WorldWideScience

Sample records for clinical performance targets

  1. Predictors of Clinical Performance

    Science.gov (United States)

    Turner, Edward; And Others

    1974-01-01

    In a search for predictors of clinical competence, 50 third-year medical students studying pediatrics were videotaped during their interview and physical examination of outpatients. Consideration should be given to the possible value of psychological tests as predictors of clinical competence. (Author)

  2. Targeting targeted agents: open issues for clinical trial design

    Directory of Open Access Journals (Sweden)

    Giannarelli Diana

    2009-05-01

    Full Text Available Abstract Molecularly targeted agents for the treatment of solid tumors had entered the market in the last 5 years, with a great impact upon both the scientific community and the society. Many randomized phase III trials conducted in recent years with new targeted agents, despite previous data coming from preclinical research and from phase II trials were often promising, have produced disappointingly negative results. Some other trials have actually met their primary endpoint, demonstrating a statistically significant result favouring the experimental treatment. Unfortunately, with a few relevant exceptions, this advantage is often small, if not negligible, in absolute terms. The difference between statistical significance and clinical relevance should always be considered when translating clinical trials' results in the practice. The reason why this 'revolution' did not significantly impact on cancer treatment to displace chemotherapy from the patient' bedside is in part due to complicated, and in many cases, unknown, mechanisms of action of such drugs; indeed, the traditional way the clinical investigators were used to test the efficacy of 'older' chemotherapeutics, has become 'out of date' from the methodological perspective. As these drugs should be theoretically tailored upon featured bio-markers expressed by the patients, the clinical trial design should follow new rules based upon stronger hypotheses than those developed so far. Indeed, the early phases of basic and clinical drug development are crucial in the correct process which is able to correctly identify the target (when present. Targeted trial designs can result in easier studies, with less, better selected, and supported by stronger proofs of response evidences, patients, in order to not waste time and resources.

  3. Performance Targets and External Benchmarking

    DEFF Research Database (Denmark)

    Friis, Ivar; Hansen, Allan; Vámosi, Tamás S.

    as a market mechanism that can be brought inside the firm to provide incentives for continuous improvement and the development of competitive advances. However, whereas extant research primarily has focused on the importance and effects of using external benchmarks, less attention has been directed towards...... towards the conditions for the use of the external benchmarks we provide more insights to some of the issues and challenges that are related to using this mechanism for performance management and advance competitiveness in organizations....

  4. Performance Simulations of Moving Target Search Algorithms

    Directory of Open Access Journals (Sweden)

    Peter K. K. Loh

    2009-01-01

    Full Text Available The design of appropriate moving target search (MTS algorithms for computer-generated bots poses serious challenges as they have to satisfy stringent requirements that include computation and execution efficiency. In this paper, we investigate the performance and behaviour of existing moving target search algorithms when applied to search-and-capture gaming scenarios. As part of the investigation, we also introduce a novel algorithm known as abstraction MTS. We conduct performance simulations with a game bot and moving target within randomly generated mazes of increasing sizes and reveal that abstraction MTS exhibits competitive performance even with large problem spaces.

  5. Performance Targets and External Market Prices

    DEFF Research Database (Denmark)

    Hansen, Allan; Friis, Ivar; Vámosi, Tamás S.

    In this paper we explore the processes of ‘bringing the market inside the firm’ to set performance targets and benchmark production workers productivity. We analyze attempts to use external suppliers’ bids in target setting in a Danish manufacturing company. The case study illustrates how...... the implementation of external market information in target setting – well known in transfer pricing, relative performance evaluation, beyond budgeting, target costing, piece rates systems and value based management – relate to challenging motivation and information problem. The analysis and discussion of those...... problems, in particular those related to accounting for the internal performance (that are going to be compared with the external target), calculating the ‘inside’ costs and defining controllability, contributes to the management accounting as well as the piece-rate literature....

  6. Texture metric that predicts target detection performance

    Science.gov (United States)

    Culpepper, Joanne B.

    2015-12-01

    Two texture metrics based on gray level co-occurrence error (GLCE) are used to predict probability of detection and mean search time. The two texture metrics are local clutter metrics and are based on the statistics of GLCE probability distributions. The degree of correlation between various clutter metrics and the target detection performance of the nine military vehicles in complex natural scenes found in the Search_2 dataset are presented. Comparison is also made between four other common clutter metrics found in the literature: root sum of squares, Doyle, statistical variance, and target structure similarity. The experimental results show that the GLCE energy metric is a better predictor of target detection performance when searching for targets in natural scenes than the other clutter metrics studied.

  7. Recent advances in targeted proteomics for clinical applications.

    Science.gov (United States)

    Domon, Bruno; Gallien, Sebastien

    2015-04-01

    MS-based approaches using targeted methods have been widely adopted by the proteomics community to study clinical questions such as the evaluation of biomarkers. At present, the most widely used targeted MS method is the SRM technique typically performed on a triple quadrupole instrument. However, the high analytical demands for performing clinical studies in combination with the extreme complexity of the samples involved are a serious challenge. The segmentation of the biomarker evaluation workflow has only partially alleviated these issues by differently balancing the analytical requirements and throughput at different stages of the process. The recent introduction of targeted high-resolution and accurate-mass analyses on fast sequencing mass spectrometers operated in parallel reaction monitoring (PRM) mode offers new avenues to conduct clinical studies and thus overcome some of the limitations of the triple quadrupole instrument. This article discusses the attributes and specificities of the PRM technique, in terms of experimental design, execution, and data analysis, and the implications for biomarker evaluation. The benefits of PRM on data quality and the impact on the consistency of results are highlighted and the definitive progress on the overall output of clinical studies, including high throughput, is discussed.

  8. Optimizing clinical drug product performance

    DEFF Research Database (Denmark)

    Dickinson, Paul A.; Kesisoglou, Filippos; Flanagan, Talia

    2016-01-01

    The aim of Biopharmaceutics Risk Assessment Roadmap (BioRAM) and the BioRAM Scoring Grid is to facilitate optimization of clinical performance of drug products. BioRAM strategy relies on therapy-driven drug delivery and follows an integrated systems approach for formulating and addressing critical...... questions and decision-making (J Pharm Sci. 2014,103(11): 3777-97). In BioRAM, risk is defined as not achieving the intended in vivo drug product performance, and success is assessed by time to decision-making and action. Emphasis on time to decision-making and time to action highlights the value of well...

  9. Disclosure of investigators' recruitment performance in multicenter clinical trials

    DEFF Research Database (Denmark)

    Dal-Ré, Rafael; Moher, David; Gluud, Christian;

    2011-01-01

    Rafael Dal-Ré and colleagues argue that the recruitment targets and performance of all site investigators in multi-centre clinical trials should be disclosed in trial registration sites before a trial starts, and when it ends.......Rafael Dal-Ré and colleagues argue that the recruitment targets and performance of all site investigators in multi-centre clinical trials should be disclosed in trial registration sites before a trial starts, and when it ends....

  10. Setting key performance targets for Croatian shipyards

    Directory of Open Access Journals (Sweden)

    Danijela Rabar

    2015-03-01

    Full Text Available The aim of this paper is to use the Data Envelopment Analysis (DEA method to measure and analyze different relative efficiencies of five Croatian shipyards. The indicators are chosen to capture different aspects of shipbuilding performance in Croatia. Window analysis is used to determine shipyard efficiency and observe possible changes in shipyard efficiency over time. This leads to identifying a subset of efficient best practice shipyards, whereas for others the magnitude of their inefficiency is ascertained along with the specified efficient input and output targets. The importance of window analysis is that its results serve as an early warning system to all inefficient shipyards. In identifying the sources of inefficiencies and formulating proposals for improving shipyard performance observed over a six-year period (2007-2012, the results presented in this paper can be used to enhance and alter decisions.

  11. Review on clinical trials of targeted treatments in malignant mesothelioma

    DEFF Research Database (Denmark)

    Jakobsen, Jan Nyrop; Sørensen, Jens Benn

    2011-01-01

    Malignant mesothelioma (MM) is an aggressive tumor of the serosal surfaces with a poor prognosis. Advances in the understanding of tumor biology have led to the development of several targeted treatments, which have been evaluated in clinical trials. This article is a comprehensive review of all...... clinical trials evaluating the effect of targeted treatments in MM....

  12. MATERIALS PERFORMANCE TARGETED THRUST FY 2004 PROJECTS

    Energy Technology Data Exchange (ETDEWEB)

    DOE

    2005-09-13

    The Yucca Mountain site was recommended by the President to be a geological repository for commercial spent nuclear fuel and high-level radioactive waste. The multi-barrier approach was adopted for assessing and predicting system behavior, including both natural barriers and engineered barriers. A major component of the long-term strategy for safe disposal of nuclear waste is first to completely isolate the radionuclides in waste packages for long times and then to greatly retard the egress and transport of radionuclides from penetrated packages. The goal of the Materials Performance Targeted Thrust program is to further enhance the understanding of the role of engineered barriers in waste isolation. In addition, the Thrust will explore technical enhancements and seek to offer improvements in materials costs and reliability.

  13. Yap: A High-Performance Cursor on Target Message Router

    Science.gov (United States)

    2014-09-01

    Yap: A High-Performance Cursor on Target Message Router by Jesse Kovach ARL-TR-7096 September 2014...High-Performance Cursor on Target Message Router Jesse Kovach Computational and Information Sciences Directorate, ARL...

  14. BRVAAF and performance analysis for target detection

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    A bistatic range-velocity-acceleration ambiguity function (BRVAAF) is proposed. The model of radar measurements of an accelerating target involving the time delay, Doppler frequency and Doppler rate is given. The relationships between these measurements and the parameters of the bistatic geometry, target position, velocity and acceleration are derived. Moreover, the effects of the bistatic geometry factors on these measurements are analyzed. Besides, the two relationships of the bistatic integration loss and the bistatic optimum integration time with these factors are built and their change trends are described respectively. This research is helpful to analyze the influences of the bistatic geometry factors on the target detection and signal processing.

  15. Intercepting accelerated moving targets: effects of practice on movement performance.

    Science.gov (United States)

    Fialho, João V A P; Tresilian, James R

    2017-02-14

    When performing a rapid manual interception, targets moving under constant motion are often intercepted with greater accuracy when compared to targets moving under accelerated motion. Usually, accelerated targets are timed too late and decelerating ones too early. The present experiment sought to investigate whether these differences in performance when intercepting targets moving under constant and accelerated motions change after a short period of practice. The task involved striking targets that moved along a straight track by moving forward a manipulandum that moved along a slide perpendicular to the target's motion. Participants were allocated to one of the three experimental groups, defined according to the type of motion of the moving targets: constant speed, constant acceleration, and constant deceleration. Results showed that after some practice participants were able to intercept (positive and negative) accelerating moving targets as accurately as constant speed targets. These results suggest that people might be able to learn how to intercept accelerating targets, corroborating the results of some recent studies.

  16. On detection performance of MIMO radar for Rician target

    Institute of Scientific and Technical Information of China (English)

    TANG Jun; WU Yong; PENG YingNing; WANG XiuTan

    2009-01-01

    By using spatial dlversity, multiple-input-multiple-output (MIMO) radar can improve detection performance for fluctuating targets. In this paper, we propose a spatial fluctuation target model for MIMO radar, where targets are classified as non-fluctuating target, Rayleigh target and Rician target. Based on Stein's lemma, we use relative entropy to study detection performance of optimum detector for Riclan target. It is found that in low signal noise ratio (SNR) region, the performance improvement of MIMO radar for detecting Rician target depends on array gain, which is related to the number of receivers. In high SNR region, the improvement of performance depends on diversity gain, which is related to the product of the number of receivers and the number of transmitters. The conclusions of this paper are Important for designing MIMO radar system.

  17. Robust analysis of guidance performance against weaving targets

    NARCIS (Netherlands)

    Weiss, M.

    2008-01-01

    Traditionally performance analysis of guidance loops against weaving targets is performed by assuming that the acceleration of the target is sinusoidal (barrel-S maneuver) or, in any case, periodic with a fixed period. Either by direct simulation, or by using the Adjoint Method, it is easy to comput

  18. Targeting small airways in asthma: Improvement in clinical benefit?

    DEFF Research Database (Denmark)

    Ulrik, Charlotte Suppli; Lange, Peter

    2010-01-01

    Background and Aim: Disease control is not achieved in a substantial proportion of patients with asthma. Recent advances in aerosol formulations and delivery devices may offer more effective therapy. This review will focus on the importance and potential clinical benefit of targeting the lung...

  19. Ligand-targeted particulate nanomedicines undergoing clinical evaluations: current status

    NARCIS (Netherlands)

    Meel, van der Roy; Vehmeijer, Laurens J.C.; Kok, Robbert J.; Storm, Gert; Gaal, van Ethlinn V.B.

    2013-01-01

    Since the introduction of Doxil® on the market nearly 20 years ago, a number of nanomedicines have become part of treatment regimens in the clinic. With the exception of antibody–drug conjugates, these nanomedicines are all devoid of targeting ligands and rely solely on their physicochemical propert

  20. Standard target sets for field sensor performance measurements

    Science.gov (United States)

    O'Connor, John D.; O'Shea, Patrick; Palmer, John E.; Deaver, Dawne M.

    2006-05-01

    The US Army Night Vision and Electronic Sensors Directorate (NVESD) Modeling and Simulation Division develops sensors models (FLIR 92, NV Therm, NV Therm IP) that predict the comparative performance of electro-optical sensors. The NVESD modeling branch developed a 12-vehicle, 12-aspect target signature set in 1998 with a known cycle criteria. It will be referred to as the 12-target set. This 12-target set has and will continue to be the modeling "gold standard" for laboratory human perception experiments supporting sensor performance modeling, and has been employed in dozens of published experiments. The 12-target set is, however, too costly for most acquisition field tests and evaluations. The authors developed an 8-vehicle 3-aspect target set, referred to as the 8- target set, and measured its discrimination task difficulty, (N50 and V50). Target identification (ID) range performance predictions for several sensors were made based on those V50/N50 values. A field collection of the 8-target set using those sensors provided imagery for a human perception study. The human perception study found excellent agreement between predicted and measured range performance. The goal of this development is to create a "silver standard" target set that is as dependable in measuring sensor performance as the "gold standard", and is affordable for Milestone A and other field trials.

  1. Clinical evaluation of target controlled infusion system for sufentanil administration

    Institute of Scientific and Technical Information of China (English)

    ZHAO Yan; ZHANG Li-ping; WU Xin-min; JIANG Jian-yu; DUAN Jing-li; HU Yong-fang; LI Min; LIU Wei; SHENG Xiao-yan; NI Cheng; XU Mao; GUO Xiang-yang

    2009-01-01

    Background Sufentanil target controlled infusion (TCI) provides stable analgesia, better hemodynamic control than a bolus injection of intravenous anesthetics, anticipated recovery and improved quality of anesthesia during perioperative period. This study evaluated the accuracy and feasibility of TCI system for sufentanil at high concentrations in Chinese surgical patients.Methods Twelve low risk adult patients undergoing elective surgery under general anesthesia were included in this study. Sufentanil was administered with a specific TCI system incorporating the population pharmacokinetic data of sufentanil previously reported, using a target effect-site concentration of sufentanil 4 or 6 ng/ml. Sufentanil TCI duration was 30 minutes. Frequent arterial blood samples were taken during and up to 24 hours after sufentanil TCI for determination of plasma sufentanil concentrations by liquid chromatography-mass spectrometry/mass spectrometry. The changes of circulatory system function during the precedure, recovery profile and adverse effects were recorded.Measured plasma sufentanil concentrations were compared with the values predicted by the TCI system. The bias (median performance error, MDPE), procision (median absolute performance error, MDAPE) and wobble (variability of performance error) of the sufentanil TCI system were determined.Results All patients had stable cardiovascular variables during induction and maintenance of anesthesia. Time to eye opening and extubation were (5.6±1.7) minutes when TCI set to 4 ng/ml and (7.2±9.3) minutes when set to 6 ng/ml.There was no episode of agitation, muscle rigidity or intraoperative awareness. The bias (MDPE), precision (MDAPE)and wobble of the sufentanil TCI system were -3.7%, 18.9% and 19.6% respectively during TCI, and the MDPE, MDAPE and wobble were -29.1%, 31.7% and 15.0% respectively after TCI (up to 8 hours).Conclusions The TCI system programmed for sufentanil at 4 or 6 ng/ml was considered acceptable for

  2. The design, construction and performance of the MICE target

    CERN Document Server

    Booth, C N; Howlett, L; Nicholson, R; Overton, E; Robinson, M; Smith, P J; Apollonio, M; Barber, G; Dobbs, A; Leaver, J; Long, K R; Shepherd, B; Adams, D; Capocci, E; McCarron, E; Tarrant, J

    2012-01-01

    The pion-production target that serves the MICE Muon Beam consists of a titanium cylinder that is dipped into the halo of the ISIS proton beam. The design and construction of the MICE target system are described along with the quality-assurance procedures, electromagnetic drive and control systems, the readout electronics, and the data-acquisition system. The performance of the target is presented together with the particle rates delivered to the MICE Muon Beam. Finally, the beam loss in ISIS generated by the operation of the target is evaluated as a function of the particle rate, and the operating parameters of the target are derived.

  3. Targeting cancer epigenetics: Linking basic biology to clinical medicine.

    Science.gov (United States)

    Shinjo, Keiko; Kondo, Yutaka

    2015-12-01

    Recent studies provide compelling evidence that epigenetic dysregulation is involved in almost every step of tumor development and progression. Differences in tumor behavior, which ultimately reflects clinical outcome, can be explained by variations in gene expression patterns generated by epigenetic mechanisms, such as DNA methylation. Therefore, epigenetic abnormalities are considered potential biomarkers and therapeutic targets. DNA methylation is stable at certain specific loci in cancer cells and predominantly reflects the characteristic clinicopathological features. Thus, it is an ideal biomarker for cancer screening, classification and prognostic purposes. Epigenetic treatment for cancers is based on the pharmacologic targeting of various core transcriptional programs that sustains cancer cell identity. Therefore, targeting aberrant epigenetic modifiers may be effective for multiple processes compared with using a selective inhibitor of aberrant single signaling pathway. This review provides an overview of the epigenetic alterations in human cancers and discusses about novel therapeutic strategies targeting epigenetic alterations.

  4. Quantifying uncertainty in NIF implosion performance across target scales

    Science.gov (United States)

    Spears, Brian; Baker, K.; Brandon, S.; Buchoff, M.; Callahan, D.; Casey, D.; Field, J.; Gaffney, J.; Hammer, J.; Humbird, K.; Hurricane, O.; Kruse, M.; Munro, D.; Nora, R.; Peterson, L.; Springer, P.; Thomas, C.

    2016-10-01

    Ignition experiments at NIF are being performed at a variety of target scales. Smaller targets require less energy and can be fielded more frequently. Successful small target designs can be scaled up to take advantage of the full NIF laser energy and power. In this talk, we will consider a rigorous framework for scaling from smaller to larger targets. The framework uses both simulation and experimental results to build a statistical prediction of target performance as scale is increased. Our emphasis is on quantifying uncertainty in scaling predictions with the goal of identifying the dominant contributors to that uncertainty. We take as a particular example the Big Foot platform that produces a round, 0.8 scale implosion with the potential to scale to full NIF size (1.0 scale). This work performed under the auspices of the U.S. Department of Energy by Lawrence Livermore National Laboratory under Contract DE-AC52-07NA27344.

  5. Modeling the effects of contrast enhancement on target acquisition performance

    Science.gov (United States)

    Du Bosq, Todd W.; Fanning, Jonathan D.

    2008-04-01

    Contrast enhancement and dynamic range compression are currently being used to improve the performance of infrared imagers by increasing the contrast between the target and the scene content, by better utilizing the available gray levels either globally or locally. This paper assesses the range-performance effects of various contrast enhancement algorithms for target identification with well contrasted vehicles. Human perception experiments were performed to determine field performance using contrast enhancement on the U.S. Army RDECOM CERDEC NVESD standard military eight target set using an un-cooled LWIR camera. The experiments compare the identification performance of observers viewing linearly scaled images and various contrast enhancement processed images. Contrast enhancement is modeled in the US Army thermal target acquisition model (NVThermIP) by changing the scene contrast temperature. The model predicts improved performance based on any improved target contrast, regardless of feature saturation or enhancement. To account for the equivalent blur associated with each contrast enhancement algorithm, an additional effective MTF was calculated and added to the model. The measured results are compared with the predicted performance based on the target task difficulty metric used in NVThermIP.

  6. Evaluating student performance in clinical dietetics.

    Science.gov (United States)

    Novascone, M A

    1985-06-01

    The focus of this study was on the development and field-testing of a set of behaviorally anchored rating scales for evaluating the clinical performance of dietetic students. The scales emphasized the application of skills and knowledge. A variation of the Smith-Kendall technique was used to develop the scales. The 42 participants involved in instrument development included dietetic students, didactic and clinical instructors, and dietetic practitioners. The completed instrument contained 8 dimension statements and 70 behavioral anchors. The instrument was field-tested in 16 clinical rotations within 8 dietetic education programs. Evaluators not only rated student performance but also critiqued the format and content of the scales. The mid-to-upper portions of each scale were used most frequently, and little score variation within or across programs was noted. The scales were deemed appropriate for formative evaluation; however, some evaluators who had to grade students' performance expressed a desire for performance standards defined in terms of grades. Because the process used to develop the instrument facilitated the articulation of performance criteria, it is recommended as a practical approach to setting performance standards.

  7. Use of clinical simulations for patient education: targeting an untapped audience.

    Science.gov (United States)

    Siwe, Karin; Berterö, Carina; Pugh, Carla; Wijma, Barbro

    2009-01-01

    In most cases, the health professional has been the target for simulation based learning curricula. We have developed a simulation based curriculum for patient education. In our curriculum lay-women learn how to perform the clinical female pelvic examination using a manikin-based trainer. Learner assessments show that prior negative expectations turned into positive expectations regarding future pelvic examinations.

