and professional variables. Implementation of emotional intelligence improvement programmes targeting the determined clinical nursing groups by nursing administrations can help the increase in

  4. 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

  5. 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.

  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. Repeatability of the evaluation of systemic microvascular endothelial function using laser doppler perfusion monitoring: clinical and statistical implications.

    PubMed

    Tibiriçá, Eduardo; Matheus, Alessandra S M; Nunes, Bruno; Sperandei, Sandro; Gomes, Marilia B

    2011-01-01

    An awareness of the repeatability of biological measures is required to properly design and calculate sample sizes for longitudinal interventional studies. We investigated the day-to-day repeatability of measures of systemic microvascular reactivity using laser Doppler perfusion monitoring. We performed laser Doppler perfusion monitoring in combination with skin iontophoresis using acetylcholine and sodium nitroprusside as well as post-occlusive reactive and thermal hyperemia twice within two weeks. The repeatability was assessed by calculating the within-subject standard deviations, limits of agreement, typical errors and intra-class correlation coefficients between days 1 and 2. The ratio of the within-subject standard deviation to the mean values obtained on days 1 and 2 (within-subject standard deviation/GM) was used to determine the condition with the best repeatability. Twenty-four healthy subjects, aged 24.6 ± 3.8 years, were recruited. The area under the curve of the vasodilatory response to post-occlusive reactivity showed marked variability (within-subject standard deviation/GM = 0.83), while the area under the curve for acetylcholine exhibited less variability (within-subject standard deviation/ GM = 0.52) and was comparable to the responses to sodium nitroprusside and thermal treatment (within-subject standard deviations/GM of 0.67 and 0.56, respectively). The area under the blood flow/time curve for vasodilation during acetylcholine administration required the smallest sample sizes, the area under the blood flow/time curve during post-occlusive reactivity required the largest sample sizes, and the area under the blood flow/time curves of vasodilation induced by sodium nitroprusside and thermal treatment required intermediate sizes. In view of the importance of random error related to the day-to-day repeatability of laser Doppler perfusion monitoring, we propose an original and robust statistical methodology for use in designing prospective clinical

  8. 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.

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

    NASA Technical Reports Server (NTRS)

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

    1994-01-01

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

  10. 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.

  11. [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).

  12. Ambulatory blood pressure monitoring-derived short-term blood pressure variability is increased in Cushing's syndrome.

    PubMed

    Rebellato, Andrea; Grillo, Andrea; Dassie, Francesca; Sonino, Nicoletta; Maffei, Pietro; Martini, Chiara; Paoletta, Agostino; Fabris, Bruno; Carretta, Renzo; Fallo, Francesco

    2014-11-01

    Cushing's syndrome is associated with high cardiovascular morbility and mortality. Blood pressure (BP) variability within a 24-h period is increasingly recognized as an independent predictor of cardiovascular risk. The aim of our study was to investigate the short-term BP variability indices in Cushing's syndrome. Twenty-five patients with Cushing's syndrome (mean age 49 ± 13 years, 4 males; 21 Cushing's disease and 4 adrenal adenoma patients) underwent 24-h ambulatory BP monitoring (ABPM) and evaluation of cardiovascular risk factors. Cushing patients were divided into 8 normotensive (NOR-CUSH) and 17 hypertensive (HYP-CUSH) patients and were compared with 20 normotensive (NOR-CTR) and 20 hypertensive (HYP-CTR) age-, sex-, and BMI-matched control subjects. Short-term BP variability was derived from ABPM and calculated as the following: (1) standard deviation (SD) of 24-h, daytime, and nighttime BP; (2) 24-h weighted SD of BP; and (3) average real variability (ARV), i.e., the average of the absolute differences between consecutive BP measurements over 24 h. In comparison with controls, patients with Cushing's syndrome, either normotensive or hypertensive, had higher 24-h and daytime SD of BP, as well as higher 24-h weighted SD and ARV of BP (P = 0.03 to P < 0.0001). No difference in metabolic parameters was observed between NOR-CTR and NOR-CUSH or between HYP-CTR and HYP-CUSH subgroups. ABPM-derived short-term BP variability is increased in Cushing's syndrome, independent of BP elevation. It may represent an additional cardiovascular risk factor in this disease. The role of excess cortisol in BP variability has to be further clarified.