  8. Implementation of Targeted Next Generation Sequencing in Clinical Diagnostics

    DEFF Research Database (Denmark)

    Larsen, Martin Jakob; Burton, Mark; Thomassen, Mads;

    Accurate mutation detection is essential in clinical genetic diagnostics of monogenic hereditary diseases. Targeted next generation sequencing (NGS) provides a promising and cost-effective alternative to Sanger sequencing and MLPA analysis currently used in most diagnostic laboratories. One...... advantage of targeted NGS is that multiple disease-specific genes can easily be sequenced simultaneously, which is favorable in genetic heterogeneous diseases. Prior to implementation in our diagnostic setting, we aimed to assess the sensitivity and specificity of targeted NGS by sequencing a collection......, respectively. For diagnostics, the sequencing coverage is essential, wherefore a minimum coverage of 30x per nucleotide in the coding regions was used as our primary quality criterion. For the majority of the included genes, we obtained adequate gene coverage, in which we were able to detect 100% of the known...

  9. Clinical improvement in psoriasis with specific targeting of interleukin-23

    DEFF Research Database (Denmark)

    Kopp, Tamara; Riedl, Elisabeth; Bangert, Christine;

    2015-01-01

    Psoriasis is a chronic inflammatory skin disorder that affects approximately 2-3% of the population worldwide and has severe effects on patients' physical and psychological well-being. The discovery that psoriasis is an immune-mediated disease has led to more targeted, effective therapies; recent...... advances have focused on the interleukin (IL)-12/23p40 subunit shared by IL-12 and IL-23. Evidence suggests that specific inhibition of IL-23 would result in improvement in psoriasis. Here we evaluate tildrakizumab, a monoclonal antibody that targets the IL-23p19 subunit, in a three-part, randomized......, placebo-controlled, sequential, rising multiple-dose phase I study in patients with moderate-to-severe psoriasis to provide clinical proof that specific targeting of IL-23p19 results in symptomatic improvement of disease severity in human subjects. A 75% reduction in the psoriasis area and severity index...

  10. The simulation study on optical target laser active detection performance

    Science.gov (United States)

    Li, Ying-chun; Hou, Zhao-fei; Fan, Youchen

    2014-12-01

    According to the working principle of laser active detection system, the paper establishes the optical target laser active detection simulation system, carry out the simulation study on the detection process and detection performance of the system. For instance, the performance model such as the laser emitting, the laser propagation in the atmosphere, the reflection of optical target, the receiver detection system, the signal processing and recognition. We focus on the analysis and modeling the relationship between the laser emitting angle and defocus amount and "cat eye" effect echo laser in the reflection of optical target. Further, in the paper some performance index such as operating range, SNR and the probability of the system have been simulated. The parameters including laser emitting parameters, the reflection of the optical target and the laser propagation in the atmosphere which make a great influence on the performance of the optical target laser active detection system. Finally, using the object-oriented software design methods, the laser active detection system with the opening type, complete function and operating platform, realizes the process simulation that the detection system detect and recognize the optical target, complete the performance simulation of each subsystem, and generate the data report and the graph. It can make the laser active detection system performance models more intuitive because of the visible simulation process. The simulation data obtained from the system provide a reference to adjust the structure of the system parameters. And it provides theoretical and technical support for the top level design of the optical target laser active detection system and performance index optimization.

  11. [Performing madness: the clinic as stage].

    Science.gov (United States)

    Herrn, Rainer; Friedland, Alexander

    2014-12-01

    In the second half of the nine- teenth century, clinical demonstrations became the dominant teaching method in psychiatry, playing a key role in medical-professional disputes, as well. This paper traces this widely used though historiographically neglected practice of knowledge implementation and mediation, as demonstrated in the psychiatric clinic of the Berlin Charité (Psychiatrische und Nervenklinik der Berliner Charité) from 1881 to 1927. Documentation of this practice, found within individual medical records, forms the basis of this research. The concept of 'theatricality' assists in uncovering the dramatic quality of the clinical demonstration: Psychiatric knowledge was not simply disseminated through such a practice; rather, such knowledge was first performatively created through the very logic of its presentation of exemplary patient histories, as well as through the examination and diagnostic positioning of its patients. The 'success' of such presentations depended on many variables, related to staff, time, place, and other situational factors. These include the presence of appropriate lecture halls, the availability and calculated selection of patients, and the employment of specific performative techniques by doctors for the sake of producing desired results. As one effect, clinical demonstrations also encouraged patients to both learn and rehearse behavior considered relevant to the particular diagnosis that was to be demonstrated.

  12. A Lightweight Approach to Performance Portability with targetDP

    CERN Document Server

    Gray, Alan

    2016-01-01

    Leading HPC systems achieve their status through use of highly parallel devices such as NVIDIA GPUs or Intel Xeon Phi many-core CPUs. The concept of performance portability across such architectures, as well as traditional CPUs, is vital for the application programmer. In this paper we describe targetDP, a lightweight abstraction layer which allows grid-based applications to target data parallel hardware in a platform agnostic manner. We demonstrate the effectiveness of our pragmatic approach by presenting performance results for a complex fluid application (with which the model was co-designed), plus a separate lattice QCD particle physics code. For each application, a single source code base is seen to achieve portable performance, as assessed within the context of the Roofline model. TargetDP can be combined with MPI to allow use on systems containing multiple nodes: we demonstrate this through provision of scaling results on traditional and GPU-accelerated large scale supercomputers.

  13. The design and performance of an improved target for MICE

    CERN Document Server

    Booth, C N; Langlands, J; Overton, E; Robinson, M; Smith, P J; Barber, G; Long, K R; Shepherd, B; Capocci, E; MacWaters, C; Tarrant, J

    2016-01-01

    The linear motor driving the target for the Muon Ionisation Cooling Experiment has been redesigned to improve its reliability and performance. A new coil-winding technique is described which produces better magnetic alignment and improves heat transport out of the windings. Improved field-mapping has allowed the more precise construction to be demonstrated, and an enhanced controller exploits the full features of the hardware, enabling increased acceleration and precision. The new user interface is described and analysis of performance data to monitor friction is shown to allow quality control of bearings and a measure of the ageing of targets during use.

  14. Assessing Students – Clinical Competence Versus Performance

    Directory of Open Access Journals (Sweden)

    John Ruedy

    2007-06-01

    Full Text Available The recent elaboration of the range of physiciancompetencies upon which the quality of health care isdependent has fostered the development of a variety ofmethods of assessing medical student competencies andperformance. Such assessments are essential inproviding feedback to students to guide their learningand to faculty on the success of the curriculum inachieving competency outcomes. In addition theyprovide evidence that students have achieved minimumrequirements for progressing. Well-designed ObservedStructured Clinical Examinations (OSCEs, MiniClinical Examinations (Mini-CEXs and some forms ofMulti-Source Feedback (MSF can meet acceptablestandards of validity and reliability and are feasible.Competency assessments are limited in predicting howa student will actually act in the work situationparticularly in humanistic skills. More emphasis needsto be placed on student performance, in suchcompetencies as communication and professionalism, ina variety of settings by a number of observers.

  15. Statistical inference on censored data for targeted clinical trials under enrichment design.

    Science.gov (United States)

    Chen, Chen-Fang; Lin, Jr-Rung; Liu, Jen-Pei

    2013-01-01

    For the traditional clinical trials, inclusion and exclusion criteria are usually based on some clinical endpoints; the genetic or genomic variability of the trial participants are not totally utilized in the criteria. After completion of the human genome project, the disease targets at the molecular level can be identified and can be utilized for the treatment of diseases. However, the accuracy of diagnostic devices for identification of such molecular targets is usually not perfect. Some of the patients enrolled in targeted clinical trials with a positive result for the molecular target might not have the specific molecular targets. As a result, the treatment effect may be underestimated in the patient population truly with the molecular target. To resolve this issue, under the exponential distribution, we develop inferential procedures for the treatment effects of the targeted drug based on the censored endpoints in the patients truly with the molecular targets. Under an enrichment design, we propose using the expectation-maximization algorithm in conjunction with the bootstrap technique to incorporate the inaccuracy of the diagnostic device for detection of the molecular targets on the inference of the treatment effects. A simulation study was conducted to empirically investigate the performance of the proposed methods. Simulation results demonstrate that under the exponential distribution, the proposed estimator is nearly unbiased with adequate precision, and the confidence interval can provide adequate coverage probability. In addition, the proposed testing procedure can adequately control the size with sufficient power. On the other hand, when the proportional hazard assumption is violated, additional simulation studies show that the type I error rate is not controlled at the nominal level and is an increasing function of the positive predictive value. A numerical example illustrates the proposed procedures.

  16. Targeting small airways in asthma: Improvement in clinical benefit?

    DEFF Research Database (Denmark)

    Ulrik, Charlotte Suppli; Lange, Peter

    2010-01-01

    Background and Aim:  Disease control is not achieved in a substantial proportion of patients with asthma. Recent advances in aerosol formulations and delivery devices may offer more effective therapy. This review will focus on the importance and potential clinical benefit of targeting the lung pe...... treatment with ultrafine formulations of ICS will change the natural history of asthma and prevent airway remodelling in both the large and small airways.......Background and Aim:  Disease control is not achieved in a substantial proportion of patients with asthma. Recent advances in aerosol formulations and delivery devices may offer more effective therapy. This review will focus on the importance and potential clinical benefit of targeting the lung...... periphery in adult asthma by means of ultrafine aerosols. Results:  Ultrafine formulations of inhaled corticosteroids have improved lung deposition up to at least 50 %, primarily in the peripheral airways. Ultrafine formulations of ICS provide equivalent asthma control to non-ultrafine ICS at approximately...

  17. The new rosetta targets observations, simulations and instrument performances

    CERN Document Server

    Epifani, Elena; Palumbo, Pasquale

    2004-01-01

    The Rosetta mission was successfully launched on March 2nd, 2004 for a rendezvous with the short period comet 67PChuryumov-Gerasimenko in 2014 The new baseline mission foresees also a double fly-by with asteroids 21 Lutetia and 2867 Steins, on the way towards the primary target This volume collects papers presented at the workshop on "The NEW Rosetta targets Observations, simulations and instrument performances", held in Capri on October 13-15, 2003 The papers cover the fields of observations of the new Rosetta targets, laboratory experiments and theoretical simulation of cometary processes, and the expected performances of Rosetta experiments Until real operations around 67PChuryumov-Gerasimenko will start in 10 years from now, new astronomical observations, laboratory experiments and theoretical models are required The goals are to increase knowledge about physics and chemistry of comets and to prepare to exploit at best Rosetta data

  18. Operational Performance Improvements to BRIght Target Explorer Constellation

    Science.gov (United States)

    Choi, Seung Yun

    The BRIght Target Explorer (BRITE)-Constellation is composed of six nano-satellites funded by Austria, Canada, and Poland, and each of them is equipped with an optical telescope that observes stars with visual magnitude +3.5 or brighter. BRITE-Constellation has provided numerous images of bright stars from Low Earth Orbit, which will eventually lead to investigation of origin of the Universe. This thesis presents the contribution of the author to BRITE mission, especially in BRITE Operations. The author performed antenna steering experiments on UniBRITE and BRITE-Toronto, to improve data downlink. To improve scientific data collection from BRITE satellites, the author computed available observation time for multiple targets every orbit, which resulted in collection of twice the amount of scientific data. Also, the author increased the available observation time for each target from 32 minutes to 48 minutes by improving the performance of the star tracker on-board BRITE-Toronto.

  19. Inflation targeting and inflation performance : a comparative analysis

    NARCIS (Netherlands)

    Samarina, Anna; De Haan, Jakob; Terpstra, M.

    2014-01-01

    This article examines how the impact of inflation targeting on inflation performance depends on the choice of country samples, adoption dates, time periods and methodological approaches. We apply two different estimation methods - difference-in-differences and propensity score matching - for our sam

  20. The Targeting Task Performance (TTP) Metric A New Model for Predicting Target Acquisition Performance

    Science.gov (United States)

    2006-05-31

    of patterns by means of spatial-frequency filte Howe, James (1993), “Electro-Optical Imaging System Performance Prediction,” In Electro-Optic systems...with respect to the wer. iven in Table D.1. Using these characteristics, the coherent n n ons for t n w re created. m ameters. ensor To

  1. Targeting Opioid-Induced Hyperalgesia in Clinical Treatment: Neurobiological Considerations.

    Science.gov (United States)

    Arout, Caroline A; Edens, Ellen; Petrakis, Ismene L; Sofuoglu, Mehmet

    2015-06-01

    Opioid analgesics have become a cornerstone in the treatment of moderate to severe pain, resulting in a steady rise of opioid prescriptions. Subsequently, there has been a striking increase in the number of opioid-dependent individuals, opioid-related overdoses, and fatalities. Clinical use of opioids is further complicated by an increasingly deleterious profile of side effects beyond addiction, including tolerance and opioid-induced hyperalgesia (OIH), where OIH is defined as an increased sensitivity to already painful stimuli. This paradoxical state of increased nociception results from acute and long-term exposure to opioids, and appears to develop in a substantial subset of patients using opioids. Recently, there has been considerable interest in developing an efficacious treatment regimen for acute and chronic pain. However, there are currently no well-established treatments for OIH. Several substrates have emerged as potential modulators of OIH, including the N-methyl-D-aspartate and γ-aminobutyric acid receptors, and most notably, the innate neuroimmune system. This review summarizes the neurobiology of OIH in the context of clinical treatment; specifically, we review evidence for several pathways that show promise for the treatment of pain going forward, as prospective adjuvants to opioid analgesics. Overall, we suggest that this paradoxical state be considered an additional target of clinical treatment for chronic pain.

  2. Targeting medullary thyroid carcinomas with bispecific antibodies and bivalent haptens. Results and clinical perspectives.

    Science.gov (United States)

    Rouvier, E; Gautherot, E; Meyer, P; Barbet, J

    1997-01-01

    The present article reviews the clinical trials that have been performed in recurrent medullary thyroid carcinoma patients with the Affinity Enhancement System. This technique uses bispecific antibodies to target radiolabelled bivalent haptens to tumour cells. Its sensitivity in the detection of known tumour sites is high (90%) and this technique also achieves good sensitivity (61%) in the detection of occult disease as revealed by abnormal thyrocalcitonin blood levels. Due to its high targeting capacity, this technique is now considered for use as a therapeutic agent in medullary thyroid carcinoma patients.

  3. Cosmic Origins Spectrograph: On-Orbit Performance of Target Acquisitions

    Science.gov (United States)

    Penton, Steven V.

    2010-07-01

    COS is a slit-less spectrograph with a very small aperture (R=1.2500). To achieve the desired wavelength accuracies, HST+COS must center the target to within 0.100 of the center of the aperture for the FUV channel, and 0.0400 for NUV. During SMOV and early Cycle 17 we fine-tuned the COS target acquisition (TA) procedures to exceed this accuracy for all three COS TA modes; NUV imaging, NUV spectroscopic, and FUV spectroscopic. In Cycle 17, we also adjusted the COSto- FGS offsets in the SIAF file. This allows us to recommend skipping the time consuming ACQ/SEARCH in cases where the target coordinates are well known. Here we will compare the on-orbit performance of all COS TA modes in terms of centering accuracy, efficiency, and required signal-to-noise (S/N).

  4. Targeting NK cells for anti-cancer immunotherapy: clinical and pre-clinical approaches

    Directory of Open Access Journals (Sweden)

    Sebastian eCarotta

    2016-04-01

    Full Text Available The recent success of checkpoint blockade has highlighted the potential of immunotherapy approaches for cancer treatment. While the majority of approved immunotherapy drugs target T cell subsets, it is appreciated that other components of the immune system have important roles in tumor immune-surveillance as well and thus represent promising additional targets for immunotherapy. Natural killer cells are the body’s first line of defense against infected or transformed cells as they kill target cells in an antigen-independent manner. Although several studies have clearly demonstrated the active role of NK cells in cancer-immune surveillance, only few clinically approved therapies currently exist that harness their potential. Our increased understanding of NK cell biology over the past few years has renewed the interest in NK cell based anti-cancer therapies, which has lead to a steady increase of NK cell based clinical and pre-clinical trials. Here, the role of NK cells in cancer immunesurveillance is summarized and several novel approaches to enhance NK cell cytotoxicity against cancer are discussed.

  5. Impact of 'stretch' targets for cardiovascular disease management within a local pay-for-performance programme.

    Science.gov (United States)

    Pape, Utz J; Huckvale, Kit; Car, Josip; Majeed, Azeem; Millett, Christopher

    2015-01-01

    Pay-for-performance programs are often aimed to improve the management of chronic diseases. We evaluate the impact of a local pay for performance programme (QOF+), which rewarded financially more ambitious quality targets ('stretch targets') than those used nationally in the Quality and Outcomes Framework (QOF). We focus on targets for intermediate outcomes in patients with cardiovascular disease and diabetes. A difference-in-difference approach is used to compare practice level achievements before and after the introduction of the local pay for performance program. In addition, we analysed patient-level data on exception reporting and intermediate outcomes utilizing an interrupted time series analysis. The local pay for performance program led to significantly higher target achievements (hypertension: p-value performance scheme was mainly attributed to increased exception reporting by practices with no discernable improvements in overall clinical quality. Hence, active monitoring of exception reporting should be considered when setting more ambitious quality targets. More generally, the study suggests a trade-off between additional incentive for better care and monitoring costs.

  6. Clinical science workshop: targeting the gut-liver-brain axis.

    Science.gov (United States)

    Patel, Vishal C; White, Helen; Støy, Sidsel; Bajaj, Jasmohan S; Shawcross, Debbie L

    2016-12-01

    A clinical science workshop was held at the ISHEN meeting in London on Friday 11th September 2014 with the aim of thrashing out how we might translate what we know about the central role of the gut-liver-brain axis into targets which we can use in the treatment of hepatic encephalopathy (HE). This review summarises the integral role that inter-organ ammonia metabolism plays in the pathogenesis of HE with specific discussion of the roles that the small and large intestine, liver, brain, kidney and muscle assume in ammonia and glutamine metabolism. Most recently, the salivary and gut microbiome have been shown to underpin the pathophysiological changes which culminate in HE and patients with advanced cirrhosis present with enteric dysbiosis with small bowel bacterial overgrowth and translocation of bacteria and their products across a leaky gut epithelial barrier. Resident macrophages within the liver are able to sense bacterial degradation products initiating a pro-inflammatory response within the hepatic parenchyma and release of cytokines such as tumour necrosis factor alpha (TNF-α) and interleukin-8 into the systemic circulation. The endotoxemia and systemic inflammatory response that are generated predispose both to the development of infection as well as the manifestation of covert and overt HE. Co-morbidities such as diabetes and insulin resistance, which commonly accompany cirrhosis, may promote slow gut transit, promote bacterial overgrowth and increase glutaminase activity and may need to be acknowledged in HE risk stratification assessments and therapeutic regimens. Therapies are discussed which target ammonia production, utilisation or excretion at an individual organ level, or which reduce systemic inflammation and endotoxemia which are known to exacerbate the cerebral effects of ammonia in HE. The ideal therapeutic strategy would be to use an agent that can reduce hyperammonemia and reduce systemic inflammation or perhaps to adopt a combination of

  7. Towards combinatorial targeted therapy in melanoma: from pre-clinical evidence to clinical application (review).

    Science.gov (United States)

    Grazia, Giulia; Penna, Ilaria; Perotti, Valentina; Anichini, Andrea; Tassi, Elena

    2014-09-01

    Over the last few years, clinical trials with BRAF and mitogen-activated protein/extracellular signal-regulated kinase (MEK) inhibitors have shown significant clinical activity in melanoma, but only a fraction of patients respond to these therapies, and development of resistance is frequent. This has prompted a large set of preclinical studies looking at several new combinatorial approaches of pathway- or target-specific inhibitors. At least five main drug association strategies have been verified in vitro and in preclinical models. The most promising include: i) vertical targeting of either MEK or phosphoinositide-3 kinase (PI3K)/mammalian target of rapamycin (mTOR) pathways, or their combined blockade; ii) association of receptor tyrosine kinases (RTKs) inhibitors with other pro-apoptotic strategies; iii) engagement of death receptors in combination with MEK-, mTOR/PI3K-, histone deacetylase (HDAC)-inhibitors, or with anti-apoptotic molecules modulators; iv) strategies aimed at blocking anti-apoptotic proteins belonging to B-cell lymphoma (Bcl-2) or inhibitors of apoptosis (IAP) families associated with MEK/BRAF/p38 inhibition; v) co-inhibition of other molecules important for survival [proteasome, HDAC and Signal transducers and activators of transcription (Stat)3] and the major pathways activated in melanoma; vi) simultaneous targeting of multiple anti-apoptotic molecules. Here we review the anti-melanoma efficacy and mechanism of action of the above-mentioned combinatorial strategies, together with the potential clinical application of the most promising studies that may eventually lead to therapeutic benefit.

  8. Target detection performed on manifold approximations recovered from hyperspectral data

    Science.gov (United States)

    Ziemann, Amanda K.; Messinger, David W.; Albano, James A.

    2013-05-01

    In high dimensional data, manifold learning seeks to identify the embedded lower-dimensional, non-linear mani- fold upon which the data lie. This is particularly useful in hyperspectral imagery where inherently m-dimensional data is often sparsely distributed throughout the d-dimensional spectral space, with m << d. By recovering the manifold, inherent structures and relationships within the data - which are not typically apparent otherwise - may be identified and exploited. The sparsity of data within the spectral space can prove challenging for many types of analysis, and in particular with target detection. In this paper, we propose using manifold recovery as a preprocessing step for spectral target detection algorithms. A graph structure is first built upon the data and the transformation into the manifold space is based upon that graph structure. Then, the Adaptive Co- sine/Coherence Estimator (ACE) algorithm is applied. We present an analysis of target detection performance in the manifold space using scene-derived target spectra from two different hyperspectral images.

  9. Targeted treatment for chronic lymphocytic leukemia: clinical potential of obinutuzumab

    Directory of Open Access Journals (Sweden)

    Smolej L

    2014-12-01

    Full Text Available Lukáš Smolej 4th Department of Internal Medicine – Hematology, University Hospital Hradec Králové and Charles University in Prague, Faculty of Medicine in Hradec Králové, Hradec Králové, Czech Republic Abstract: Introduction of targeted agents revolutionized the treatment of chronic lymphocytic leukemia (CLL in the past decade. Addition of chimeric monoclonal anti-CD20 antibody rituximab to chemotherapy significantly improved efficacy including overall survival (OS in untreated fit patients; humanized anti-CD52 antibody alemtuzumab and fully human anti-CD20 antibody ofatumumab lead to improvement in refractory disease. Novel small molecule inhibitors such as ibrutinib and idelalisib demonstrated excellent activity and were very recently licensed in relapsed/refractory CLL. Obinutuzumab (GA101 is the newest monoclonal antibody approved for the treatment of CLL. This novel, glycoengineered, type II humanized anti-CD20 antibody is characterized by enhanced antibody-dependent cellular cytotoxicity and direct induction of cell death compared to type I antibodies. Combination of obinutuzumab and chlorambucil yielded significantly better OS in comparison to chlorambucil monotherapy in untreated comorbid patients. These results led to approval of obinuzutumab for the treatment of CLL. Numerous clinical trials combining obinutuzumab with other cytotoxic drugs and novel small molecules are currently under way. This review focuses on the role of obinutuzumab in the treatment of CLL. Keywords: chronic lymphocytic leukemia, anti-CD20 antibodies, chlorambucil, rituximab, ofatumumab, obinutuzumab, overall survival

  10. Targeted treatment for chronic lymphocytic leukemia: clinical potential of obinutuzumab.

    Science.gov (United States)

    Smolej, Lukáš

    2015-01-01

    Introduction of targeted agents revolutionized the treatment of chronic lymphocytic leukemia (CLL) in the past decade. Addition of chimeric monoclonal anti-CD20 antibody rituximab to chemotherapy significantly improved efficacy including overall survival (OS) in untreated fit patients; humanized anti-CD52 antibody alemtuzumab and fully human anti-CD20 antibody ofatumumab lead to improvement in refractory disease. Novel small molecule inhibitors such as ibrutinib and idelalisib demonstrated excellent activity and were very recently licensed in relapsed/refractory CLL. Obinutuzumab (GA101) is the newest monoclonal antibody approved for the treatment of CLL. This novel, glycoengineered, type II humanized anti-CD20 antibody is characterized by enhanced antibody-dependent cellular cytotoxicity and direct induction of cell death compared to type I antibodies. Combination of obinutuzumab and chlorambucil yielded significantly better OS in comparison to chlorambucil monotherapy in untreated comorbid patients. These results led to approval of obinuzutumab for the treatment of CLL. Numerous clinical trials combining obinutuzumab with other cytotoxic drugs and novel small molecules are currently under way. This review focuses on the role of obinutuzumab in the treatment of CLL.

  11. The effect of target and non-target similarity on neural classification performance: A boost from confidence

    Directory of Open Access Journals (Sweden)

    Amar R Marathe

    2015-08-01

    Full Text Available Brain computer interaction (BCI technologies have proven effective in utilizing single-trial classification algorithms to detect target images in rapid serial visualization presentation tasks. While many factors contribute to the accuracy of these algorithms, a critical aspect that is often overlooked concerns the feature similarity between target and non-target images. In most real-world environments there are likely to be many shared features between targets and non-targets resulting in similar neural activity between the two classes. It is unknown how current neural-based target classification algorithms perform when qualitatively similar target and non-target images are presented. This study address this question by comparing behavioral and neural classification performance across two conditions: first, when targets were the only infrequent stimulus presented amongst frequent background distracters; and second when targets were presented together with infrequent non-targets containing similar visual features to the targets. The resulting findings show that behavior is slower and less accurate when targets are presented together with similar non-targets; moreover, single-trial classification yielded high levels of misclassification when infrequent non-targets are included. Furthermore, we present an approach to mitigate the image misclassification. We use confidence measures to assess the quality of single-trial classification, and demonstrate that a system in which low confidence trials are reclassified through a secondary process can result in improved performance.

  12. The effect of target and non-target similarity on neural classification performance: a boost from confidence.

    Science.gov (United States)

    Marathe, Amar R; Ries, Anthony J; Lawhern, Vernon J; Lance, Brent J; Touryan, Jonathan; McDowell, Kaleb; Cecotti, Hubert

    2015-01-01

    Brain computer interaction (BCI) technologies have proven effective in utilizing single-trial classification algorithms to detect target images in rapid serial visualization presentation tasks. While many factors contribute to the accuracy of these algorithms, a critical aspect that is often overlooked concerns the feature similarity between target and non-target images. In most real-world environments there are likely to be many shared features between targets and non-targets resulting in similar neural activity between the two classes. It is unknown how current neural-based target classification algorithms perform when qualitatively similar target and non-target images are presented. This study address this question by comparing behavioral and neural classification performance across two conditions: first, when targets were the only infrequent stimulus presented amongst frequent background distracters; and second when targets were presented together with infrequent non-targets containing similar visual features to the targets. The resulting findings show that behavior is slower and less accurate when targets are presented together with similar non-targets; moreover, single-trial classification yielded high levels of misclassification when infrequent non-targets are included. Furthermore, we present an approach to mitigate the image misclassification. We use confidence measures to assess the quality of single-trial classification, and demonstrate that a system in which low confidence trials are reclassified through a secondary process can result in improved performance.

  13. Cryogneic-Target Performance and Implosion Physics Studies on OMEGA

    Energy Technology Data Exchange (ETDEWEB)

    Smalyuk, V.A.; Betti, R.; Boehly, T.R.; Craxton, R.S.; Delettrez, J.A.; Edgell, D.H.; Glebov, V.Yu.; Goncharov, V.N.; Harding, D.R.; Hu, S.X.; Knauer, J.P.; Marshall, F.J.; McCrory, R.L.; McKenty, P.W.; Meyerhofer, D.D.; Radha, R.B.; Regan, S.P.; Sangster, T.C.; Seka, W.; Short, R.W.; Shvarts, D.; Skupsky, S.; Soures, J.M.; Stoeckl, C.; Yaakobi, B.; Frenje, J.A.; Li, C.K.; Petrasso, R.D.; Seguin, F.H.

    2009-03-06

    Recent progress in direct-drive cryogenic implosions on the OMEGA Laser Facility [T. R. Boehly et al., Opt. Commun. 133, 495 (1997)] is reviewed. Ignition-relevant areal densities of ~200 mg/cm^2 in cryogenic D2 implosions with peak laser-drive intensities of ~5 x 10^14 W/cm^2 were previously reported [T. C. Sangster et al., Phys. Rev. Lett. 100, 185006 (2008)]. The laser intensity is increased to ~10^15 W/cm^2 to demonstrate ignition-relevant implosion velocities of 3–4 x 10^7 cm/ s, providing an understanding of the relevant target physics. Planar-target acceleration experiments show the importance of the nonlocal electron-thermal-transport effects for modeling the laser drive. Nonlocal and hot-electron preheat is observed to stabilize the Rayleigh–Taylor growth at a peak drive intensity of ~10^15 W/cm^2. The shell preheat caused by hot electrons generated by two-plasmon-decay instability was reduced by using Si-doped ablators. The measured compressibility of planar plastic targets driven with high-compression shaped pulses agrees well with one-dimensional simulations at these intensities. Shock mistiming has contributed to compression degradation of recent cryogenic implosions driven with continuous pulses. Multiple-picket (shock-wave) target designs make it possible for a more robust tuning of the shock-wave arrival times. Cryogenic implosions driven with double-picket pulses demonstrate somewhat improved compression performance at a peak drive intensity of ~10^15 W/cm^2.

  14. Performing target specific band reduction using artificial neural networks and assessment of its efficacy using various target detection algorithms

    Science.gov (United States)

    Yadav, Deepti; Arora, M. K.; Tiwari, K. C.; Ghosh, J. K.

    2016-04-01

    Hyperspectral imaging is a powerful tool in the field of remote sensing and has been used for many applications like mineral detection, detection of landmines, target detection etc. Major issues in target detection using HSI are spectral variability, noise, small size of the target, huge data dimensions, high computation cost, complex backgrounds etc. Many of the popular detection algorithms do not work for difficult targets like small, camouflaged etc. and may result in high false alarms. Thus, target/background discrimination is a key issue and therefore analyzing target's behaviour in realistic environments is crucial for the accurate interpretation of hyperspectral imagery. Use of standard libraries for studying target's spectral behaviour has limitation that targets are measured in different environmental conditions than application. This study uses the spectral data of the same target which is used during collection of the HSI image. This paper analyze spectrums of targets in a way that each target can be spectrally distinguished from a mixture of spectral data. Artificial neural network (ANN) has been used to identify the spectral range for reducing data and further its efficacy for improving target detection is verified. The results of ANN proposes discriminating band range for targets; these ranges were further used to perform target detection using four popular spectral matching target detection algorithm. Further, the results of algorithms were analyzed using ROC curves to evaluate the effectiveness of the ranges suggested by ANN over full spectrum for detection of desired targets. In addition, comparative assessment of algorithms is also performed using ROC.

  15. Phase I clinical study of vascular targeting fluorescent cationic liposomes in head and neck cancer.

    Science.gov (United States)

    Strieth, Sebastian; Dunau, Christoph; Kolbow, Kristina; Knuechel, Ruth; Michaelis, Uwe; Ledderose, Hannelore; Eichhorn, Martin E; Strelczyk, Donata; Tschiesner, Uta; Wollenberg, Barbara; Dellian, Marc

    2013-03-01

    The aim of this first-time-in-human non-randomized dose-escalating prospective phase I clinical trial was to analyze safety of two doses of fluorescent rhodamine-labeled cationic liposomes (LDF01) in head and neck squamous cell carcinoma (HNSCC). Patients had resectable UICC stadium I-IV A HNSCCs. LDF01 was administered before tumor resection under general anesthesia as an intravenous infusion with effective lipid doses of 0.5 or 2 mg/kg b.w., respectively. In addition to clinical monitoring for safety assessment, tumor biopsies were taken during the surgical procedure for fluorescence histological analysis. Eight patients were assigned to the two dose groups. During safety follow-up no clinically relevant adverse events occurred. Fluorescence histology revealed some evidence of favorable selectivity of LDF01 for tumor microvessels in the high-dose group. LDF01 is safe applied as infusion at both tested dose levels. Furthermore, LDF01 can be detected in the vicinity of tumor cells and could be assigned to the microvessel target in individual HNSSC cases. Detailed analysis of targeting properties of LDF01 has to be performed in upcoming clinical phase II trials.

  16. Impact of target modifications on Magnetized Liner Inertial Fusion performance

    Science.gov (United States)

    Gomez, Matthew; Knapp, Patrick; Sefkow, Adam; Slutz, Stephen; Awe, Thomas; Hansen, Stephanie; Hahn, Kelly; Harding, Eric; Jennings, Christopher; McBride, Ryan; Sinars, Daniel; Rochau, Gregory; Peterson, Kyle

    2015-11-01

    Magnetized Liner Inertial Fusion (MagLIF) is a magnetically-driven fusion concept in which an axial magnetic field and laser heating are used to relax the implosion requirements of inertial confinement fusion. Initial experiments demonstrated the promise of the concept with relatively high yields (primary DD = 2e12), ion temperatures (2.5 keV), and magnetic field-radius products (>0.3 MG-cm). In order to better understand the portions of parameter space in which MagLIF can operate effectively, a series of experiments are being conducted to test the impact of various changes (e.g., laser-entrance-hole window thickness, imploding height of the target, endcap material, laser energy, laser spot size, initial fuel density). The impact of these changes on target performance (primary neutron yield, ion temperature, stagnation volume, etc.) will be discussed. Sandia National Laboratories is a multi-program laboratory managed and operated by Sandia Corporation, a wholly owned subsidiary of Lockheed Martin Corporation, for the U.S. Department of Energy's National Nuclear Security Administration under Contract No. DE-AC04-94AL85000.

  17. Validation of the propagation, target echo and sonar performance model ALMOST with near field target echo measurements

    NARCIS (Netherlands)

    Schippers, P.

    2005-01-01

    Since the late eighties the sonar performance model ALMOST of TNO Defence, Security and Safety is under development. For active detection performance first a point target with one Target Strength (TS) value dependent on aspect angle was used, based on measurements or other sources. Within the Torped

  18. Ethnic disparities in undergraduate pre-clinical and clinical performance

    NARCIS (Netherlands)

    Stegers-Jager, Karen M.; Steyerberg, Ewout W.; Cohen-Schotanus, Janke; Themmen, Axel P. N.

    2012-01-01

    Medical Education 2012: 46:575585 Context Research from numerous medical schools has shown that students from ethnic minorities underperform compared with those from the ethnic majority. However, little is known about why this underperformance occurs and whether there are performance differences amo

  19. Bioinformatic Challenges in Clinical Diagnostic Application of Targeted Next Generation Sequencing: Experience from Pheochromocytoma.

    Directory of Open Access Journals (Sweden)

    Joakim Crona

    Full Text Available Recent studies have demonstrated equal quality of targeted next generation sequencing (NGS compared to Sanger Sequencing. Whereas these novel sequencing processes have a validated robust performance, choice of enrichment method and different available bioinformatic software as reliable analysis tool needs to be further investigated in a diagnostic setting.DNA from 21 patients with genetic variants in SDHB, VHL, EPAS1, RET, (n=17 or clinical criteria of NF1 syndrome (n=4 were included. Targeted NGS was performed using Truseq custom amplicon enrichment sequenced on an Illumina MiSEQ instrument. Results were analysed in parallel using three different bioinformatics pipelines; (1 Commercially available MiSEQ Reporter, fully automatized and integrated software, (2 CLC Genomics Workbench, graphical interface based software, also commercially available, and ICP (3 an in-house scripted custom bioinformatic tool.A tenfold read coverage was achieved in between 95-98% of targeted bases. All workflows had alignment of reads to SDHA and NF1 pseudogenes. Compared to Sanger sequencing, variant calling revealed a sensitivity ranging from 83 to 100% and a specificity of 99.9-100%. Only MiSEQ reporter identified all pathogenic variants in both sequencing runs.We conclude that targeted next generation sequencing have equal quality compared to Sanger sequencing. Enrichment specificity and the bioinformatic performance need to be carefully assessed in a diagnostic setting. As acceptable accuracy was noted for a fully automated bioinformatic workflow, we suggest that processing of NGS data could be performed without expert bioinformatics skills utilizing already existing commercially available bioinformatics tools.

  20. Trends in pharmaceutical targeting of clinical indications: 1930-2013.

    Science.gov (United States)

    Kinch, Michael S; Merkel, Janie; Umlauf, Sheila

    2014-11-01

    An analysis of FDA-approved new molecular entities (NMEs) reveals trends in therapeutic applications. Four groupings (infectious diseases, cardiovascular diseases, autoimmune/inflammatory diseases and cancer) capture more than 60% of NMEs. Infectious diseases are the most targeted indications. Near the turn of the new millennium, the rate of new approvals for infectious diseases decreased. The absolute and relative number of NMEs targeting psychiatric, neurological and pain/itch indications also declined. By contrast, NMEs targeting cancer have risen in the past two decades as have NMEs targeting orphan indications. These results suggest the drug development community has largely been responsive to public health and market needs. However, finite resources might indicate emphasis on some unmet needs could come at the cost of others.

  1. Designing block copolymer architectures for targeted membrane performance

    KAUST Repository

    Dorin, Rachel Mika

    2014-01-01

    Using a combination of block copolymer self-assembly and non-solvent induced phase separation, isoporous ultrafiltration membranes were fabricated from four poly(isoprene-b-styrene-b-4-vinylpyridine) triblock terpolymers with similar block volume fractions but varying in total molar mass from 43 kg/mol to 115 kg/mol to systematically study the effect of polymer size on membrane structure. Small-angle X-ray scattering was used to probe terpolymer solution structure in the dope. All four triblocks displayed solution scattering patterns consistent with a body-centered cubic morphology. After membrane formation, structures were characterized using a combination of scanning electron microscopy and filtration performance tests. Membrane pore densities that ranged from 4.53 × 1014 to 1.48 × 1015 pores/m 2 were observed, which are the highest pore densities yet reported for membranes using self-assembly and non-solvent induced phase separation. Hydraulic permeabilities ranging from 24 to 850 L m-2 h-1 bar-1 and pore diameters ranging from 7 to 36 nm were determined from permeation and rejection experiments. Both the hydraulic permeability and pore size increased with increasing molar mass of the parent terpolymer. The combination of polymer characterization and membrane transport tests described here demonstrates the ability to rationally design macromolecular structures to target specific performance characteristics in block copolymer derived ultrafiltration membranes. © 2013 Elsevier Ltd. All rights reserved.

  2. Memory for found targets interferes with subsequent performance in multiple-target visual search.

    Science.gov (United States)

    Cain, Matthew S; Mitroff, Stephen R

    2013-10-01

    Multiple-target visual searches--when more than 1 target can appear in a given search display--are commonplace in radiology, airport security screening, and the military. Whereas 1 target is often found accurately, additional targets are more likely to be missed in multiple-target searches. To better understand this decrement in 2nd-target detection, here we examined 2 potential forms of interference that can arise from finding a 1st target: interference from the perceptual salience of the 1st target (a now highly relevant distractor in a known location) and interference from a newly created memory representation for the 1st target. Here, we found that removing found targets from the display or making them salient and easily segregated color singletons improved subsequent search accuracy. However, replacing found targets with random distractor items did not improve subsequent search accuracy. Removing and highlighting found targets likely reduced both a target's visual salience and its memory load, whereas replacing a target removed its visual salience but not its representation in memory. Collectively, the current experiments suggest that the working memory load of a found target has a larger effect on subsequent search accuracy than does its perceptual salience.

  3. Nursing students’ perceived stress and influences in clinical performance

    OpenAIRE

    Laila Akhu-Zaheya; Insaf Shaban; Wejdan Khater

    2015-01-01

    Background: It is known that stress related to clinical training among nursing students could contribute to many physical and mental problems. However, little empirical evidence about the influence of stress in nurse students’ clinical performance Objective: The objective of this study was to assess the association between perceived stresses, stress related factors, and students’ clinical performance. Method: Using the perceived stress scale, 539 Jordanian nursing students from 2 publ...

  4. Clinical performance of machined titanium restorations.

    Science.gov (United States)

    Walter, M; Böning, K; Reppel, P D

    1994-12-01

    In 37 patients 88 titanium restorations were placed during a 1-year period 1990-91. The 69 crowns and 19 fixed partial dentures comprised 147 prosthodontic units. All restorations were fabricated by duplication milling and electrical discharge machining of pure titanium (Procera Technology, Nobelpharma, Gothenburg, Sweden). Based on the results of clinical follow-up, Kaplan-Meier survivor functions were calculated. The survivor rate of 40 metal crowns and pontics was 100%. In 107 porcelain-fused-to-metal units the 3-year survivor rate concerning removal was 95%. When relating the survival to an intact ceramic veneer, the 3-year survivor rate of porcelain-fused-to-metal units was 84%. The quality of the restorations evaluated by the rating system of the California Dental Association was found to be satisfactory in the vast majority of cases. It can be concluded that machined titanium restorations are suitable for clinical use, although not all problems, especially in the field of metal-ceramics have yet been completely solved.

  5. The evaluation study of high performance gas target system

    Energy Technology Data Exchange (ETDEWEB)

    Hur, Min Goo; Yang, Seung Dae; Kim, Sang Wook

    2008-06-15

    The object of this study is a improvement of a gas target and targetry for increasing the radioisotope production yields. The main results are as follows 1. Improvement of beam entrance of the gas target : In this work, deep hole grid was designed for improvement of beam entrance. Using FEM(Finite Elements Method) analysis, it was verified that this design is more effective than the old one. 2. Improvement of target gas loading and withdrawing system : For the targetry, Helium gas and vacuum lines was installed for evaluating the production yields. Using these lines, it was proved that the recovery yields was improved and the residual impurity was reduced. 3. Improvement of target cooling efficiency : In case of the cylindrical target, it is more effective to use short length of target cavity for the high production yields. For improving the cooling efficiency, cooling fin was suggested to the target design. It is more effective to put the cooling fins inside the target cavity for the suppressed target pressure and density reduction effect during the proton beam irradiation. In conclusion, the target with fins inside the target cavity was better for high current irradiation and mass RI production.

  6. Targeting hedgehog signaling in cancer: research and clinical developments

    Directory of Open Access Journals (Sweden)

    Xie J

    2013-10-01

    Full Text Available Jingwu Xie, Christopher M Bartels, Scott W Barton, Dongsheng GuWells Center for Pediatric Research, Division of Hematology and Oncology, Department of Pediatrics, Indiana University Simon Cancer Center, Indiana University, Indianapolis, IN, USAAbstract: Since its first description in Drosophila by Drs Nusslein-Volhard and Wieschaus in 1980, hedgehog (Hh signaling has been implicated in regulation of cell differentiation, proliferation, tissue polarity, stem cell maintenance, and carcinogenesis. The first link of Hh signaling to cancer was established through studies of Gorlin syndrome in 1996 by two independent teams. Later, it was shown that Hh signaling may be involved in many types of cancer, including skin, leukemia, lung, brain, and gastrointestinal cancers. In early 2012, the US Food and Drug Administration approved the clinical use of Hh inhibitor Erivedge/vismodegib for treatment of locally advanced and metastatic basal cell carcinomas. With further investigation, it is possible to see more clinical applications of Hh signaling inhibitors. In this review, we will summarize major advances in the last 3 years in our understanding of Hh signaling activation in human cancer, and recent developments in preclinical and clinical studies using Hh signaling inhibitors.Keywords: hedgehog, smoothened, PTCH1, cancer, signal transduction, clinical trials, animal model

  7. Evolution of targeted therapies in cancer: opportunities and challenges in the clinic.

    Science.gov (United States)

    Santhosh, Sam; Kumar, Prasanna; Ramprasad, Vedam; Chaudhuri, Amitabha

    2015-01-01

    Targeted therapies have changed the course of cancer treatment in recent years. By reducing toxicity and improving outcome, these new generations of precision medicines have extended patient lives beyond what could be achieved by the use of nontargeted therapies. In the last 2 years, several new molecular entities targeting signaling proteins and immune pathways have gone through successful clinical development resulting in their approval. These new targeted therapies require patient selection and the discovery of biomarkers of response. This review discusses the evolution of targeted therapies in cancer and challenges in translating the concepts into clinical practice.

  8. Inflation targeting and economic performance: The case of Mexico

    Directory of Open Access Journals (Sweden)

    Carrasco Carlos A.