  13. 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.

  14. Exact tests using two correlated binomial variables in contemporary cancer clinical trials.

    PubMed

    Yu, Jihnhee; Kepner, James L; Iyer, Renuka

    2009-12-01

    New therapy strategies for the treatment of cancer are rapidly emerging because of recent technology advances in genetics and molecular biology. Although newer targeted therapies can improve survival without measurable changes in tumor size, clinical trial conduct has remained nearly unchanged. When potentially efficacious therapies are tested, current clinical trial design and analysis methods may not be suitable for detecting therapeutic effects. We propose an exact method with respect to testing cytostatic cancer treatment using correlated bivariate binomial random variables to simultaneously assess two primary outcomes. The method is easy to implement. It does not increase the sample size over that of the univariate exact test and in most cases reduces the sample size required. Sample size calculations are provided for selected designs.

  15. Monitoring the variability of sea level and surface circulation with satellite altimetry

    NASA Astrophysics Data System (ADS)

    Volkov, Denis L. "Jr"

    2004-10-01

    Variability in the ocean plays an important role in determining global weather and climate conditions. The advent of satellite altimetry has significantly facilitated the study of the variability of sea level and surface circulation. Satellites provide high-quality regular and nearly global measurements enabling us to study the oceanic variability on the spatial scales from the size of an eddy to global, and on the temporal scales from weeks to interannual and longer. This thesis demonstrates how satellite altimetry measurements can be used to study the mesoscale, seasonal and interannual variability of sea level and surface circulation. Oceanic variability at these time scales is mainly induced by the variations of heat and fresh water fluxes (buoyancy fluxes) at air-sea interface, the variations of heat and salt budget due to the advection of water masses with different properties, eddy generation mechanisms due to the instability of oceanic currents, Rossby waves, etc. It is shown how the sea level in the extratropical North Atlantic Ocean was changing during the investigated time interval from 1993 to 2003. The mesoscale, seasonal and inter-annual modes of the variability are revealed, and the magnitude and relative contribution of each mode to the total variance is assessed. The inter-annual change of the sea surface height in the northern North Atlantic, measured with altimetry, is coupled with in situ observations along the transatlantic section AR7E, repeated almost every year from 1990 to 2003 in the framework of the WOCE (World Ocean Circulation Experiment) and CLIVAR (CLImate VARiability) hydrographic programs. This allowed interpreting the observed inter-annual change of sea level in terms of changes in the sea water properties and the distribution of water masses. A comparative analysis of changes observed in the extratropical North Atlantic and in the extratropical North Pacific is performed. The magnitudes, spatial patterns, and also trends of the

  16. Monitoring the development of clinical skills during training in a clinical placement.

    PubMed

    Pender, F T; de Looy, A E

    2004-02-01

    The education and training of health care practitioners has undergone recent reform, and indicate that curricula should place emphasis on the development of clinical skills and attitude. The purpose of this study was two-fold: to define the key skills necessary for a competent dietetic student practitioner and to devise a reliable assessment tool to measure and track performance in these key skill areas throughout the period of clinical placement. Key clinical skills were identified by a concensus group of experienced dietitians and academic practitioners. An assessment tool was then developed to measure these attributes in 43 students undertaking clinical placement at a number of training centres in Scotland. Development of skills was tracked for the entire duration of placements using the novel assessment tool. The assessment tool used a visual analogue scale (VAS) as the measuring score. A high level of skill attainment was equated with high VAS scores. Performance in three of the four key skills (written skills: r = 0.762, P

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

    DTIC Science & Technology

    2015-09-01

    collected by the FRR algorithms are being used to accurately determine usage credits . Variability is defined as the dispersion of the data, which...effect on HUMS, FAA usage credits 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT UU 18. NUMBER OF PAGES 20 19a. NAME OF RESPONSIBLE...the HUMS and processed by the FRR algorithms are being used to accurately determine usage credits (a method of identifying the amount of usage an

  18. 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

  19. 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

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

    PubMed

    Barrio, Irantzu; Arostegui, Inmaculada; Quintana, José M; Group, Iryss-Copd

    2013-06-26

    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. 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. 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 significant differences being found

  1. 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

  2. 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

  3. 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.