    2011-01-01

    Full Text Available In the paper we analyze the impact of Inflation Targeting (IT in Mexico. The objective is to evaluate the impact of the implementation of inflation targeting and full-fledged inflation targeting (FFIT on the level and the variability of the inflation and the output in the Mexican economy. We conclude that inflation rates had been reduced in Mexico before the introduction of IT and FFIT. In our opinion, the structural reforms, including the Banxico reforms, are the main determinants of the decrease in inflation and its variability. The main impact of IT would have been the lock-in of inflation expectations around a low rate of inflation.

  9. Feedback-giving behaviour in performance evaluations during clinical clerkships

    NARCIS (Netherlands)

    Bok, Harold G J; Jaarsma, Debbie A D C; Spruijt, Annemarie; Van Beukelen, Peter; Van Der Vleuten, Cees P M; Teunissen, Pim W

    2016-01-01

    CONTEXT: Narrative feedback documented in performance evaluations by the teacher, i.e. the clinical supervisor, is generally accepted to be essential for workplace learning. Many studies have examined factors of influence on the usage of mini-clinical evaluation exercise (mini-CEX) instruments and p

  10. Feedback-giving behaviour in performance evaluations during clinical clerkships

    NARCIS (Netherlands)

    Bok, Harold G J; Jaarsma, Debbie A D C; Spruijt, Annemarie; Van Beukelen, Peter; Van Der Vleuten, Cees P M; Teunissen, Pim W

    2015-01-01

    CONTEXT: Narrative feedback documented in performance evaluations by the teacher, i.e. the clinical supervisor, is generally accepted to be essential for workplace learning. Many studies have examined factors of influence on the usage of mini-clinical evaluation exercise (mini-CEX) instruments and p

  11. Clinical roundtable monograph: CD30 in lymphoma: its role in biology, diagnostic testing, and targeted therapy.

    Science.gov (United States)

    Sotomayor, Eduardo M; Young, Ken H; Younes, Anas

    2014-04-01

    CD30, a member of the tumor necrosis factor receptor superfamily, is a transmembrane glycoprotein receptor consisting of an extracellular domain, a transmembrane domain, and an intracellular domain. CD30 has emerged as an important molecule in the field of targeted therapy because its expression is generally restricted to specific disease types and states. The major cancers with elevated CD30 expression include Hodgkin lymphoma and anaplastic large T-cell lymphoma, and CD30 expression is considered essential to the differential diagnosis of these malignancies. Most commonly, CD30 expression is detected and performed by immunohistochemical staining of biopsy samples. Alternatively, flow cytometry analysis has also been developed for fresh tissue and cell aspiration specimens, including peripheral blood and bone marrow aspirate. Over the past several years, several therapeutic agents were developed to target CD30, with varying success in clinical trials. A major advance in the targeting of CD30 was seen with the development of the antibody-drug conjugate brentuximab vedotin, which consists of the naked anti-CD30 antibody SGN-30 conjugated to the synthetic antitubulin agent monomethyl auristatin E. In 2011, brentuximab vedotin was approved by the US Food and Drug Administration for use in Hodgkin lymphoma and anaplastic large cell lymphoma based on clinical trial data showing high response rates in these indications. Ongoing trials are examining brentuximab vedotin after autologous stem cell transplantation, as part of chemotherapy combination regimens, and in other CD30-expressing malignancies, including primary mediastinal large B-cell lymphomas, diffuse large B-cell lymphoma, lymphoma positive for Epstein-Barr virus, peripheral T-cell lymphoma not otherwise specified, and cutaneous anaplastic large cell lymphoma.

  12. Pharmaceutical and clinical development of phosphonate-based radiopharmaceuticals for the targeted treatment of bone metastases.

    Science.gov (United States)

    Lange, Rogier; Ter Heine, Rob; Knapp, Russ Ff; de Klerk, John M H; Bloemendal, Haiko J; Hendrikse, N Harry

    2016-10-01

    Therapeutic phosphonate-based radiopharmaceuticals radiolabeled with beta, alpha and conversion electron emitting radioisotopes have been investigated for the targeted treatment of painful bone metastases for >35years. We performed a systematic literature search and focused on the pharmaceutical development, preclinical research and early human studies of these radiopharmaceuticals. The characteristics of an ideal bone-targeting therapeutic radiopharmaceutical are presented and compliance with these criteria by the compounds discussed is verified. The importance of both composition and preparation conditions for the stability and biodistribution of several agents is discussed. Very few studies have described the characterization of these products, although knowledge on the molecular structure is important with respect to in vivo behavior. This review discusses a total of 91 phosphonate-based therapeutic radiopharmaceuticals, of which only six agents have progressed to clinical use. Extensive clinical studies have only been described for (186)Re-HEDP, (188)Re-HEDP and (153)Sm-EDTMP. Of these, (153)Sm-EDTMP represents the only compound with worldwide marketing authorization. (177)Lu-EDTMP has recently received approval for clinical use in India. This review illustrates that a thorough understanding of the radiochemistry of these agents is required to design simple and robust preparation and quality control methods, which are needed to fully exploit the potential benefits of these theranostic radiopharmaceuticals. Extensive biodistribution and dosimetry studies are indispensable to provide the portfolios that are required for assessment before human administration is possible. Use of the existing knowledge collected in this review should guide future research efforts and may lead to the approval of new promising agents.

  13. The Clinical Development of Molecularly Targeted Agents in Combination With Radiation Therapy: A Pharmaceutical Perspective

    Energy Technology Data Exchange (ETDEWEB)

    Ataman, Ozlem U., E-mail: ouataman@hotmail.com [Global Medicines Development, AstraZeneca, Alderley Park, Macclesfield, Cheshire (United Kingdom); Sambrook, Sally J. [Global Medicines Development, AstraZeneca, Alderley Park, Macclesfield, Cheshire (United Kingdom); Wilks, Chris [Innovative Medicines, AstraZeneca, Alderley Park, Macclesfield, Cheshire (United Kingdom); Lloyd, Andrew [Global Medicines Development, AstraZeneca, Alderley Park, Macclesfield, Cheshire (United Kingdom); Taylor, Amanda E. [Yellow Delaney Communications Ltd, Wilmslow, Cheshire (United Kingdom); Wedge, Stephen R. [Innovative Medicines, AstraZeneca, Alderley Park, Macclesfield, Cheshire (United Kingdom)

    2012-11-15

    Summary: This paper explores historical and current roles of pharmaceutical industry sponsorship of clinical trials testing radiation therapy combinations with molecularly targeted agents and attempts to identify potential solutions to expediting further combination studies. An analysis of clinical trials involving a combination of radiation therapy and novel cancer therapies was performed. Ongoing and completed trials were identified by searching the (clinicaltrials.gov) Web site, in the first instance, with published trials of drugs of interest identified through American Society of Clinical Oncology, European CanCer Organisation/European Society for Medical Oncology, American Society for Radiation Oncology/European Society for Therapeutic Radiology and Oncology, and PubMed databases and then cross-correlated with (clinicaltrials.gov) protocols. We examined combination trials involving radiation therapy with novel agents and determined their distribution by tumor type, predominant molecular mechanisms examined in combination to date, timing of initiation of trials relative to a novel agent's primary development, and source of sponsorship of such trials. A total of 564 studies of targeted agents in combination with radiation therapy were identified with or without concomitant chemotherapy. Most studies were in phase I/II development, with only 36 trials in phase III. The tumor site most frequently studied was head and neck (26%), followed by non-small cell lung cancer. Pharmaceutical companies were the sponsors of 33% of studies overall and provided support for only 16% of phase III studies. In terms of pharmaceutical sponsorship, Genentech was the most active sponsor of radiation therapy combinations (22%), followed by AstraZeneca (14%). Most radiation therapy combination trials do not appear to be initiated until after drug approval. In phase III studies, the most common (58%) primary endpoint was overall survival. Collectively, this analysis suggests that

  14. Platelet P2 receptors: from curiosity to clinical targets.

    Science.gov (United States)

    Cusack, N J; Hourani, S M

    2000-07-01

    Adenosine 5'-diphosphate (ADP) is a paracrine mediator that activates human blood platelets, causing them to become adhesive and thereby contributing to their role in hemostasis. The actions of ADP were initially thought to be mediated by a unique ADP receptor termed P2(T) found only on platelets and antagonized by ATP, but it appears that at least two P2Y receptor subtypes are involved, a P2Y(1) receptor linked in some way to control of intracellular-free calcium levels and another P2Y receptor linked via an inhibitory G protein to adenylate cyclase. In addition, the presence of excitatory P2X(1) receptors that mediate the influx of monovalent and divalent cations in response to both ADP and ATP has been demonstrated. The precise contribution that each of these P2 receptors make to the overall phenomena associated with platelet aggregation, adhesion and hemostasis is yet to be defined. Antithrombotic agents that interfere with the actions of ADP are marketed, and P2 receptor antagonists are entering clinical trials for acute treatments of thrombosis. This review seeks to summarize the present state of knowledge of platelet P2 receptor pharmacology and therapeutics.

  15. Description and Performance Evaluation of the Moving Target Detector

    Science.gov (United States)

    1977-03-08

    either processor provides target doppler information. Through direct comparison it has been found that a simple three-pulse can- celler witho.it feedback ...samples with sign extended). 164 RDR QIUAD/VIDEO ADs SAMPLED COMPLEX TIME SERIES OFT RE-NSETCOR l IER RCR~ EFLE EEAO IPA Fig. ~ ~ ~ NV A-i

  16. Workplace Correlates and Scholarly Performance of Clinical Pharmacy Faculty.

    Science.gov (United States)

    Jungnickel, Paul W.; Creswell, John W.

    1994-01-01

    This study sought to develop a correlate model of 3-year scholarly performance of 296 clinical pharmacy faculty. Participants were surveyed concerning refereed research, grants/books research, and nonresearch scholarship. Eight correlates, including two related to the departmental workplace, emerged as significant factors in scholarly performance.…

  17. Bill restricts abortion blockades. Clinic violence is target of action.

    Science.gov (United States)

    1993-11-17

    On November 16, 1993, the US Senate voted approval, by 69 to 30 members, to impose stiff penalties on those obstructing access to abortion clinics. The penalties include up to 1 year in jail and a $100,000 fine for first violent offenses. Obstruction without violence would lead to a fine of $10,000 and 6 months in jail. The legislation was deemed necessary after the murder of a doctor in Florida and the wounding of another doctor in Kansas. Democratic Senator Edward Kennedy said that those who do not obstruct access have nothing to fear. Support came not only from abortion rights advocates, but from those against lawlessness in the pro-life movement. Maryland's Democratic Senators Mikulski and Sarbanes and California's Democratic Senator Barbara Boxes supported the bill, as well as Attorney General Janet Reno and President Clinton. House Speaker Thomas S. Foley announced that the House would consider its version of the bill on November 18, 1993. The original version was changed to reduce fines for nonviolent offenders from $100,000 to $10,000. Opponents argued that the legislation treated peaceful protesters as felons, and was directed in a singular=sided way with no regard to civil disobedience by animal rights activists, antinuclear protesters, and AIDS activists. North Carolina Republican Senator Jesse Helms thought that the Supreme Court would find the bill unconstitutional. Other arguments were that civil disobedience should be allowed for anti-abortion protesters, as it was allowed for civil rights protesters such as Dr. Martin Luther King, Jr. Senator Kennedy pointed out the Dr. King was trying to secure a constitutional right, unlike anti-abortion protesters who were trying to deny a constitutional right.

  18. EGFR-Targeting as a Biological Therapy: Understanding Nimotuzumab's Clinical Effects

    Energy Technology Data Exchange (ETDEWEB)

    Perez, Rolando, E-mail: rolando@cim.sld.cu; Moreno, Ernesto; Garrido, Greta; Crombet, Tania [Center of Molecular Immunology, P.O. Box 16040, Havana 11600 (Cuba)

    2011-04-18

    Current clinical trials of epidermal growth factor receptor (EGFR)-targeted therapies are mostly guided by a classical approach coming from the cytotoxic paradigm. The predominant view is that the efficacy of EGFR antagonists correlates with skin rash toxicity and induction of objective clinical response. Clinical benefit from EGFR-targeted therapies is well documented; however, chronic use in advanced cancer patients has been limited due to cumulative and chemotherapy-enhanced toxicity. Here we analyze different pieces of data from mechanistic and clinical studies with the anti-EGFR monoclonal antibody Nimotuzumab, which provides several clues to understand how this antibody may induce a biological control of tumor growth while keeping a low toxicity profile. Based on these results and the current state of the art on EGFR-targeted therapies, we discuss the need to evaluate new therapeutic approaches using anti-EGFR agents, which would have the potential of transforming advanced cancer into a long-term controlled chronic disease.

  19. Emotional intelligence and clinical performance/retention of nursing students

    Directory of Open Access Journals (Sweden)

    Chelsea Marvos

    2015-01-01

    Full Text Available Objective: This exploratory, quantitative, descriptive study was undertaken to explore the relationship between clinical performance and anticipated retention in nursing students. Methods: After approval by the university′s Human Subjects Committee, a sample of 104 nursing students were recruited for this study, which involved testing with a valid and reliable emotional intelligence (EI instrument and a self-report survey of clinical competencies. Results: Statistical analysis revealed that although the group average for total EI score and the 6 score subsets were in the average range, approximately 30% of the individual total EI scores and 30% of two branch scores, identifying emotions correctly and understanding emotions, fell in the less than average range. This data, as well as the analysis of correlation with clinical self-report scores, suggest recommendations applicable to educators of clinical nursing students. Conclusions: Registered nurses make-up the largest segment of the ever-growing healthcare workforce. Yet, retention of new graduates has historically been a challenge for the profession. Given the projected employment growth in nursing, it is important to identify factors which correlate with high levels of performance and job retention among nurses. There is preliminary evidence that EI "a nontraditional intelligence measure" relates positively not only with retention of clinical staff nurses, but with overall clinical performance as well.

  20. Prostate bed target interfractional motion using RTOG consensus definitions and daily CT on rails. Does target motion differ between superior and inferior portions of the clinical target volume

    Energy Technology Data Exchange (ETDEWEB)

    Verma, Vivek; Zhou, Sumin; Enke, Charles A.; Wahl, Andrew O. [University of Nebraska Medical Center, Department of Radiation Oncology, Omaha (United States); Chen, Shifeng [University of Maryland School of Medicine, Department of Radiation Oncology, Baltimore, MD (United States)

    2017-01-15

    Using high-quality CT-on-rails imaging, the daily motion of the prostate bed clinical target volume (PB-CTV) based on consensus Radiation Therapy Oncology Group (RTOG) definitions (instead of surgical clips/fiducials) was studied. It was assessed whether PB motion in the superior portion of PB-CTV (SUP-CTV) differed from the inferior PB-CTV (INF-CTV). Eight pT2-3bN0-1M0 patients underwent postprostatectomy intensity-modulated radiotherapy, totaling 300 fractions. INF-CTV and SUP-CTV were defined as PB-CTV located inferior and superior to the superior border of the pubic symphysis, respectively. Daily pretreatment CT-on-rails images were compared to the planning CT in the left-right (LR), superoinferior (SI), and anteroposterior (AP) directions. Two parameters were defined: ''total PB-CTV motion'' represented total shifts from skin tattoos to RTOG-defined anatomic areas; ''PB-CTV target motion'' (performed for both SUP-CTV and INF-CTV) represented shifts from bone to RTOG-defined anatomic areas (i. e., subtracting shifts from skin tattoos to bone). Mean (± standard deviation, SD) total PB-CTV motion was -1.5 (± 6.0), 1.3 (± 4.5), and 3.7 (± 5.7) mm in LR, SI, and AP directions, respectively. Mean (± SD) PB-CTV target motion was 0.2 (±1.4), 0.3 (±2.4), and 0 (±3.1) mm in the LR, SI, and AP directions, respectively. Mean (± SD) INF-CTV target motion was 0.1 (± 2.8), 0.5 (± 2.2), and 0.2 (± 2.5) mm, and SUP-CTV target motion was 0.3 (± 1.8), 0.5 (± 2.3), and 0 (± 5.0) mm in LR, SI, and AP directions, respectively. No statistically significant differences between INF-CTV and SUP-CTV motion were present in any direction. There are no statistically apparent motion differences between SUP-CTV and INF-CTV. Current uniform planning target volume (PTV) margins are adequate to cover both portions of the CTV. (orig.) [German] Zur Evaluation der interfraktionellen Variabilitaet des klinischen Zielvolumens der Prostataloge

  1. Comparison of the cancer gene targeting and biochemical selectivities of all targeted kinase inhibitors approved for clinical use.

    Directory of Open Access Journals (Sweden)

    Joost C M Uitdehaag

    Full Text Available The anti-proliferative activities of all twenty-five targeted kinase inhibitor drugs that are in clinical use were measured in two large assay panels: (1 a panel of proliferation assays of forty-four human cancer cell lines from diverse tumour tissue origins; and (2 a panel of more than 300 kinase enzyme activity assays. This study provides a head-on comparison of all kinase inhibitor drugs in use (status Nov. 2013, and for six of these drugs, the first kinome profiling data in the public domain. Correlation of drug activities with cancer gene mutations revealed novel drug sensitivity markers, suggesting that cancers dependent on mutant CTNNB1 will respond to trametinib and other MEK inhibitors, and cancers dependent on SMAD4 to small molecule EGFR inhibitor drugs. Comparison of cellular targeting efficacies reveals the most targeted inhibitors for EGFR, ABL1 and BRAF(V600E-driven cell growth, and demonstrates that the best targeted agents combine high biochemical potency with good selectivity. For ABL1 inhibitors, we computationally deduce optimized kinase profiles for use in a next generation of drugs. Our study shows the power of combining biochemical and cellular profiling data in the evaluation of kinase inhibitor drug action.

  2. Divertor performance on carbon and beryllium targets in JET

    Energy Technology Data Exchange (ETDEWEB)

    Janeschitz, G.; Koenig, R.; Lauro-Taroni, L.; Lingertat, J.; Matthews, G.; Stamp, M.; Vlases, G.; Campbell, D.; Clement, S.; De Kock, L.; Ehrenberg, J.; Gottardi, N.; Harbour, P.; Horton, L.; Jaeckel, H.; Lesourd, M.; Loarte, A.; Lowry, C.; Saibene, G.; Summers, D.; Tagle, J.A.; Thomas, P.R.; Von Hellerman, M. (JET Joint Undertaking, Abingdon (United Kingdom)); Eckstein, W.; Roth, J. (Max Planck Inst. fuer Plasmaphysik, Garching (Germany))

    1992-12-01

    The dependence of impurity production and retention on the divertor density, on the power flow into this region as well as on the X-point to target distance are investigated. Model predictions suggest a good impurity retention above a certain divertor (scrape-off) density threshold, which is dependent on heating power. In our experiments pre-programmed midplane or X-point gas puffs were used to scan the density, as well as to avoid the depletion of particles from the divertor and the scrape-off during H-models. The gas puffs reduce T[sub e] and increase N[sub e] in particular at the outer strike zone. In general the Be as well as the C influx increases with density, which is understood from the T[sub e] (T[sub i]) dependence of the sputtering yields. The impurity retention shows the expected improvement with increasing scrape-off (divertor) density as well as with increasing X-point to target distance (connection length). (orig.).

  3. SU-E-J-34: Clinical Evaluation of Targeting Accuracy and Tractogrphy Delineation of Radiosurgery

    Energy Technology Data Exchange (ETDEWEB)

    Juh, R; Suh, T; Kim, Y; Han, J; Kim, C; Oh, C; Kim, D [Seoul National University Bundang Hospital (Korea, Republic of)

    2014-06-01

    Purpose: Focal radiosurgery is a common treatment modality for trigeminal neuralgia (TN), a neuropathic facial pain condition. Assessment of treatment effectiveness is primarily clinical, given the paucity of investigational tools to assess trigeminal nerve changes. The efficiency of radiosurgery is related to its highly precise targeting. We assessed clinically the targeting accuracy of radiosurgery with Gamma knife. We hypothesized that trigeminal tractography provides more information than 2D-MR imaging, allowing detection of unique, focal changes in the target area after radiosurgery. Methods: Sixteen TN patients (2 females, 4 male, average age 65.3 years) treated with Gamma Knife radiosurgery, 40 Gy/50% isodose line underwent 1.5Tesla MR trigeminal nerve . Target accuracy was assessed from deviation of the coordinates of the target compared with the center of enhancement on post MRI. Radiation dose delivered at the borders of contrast enhancement was evaluated Results: The median deviation of the coordinates between the intended target and the center of contrast enhancement was within 1mm. The radiation doses fitting within the borders of the contrast enhancement the target ranged from 37.5 to 40 Gy. Trigeminal tractography accurately detected the radiosurgical target. Radiosurgery resulted in 47% drop in FA values at the target with no significant change in FA outside the target, suggesting that radiosurgery primarily affects myelin. Tractography was more sensitive, since FA changes were detected regardless of trigeminal nerve enhancement Conclusion: The median deviation found in clinical assessment of gamma knife treatment for TN Is low and compatible with its high rate of efficiency. DTI parameters accurately detect the effects of focal radiosurgery on the trigeminal nerve, serving as an in vivo imaging tool to study TN. This study is a proof of principle for further assessment of DTI parameters to understand the pathophysiology of TN and treatment effects.

  4. Dynamic Target Acquisition: Empirical Models of Operator Performance.

    Science.gov (United States)

    1980-08-01

    tarjet to )e centered. At the beginning of those trials with ,i t.trqet present, ,t woiild I nywhere withln the center two-thirds (if the d%,,1 y. MD...Target Tpe Tank Half-Track Truck Low 0.206 0.169 0.191 Medium 0.252 0.205 0.226 High 0.253 o.I l 0.211 Speed FT_SEC. x_ Tarjet 7 ype Tank Half-Track Truck...1 25915 27212 I Scene Complexity Tarjet Type ORDERED MEANS 22521 23190 27743 NS 22521 * 23190 * 27743 I I I I I I I I *p •.05 1723 AOCDOPWOVELL

  5. Tau-Centric Targets and Drugs in Clinical Development for the Treatment of Alzheimer's Disease

    OpenAIRE

    Francesco Panza; Vincenzo Solfrizzi; Davide Seripa; Imbimbo, Bruno P.; Madia Lozupone; Andrea Santamato; Chiara Zecca; Maria Rosaria Barulli; Antonello Bellomo; Alberto Pilotto; Antonio Daniele; Antonio Greco; Giancarlo Logroscino

    2016-01-01

    The failure of several Phase II/III clinical trials in Alzheimer’s disease (AD) with drugs targeting β-amyloid accumulation in the brain fuelled an increasing interest in alternative treatments against tau pathology, including approaches targeting tau phosphatases/kinases, active and passive immunization, and anti-tau aggregation. The most advanced tau aggregation inhibitor (TAI) is methylthioninium (MT), a drug existing in equilibrium between a reduced (leuco-methylthioninium) and oxidized f...