  4. Effects of food or sleep deprivation during civilian survival training on clinical chemistry variables.

    PubMed

    Ståhle, Lars; Granström, Elisabeth; Ljungdahl Ståhle, Ewa; Isaksson, Sven; Samuelsson, Anders; Rudling, Mats; Sepp, Harry

    2013-06-01

    To describe clinical chemistry and weight changes after short-term food or sleep deprivation or multiple deprivations during civilian survival training. Data from one baseline-controlled two-period crossover study designed to compare sleep deprivation for up to 50 hours with food deprivation for up to 66 hours (n = 12) and data from regular multiple-deprivations survival training comparing participants (n = 33) with nondeprived instructors (n = 10). Food deprivation was associated with decreased body weight, blood glucose, serum triglycerides, sodium, chloride, and urine pH, and there were increases in blood and urine ketones and serum free fatty acids. Sleep deprivation was associated with a minor decrease in hemoglobin and erythrocyte particle count and volume fraction and an increase in leukocytes. The clinical chemistry and body weight changes associated with food deprivation were qualitatively similar to those observed in fasting obese patients but developed quicker in the survival training setting. Sleep deprivation had few effects on the clinical chemistry profile except for hematological variables. Physicians evaluating clinical chemistry data from patients subjected to short-term food or sleep deprivation should take the physiological state into account in their assessment. Copyright © 2013 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

  5. Predictive and Prognostic Clinical Variables in Cancer Patients Treated With Adenoviral Oncolytic Immunotherapy.

    PubMed

    Taipale, Kristian; Liikanen, Ilkka; Koski, Anniina; Heiskanen, Raita; Kanerva, Anna; Hemminki, Otto; Oksanen, Minna; Grönberg-Vähä-Koskela, Susanna; Hemminki, Kari; Joensuu, Timo; Hemminki, Akseli

    2016-08-01

    The development of oncolytic viruses has recently made great progress towards being available to cancer patients. With the breakthrough into clinics, it is crucial to analyze the existing clinical experience and use it as a basis for treatment improvements. Here, we report clinical data from 290 patients treated with oncolytic adenovirus. Using clinical variables and treatment characteristics, we constructed statistical models with regard to treatment response and overall survival (OS). Additionally, we investigated effects of neutralizing antibodies, tumor burden, and peripheral blood leucocyte counts on these outcomes. We found the absence of liver metastases to correlate with an improved rate of disease control (P = 0.021). In multivariate evaluation, patients treated with viruses coding for immunostimulatory granulocyte macrophage colony-stimulating factor were linked to better prognosis (hazard ratio (HR) 0.378, P < 0.001), as well as women with any cancer type (HR 0.694, P = 0.017). In multivariate analysis for imaging response, patients treated via intraperitoneal injection were more likely to achieve disease control (odds ratio (OR) 3.246, P = 0.027). Patients with low neutrophil-to-lymphocyte ratio before treatment had significantly longer OS (P < 0.001). These findings could explain some of the variation seen in treatment outcomes after virotherapy. Furthermore, the results offer hypotheses for treatment optimization and patient selection in oncolytic adenovirus immunotherapy.

  6. Clinical monitoring and high-risk conditions among patients with SUD newly prescribed opioids and benzodiazepines.

    PubMed

    Grossbard, Joel R; Malte, Carol A; Saxon, Andrew J; Hawkins, Eric J

    2014-09-01

    Opioid therapy alone or in combination with benzodiazepines poses safety concerns among patients with substance use disorders (SUD). Guidelines for opioid therapy recommend SUD treatment and enhanced monitoring, especially in patients with additional risk factors, but information on monitoring practices is sparse. This study estimated high-risk conditions - psychiatric comorbidity, suicide risk, and age <35 and ≥65 - and described clinical monitoring among patients with SUD who were newly prescribed opioids alone and concurrent with benzodiazepines long-term. This study included VA Northwest Veterans Network patients with SUD who started opioids only (n=980) or benzodiazepines and opioids concurrently (n=353) long-term (≥90 days) in 2009-2010. Clinical characteristics, outpatient visits and urine drug screens (UDS) documented within 7-months after starting medications were extracted from VA data. Approximately 67% (95% CI: 64-70) of opioids only and 94% (92-97) of concurrent medications groups had ≥1 psychiatric diagnoses. Prevalences of suicide risk and age <35 and ≥65 were 7% (5-8), 6% (5-8) and 18% (15-20) among the opioids only group, and 20% (16-24), 8% (5-11) and 13% (9-16) among the concurrent medications group. Among patients prescribed opioids only and medications concurrently, 87% and 91% attended primary care, whereas 28% and 26% attended SUD specialty-care. Overall, 30% and 48% of opioids only and concurrent medications groups engaged in mental health or SUD care, and 35% and 39% completed UDS. Improvements in clinical monitoring are needed as many VA patients with SUD and comorbid risks who initiate opioid therapy do not receive sufficient mental health/SUD care or UDS monitoring. Published by Elsevier Ireland Ltd.

  7. Clinical review: Continuous and simplified electroencephalography to monitor brain recovery after cardiac arrest

    PubMed Central

    2013-01-01

    There has been a dramatic change in hospital care of cardiac arrest survivors in recent years, including the use of target temperature management (hypothermia). Clinical signs of recovery or deterioration, which previously could be observed, are now concealed by sedation, analgesia, and muscle paralysis. Seizures are common after cardiac arrest, but few centers can offer high-quality electroencephalography (EEG) monitoring around the clock. This is due primarily to its complexity and lack of resources but also to uncertainty regarding the clinical value of monitoring EEG and of treating post-ischemic electrographic seizures. Thanks to technical advances in recent years, EEG monitoring has become more available. Large amounts of EEG data can be linked within a hospital or between neighboring hospitals for expert opinion. Continuous EEG (cEEG) monitoring provides dynamic information and can be used to assess the evolution of EEG patterns and to detect seizures. cEEG can be made more simple by reducing the number of electrodes and by adding trend analysis to the original EEG curves. In our version of simplified cEEG, we combine a reduced montage, displaying two channels of the original EEG, with amplitude-integrated EEG trend curves (aEEG). This is a convenient method to monitor cerebral function in comatose patients after cardiac arrest but has yet to be validated against the gold standard, a multichannel cEEG. We recently proposed a simplified system for interpreting EEG rhythms after cardiac arrest, defining four major EEG patterns. In this topical review, we will discuss cEEG to monitor brain function after cardiac arrest in general and how a simplified cEEG, with a reduced number of electrodes and trend analysis, may facilitate and improve care. PMID:23876221

  8. 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

  9. 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.

  10. 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

  11. 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.

  12. The efficacy of postoperative monitoring: a single surgeon comparison of clinical monitoring and the implantable Doppler probe in 547 consecutive free flaps.

    PubMed

    Rozen, Warren M; Chubb, Daniel; Whitaker, Iain S; Acosta, Rafael

    2010-01-01

    An important element in achieving high success rates with free flap surgery has been the use of different techniques for monitoring flaps postoperatively as a means to detecting vascular compromise. Successful monitoring of the vascular pedicle to a flap can potentiate rapid return to theater in the setting of compromise, with the potential to salvage the flap. There is little evidence that any technique offers any advantage over clinical monitoring alone. A consecutive series of 547 patients from a single plastic surgical unit who underwent a fasciocutaneous free flap operation for breast reconstruction [deep inferior epigastric artery perforator (DIEP) flap, superficial inferior epigastric artery (SIEA) flap, or superior gluteal artery perforator (SGAP) flap] were included. A comparison was made between the first 426 consecutive patients in whom flap monitoring was performed using clinical monitoring alone and the subsequent 121 patients in whom monitoring was achieved with the Cook-Swartz implantable Doppler probe. Outcome measures included flap salvage rate and false-positive rate. There was a strong trend toward improved salvage rates with the implantable Doppler probe compared with clinical monitoring (80% vs. 66%, P = 0.48). When combined with the literature (meta-analysis), the data prove statistically significant (P < 0.01). There was no statistical difference between the groups for false-positive rates. Flap monitoring with the implantable Doppler probe can improve flap salvage rates without increasing the rate of false-positive takebacks. Copyright 2009 Wiley-Liss, Inc. Microsurgery, 2010.