  6. Embedded performance validity testing in neuropsychological assessment: Potential clinical tools.

    Science.gov (United States)

    Rickards, Tyler A; Cranston, Christopher C; Touradji, Pegah; Bechtold, Kathleen T

    2017-01-31

    The article aims to suggest clinically-useful tools in neuropsychological assessment for efficient use of embedded measures of performance validity. To accomplish this, we integrated available validity-related and statistical research from the literature, consensus statements, and survey-based data from practicing neuropsychologists. We provide recommendations for use of 1) Cutoffs for embedded performance validity tests including Reliable Digit Span, California Verbal Learning Test (Second Edition) Forced Choice Recognition, Rey-Osterrieth Complex Figure Test Combination Score, Wisconsin Card Sorting Test Failure to Maintain Set, and the Finger Tapping Test; 2) Selecting number of performance validity measures to administer in an assessment; and 3) Hypothetical clinical decision-making models for use of performance validity testing in a neuropsychological assessment collectively considering behavior, patient reporting, and data indicating invalid or noncredible performance. Performance validity testing helps inform the clinician about an individual's general approach to tasks: response to failure, task engagement and persistence, compliance with task demands. Data-driven clinical suggestions provide a resource to clinicians and to instigate conversation within the field to make more uniform, testable decisions to further the discussion, and guide future research in this area.

  7. Legal Issues in Faculty Evaluation of Student Clinical Performance.

    Science.gov (United States)

    Kapp, Marshall B.

    1981-01-01

    Many faculty members are reluctant to evaluate the clinical performance of medical students because of fear of legal liability and lawsuits. Current methods and uses of evaluation and legal issues are discussed. The Supreme Court's decision in Board of Curators of the University of Missouri v. Horowitz is discussed. (Author/MLW)

  8. COCO 3: hybrid power plant surpasses performance target

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-12-01

    Cogeneration company's third power plant at the Map Ta Phut industrial estate in Thailand is a coal fired circulating fluidized bed boiler linked in a unique steam cycle with the heat recovery units of two gas turbines. These HRUs function as both economiser and reheater. With nearly one year of operation behind it, performance has surpassed expectation for output, efficiency, and emission levels. 4 figs.

  9. Cognitive Alignment with Performance Targeted Training Intervention Model: CAPTTIM

    Science.gov (United States)

    2015-02-01

    Kennedy, Ph.D.; MAJ Peter Nesbitt , USA; LTC Jon Alt, USA; and Ronald D. Fricker, Jr., Ph.D. February 2015 Approved for public release; distribution...Peter Nesbitt , USA; LTC Jon Alt, USA; and Ronald D. Fricker, Jr., Ph.D. 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING...of all or part of this report is authorized. This report was prepared by: Quinn Kennedy Peter Nesbitt Senior Lecturer of Operations

  10. Comparison of FDA Approved Kinase Targets to Clinical Trial Ones: Insights from Their System Profiles and Drug-Target Interaction Networks

    Directory of Open Access Journals (Sweden)

    Jingyu Xu

    2016-01-01

    Full Text Available Kinase is one of the most productive classes of established targets, but the majority of approved drugs against kinase were developed only for cancer. Intensive efforts were therefore exerted for releasing its therapeutic potential by discovering new therapeutic area. Kinases in clinical trial could provide great opportunities for treating various diseases. However, no systematic comparison between system profiles of established targets and those of clinical trial ones was conducted. The reveal of probable difference or shift of trend would help to identify key factors defining druggability of established targets. In this study, a comparative analysis of system profiles of both types of targets was conducted. Consequently, the systems profiles of the majority of clinical trial kinases were identified to be very similar to those of established ones, but percentages of established targets obeying the system profiles appeared to be slightly but consistently higher than those of clinical trial targets. Moreover, a shift of trend in the system profiles from the clinical trial to the established targets was identified, and popular kinase targets were discovered. In sum, this comparative study may help to facilitate the identification of the druggability of established drug targets by their system profiles and drug-target interaction networks.

  11. Documenting clinical performance problems among medical students: feedback for learner remediation and curriculum enhancement

    Directory of Open Access Journals (Sweden)

    Brian E. Mavis

    2013-07-01

    Full Text Available Introduction: We operationalized the taxonomy developed by Hauer and colleagues describing common clinical performance problems. Faculty raters pilot tested the resulting worksheet by observing recordings of problematic simulated clinical encounters involving third-year medical students. This approach provided a framework for structured feedback to guide learner improvement and curricular enhancement. Methods: Eighty-two problematic clinical encounters from M3 students who failed their clinical competency examination were independently rated by paired clinical faculty members to identify common problems related to the medical interview, physical examination, and professionalism. Results: Eleven out of 26 target performance problems were present in 25% or more encounters. Overall, 37% had unsatisfactory medical interviews, with ‘inadequate history to rule out other diagnoses’ most prevalent (60%. Seventy percent failed because of physical examination deficiencies, with missing elements (69% and inadequate data gathering (69% most common. One-third of the students did not introduce themselves to their patients. Among students failing based on standardized patient (SP ratings, 93% also failed to demonstrate competency based on the faculty ratings. Conclusions: Our review form allowed clinical faculty to validate pass/fail decisions based on standardized patient ratings. Detailed information about performance problems contributes to learner feedback and curricular enhancement to guide remediation planning and faculty development.

  12. Clinical laboratory as an economic model for business performance analysis

    Science.gov (United States)

    Buljanović, Vikica; Patajac, Hrvoje; Petrovečki, Mladen

    2011-01-01

    Aim To perform SWOT (strengths, weaknesses, opportunities, and threats) analysis of a clinical laboratory as an economic model that may be used to improve business performance of laboratories by removing weaknesses, minimizing threats, and using external opportunities and internal strengths. Methods Impact of possible threats to and weaknesses of the Clinical Laboratory at Našice General County Hospital business performance and use of strengths and opportunities to improve operating profit were simulated using models created on the basis of SWOT analysis results. The operating profit as a measure of profitability of the clinical laboratory was defined as total revenue minus total expenses and presented using a profit and loss account. Changes in the input parameters in the profit and loss account for 2008 were determined using opportunities and potential threats, and economic sensitivity analysis was made by using changes in the key parameters. The profit and loss account and economic sensitivity analysis were tools for quantifying the impact of changes in the revenues and expenses on the business operations of clinical laboratory. Results Results of simulation models showed that operational profit of €470 723 in 2008 could be reduced to only €21 542 if all possible threats became a reality and current weaknesses remained the same. Also, operational gain could be increased to €535 804 if laboratory strengths and opportunities were utilized. If both the opportunities and threats became a reality, the operational profit would decrease by €384 465. Conclusion The operational profit of the clinical laboratory could be significantly reduced if all threats became a reality and the current weaknesses remained the same. The operational profit could be increased by utilizing strengths and opportunities as much as possible. This type of modeling may be used to monitor business operations of any clinical laboratory and improve its financial situation by

  13. Targeted next-generation sequencing can replace Sanger sequencing in clinical diagnostics

    NARCIS (Netherlands)

    Sikkema-Raddatz, B.; Johansson, L.F.; de Boer, E.N.; Almomani, R.; Boven, L.G.; van den Berg, M.P.; van Spaendonck-Zwarts, K.Y.; van Tintelen, J.P.; Sijmons, R.H.; Jongbloed, J.D.H.; Sinke, R.J.

    2013-01-01

    Mutation detection through exome sequencing allows simultaneous analysis of all coding sequences of genes. However, it cannot yet replace Sanger sequencing (SS) in diagnostics because of incomplete representation and coverage of exons leading to missing clinically relevant mutations. Targeted next-g

  14. Clinical simulation training improves the clinical performance of Chinese medical students

    Directory of Open Access Journals (Sweden)

    Ming-ya Zhang

    2015-10-01

    Full Text Available Background: Modern medical education promotes medical students’ clinical operating capacity rather than the mastery of theoretical knowledge. To accomplish this objective, clinical skill training using various simulations was introduced into medical education to cultivate creativity and develop the practical ability of students. However, quantitative analysis of the efficiency of clinical skill training with simulations is lacking. Methods: In the present study, we compared the mean scores of medical students (Jinan University who graduated in 2013 and 2014 on 16 stations between traditional training (control and simulative training groups. In addition, in a clinical skill competition, the objective structured clinical examination (OSCE scores of participating medical students trained using traditional and simulative training were compared. The data were statistically analyzed and qualitatively described. Results: The results revealed that simulative training could significantly enhance the graduate score of medical students compared with the control. The OSCE scores of participating medical students in the clinical skill competition, trained using simulations, were dramatically higher than those of students trained through traditional methods, and we also observed that the OSCE marks were significantly increased for the same participant after simulative training for the clinical skill competition. Conclusions: Taken together, these data indicate that clinical skill training with a variety of simulations could substantially promote the clinical performance of medical students and optimize the resources used for medical education, although a precise analysis of each specialization is needed in the future.

  15. RT-PCR using glycoprotein target is more sensitive for the detection of Ebola virus in clinical samples.

    Science.gov (United States)

    Yang, Mingjuan; Ke, Yuehua; Zhang, Wenyi; Liu, Chao; Yang, Ruifu; Chen, Zeliang

    2017-03-01

    The recent largest ever Ebola virus disease (EVD) outbreak in West Africa has been of worldwide concern, causing huge economic losses and constituting serious threat to the local residents and health care workers. Rapid detection of Ebola virus (EBOV) using RT-PCR has been suggested to be of great value in stopping the outbreak, because it is highly sensitive and specific and can return results within hours. In this study, 210 clinical samples, including 109 blood and 101 nasopharyngeal swab samples were used to compare the performance of glycoprotein (GP) and nucleoprotein (NP) gene targets for the detection of EBOV. The analytical sensitivity of both assays were 10 molecules/μL. For clinical samples, the sensitivity of the assay targeting GP gene is higher than that of NP gene (respectively 98% and 94%) and the specificities for both targets were 100%. In addition, the positive samples in the RT-PCR assay targeting GP showed lower cycle threshold values and higher virus loads than NP gene.

  16. The biopharmaceutics risk assessment roadmap for optimizing clinical drug product performance.

    Science.gov (United States)

    Selen, Arzu; Dickinson, Paul A; Müllertz, Anette; Crison, John R; Mistry, Hitesh B; Cruañes, Maria T; Martinez, Marilyn N; Lennernäs, Hans; Wigal, Tim L; Swinney, David C; Polli, James E; Serajuddin, Abu T M; Cook, Jack A; Dressman, Jennifer B

    2014-11-01

    The biopharmaceutics risk assessment roadmap (BioRAM) optimizes drug product development and performance by using therapy-driven target drug delivery profiles as a framework to achieve the desired therapeutic outcome. Hence, clinical relevance is directly built into early formulation development. Biopharmaceutics tools are used to identify and address potential challenges to optimize the drug product for patient benefit. For illustration, BioRAM is applied to four relatively common therapy-driven drug delivery scenarios: rapid therapeutic onset, multiphasic delivery, delayed therapeutic onset, and maintenance of target exposure. BioRAM considers the therapeutic target with the drug substance characteristics and enables collection of critical knowledge for development of a dosage form that can perform consistently for meeting the patient's needs. Accordingly, the key factors are identified and in vitro, in vivo, and in silico modeling and simulation techniques are used to elucidate the optimal drug delivery rate and pattern. BioRAM enables (1) feasibility assessment for the dosage form, (2) development and conduct of appropriate "learning and confirming" studies, (3) transparency in decision-making, (4) assurance of drug product quality during lifecycle management, and (5) development of robust linkages between the desired clinical outcome and the necessary product quality attributes for inclusion in the quality target product profile.

  17. Toward prediction of hyperspectral target detection performance after lossy image compression

    Science.gov (United States)

    Kaufman, Jason R.; Vongsy, Karmon M.; Dill, Jeffrey C.

    2016-05-01

    Hyperspectral imagery (HSI) offers numerous advantages over traditional sensing modalities with its high spectral content that allows for classification, anomaly detection, target discrimination, and change detection. However, this imaging modality produces a huge amount of data, which requires transmission, processing, and storage resources; hyperspectral compression is a viable solution to these challenges. It is well known that lossy compression of hyperspectral imagery can impact hyperspectral target detection. Here we examine lossy compressed hyperspectral imagery from data-centric and target-centric perspectives. The compression ratio (CR), root mean square error (RMSE), the signal to noise ratio (SNR), and the correlation coefficient are computed directly from the imagery and provide insight to how the imagery has been affected by the lossy compression process. With targets present in the imagery, we perform target detection with the spectral angle mapper (SAM) and adaptive coherence estimator (ACE) and evaluate the change in target detection performance by examining receiver operating characteristic (ROC) curves and the target signal-to-clutter ratio (SCR). Finally, we observe relationships between the data- and target-centric metrics for selected visible/near-infrared to shortwave infrared (VNIR/SWIR) HSI data, targets, and backgrounds that motivate potential prediction of change in target detection performance as a function of compression ratio.

  18. Development of Clinic Specific Physical Therapy Efficiency Targets Based on Clinic Specific Metrics

    Science.gov (United States)

    2009-04-24

    efficiency ratings in the PBAM model which inflates the monetary budget adjustment for the MTF under the orthopedic product line. Developing individual... Veterinarians IF Fellow-Medical 1R Resident-Medical IS Intern-Dental IT Fellow-Dental 1U Resident-Dental IV Veterinarian 2 Direct Care Professional 2P...concerned with the Physical Therapy clinic under the Orthopedic (ORTHO) primary product line within the ambulatory section of the Product Line

  19. Incontinence pads: clinical performance, design and technical properties.

    Science.gov (United States)

    Cottenden, A M

    1988-11-01

    The paper describes the functional requirements of urinary incontinence pads and reviews the results of several studies which seek to relate the clinical performance of pads to their design and the technical properties of their constituent materials. Pad designs covered include: simple rectangular (for use with conventional pants or marsupial pants containing a pouch); wing-folded; shaped; and all-in-one infant-style diapers. Data on the clinical and technical properties of fluff wood pulp and hydrogel absorbents, and viscose rayon, polyester, polypropylene and polyethylene coverstocks are presented. Attention is focussed on four major aspects of pad function: freedom from leakage; freedom from discomfort and skin damage; ease of application and removal; and aesthetic properties. The relationships established between clinical and technical data will be of interest to health care professionals selecting products; organizations seeking to create standards; and pad designers.

  20. Limbic, associative, and motor territories within the targets for deep brain stimulation: potential clinical implications.

    Science.gov (United States)

    Sudhyadhom, Atchar; Bova, Frank J; Foote, Kelly D; Rosado, Christian A; Kirsch-Darrow, Lindsey; Okun, Michael S

    2007-07-01

    The use of deep brain stimulation (DBS) has recently been expanding for the treatment of many neurologic disorders such as Parkinson disease, dystonia, essential tremor, Tourette's syndrome, cluster headache, epilepsy, depression, and obsessive compulsive disorder. The target structures for DBS include specific segregated territories within limbic, associative, or motor regions of very small subnuclei. In this review, we summarize current clinical techniques for DBS, the cognitive/mood/motor outcomes, and the relevant neuroanatomy with respect to functional territories within specific brain targets. Future development of new techniques and technology that may include a more direct visualization of "motor" territories within target structures may prove useful for avoiding side effects that may result from stimulation of associative and limbic regions. Alternatively, newer procedures may choose and specifically target non-motor territories for chronic electrical stimulation.

  1. Tau-Centric Targets and Drugs in Clinical Development for the Treatment of Alzheimer’s Disease

    Directory of Open Access Journals (Sweden)

    Francesco Panza

    2016-01-01

    Full Text Available The failure of several Phase II/III clinical trials in Alzheimer’s disease (AD with drugs targeting β-amyloid accumulation in the brain fuelled an increasing interest in alternative treatments against tau pathology, including approaches targeting tau phosphatases/kinases, active and passive immunization, and anti-tau aggregation. The most advanced tau aggregation inhibitor (TAI is methylthioninium (MT, a drug existing in equilibrium between a reduced (leuco-methylthioninium and oxidized form (MT+. MT chloride (methylene blue was investigated in a 24-week Phase II clinical trial in 321 patients with mild to moderate AD that failed to show significant positive effects in mild AD patients, although long-term observations (50 weeks and biomarker studies suggested possible benefit. The dose of 138 mg/day showed potential benefits on cognitive performance of moderately affected AD patients and cerebral blood flow in mildly affected patients. Further clinical evidence will come from the large ongoing Phase III trials for the treatment of AD and the behavioral variant of frontotemporal dementia on a new form of this TAI, more bioavailable and less toxic at higher doses, called TRx0237. More recently, inhibitors of tau acetylation are being actively pursued based on impressive results in animal studies obtained by salsalate, a clinically used derivative of salicylic acid.

  2. Targeting apoptosis: preclinical and early clinical experience with mapatumumab, an agonist monoclonal antibody targeting TRAIL-R1.

    Science.gov (United States)

    Moretto, Patricia; Hotte, Sébastien J

    2009-03-01

    In spite of the advances in survival with chemotherapy and radiotherapy, many cancer patients continue to experience failure with treatments. Advances in molecular oncology and the development of numerous targeted therapies, used by themselves or in combination with at present available treatments such as chemotherapy and radiation, will hopefully improve the fate of these patients. It has been well understood for many years now that deregulation of apoptosis is a major hallmark of cancer cells. Mapatumumab, a fully human agonistic monoclonal antibody to TNF-related apoptosis-inducing ligand receptor 1, has been developed to induce apoptosis in cancer cells although having minimal effects on normal cells. This paper reviews the preclinical and early clinical data of this exciting new agent and discusses options for future development of mapatumumab, mostly in combinations with other therapies.

  3. The Effect of Haze on an Operator’s Visual Field and his Target Detection Performance.

    Science.gov (United States)

    1983-11-01

    OPERATOR’S VISUAL ,I* FIELD AND HIS TARGET DETECTION PERFORMANCE WILLIAM N. KAMA LOUIS V. GENCO , O.D., LT. COL, USAF AIR FORCE AEROSPACE MEDICAL RESEARCH...PERFORMANCE. 6. PERFORMING ORG. REPORT NUMBER 7. AUTHOR(a) S. CONTRACT OR GRANT NUMBER(&) William N. Kama *Martha D. Hausmann Louis V. Genco , OD, Lt Col, USAF

  4. Dependable and Efficient Clinical Molecular Diagnosis of Chinese RP Patient with Targeted Exon Sequencing.

    Science.gov (United States)

    Yang, Liping; Cui, Hui; Yin, Xiaobei; Dou, Hongliang; Zhao, Lin; Chen, Ningning; Zhang, Jinlu; Zhang, Huirong; Li, Genlin; Ma, Zhizhong

    2015-01-01

    Retinitis pigmentosa (RP) is the most common inherited retinal disease. It is a clinically and genetically heterogeneous disorder, which is why it is particularly challenging to diagnose. The aim of this study was to establish a targeted next-generation sequencing (NGS) approach for the comprehensive, rapid, and cost-effective clinical molecular diagnosis of RP. A specific hereditary eye disease enrichment panel (HEDEP) based on exome capture technology was used to collect the protein coding regions of 371 targeted hereditary eye disease genes, followed by high-throughput sequencing on the Illumina HiSeq2000 platform. From a cohort of 34 Chinese RP families, 13 families were successfully diagnosed; thus, the method achieves a diagnostic rate of approximately 40%. Of 16 pathogenic mutations identified, 11 were novel. Our study demonstrates that targeted capture sequencing offers a rapid and effective method for the molecular diagnosis of RP, which helps to provide a more accurate clinical diagnosis and paves the way for genetic counseling, family planning, and future gene-targeted treatment.

  5. Performance-Based Assessment of Clinical Ethics Using an Objective Structured Clinical Examination.

    Science.gov (United States)

    Singer, Peter A.; And Others

    1996-01-01

    Final-year Ontario medical students (n=88) took a 4-station objective structured clinical examination (OSCE) using standardized patients and involving decisions to forgo life-sustaining treatment. Performance was scored on a checklist of behaviors unique to each case. Results indicated that because of low reliability, the OSCE is not a feasible…

  6. Targeting Carcinoembryonic Antigen with DNA Vaccination: On-Target Adverse Events Link with Immunological and Clinical Outcomes

    Science.gov (United States)

    Chudley, Lindsey; Stasakova, Jana; Thirdborough, Stephen; King, Andrew; Lloyd-Evans, Paul; Buxton, Emily; Edwards, Ceri; Halford, Sarah; Bateman, Andrew; O’Callaghan, Ann; Clive, Sally; Anthoney, Alan; Jodrell, Duncan I.; Weinschenk, Toni; Simon, Petra; Sahin, Ugur; Thomas, Gareth J.; Stevenson, Freda K.; Ottensmeier, Christian H.

    2017-01-01

    Purpose We have clinically evaluated a DNA fusion vaccine to target the HLA-A*0201 binding peptide CAP-1 from carcinoembryonic antigen (CEA605–613) linked to an immunostimulatory domain (DOM) from fragment C of tetanus toxin. Experimental Design Twenty-seven patients with CEA-expressing carcinomas were recruited: 15 patients with measurable disease (Arm-I) and 12 patients without radiological evidence of disease (Arm-II). Six intramuscular vaccinations of naked DNA (1mg/dose) were administered up to week 12. Clinical and immunological follow-up was to week 64 or clinical/radiological disease. Results DOM-specific immune responses demonstrated successful vaccine delivery. All patients without measurable disease compared to 60% with advanced disease responded immunologically, while 58% and 20% expanded anti-CAP-1 CD8+ T-cells, respectively. CAP-1-specific T-cells were only detectable in the blood post-vaccination, but could also be identified in previously resected cancer tissue. The gastrointestinal adverse event diarrhea was reported by 48% of patients and linked to more frequent decreases in CEA (pdiarrhea. In advanced disease patients, decreases in CEA were associated with better overall survival (HR=0.14, p=0.017). CAP-1 peptide was detectable on MHC class I of normal bowel mucosa and primary colorectal cancer tissue by mass-spectrometry, offering a mechanistic explanation for diarrhea through CD8+ T-cell attack. Conclusions Our data suggest that DNA vaccination is able to overcome peripheral tolerance in normal and tumor tissue and warrants testing in combination studies, for example, by vaccinating in parallel to treatment with an anti-PD1 antibody. PMID:27091407

  7. Genetic and epigenetic heterogeneity of epithelial ovarian cancer and the clinical implications for molecular targeted therapy.

    Science.gov (United States)

    Bai, Huimin; Cao, Dongyan; Yang, Jiaxin; Li, Menghui; Zhang, Zhenyu; Shen, Keng

    2016-04-01

    Epithelial ovarian cancer (EOC) is the most lethal gynaecological malignancy, and tumoural heterogeneity (TH) has been blamed for treatment failure. The genomic and epigenomic atlas of EOC varies significantly with tumour histotype, grade, stage, sensitivity to chemotherapy and prognosis. Rapidly accumulating knowledge about the genetic and epigenetic events that control TH in EOC has facilitated the development of molecular-targeted therapy. Poly (ADP-ribose) polymerase (PARP) inhibitors, designed to target homologous recombination, are poised to change how breast cancer susceptibility gene (BRCA)-related ovarian cancer is treated. Epigenetic treatment regimens being tested in clinical or preclinical studies could provide promising novel treatment approaches and hope for improving patient survival.

  8. Impact on outcome of a targeted performance improvement programme in haemodynamically unstable patients with a pelvic fracture.

    Science.gov (United States)

    Perkins, Z B; Maytham, G D; Koers, L; Bates, P; Brohi, K; Tai, N R M

    2014-08-01

    We describe the impact of a targeted performance improvement programme and the associated performance improvement interventions, on mortality rates, error rates and process of care for haemodynamically unstable patients with pelvic fractures. Clinical care and performance improvement data for 185 adult patients with exsanguinating pelvic trauma presenting to a United Kingdom Major Trauma Centre between January 2007 and January 2011 were analysed with univariate and multivariate regression and compared with National data. In total 62 patients (34%) died from their injuries and opportunities for improved care were identified in one third of deaths. Three major interventions were introduced during the study period in response to the findings. These were a massive haemorrhage protocol, a decision-making algorithm and employment of specialist pelvic orthopaedic surgeons. Interventions which improved performance were associated with an annual reduction in mortality (odds ratio 0.64 (95% confidence interval (CI) 0.44 to 0.93), p = 0.02), a reduction in error rates (p = 0.024) and significant improvements in the targeted processes of care. Exsanguinating patients with pelvic trauma are complex to manage and are associated with high mortality rates; implementation of a targeted performance improvement programme achieved sustained improvements in mortality, error rates and trauma care in this group of severely injured patients.

  9. The Multi MegaWatt target station of EURISOL facility and its performance (SATIF9)

    CERN Document Server

    Kharoua, C

    This presentation summarises the work carried out for the Multi Megawatt target station of the EURISOL Design Study with a special attention to the coupled neutronics of the liquid converter and fission target (MAFF/PIAFE design like) and the overall performance of the facility, which will sustain fast neutron fluxes of the order of 1014 n/cm2/s. The production of radionuclides in the actinide targets as well as in the liquid metal are also evaluated, showing that the targeted 1015 fissions/s can be achieved.

  10. Effects of Target and Distractor Saturations on the Cognitive Performance of an Integrated Display Interface

    Institute of Scientific and Technical Information of China (English)

    XUE Chengqi; LI Jing; WANG Haiyan; NIU Yafeng

    2015-01-01

    Color coding is often used to enhance decision quality in complex man-machine interfaces of integrated display systems. However, people are easily distracted by irrelevant colors and by the numerous data points and complex structures in the interface. Although an increasing number of studies are seriously focusing on the problem of achieving efficient color coding, few are able to determine the effects of target and distractor saturations on cognitive performance. To study the performances of target colors among distractors, a systematic experiment is conducted to assess the influence of high and low saturated targets on cognitive performance, and the affecting extent of different saturated distractors of homogeneous colors on targets. According to the analysis of the reaction time through the non-parametric statistical method, a calculation method of the cognitive performance of each color is proposed. Based on the calculation of the color differences and the accumulation of the reaction times, it is shown that with the different saturated distractors of homogeneous colors, the high saturated yellow targets perform better than the low saturated ones, and the green and blue targets have moderate performances. When searching for a singleton target placed on a black background, the color difference between the target and the distractor should be more than 20ΔE*ab units in the yellow saturation coding, whereas the color difference should be more than 40ΔE*ab units in the blue and green saturation coding. In addition, as regards saturation coding, the influence of the color difference between the target and the background on cognitive performance is greater than that of the color difference between the target and the distractor. Seemingly, the hue attribute determines whether the saturation difference between the target and the distractor affects the cognitive performance. Based on the experimental results, the simulation design of the instrument dials in a flight

  11. Clinical performance feedback and quality improvement opportunities for perioperative physicians

    Directory of Open Access Journals (Sweden)

    Kaye AD

    2014-05-01

    Full Text Available Alan David Kaye,1 Olutoyin J Okanlawon,2 Richard D Urman21Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, LA, 2Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston MA, USAAbstract: Clinical performance feedback is an important component of the ongoing development and education of health care practitioners. For physicians, feedback about their clinical practice and outcomes is central to developing both confidence and competence at all stages of their medical careers. Cultural and financial infrastructures need to be in place, and the concept of feedback needs to be readily embraced and encouraged by clinical leadership and other stakeholders. The "buy-in" includes the expectation and view that feedback occurs on a routine basis, and those engaged in the process are both encouraged to participate and held accountable. Feedback must be part of an overarching quality improvement and physician education agenda; it is not meant to be an isolated, fragmented initiative that is typically undermined by lack of resources or systemic barriers to gaining improvement within programs. Effective feedback should be an integral part of clinical practice. Anesthesiologists and other perioperative physicians are identifying specialty-specific indicators that can be used when creating a broader quality improvement agenda. Placing a more immediate formal feedback strategy that focuses on goal-oriented behavior is rapidly becoming a mainstay. Physicians may use their individual feedback reports for reflection and designing personal development plans as lifelong learners and leaders in improving patient care.Keywords: physician education, outcomes measurement, performance improvement, anesthesiology

  12. Immunology in the clinic review series; focus on cancer: glycolipids as targets for tumour immunotherapy.

    Science.gov (United States)

    Durrant, L G; Noble, P; Spendlove, I

    2012-02-01

    Research into aberrant glycosylation and over-expression of glycolipids on the surface of the majority of cancers, coupled with a knowledge of glycolipids as functional molecules involved in a number of cellular physiological pathways, has provided a novel area of targets for cancer immunotherapy. This has resulted in the development of a number of vaccines and monoclonal antibodies that are showing promising results in recent clinical trials.

  13. Challenges in the design of clinically useful brain-targeted drug nanocarriers.

    Science.gov (United States)

    Costantino, L; Boraschi, D; Eaton, M

    2014-01-01

    Nowadays, the delivery of drugs by means of intravenously administered nanosized drug carriers - polymerdrug conjugates, liposomes and micelles, is technically possible. These delivery systems are mainly designed for tumour therapy, and accumulate passively into tumours by means of the well known EPR effect. Targeted nanocarriers, that additionally contain ligands for receptors expressed on cell surfaces, are also widely studied but products of this kind are not marketed, and only a few are in clinical trial. Polymeric nanoparticles (Np) able to deliver drugs to the CNS were pioneered in 1995; a number of papers have been published dealing with brain-targeted drug delivery using polymeric Np able to cross the BBB, mainly for the treatment of brain tumours. At present, however, the translation potential of these Np seems to have been exceeded by targeted liposomes, a platform based on a proven technology. This drug delivery system entered clinical trials soon after its discovery, while the challenges in formulation, characterization and manufacturing of brain-targeted polymeric Np and the cost/benefit ratio could be the factors that have prevented their development. A key issue is that it is virtually impossible to define the in vivo fate of polymers, especially in the brain, which is a regulatory requirement; perhaps this is why no progress has been made. The most advanced Np for brain tumours treatment will be compared here with the published data available for those in clinical trial for tumours outside the CNS, to highlight the knowledge gaps that still penalise these delivery systems. At present, new approaches for brain tumours are emerging, such as lipid Np or the use of monoclonal antibody (mAb)-drug conjugates, which avoid polymers. The success or failure in the approval of the polymeric Np currently in clinical trials will certainly affect the field. At present, the chances of their approval appear to be very low.

  14. Pilot proof of concept clinical trials of Stochastic Targeted (STAR) glycemic control

    OpenAIRE

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

    2011-01-01

    ABSTRACT: INTRODUCTION: Tight glycemic control (TGC) has shown benefits but has been difficult to achieve consistently. STAR (Stochastic TARgeted) is a flexible, model-based TGC approach directly accounting for intra- and inter- patient variability with a stochastically derived maximum 5% risk of blood glucose (BG) < 4.0 mmol/L. This research assesses the safety, efficacy, and clinical burden of a STAR TGC controller modulating both insulin and nutrition inputs in pilot trials. METHODS: Seven...

  15. Targeting Notch, Hedgehog, and Wnt pathways in cancer stem cells: clinical update.

    Science.gov (United States)

    Takebe, Naoko; Miele, Lucio; Harris, Pamela Jo; Jeong, Woondong; Bando, Hideaki; Kahn, Michael; Yang, Sherry X; Ivy, S Percy

    2015-08-01

    During the past decade, cancer stem cells (CSCs) have been increasingly identified in many malignancies. Although the origin and plasticity of these cells remain controversial, tumour heterogeneity and the presence of small populations of cells with stem-like characteristics is established in most malignancies. CSCs display many features of embryonic or tissue stem cells, and typically demonstrate persistent activation of one or more highly conserved signal transduction pathways involved in development and tissue homeostasis, including the Notch, Hedgehog (HH), and Wnt pathways. CSCs generally have slow growth rates and are resistant to chemotherapy and/or radiotherapy. Thus, new treatment strategies targeting these pathways to control stem-cell replication, survival and differentiation are under development. Herein, we provide an update on the latest advances in the clinical development of such approaches, and discuss strategies for overcoming CSC-associated primary or acquired resistance to cancer treatment. Given the crosstalk between the different embryonic developmental signalling pathways, as well as other pathways, designing clinical trials that target CSCs with rational combinations of agents to inhibit possible compensatory escape mechanisms could be of particular importance. We also share our views on the future directions for targeting CSCs to advance the clinical development of these classes of agents.

  16. Clinical immunotherapy of B-cell malignancy using CD19-targeted CAR T-cells.

    Science.gov (United States)

    Maher, John

    2014-02-01

    The CD19 molecule is ubiquitously expressed throughout all stages of B-cell differentiation, but is not found on haemopoietic stem cells. Since most B-cell leukaemias and lymphomas retain CD19 expression, it represents an excellent target for immunotherapy of these malignant disorders. Over the past 10 years, compelling pre-clinical evidence has accrued to indicate that expression of a CD19-targeted chimeric antigen receptor (CAR) in peripheral blood T-cells exerts therapeutic efficacy in diverse models of B-cell malignancy. Building on this, clinical studies are ongoing in several centres in which autologous CD19-specific CAR T-cells are undergoing evaluation in patients with acute and chronic B-cell leukaemia and refractory lymphoma. Early data have generated considerable excitement, providing grounds to speculate that CAR-based immunotherapy will radically alter existing management paradigms in B-cell malignancy. The focus of this mini-review is to evaluate these emerging clinical data and to speculate on clinical prospects for this new therapeutic modality.

  17. Challenges of clinical trial design for targeted agents against pediatric leukemias

    Directory of Open Access Journals (Sweden)

    Francis Jay Mussai

    2015-01-01

    Full Text Available The past 40 years have seen significant improvements in both event-free and overall survival for children with acute lymphoblastic or acute myeloid leukemia (ALL or AML respectively. Serial national and international clinical trials have optimised the use of conventional chemotherapeutic drugs and, along with improvements in supportive care that have enabled the delivery of more intensive regimens, have been responsible for the major improvements in patient outcome seen over the past few decades,. The benefits of dose intensification, however, have likely now been maximised, and over the same period, the identification of new cytotoxic drugs has been limited.As the biology of leukemogenesis has become better understood, key molecules and intracellular pathways have been identified that offer the possibility of targeting directly the leukemia cells whilst sparing normal cells. Consequently, there is now a drive to develop novel leukemia-specific or ‘targeted’ therapies. These new classes of drugs will have mechanisms of action, toxicities and therapeutic indices quite different from conventional cytotoxic drugs previously encountered, thus rendering current clinical trial methodologies inappropriate; clinical trial methods will need to be adapted to accommodate these features of these new classes of drugs. This review will address the challenges and some of the techniques for developing clinical trials for targeted therapies.

  18. Online virtual isocenter based radiation field targeting for high performance small animal microirradiation

    Science.gov (United States)

    Stewart, James M. P.; Ansell, Steve; Lindsay, Patricia E.; Jaffray, David A.

    2015-12-01

    Advances in precision microirradiators for small animal radiation oncology studies have provided the framework for novel translational radiobiological studies. Such systems target radiation fields at the scale required for small animal investigations, typically through a combination of on-board computed tomography image guidance and fixed, interchangeable collimators. Robust targeting accuracy of these radiation fields remains challenging, particularly at the millimetre scale field sizes achievable by the majority of microirradiators. Consistent and reproducible targeting accuracy is further hindered as collimators are removed and inserted during a typical experimental workflow. This investigation quantified this targeting uncertainty and developed an online method based on a virtual treatment isocenter to actively ensure high performance targeting accuracy for all radiation field sizes. The results indicated that the two-dimensional field placement uncertainty was as high as 1.16 mm at isocenter, with simulations suggesting this error could be reduced to 0.20 mm using the online correction method. End-to-end targeting analysis of a ball bearing target on radiochromic film sections showed an improved targeting accuracy with the three-dimensional vector targeting error across six different collimators reduced from 0.56+/- 0.05 mm (mean  ±  SD) to 0.05+/- 0.05 mm for an isotropic imaging voxel size of 0.1 mm.

  19. Effects of touch target location on performance and physical demands of computer touchscreen use.

    Science.gov (United States)

    Kang, Hwayeong; Shin, Gwanseob

    2017-05-01

    Touchscreen interfaces for computers are known to cause greater physical stress compared to traditional computer interfaces. The objective of this study was to evaluate how physical demands and task performance of a tap gesture on a computer touchscreen vary between target locations and display positions. Twenty-three healthy participants conducted reach-tap-return trials with touch targets at fifteen locations in three display positions. Mean completion time, touch accuracy and electromyography of the shoulder and neck extensor muscles were compared between the target locations and display positions. The results demonstrated that participants completed the trial 12%-27% faster with 13%-39% less muscle activity when interacting with targets in the lower area of the display compared to when tapping upper targets (p computer touchscreen interface use.

  20. [Impact on evaluation of clinical efficacy of traditional Chinese medicine for level in soft targets of processing technology].

    Science.gov (United States)

    Shao, Ming-Yi; Wei, Ming; Yan, Bo-Hua

    2014-04-01

    Traditional Chinese medicine (TCM) is a very practical subject, which has its unique theoretical system and clinical characteristics. In the course of clinical practice, the exact clinical efficacy is the key of existence and development. But the existing evaluation system is difficult to objectively evaluate the clinical efficacy of TCM. Therefore, how to objectively evaluate the clinical efficacy and get definitive evidence is the focus of the evaluation of clinical efficacy of TCM. Relative to modern medicine, TCM is more concerned about the changes of feelings and clinical symptoms of the patient in the course of the evolution of the disease. Soft targets mainly used for the evaluation of the clinical efficacy of symptoms and functional activity of the disease. The level in soft targets of processing technology is often used methods in clinical evaluation. But it has often produced the phenomenon which the results of the evaluation is mutual contradiction, which will ultimately affect the effect of evaluation of clinical efficacy of TCM. In order to better evaluate the clinical efficacy of TCM, in the process of adoption of soft targets, it clearly identify it's role, highlighting the characteristics of interventions on disease, and as much as possibly avoid the level in soft targets of processing technology to real assess clinical efficacy of TCM.

  1. Effects of localized auditory information on visual target detection performance using a helmet-mounted display.

    Science.gov (United States)

    Nelson, W T; Hettinger, L J; Cunningham, J A; Brickman, B J; Haas, M W; McKinley, R L

    1998-09-01

    An experiment was conducted to evaluate the effects of localized auditory information on visual target detection performance. Visual targets were presented on either a wide field-of-view dome display or a helmet-mounted display and were accompanied by either localized, nonlocalized, or no auditory information. The addition of localized auditory information resulted in significant increases in target detection performance and significant reductions in workload ratings as compared with conditions in which auditory information was either nonlocalized or absent. Qualitative and quantitative analyses of participants' head motions revealed that the addition of localized auditory information resulted in extremely efficient and consistent search strategies. Implications for the development and design of multisensory virtual environments are discussed. Actual or potential applications of this research include the use of spatial auditory displays to augment visual information presented in helmet-mounted displays, thereby leading to increases in performance efficiency, reductions in physical and mental workload, and enhanced spatial awareness of objects in the environment.

  2. targetDP: an Abstraction of Lattice Based Parallelism with Portable Performance

    CERN Document Server

    Gray, Alan

    2014-01-01

    To achieve high performance on modern computers, it is vital to map algorithmic parallelism to that inherent in the hardware. From an application developer's perspective, it is also important that code can be maintained in a portable manner across a range of hardware. Here we present targetDP, a lightweight programming layer that allows the abstraction of data parallelism for applications that employ structured grids. A single source code may be used to target both thread level parallelism (TLP) and instruction level parallelism (ILP) on either SIMD multi-core CPUs or GPU-accelerated platforms. targetDP is implemented via standard C preprocessor macros and library functions, can be added to existing applications incrementally, and can be combined with higher-level paradigms such as MPI. We present CPU and GPU performance results for a benchmark taken from the lattice Boltzmann application that motivated this work. These demonstrate not only performance portability, but also the improved optimisation resulting...

  3. Quantitative performance targets by using balanced scorecard system: application to waste management and public administration.

    Science.gov (United States)

    Mendes, Paula; Nunes, Luis Miguel; Teixeira, Margarida Ribau

    2014-09-01

    This article demonstrates how decision-makers can be guided in the process of defining performance target values in the balanced scorecard system. We apply a method based on sensitivity analysis with Monte Carlo simulation to the municipal solid waste management system in Loulé Municipality (Portugal). The method includes two steps: sensitivity analysis of performance indicators to identify those performance indicators with the highest impact on the balanced scorecard model outcomes; and sensitivity analysis of the target values for the previously identified performance indicators. Sensitivity analysis shows that four strategic objectives (IPP1: Comply with the national waste strategy; IPP4: Reduce nonrenewable resources and greenhouse gases; IPP5: Optimize the life-cycle of waste; and FP1: Meet and optimize the budget) alone contribute 99.7% of the variability in overall balanced scorecard value. Thus, these strategic objectives had a much stronger impact on the estimated balanced scorecard outcome than did others, with the IPP1 and the IPP4 accounting for over 55% and 22% of the variance in overall balanced scorecard value, respectively. The remaining performance indicators contribute only marginally. In addition, a change in the value of a single indicator's target value made the overall balanced scorecard value change by as much as 18%. This may lead to involuntarily biased decisions by organizations regarding performance target-setting, if not prevented with the help of methods such as that proposed and applied in this study.

  4. Quiet eye training: the acquisition, refinement and resilient performance of targeting skills.

    Science.gov (United States)

    Vine, Samuel J; Moore, Lee J; Wilson, Mark R

    2014-01-01

    How we learn and refine motor skills in the most effective manner and how we prevent performance breakdown in pressurised or demanding circumstances are among the most important questions within the sport psychology and skill acquisition literature. The quiet eye (QE) has emerged as a characteristic of highly skilled perceptual and motor performance in visually guided motor tasks. Defined as the final fixation that occurs prior to a critical movement, over 70 articles have been published in the last 15 years probing the role that the QE plays in underpinning skilled performance. The aim of this review is to integrate research findings from studies examining the QE as a measure of visuomotor control in the specific domain of targeting skills; motor skills requiring an object to be propelled to a distant target. Previous reviews have focused primarily on the differences in QE between highly skilled performers and their less skilled counterparts. The current review aims to discuss contemporary findings relating to 1. The benefits of QE training for the acquisition and refinement of targeting skills; 2. The effects of anxiety upon the QE and subsequent targeting skill performance and 3. The benefits of QE training in supporting resilient performance under elevated anxiety. Finally, potential processes through which QE training proffers this advantage, including improved attentional control, response programming and external focus, will be discussed and directions for future research proposed.

  5. Bridging academic science and clinical research in the search for novel targeted anti-cancer agents

    Institute of Scientific and Technical Information of China (English)

    Alex Matter

    2015-01-01

    This review starts with a brief history of drug discovery&development, and the place of Asia in this worldwide effort discussed. hTe conditions and constraints of a successful translational R&D involving academic basic research and clinical research are discussed and the Singapore model for pursuit of open R&D described. hTe importance of well-characterized, validated drug targets for the search for novel targeted anti-cancer agents is emphasized, as well as a structured, high quality translational R&D. Furthermore, the characteristics of an attractive preclinical development drug candidate are discussed laying the foundation of a successful preclinical development. hTe most frequent sources of failures are described and risk management at every stage is highly recommended. Organizational factors are also considered to play an important role. hTe factors to consider before starting a new drug discovery&development project are described, and an example is given of a successful clinical project that has had its roots in local universities and was carried through preclinical development into phase I clinical trials.