  13. [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.

  14. 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

  15. Association between clinical variables and mortality after parathyroidectomy in maintenance hemodialysis patients.

    PubMed

    Chen, Jin-Bor; Chou, Fong-Fu; Yang, Cheng-Hong; Hua, Moi-Sin

    2017-01-01

    We investigated factors associated with all-cause mortality and cardiovascular disease (CVD)-associated mortality after parathyroidectomy (PTX) in patients on maintenance hemodialysis (HD). Our study population consisted of 161 consecutive HD patients who underwent PTX before 2009 and 354 consecutive HD patients without PTX as controls from those visiting the Kaohsiung Chang Gung Memorial Hospital, Taiwan between 2009 and 2013. All-cause and CVD mortality with clinical variables were compared in PTX and non-PTX HD patients. PTX patients had significantly lower all-cause and CVD mortality than controls. Multivariate logistic regression analyses showed PTX patients had a lower odds ratio for all-cause mortality than those without (odds ratio = .35, 95% confidence interval = .16 to .74). Association analysis based on clinical variables revealed patients with higher hemoglobin, albumin, creatinine, and HD adequacy index-Kt/V levels had significantly decreased risk of all-cause mortality. PTX in HD patients reduces the risk of death. Copyright © 2016. Published by Elsevier Inc.

  16. 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.

  17. Economic impact of clinical variability in preoperative testing for major outpatient surgery.

    PubMed

    Gil-Borrelli, Christian Carlo; Agustí, Salomé; Pla, Rosa; Díaz-Redondo, Alicia; Zaballos, Matilde

    2016-05-01

    With the purpose of decreasing the existing variability in the criteria of preoperative evaluation and facilitating the clinical decision-making process, our hospital has a protocol of preoperative tests to use with ASA I and ASA II patients. The aim of the study was to calculate the economic impact caused by clinicians' non-adherence to the protocol for the anaesthesiological evaluation of ASA 1 and ASA II patients. A retrospective study of costs with a random sample of 353 patients that were seen in the consultation for Anesthesiology over a period of one year. Aspects related to the costs, patient's profiles and specialties were analysed, according to the degree of fulfillment of the protocol. The lack of adherence to the the protocol was 70%. 130 chest X-rays and 218 ECG were performed without indication. This generated an excess costs of 34 € per patient. Taking into account the expenses of both tests and the attended population undergoing ambulatory surgery during the one-year period, an excess spending for the hospital of between 69.164 € and 83.312 € was estimated. Clinical variability should be reduced and the creation of synergies between the different departments should be enhanced in order to adjust the request for unnecessary complementary tests to decrease health care and to improve the quality of patient care. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. 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

  19. 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.

  20. Automatic scoring of medical students' clinical notes to monitor learning in the workplace.

    PubMed

    Spickard, Anderson; Ridinger, Heather; Wrenn, Jesse; O'brien, Nathan; Shpigel, Adam; Wolf, Michael; Stein, Glenn; Denny, Joshua

    2014-01-01

    Educators need efficient and effective means to track students' clinical experiences to monitor their progress toward competency goals. To validate an electronic scoring system that rates medical students' clinical notes for relevance to priority topics of the medical school curriculum. The Vanderbilt School of Medicine Core Clinical Curriculum enumerates 25 core clinical problems (CCP) that graduating medical students must understand. Medical students upload clinical notes pertinent to each CCP to a web-based dashboard, but criteria for determining relevance of a note and consistent uploading practices by students are lacking. The Vanderbilt Learning Portfolio (VLP) system automates both tasks by rating relevance for each CCP and uploading the note to the student's electronic dashboard. We validated this electronic scoring system by comparing the relevance of 265 clinical notes written by third year medical students to each of the 25 core patient problems as scored by VLP verses an expert panel of raters. We established the threshold score which yielded 75% positive prediction of relevance for 16 of the 25 clinical problems to expert opinion. Automated scoring of student's clinical notes provides a novel, efficient and standardized means of tracking student's progress toward institutional competency goals.