  6. Relationship between oral clinical conditions and daily performances

    Directory of Open Access Journals (Sweden)

    Andréa Silveira Gomes

    2009-03-01

    Full Text Available The aim of this study was to assess the impact of oral status on the daily performances of civil servants from the Public Works and Waste Management Department of the city of Porto Alegre, located in Southern Brazil. A cross-sectional study was conducted on a representative sample composed of 276 civil servants with ages ranging from 35 to 44 years. The Oral Impacts on Daily Performances index developed was employed to measure impacts caused by oral clinical conditions. Oral examinations were performed after the interviews. Multinomial Logistic Regression Analysis was used. After adjusting for sex and educational level, the results showed that the subjects with high DMFT scores were 5.8 times (95% CI = 2.1-16.1 more likely to have high impacts on their everyday life than those with low DMFT scores. Subjects that presented some coronal caries were 4.3 times (95% CI = 1.9-9.8 more likely to have high impacts on their everyday life than those with no coronal caries. Dental status assessed through the DMFT index and coronal caries are important indicators of impacts on the everyday life of the studied population.

  7. Quantifying warfighter performance in a target acquisition and aiming task using wireless inertial sensors.

    Science.gov (United States)

    Davidson, Steven P; Cain, Stephen M; McGinnis, Ryan S; Vitali, Rachel R; Perkins, Noel C; McLean, Scott G

    2016-09-01

    An array of inertial measurement units (IMUS) was experimentally employed to analyze warfighter performance on a target acquisition task pre/post fatigue. Eleven participants (5M/6F) repeated an exercise circuit carrying 20 kg of equipment until fatigued. IMUs secured to the sacrum, sternum, and a rifle quantified peak angular velocity magnitude (PAVM) and turn time (TT) on a target acquisition task (three aiming events with two 180° turns) within the exercise circuit. Turning performance of two turns was evaluated pre/post fatigue. Turning performance decreased with fatigue. PAVMs decreased during both turns for the sternum (p performance after fatigue. Similar methodologies can be applied to many movement tasks, including quantifying movement performance for load, fatigue, and equipment conditions.

  8. Target detection performance in helmet-mounted and conventional dome displays.

    Science.gov (United States)

    Hettinger, L J; Nelson, W T; Haas, M W

    1996-01-01

    An experiment was conducted to assess visual target detection performance using a helmet-mounted display (HMD) and a conventional flight simulation dome display. Measures of workload and mood were also obtained. Participants in both viewing conditions scanned an area 120 degrees vertical by 240 degrees horizontal while attempting to locate targets that appeared to be approaching them from one of a possible 18 locations. Results indicated significantly superior performance in the conventional dome display. Workload and mood measures also showed a significant advantage for the dome display. Results are discussed in terms of their implications for the design and use of HMD systems as components of airborne virtual environment interfaces.

  9. Pay-for-performance in a community substance abuse clinic.

    Science.gov (United States)

    Vandrey, Ryan; Stitzer, Maxine L; Acquavita, Shauna P; Quinn-Stabile, Patricia

    2011-09-01

    Pay-for-performance (P4P) strategies improve employee productivity and morale in business settings and are increasingly being implemented in medical care settings. This study investigated whether P4P could improve treatment utilization and retention at a community drug treatment clinic. Counselors had the opportunity to earn cash bonuses based on therapy attendance rates of individual clients and on the quarterly retention rates of their caseload. Using a pre-post study design, average therapy sessions attended during the first month of treatment increased from 4.6 sessions prior to the intervention to 5.5 sessions per client during the intervention. The 90-day client retention rate increased from 40% to 53%. Additional analyses suggest that the improvement in the 90-day retention was mediated by the increase in attendance during the first month of treatment. This project demonstrates that implementing a P4P incentive program in community drug abuse treatment clinics is feasible and effective at improving utilization and retention.

  10. The mTOR pathway in obesity driven gastrointestinal cancers: Potential targets and clinical trials.

    Science.gov (United States)

    Malley, Cian O; Pidgeon, Graham P

    2016-06-01

    The mechanistic target of rapamycin (mTOR) is a crucial point of convergence between growth factor signalling, metabolism, nutrient status and cellular proliferation. The mTOR pathway is heavily implicated in the progression of many cancers and is emerging as an important driver of gastrointestinal (GI) malignancies. Due to its central role in adapting metabolism to environmental conditions, mTOR signalling is also believed to be critical in the development of obesity. Recent research has delineated that excessive nutrient intake can promote signalling through the mTOR pathway and possibly evoke changes to cellular metabolism that could accelerate obesity related cancers. Acting through its two effector complexes mTORC1 and mTORC2, mTOR dictates the transcription of genes important in glycolysis, lipogenesis, protein translation and synthesis and has recently been defined as a central mediator of the Warburg effect in cancer cells. Activation of the mTOR pathway is involved in both the pathogenesis of GI malignancies and development of resistance to conventional chemotherapy and radiotherapy. The use of mTOR inhibitors is a promising therapeutic option in many GI malignancies, with greatest clinical efficacy seen in combination regimens. Recent research has also provided insight into crosstalk between mTOR and other pathways which could potentially expand the list of therapeutic targets in the mTOR pathway. Here we review the available strategies for targeting the mTOR pathway in GI cancers. We discuss current clinical trials of both established and novel mTOR inhibitors, with particular focus on combinations of these drugs with conventional chemotherapy, radiotherapy and targeted therapies.

  11. Targeting apoptosis in solid tumors: the role of bortezomib from preclinical to clinical evidence.

    Science.gov (United States)

    Russo, Antonio; Fratto, Maria E; Bazan, Viviana; Schiró, Valentina; Agnese, Valentina; Cicero, Giuseppe; Vincenzi, Bruno; Tonini, Giuseppe; Santini, Daniele

    2007-12-01

    The ubiquitin-proteasome pathway is the main proteolytic system present in the nucleus and cytoplasm of all eukaryotic cells. Apoptosis activation induced by ubiquitin-proteasome pathway inhibition makes the proteasome a new target of anticancer therapy. Bortezomib is the first proteasome inhibitor to be approved by the US FDA; in 2003 as a third line and in 2005 as a second line therapy for the treatment of multiple myeloma only. This review focuses on the use of bortezomib, not only in its therapeutic role but also, more specifically, in its biologic role and discusses the most recent applications of the drug in solid tumors, both at a preclinical and clinical level.

  12. 乳腺单纯簇状钙化灶数字化钼铑双靶X线摄影的影像表现及临床价值%IMAGING PERFORMANCE AND CLINICAL VALUE OF ISOLATED CLUSTERED MICROCALCIFICATIONS IN BREST BY DIGITAL MOLYBDENUM AND RHODIUM DOUBLE - TARGETED X - RAY MAMMOGRAPHY

    Institute of Scientific and Technical Information of China (English)

    陈健; 徐海峰; 牛广明

    2011-01-01

    目的:应用数字化钼铑双靶摄影观察乳腺内局灶性单纯簇状微钙化灶的影像表现,探讨其诊断及治疗价值.方法:使用GE Senographe2000D全数字钼铑双靶乳腺摄影机,全自动曝光条件,常规头尾位、侧斜位或加撮侧位对乳腺1.0cm2内单纯簇状钙化灶进行定位诊断后行手术治疗.对部分较小簇状钙化灶术后病灶组织再摄片确定钙化灶切除是否完整.对其中3例微小钙化灶术后摄片同时针刺定位以助病理切片.结果:21例25个钙化灶中,簇状微细钙化19例23个病灶;分支状钙化灶1例1个病灶,粗细不均钙化灶1例1个病灶.经手术、病理证实为浸润型乳腺癌7例9个病灶(占36%),早期浸润型乳癌12例14个病灶(56%);良性病变2例2个病灶(8%).结论:数字化钼铑双靶乳腺摄影可提高早期乳腺癌及微小乳腺癌的检出率.乳腺术前术后摄片可以辅助手术切除病灶、病理取材,提高乳腺疾病的临床诊断治疗水平.%Objective: To observe the imaging findings and clinical value of brest isolated clustered microcalcifications by digital Molybdenum and Rhodium double - targeted mammography. Method; Breast isolated clustered microcalcifications within 1 cm2 found by digital X - ray mammography were operated. Excisional tissue was re - filmed to determine the completeness of resection. For assisting biopsy , microcalcifications in excisional tissue were located by needling after re - filming. Result: There are 23 clustered microcalcifications (in 19 cases) , 1 branching calcification and 1 thickness uneven calcification in 25 clustered calcifications (in 21 cases). Invasive breast cancer were 7 cases 9 leisons (36% ) , early invasive breast cancer were 12 cases 14 leisons (56% ), and 2 cases 2 leisons (8% )are benign after surgical biopsy. Conclusion: Digital Molybdenum and Rhodium double - targeted X -ray mammography can increase the detection rate of early breast cancer and minute breast

  13. Antibodies to autoantigen targets in myasthenia and their value in clinical practice

    Directory of Open Access Journals (Sweden)

    S. I. Dedaev

    2014-01-01

    Full Text Available Myasthenia gravis is a classic autoimmune disease, which clinical manifestations in the form of weakness and abnormal muscle fatigue, due to the damaging effect of polyclonal antibodies to different structures of the neuromuscular synapse and muscles. The study of autoimmune substrate with myasthenia is routine in many clinics dealing with the problems of neuromuscular pathology, and the identification of high concentration of serum antibodies to a number of antigenic structures is the gold standard in diagnosis.Determination of serum antibodies to various autoimmune targets is an important tool in clinical practice. The majority of patients shows the high concentration of antibodies to AchR that gives the opportunity to use it as an important diagnostic criterion. The specificity of changes in the concentration of AchR-antibodies due to pathogenetic treatment allows to objectify the suppression of autoimmune aggression and evaluate the reliability of remission. However, the absence of AchR-antibodies when there are clear clinical and electromyography signs of myasthenia gravis suggests an autoimmune attack against a number of other targets, the most studied of which is the MuSK. On the contrary, patients with myasthenia gravis associated with thymoma, almost always have a higher level of AchR-antibodies. The presence of thymoma is accompanied by the generation of antibodies to titin and RyR, which is also observed in persons with late-onset myasthenia without thymoma. High concentration of antibodies to these structures can be interpreted as a reliable sign of thymoma in patients younger than 60 years.

  14. Experimental investigation of penetration performance of shaped charge into concrete targets

    Institute of Scientific and Technical Information of China (English)

    Cheng Wang; Tianbao Ma; Jianguo Ning

    2008-01-01

    In order to develop a tandem warhead that can effectively destroy concrete targets, this paper explores the penetration performance of shaped charges with different cone angles and liner materials into concrete targets by means of experiments. The penetration process and the destruction mechanism of concrete targets by shaped charges and kinetic energy projectiles are analyzed and compared. Experimental results suggest that both kinetic energetic projectile and shaped charge are capable of destroying concrete targets, but the magnitudes of damage are different. Compared with a kinetic energy projectile, a shaped charge has more significant effect of penetration into the target, and causes very large spalling area. Hence, a shaped charge is quite suitable for first-stage charge of tandem warhead. It is also found that, with the increase of shaped charge liner cone angle, the depth of penetration decreases gradually while the hole diameter becomes larger. Penetration depth with copper liner is larger than of aluminum liner but hole diameter is relatively smaller, and the shaped charge with steel liner is between the above two cases. The shaped charge with a cone angle of 100° can form a jet projectile charge (JPC). With JPC, a hole with optimum depth and diameter on concrete targets can be formed, which guarantees that the second-stage warhead smoothly penetrates into the hole and explodes at the optimum depth to achieve the desired level of destruction in concrete targets.

  15. The PCSK9 Inhibitors: A Novel Therapeutic Target Enters Clinical Practice

    Science.gov (United States)

    Lepor, Norman E.; Kereiakes, Dean J.

    2015-01-01

    There is a critical need for alternative, potent agents that can reduce low-density lipoprotein cholesterol (LDL-C) levels in patients with heterozygous familial hyperlipidemia and statin intolerance and those not reaching lipid-lowering treatment goals who are at high risk for cardiovascular (CV) events. The first proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor was approved in July 2015 by the US Food and Drug Administration as an adjunct to diet and maximally tolerated statin therapy for treatment of adults with heterozygous familial hyperlipidemia or clinical atherosclerotic CV disease, who require additional lowering of LDL-C levels. In clinical trials, PCSK9 inhibitors have been shown to reduce LDL-C levels by as much as 60% to 70% when administered as monotherapy or as an add-on treatment to statins and other lipid-lowering therapies. In studies of PCSK9 genetic mutations, loss of function in the PCSK9 allele was associated with a relative decrease of 88% in the risk for atherosclerotic CV events during 15 years of patient follow-up. The use of PCSK9 inhibitors may eventually support the LDL-C hypothesis that the lower the LDL-C level, the lower the CV risk. Although some recent clinical practice guidelines have deemphasized the importance of numeric LDL-C targets, many clinicians are reluctant to discard them, and this position is supported by recent clinical evidence. We eagerly await the results of the ODYSSEY, FOURIER, and SPIRE clinical outcome trials, which we anticipate will provide further validation that “lower is better” with respect to reducing LDL-C levels and improving clinical outcomes. PMID:26834934

  16. Performance Validation of Refrigeration Recovery for Experimental Hall High Target Loads

    Energy Technology Data Exchange (ETDEWEB)

    Errol Yuksek, Venkatarao, Ganni,Robert Norton, Peter Knudsen

    2012-07-01

    The Qweak experiment at Jefferson Lab (JLab) is a 3000 W hydrogen target scheduled to run until the planned shutdown in the spring of 2012 for the 12 GeV installation. As detailed in previous proceedings, support of this target's cryogenic load was made possible by incorporating modifications to the End Station Refrigerator (ESR) to recover the refrigeration supplied by the Central Helium Liquefier (CHL). Testing and commissioning for these modifications was performed in January and February 2010 demonstrating that the performance met or exceeded projected expectations. In this paper, we present the analysis of the test results in regards to the actual loads capable of being supported and the process boundaries encountered, as well as a discussion of the commissioning results for the cryogenic support of the Qweak target.

  17. Do "Virtual" and "Outpatient" Public Health Tuberculosis Clinics Perform Equally Well? A Program-Wide Evaluation in Alberta, Canada.

    Directory of Open Access Journals (Sweden)

    Richard Long

    Full Text Available Meeting the challenge of tuberculosis (TB elimination will require adopting new models of delivering patient-centered care customized to diverse settings and contexts. In areas of low incidence with cases spread out across jurisdictions and large geographic areas, a "virtual" model is attractive. However, whether "virtual" clinics and telemedicine deliver the same outcomes as face-to-face encounters in general and within the sphere of public health in particular, is unknown. This evidence is generated here by analyzing outcomes between the "virtual" and "outpatient" public health TB clinics in Alberta, a province of Western Canada with a large geographic area and relatively small population.In response to the challenge of delivering equitable TB services over long distances and to hard to reach communities, Alberta established three public health clinics for the delivery of its program: two outpatient serving major metropolitan areas, and one virtual serving mainly rural areas. The virtual clinic receives paper-based or electronic referrals and generates directives which are acted upon by local providers. Clinics are staffed by dedicated public health nurses and university-based TB physicians. Performance of the two types of clinics is compared between the years 2008 and 2012 using 16 case management and treatment outcome indicators and 12 contact management indicators.In the outpatient and virtual clinics, respectively, 691 and 150 cases and their contacts were managed. Individually and together both types of clinics met most performance targets. Compared to outpatient clinics, virtual clinic performance was comparable, superior and inferior in 22, 3, and 3 indicators, respectively.Outpatient and virtual public health TB clinics perform equally well. In low incidence settings a combination of the two clinic types has the potential to address issues around equitable service delivery and declining expertise.

  18. A New Method of Small Moving Target Detection and Its Performance Analysis

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    This paper describes a new method of small moving target detection and analyzes the performance of this algo-rithm. The method is based on multi-level threshold decision-making and sliding trajectory confidence testing technology.The parameters of the algorithm are also given. Experiments have been conducted, the results show that the algorithm hasadvantages of high detection probability, simple structure, and excellent real-time performance.

  19. A Semi-Analytical Target Strength Model for Active Sonar Performance in Realistic Propagation Conditions

    NARCIS (Netherlands)

    Schippers, P.; Volker, A.W.F.; Golliard, J.; Jong, C. de

    2006-01-01

    Propagation and sonar performance are modelled by TNO’s ALMOST program, already being developed since the Eighties. It models propagation between sonar and target based on ray theory, including effects of sediment bottoms, reverberation and ambient noise. Moreover, antenna directivity (beam forming)

  20. Sustained Attention to Local and Global Target Features Is Different: Performance and Tympanic Membrane Temperature

    Science.gov (United States)

    Helton, William S.; Hayrynen, Lauren; Schaeffer, David

    2009-01-01

    Vision researchers have investigated the differences between global and local feature perception. No one has, however, examined the role of global and local feature discrimination in sustained attention tasks. In this experiment participants performed a sustained attention task requiring either global or local letter target discriminations or…

  1. Developing Performance Cost Index Targets for ASHRAE Standard 90.1 Appendix G – Performance Rating Method

    Energy Technology Data Exchange (ETDEWEB)

    Rosenberg, Michael I. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Hart, Philip R. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-16

    Appendix G, the Performance Rating Method in ASHRAE Standard 90.1 has been updated to make two significant changes for the 2016 edition, to be published in October of 2016. First, it allows Appendix G to be used as a third path for compliance with the standard in addition to rating beyond code building performance. This prevents modelers from having to develop separate building models for code compliance and beyond code programs. Using this new version of Appendix G to show compliance with the 2016 edition of the standard, the proposed building design needs to have a performance cost index (PCI) less than targets shown in a new table based on building type and climate zone. The second change is that the baseline design is now fixed at a stable level of performance set approximately equal to the 2004 code. Rather than changing the stringency of the baseline with each subsequent edition of the standard, compliance with new editions will simply require a reduced PCI (a PCI of zero is a net-zero building). Using this approach, buildings of any era can be rated using the same method. The intent is that any building energy code or beyond code program can use this methodology and merely set the appropriate PCI target for their needs. This report discusses the process used to set performance criteria for compliance with ASHRAE Standard 90.1-2016 and suggests a method for demonstrating compliance with other codes and beyond code programs.

  2. Developing Performance Cost Index Targets for ASHRAE Standard 90.1 Appendix G – Performance Rating Method - Rev.1

    Energy Technology Data Exchange (ETDEWEB)

    Rosenberg, Michael I. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Hart, Philip R. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-03-01

    Appendix G, the Performance Rating Method in ASHRAE Standard 90.1 has been updated to make two significant changes for the 2016 edition, to be published in October of 2016. First, it allows Appendix G to be used as a third path for compliance with the standard in addition to rating beyond code building performance. This prevents modelers from having to develop separate building models for code compliance and beyond code programs. Using this new version of Appendix G to show compliance with the 2016 edition of the standard, the proposed building design needs to have a performance cost index (PCI) less than targets shown in a new table based on building type and climate zone. The second change is that the baseline design is now fixed at a stable level of performance set approximately equal to the 2004 code. Rather than changing the stringency of the baseline with each subsequent edition of the standard, compliance with new editions will simply require a reduced PCI (a PCI of zero is a net-zero building). Using this approach, buildings of any era can be rated using the same method. The intent is that any building energy code or beyond code program can use this methodology and merely set the appropriate PCI target for their needs. This report discusses the process used to set performance criteria for compliance with ASHRAE Standard 90.1-2016 and suggests a method for demonstrating compliance with other codes and beyond code programs.

  3. Importance/performance analysis: a tool for service quality control by clinical laboratories.

    Science.gov (United States)

    Scammon, D L; Weiss, R

    1991-01-01

    A study of customer satisfaction with clinical laboratory service is used as the basis for identifying potential improvements in service and more effectively targeting marketing activities to enhance customer satisfaction. Data on customer satisfaction are used to determine the aspects of service most critical to customers, how well the organization is doing in delivery of service, and how consistent service delivery is. Importance-performance analysis is used to highlight areas for future resource reallocation and strategic emphasis. Suggestions include the establishment of performance guidelines for customer contact personnel, the enhancement of timely delivery of reports via electronic transmission (computer and fax), and the development of standardized graphics for request and report forms to facilitate identification of appropriate request forms and guide clients to key items of information on reports.

  4. Clinical regressions and broad immune activation following combination therapy targeting human NKT cells in myeloma.

    Science.gov (United States)

    Richter, Joshua; Neparidze, Natalia; Zhang, Lin; Nair, Shiny; Monesmith, Tamara; Sundaram, Ranjini; Miesowicz, Fred; Dhodapkar, Kavita M; Dhodapkar, Madhav V

    2013-01-17

    Natural killer T (iNKT) cells can help mediate immune surveillance against tumors in mice. Prior studies targeting human iNKT cells were limited to therapy of advanced cancer and led to only modest activation of innate immunity. Clinical myeloma is preceded by an asymptomatic precursor phase. Lenalidomide was shown to mediate antigen-specific costimulation of human iNKT cells. We treated 6 patients with asymptomatic myeloma with 3 cycles of combination of α-galactosylceramide-loaded monocyte-derived dendritic cells and low-dose lenalidomide. Therapy was well tolerated and led to reduction in tumor-associated monoclonal immunoglobulin in 3 of 4 patients with measurable disease. Combination therapy led to activation-induced decline in measurable iNKT cells and activation of NK cells with an increase in NKG2D and CD56 expression. Treatment also led to activation of monocytes with an increase in CD16 expression. Each cycle of therapy was associated with induction of eosinophilia as well as an increase in serum soluble IL2 receptor. Clinical responses correlated with pre-existing or treatment-induced antitumor T-cell immunity. These data demonstrate synergistic activation of several innate immune cells by this combination and the capacity to mediate tumor regression. Combination therapies targeting iNKT cells may be of benefit toward prevention of cancer in humans.

  5. Development and clinical utility of a novel diagnostic nystagmus gene panel using targeted next-generation sequencing.