  1. 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.

  2. 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.

  3. 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.

  4. [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.

  5. 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

  6. 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.

  7. Long-term spectroscopic monitoring of BA-type supergiants. I. Halpha_ line-profile variability.

    NASA Astrophysics Data System (ADS)

    Kaufer, A.; Stahl, O.; Wolf, B.; Gaeng, T.; Gummersbach, C. A.; Kovacs, J.; Mandel, H.; Szeifert, T.

    1996-01-01

    We have obtained time series of spectra in the wavelength range 4000-6800 A over several months with high S/N and high resolution in wavelength (λ/{DELTA}λ=~20000) and time ({DELTA}t=~1d) of the late-type B and early-type A supergiants HD91619 (B7Ia), βOri (B8Ia), HD96919 (B9Ia), HD92207 (A0Ia), HD100262 (A2Ia) and αCyg (A2Ia). Halpha_ is found to show broad emission extended to about +/-1200km/s for all objects except αCyg. Due to the lack of strong line-emission in Halpha_ the electron-scattered photons are expected to originate in deep atmospheric layers. In all of the objects the Halpha_-line profiles are found to be highly variable on different time scales reaching from days to months. Patterns of variation in Halpha_ are found to be quite symmetric about the systemic velocity and are mainly due to variable blue and red-shifted emission superimposed on almost constant photospheric and/or wind profiles. These V/R variations are interpreted in terms of axial symmetry of the envelopes of these objects. Time-series analyses of the variations reveal Halpha_ time scales up to a factor of 6 longer than expected radial fundamental pulsation periods but consistent with rotational periods. Therefore, rotational modulation as a possible source of variability is concluded. Corotating weak magnetic surface structures are suggested as the source for a rotationally modulated lower wind region. Suddenly appearing deep and highly blue-shifted absorptions in Halpha_ are ascribed to instabilities of the ionization structure of the wind. Outwards propagating discrete absorption components have been observed only once in HD92207.

  8. 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.

  9. Randomized controlled trial of a nurse-led rheumatology clinic for monitoring biological therapy.

    PubMed

    Larsson, Ingrid; Fridlund, Bengt; Arvidsson, Barbro; Teleman, Annika; Bergman, Stefan

    2014-01-01

    To compare and evaluate the treatment outcomes of a nurse-led rheumatology clinic and a rheumatologist-led clinic in patients with low disease activity or in remission who are undergoing biological therapy. Patients with chronic inflammatory arthritis treated with biological therapy are usually monitored by rheumatologists. Nurse-led rheumatology clinics have been proposed in patients with low disease activity or in remission. Randomized controlled trial. A 12-month follow-up trial was conducted between October 2009 and August 2011, where 107 patients were randomized into two groups with a 6-month follow-up to a nurse-led rheumatology clinic based on person-centred care (intervention group; n = 53) or to a rheumatologist-led clinic (control group; n = 54). The hypothesis was that the nurse-led clinic outcomes would not be inferior to those obtained from a rheumatologist-led clinic at the 12-month follow-up. The primary outcome was disease activity measured by Disease Activity Score 28. A total of 47 patients in the intervention group and 50 in the control group completed the 12-month trial. The trial revealed no statistically significant differences between groups in mean change of Disease Activity Score 28, Visual Analogue Scales for pain, the Health Assessment Questionnaire, satisfaction with or confidence in obtaining rheumatology care. Patients with stable chronic inflammatory arthritis undergoing biological therapy could be monitored by a nurse-led rheumatology clinic without difference in outcome as measured by the Disease Activity Score 28. © 2013 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.

  10. 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.

  11. 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.

  12. 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%.

  13. Methodology and technology for peripheral and central blood pressure and blood pressure variability measurement: current status and future directions - Position statement of the European Society of H