    Science.gov (United States)

    Thomas, Mervyn G; Maconachie, Gail DE; Sheth, Viral; McLean, Rebecca J; Gottlob, Irene

    2017-04-05

    Infantile nystagmus (IN) is a genetically heterogeneous disorder arising from variants of genes expressed within the developing retina and brain. IN presents a diagnostic challenge and patients often undergo numerous investigations. We aimed to develop and assess the utility of a next-generation sequencing (NGS) panel to enhance the diagnosis of IN. We identified 336 genes associated with IN from the literature and OMIM. NimbleGen Human custom array was used to enrich the target genes and sequencing was performed using HiSeq2000. Using reference genome material (NA12878), we show the sensitivity (98.5%) and specificity (99.9%) of the panel. Fifteen patients with familial IN were sequenced using the panel. Two authors were masked to the clinical diagnosis. We identified variants in 12/15 patients in the following genes: FRMD7 (n=3), CACNA1F (n=2), TYR (n=5), CRYBA1 (n=1) and TYRP1 (n=1). In 9/12 patients, the clinical diagnosis was consistent with the genetic diagnosis. In 3/12 patients, the results from the genetic diagnoses (TYR, CRYBA1 and TYRP1 variants) enabled revision of clinical diagnoses. In 3/15 patients, we were unable to determine a genetic diagnosis. In one patient, copy number variation analysis revealed a FRMD7 deletion. This is the first study establishing the clinical utility of a diagnostic NGS panel for IN. We show that the panel has high sensitivity and specificity. The genetic information from the panel will lead to personalised diagnosis and management of IN and enable accurate genetic counselling. This will allow development of a new clinical care pathway for IN.European Journal of Human Genetics advance online publication, 5 April 2017; doi:10.1038/ejhg.2017.44.

  6. Early intervention surveillance strategies (EISS) in dental student clinical performance: a mathematical approach.

    Science.gov (United States)

    Tennant, Marc; Kruger, Estie

    2005-12-01

    Graduating dental practitioners requires the mastery of a number of skills and a significant body of basic information. Dental education is a complex combination of didactic and physical skill learning processes. It is necessary to develop appropriate tools to measure student clinical performance to allow the provision of interventional strategies at the right time targeted at the right individuals. In this study, an approach to early intervention surveillance strategies was developed that is cost-effective, transparent, and robust based on mathematical predictions of student clinical achievements. Using a cohort of students' clinical activity profile, a polynomial pair was developed that represents the predictive function of low and high achieving students. This polynomial pair can then be applied to students to predict their final achievement based on their current status. The polynomial methodology is adaptable to local variation such as access to clinical facilities. The early intervention surveillance strategy developed in this study provides a simple, cost-effective, predictive risk assessment system that relies on data sets already collected in most dental schools and can be completed without the need for significant human intervention. The mathematical approach allows the focusing of educational support towards students that require the assistance, thus augmenting the better use of resources.

  7. Molecular profiling of patients with colorectal cancer and matched targeted therapy in phase I clinical trials.

    Science.gov (United States)

    Dienstmann, Rodrigo; Serpico, Danila; Rodon, Jordi; Saura, Cristina; Macarulla, Teresa; Elez, Elena; Alsina, Maria; Capdevila, Jaume; Perez-Garcia, Jose; Sánchez-Ollé, Gessamí; Aura, Claudia; Prudkin, Ludmila; Landolfi, Stefania; Hernández-Losa, Javier; Vivancos, Ana; Tabernero, Josep

    2012-09-01

    Clinical experience increasingly suggests that molecular prescreening and biomarker enrichment strategies in phase I trials with targeted therapies will improve the outcomes of patients with cancer. In keeping with the exigencies of a personalized oncology program, tumors from patients with advanced chemorefractory colorectal cancer were analyzed for specific aberrations (KRAS/BRAF/PIK3CA mutations, PTEN and pMET expression). Patients were subsequently offered phase I trials with matched targeted agents (MTA) directed at the identified anomalies. During 2010 and 2011, tumor molecular analysis was conducted in 254 patients: KRAS mutations (80 of 254, 31.5%), BRAF mutations (24 of 196, 12.2%), PIK3CA mutations (15 of 114, 13.2%), KRAS and PIK3CA mutations (9 of 114, 7.9%), low PTEN expression (97 of 183, 53.0%), and high pMET expression (38 of 64, 59.4%). In total, 68 patients received 82 different MTAs: phosphoinositide 3-kinase (PI3K) pathway inhibitor (if PIK3CA mutation, n = 10; or low PTEN, n = 32), PI3K pathway inhibitor plus MEK inhibitor (if KRAS mutation, n = 10; or BRAF mutation, n = 1), second-generation anti-EGF receptor monoclonal antibodies (if wild-type KRAS, n = 11), anti-hepatocyte growth factor monoclonal antibody (if high pMET, n = 10), mTOR inhibitor plus anti-insulin-like growth factor-1 receptor monoclonal antibody (if low PTEN, n = 5), and BRAF inhibitor (if BRAF mutation, n = 3). Median time-to-treatment failure on MTA was 7.9 versus 16.3 weeks for their prior systemic antitumor therapy (P 16 weeks in 10 cases (12.2%). These results suggest that matching chemorefractory patients with colorectal cancer with targeted agents in phase I trials based on the current molecular profile does not confer a significant clinical benefit.

  8. Cool-down performance of the new apparatus for fuel layering demonstrations of FIREX targets

    Science.gov (United States)

    Iwamoto, A.; Norimatsu, T.; Nakai, M.; Sakagami, H.; Shiraga, H.; Azechi, H.

    2016-03-01

    FIREX targets have been developed under two layering strategies: foam shell and cone guide laser heating methods. Basic studies have been conducted by the collaboration research between ILE and NIFS. Then the next stage requires the characterization of a layered solid fuel. The present system is at the disadvantage of optical observations. Therefore, a new apparatus is designed to solve it. Glass windows with a wide aperture are installed for an interferometer and a microscope. To isolate the vibration from a cryocooler, active vibration control units are equipped, and flexible thermal conductive links are utilized. Furthermore, a quick target exchange mechanism is applied to deal with different types of FIREX targets. A target holder is detachable from a main vacuum chamber. A metal gasket with not fixing bolts but a load of ∼ thousand newtons on ensures GHe leak tightness for target cooling. Eventually, the design temperature of 10.00 K at a target container has been achieved. The cool-down performance indecates that the new apparatus provides a cryogenic environment for fuel layering demonstrations.

  9. Non-target adjacent stimuli classification improves performance of classical ERP-based brain computer interface

    Science.gov (United States)

    Ceballos, G. A.; Hernández, L. F.

    2015-04-01

    Objective. The classical ERP-based speller, or P300 Speller, is one of the most commonly used paradigms in the field of Brain Computer Interfaces (BCI). Several alterations to the visual stimuli presentation system have been developed to avoid unfavorable effects elicited by adjacent stimuli. However, there has been little, if any, regard to useful information contained in responses to adjacent stimuli about spatial location of target symbols. This paper aims to demonstrate that combining the classification of non-target adjacent stimuli with standard classification (target versus non-target) significantly improves classical ERP-based speller efficiency. Approach. Four SWLDA classifiers were trained and combined with the standard classifier: the lower row, upper row, right column and left column classifiers. This new feature extraction procedure and the classification method were carried out on three open databases: the UAM P300 database (Universidad Autonoma Metropolitana, Mexico), BCI competition II (dataset IIb) and BCI competition III (dataset II). Main results. The inclusion of the classification of non-target adjacent stimuli improves target classification in the classical row/column paradigm. A gain in mean single trial classification of 9.6% and an overall improvement of 25% in simulated spelling speed was achieved. Significance. We have provided further evidence that the ERPs produced by adjacent stimuli present discriminable features, which could provide additional information about the spatial location of intended symbols. This work promotes the searching of information on the peripheral stimulation responses to improve the performance of emerging visual ERP-based spellers.

  10. Survey and Rapid detection of Bordetella pertussis in clinical samples targeting the BP485 in China

    Directory of Open Access Journals (Sweden)

    Wei eLiu

    2015-03-01

    Full Text Available Bordetella pertussis is an important human respiratory pathogen. Here, we describe a loop-mediated isothermal amplification (LAMP method for the rapid detection of B. pertussis in clinical samples based on a visual test. The LAMP assay detected the BP485 target sequence within 60 min with a detection limit of 1.3 pg/µl, a 10-fold increase in sensitivity compared with conventional PCR. All 31 non-pertussis respiratory pathogens tested were negative for LAMP detection, indicating the high specificity of the primers for B. pertussis. To evaluate the application of the LAMP assay to clinical diagnosis, of 105 sputum and nasopharyngeal samples collected from the patients with suspected respiratory infections in China, a total of 12 Bordetella pertussis isolates were identified from 33 positive samples detected by LAMP-based surveillance targeting BP485. Strikingly, a 4.5 months old baby and her mother were found to be infected with B. pertussis at the same time. All isolates belonged to different B. pertussis multilocus sequence typing (MLST groups with different alleles of the virulence-related genes including 4 alleles of ptxA, 6 of prn, 4 of tcfA, 2 of fim2 and 3 of fim3. The diversity of B. pertussis carrying toxin genes in clinical strains indicates a rapid and continuing evolution of B. pertussis. This combined with its high prevalence will make it difficult to control. In conclusion, we have developed a visual detection LAMP assay, which could be a useful tool for rapid B. pertussis detection, especially in situations where resources are poor and in point-of-care tests.

  11. Analytical performance specifications: relating laboratory performance to quality required for intended clinical use.

    Science.gov (United States)

    Dalenberg, Daniel A; Schryver, Patricia G; Klee, George G

    2013-03-01

    This article proposes analytic performance goals for five quality indicators: precision, trueness, linearity, detection limits, and consistency across instruments and time. We defined our goals using methods linked to clinical practice data. Goals for desirable precision and trueness are based on biological variation. Linearity goals are related to total error recommendations. Detection limit goals are derived from 0.1 percentile of patient values. Goals for consistency are derived from the variability of distributions of patient test values. Data were collected and evaluated for each of these quality indicators for 46 chemistry tests measured on the Roche cobas 8000 analyzer.

  12. Risk of Hyponatraemia in Cancer Patients Treated with Targeted Therapies: A Systematic Review and Meta-Analysis of Clinical Trials.

    Directory of Open Access Journals (Sweden)

    Rossana Berardi

    Full Text Available Hyponatraemia has been reported with targeted therapies in cancer patients. Aim of the study was to perform an up-to-date meta-analysis in order to determine the incidence and relative risk (RR in cancer patients treated with these agents.The scientific literature regarding hyponatraemia was extensively reviewed using MEDLINE, PubMed, Embase and Cochrane databases. Eligible studies were selected according to PRISMA statement. Summary incidence, RR, and 95% Confidence Intervals were calculated using random-effects or fixed-effects models based on the heterogeneity of selected studies.4803 potentially relevant trials were identified: of them, 13 randomized phase III studies were included in this meta-analysis. 6670 patients treated with 8 targeted agents were included: 2574 patients had hepatocellular carcinoma, whilst 4096 had other malignancies. The highest incidences of all-grade hyponatraemia were observed with the combination of brivanib and cetuximab (63.4 and pazopanib (31.7, while the lowest incidence was reported by afatinib (1.7. The highest incidence of high-grade hyponatraemia was reported by cetuximab (34.8, while the lowest incidences were reported by gefitinib (1.0. Summary RR of developing all-grade and high-grade hyponatraemia with targeted agents was 1.36 and 1.52, respectively. The highest RRs of all-grade and high-grade hyponatraemia were associated with brivanib (6.5 and 5.2, respectively. Grouping by drug category, the RR of high-grade hyponatraemia with angiogenesis inhibitors was 2.69 compared to anti-Epidermal Growth Factor Receptors agents (1.12.Treatment with biological therapy in cancer patients is associated with a significant increased risk of hyponatraemia, therefore frequent clinical monitoring should be emphasized when managing targeted agents.

  13. Target identification and navigation performance modeling of a passive millimeter wave imager.

    Science.gov (United States)

    Jacobs, Eddie L; Furxhi, Orges

    2010-07-01

    Human task performance using a passive interferometric millimeter wave imaging sensor is modeled using a task performance modeling approach developed by the U.S. Army Night Vision and Electronic Sensors Directorate. The techniques used are illustrated for an imaging system composed of an interferometric antenna array, optical upconversion, and image formation using a shortwave infrared focal plane array. Two tasks, target identification and pilotage, are modeled. The effects of sparse antenna arrays on task performance are considered. Applications of this model include system trade studies for concealed weapon identification, navigation in fog, and brownout conditions.

  14. Performance of passive target tracking using bearing-frequency and bearings of multiple arrays

    Institute of Scientific and Technical Information of China (English)

    DU Xuanmin; YAO Lan

    2002-01-01

    Two target motion analysis (TMA) methods using multi-dimension information are studied, one is TMA with bearing-frequency and the other is TMA with multiple arrays. The optimization algorithm combining Gauss-Newton (G-N) method with Levenberg-Marquardt(LM) method is applied to analyze the performance of target tracking with maximum likelihood estimation(MLE), and Monte Carlo experiments are presented. The results show that although the TMA with multi-dimension information have eliminated the maneuvers needed by conventional bearing-only TMA, but the application are not of universality.

  15. Comparison of monostatic and bistatic bearing estimation performance for low RCS targets

    Science.gov (United States)

    Boyle, Robert J.; Wasylkiwskyj, Wasyl

    1994-07-01

    Bistatic radars, specifically forward-scatter radars, are proposed as an alternative to standard monostatic radars against targets whose radar cross sections (RCS) have been reduced by passive means. Forward-scatter radars operate by detecting echoes from a targets forward-scatter RCS, which is insensitive to effects of passive RCS reduction techniques. However, the performance of the forward-scatter radar is compromised when the angular separation between the interference, which propagates directly from the transmitter to the receiver, and the target return is less than the Rayleigh resolution limit of the receiving antenna. This research presents the results of a parametric study of the ability of a forward-scatter radar to detect and measure the bearing of a large target, whose RCS is reduced via passive means. Super-resolution array processing techniques, particularly root-MUSIC (multiple signal classification), are used to overcome the traditional limitations resulting from the Rayleigh resolution limit of the antenna. The study compares the received power and the bearing measurement accuracy of the forward-scatter radar to that of an 'equivalent' monostatic radar system. The results indicate that forward-scatter radars enjoy advantages in detection and bearing measurement when the backscatter RCS of the target has been reduced and when the target is close to the baseline. The results also indicate that, through the use of super-resolution array processing, the capability of the forward-scatter radar to accurately measure the bearing of the target is dependent upon the amount of interference from the direct wave (i.e., the wave which propagates from the transmitter directly to the receiver) and the correlation between the direct wave and the target echo. Good bearing estimates can be achieved if the correlation coefficient is less than 0.95. Bearing measurements may be improved by suppressing the direct wave by either sidelobe control or null steering

  16. Physician judgment in clinical settings: methodological influences and cognitive performance.

    Science.gov (United States)

    Dawson, N V

    1993-07-01

    Understanding the quality of physicians' intuitive judgments is essential in determining the appropriate use of their judgments in medical decision-making (vis-a-vis analytical or actuarial approaches). As part of this process, the quality of physicians' predictions must be assessed because prediction is fundamental to common clinical tasks: determining diagnosis, prognosis, and therapy; establishing monitoring intervals; performing screening and preventive maneuvers. Critical evaluation of predictive capabilities requires an assessment of the components of the prediction process: the data available for prediction, the method used for prediction, and the accuracy of prediction. Although variation in and uncertainty about the underlying data elements are often acknowledged as a source of inaccurate predictions, prediction also can be confounded by both methodological and cognitive limitations. During the past two decades, numerous factors have been recognized that may bias test characteristics (sensitivity and specificity). These same factors may also produce bias in intuitive judgments. The use of cognitive processes to simplify judgment tasks (e.g., the availability and representativeness heuristics) and the presence of certain biases in the judgment process (e.g., ego, regret) may present obstacles to accurate estimation of probabilities by physicians. Limitations on the intuitive use of information (cognitive biases) have been demonstrated in both medical and nonmedical decision-making settings. Recent studies have led to a deepening understanding of the advantages and disadvantages of intuitive and analytical approaches to decision making. Here, many aspects of the basis for this understanding are reviewed.

  17. Comprehensive screening of target molecules by next-generation sequencing in patients with malignant solid tumors: guiding entry into phase I clinical trials

    OpenAIRE

    Tanabe, Yuko; Ichikawa, Hitoshi; Kohno, Takashi; Yoshida, Hiroshi; Kubo, Takashi; Kato, Mamoru; Iwasa, Satoru; Ochiai, Atsushi; Yamamoto, Noboru; Fujiwara, Yasuhiro; Tamura, Kenji

    2016-01-01

    It is still controversial whether comprehensive genome screening of target molecules by next generation sequencing (NGS) is needed to increase clinical efficacy of investigational drugs or accelerate drug development, although several studies are being carried out. Therefore, we performed a prospective study to evaluate the feasibility of comprehensive gene screening in this setting. Our findings indicate that actionable alterations were identified in 45% of the analyzed patients, most freque...

  18. 1-MJ, Wetted-Foam Target-Design Performance for the NIF

    Science.gov (United States)

    Collins, T. J. B.

    2006-10-01

    Wetted-foam, direct-drive target designs are a path to high-gain experiments on the National Ignition Facility (NIF). Wetted-foam designs take advantage of the increased laser absorption provided by the higher-atomic-number elements in the mixture of plastic foam and deuterium--tritium (DT). The fractional absorption is expected to increase by as much as 30% relative to an ``all-DT'' target for a ˜1-MJ design, depending on the density of the foam and the specific target design. With the increased laser coupling, more fuel can be driven with the same incident laser energy, resulting in increased target gain and/or increased hydrodynamic stability. A stability analysis of a 1-MJ design performed using two-dimensional hydrodynamic simulations in the presence of expected levels of laser and target nonuniformities will be shown. For this design, the sources of nonuniformity from the laser include power imbalance between laser beams and the imprint of single-beam nonuniformities on the target. Target nonuniformities include surface finish and inner-surface DT-ice roughness. The relative impact of these sources of nonuniformity on target performance will be examined. Particular emphasis will be placed on identifying the required levels of beam smoothing with regard to smoothing by spectral dispersion. While this emphasizes symmetric illumination, the results are relevant to polar direct drive, where a direct-drive target is driven on the NIF while it is in its indirect-drive configuration. S. Skupsky et al., in Inertial Fusion Sciences and Applications 2001, edited by K. Tanaka, D. D. Meyerhofer, and J. Meyer-ter-Vehn (Elsevier, Paris, 2002), p. 240. D.G. Colombant et al., Phys. Plasmas 7, 2046 (2000). P. W. McKenty et al., Phys. Plasmas 8, 2315 (2001). S. Skupsky et al., Phys. Plasmas 11, 2763 (2004). This work was supported by U. S. Department of Energy Office of Inertial Confinement Fusion under Cooperative Agreement No. DE-FC52-92SF19460. Contributors: S. Skupsky, R

  19. Performance Analysis of a Noncontact Plastic Fiber Optical Fiber Displacement Sensor with Compensation of Target Reflectivity

    Directory of Open Access Journals (Sweden)

    Daniele Tosi

    2013-01-01

    Full Text Available An inexpensive fiber-based noncontact distance sensor specific for monitoring short-range displacements in micromachining applications is presented. To keep the overall costs low, the sensor uses plastic optical fibers and an intensiometric approach based on the received light intensity after the reflection from the target whose displacement has to be measured. A suitable target reflectivity compensation technique is implemented to mitigate the effects due to target surface nonuniformity or ageing. The performances of the sensor are first evaluated for different fiber configurations and target reflectivity profiles and positions using a numerical method based on Monte Carlo simulations. Then, experimental validations on a configuration designed to work up to 1.5 mm have been conducted. The results have confirmed the validity of the proposed sensor architecture, which demonstrated excellent compensation capabilities, with errors below 0.04 mm in the (0-1 mm range regardless the color and misalignment of the target.

  20. Performance of a Predictive Model for Calculating Ascent Time to a Target Temperature

    Directory of Open Access Journals (Sweden)

    Jin Woo Moon

    2016-12-01

    Full Text Available The aim of this study was to develop an artificial neural network (ANN prediction model for controlling building heating systems. This model was used to calculate the ascent time of indoor temperature from the setback period (when a building was not occupied to a target setpoint temperature (when a building was occupied. The calculated ascent time was applied to determine the proper moment to start increasing the temperature from the setback temperature to reach the target temperature at an appropriate time. Three major steps were conducted: (1 model development; (2 model optimization; and (3 performance evaluation. Two software programs—Matrix Laboratory (MATLAB and Transient Systems Simulation (TRNSYS—were used for model development, performance tests, and numerical simulation methods. Correlation analysis between input variables and the output variable of the ANN model revealed that two input variables (current indoor air temperature and temperature difference from the target setpoint temperature, presented relatively strong relationships with the ascent time to the target setpoint temperature. These two variables were used as input neurons. Analyzing the difference between the simulated and predicted values from the ANN model provided the optimal number of hidden neurons (9, hidden layers (3, moment (0.9, and learning rate (0.9. At the study’s conclusion, the optimized model proved its prediction accuracy with acceptable errors.

  1. SGLT 2 Inhibitors: A New Therapeutic Target And Its Role In Current Clinical Practice

    Directory of Open Access Journals (Sweden)

    PV Shiji

    2015-10-01

    Full Text Available Diabetes, one of the major life style diseases, is associated with high morbidity and mortality owing to its microvascular and macrovascular complications. The chance of development of various complications can be effectively prevented by tight glycemic control. We have various groups of drugs like Biguanides, Sulfonyl ureas, Glitazones, Alpha-glucosidase inhibitors, Incretin based therapy, Insulin and Insulin analogues in the armamentarium to treat diabetes. But still, the number of patients attaining glycemic targets are relatively low and various adverse effect limit the use of some of these drugs, especially in special groups. Hence there is ongoing research to develop newer and newer drugs which provide sustained blood glucose reduction with minimal adverse effects. SGLT-2 inhibitors are a new group of drugs recently approved by FDA to treat Diabetes. In this review we discuss about mechanism of action, various adverse effects and the clinical role of various SGLT-2 Inhibitors.

  2. Alpha-1 Antitrypsin Deficiency Targeted Testing and Augmentation Therapy: A Canadian Thoracic Society Clinical Practice Guideline

    Directory of Open Access Journals (Sweden)

    DD Marciniuk

    2012-01-01

    Full Text Available Alpha-1 antitrypsin (A1AT functions primarily to inhibit neutrophil elastase, and deficiency predisposes individuals to the development of chronic obstructive pulmonary disease (COPD. Severe A1AT deficiency occurs in one in 5000 to one in 5500 of the North American population. While the exact prevalence of A1AT deficiency in patients with diagnosed COPD is not known, results from small studies provide estimates of 1% to 5%. The present document updates a previous Canadian Thoracic Society position statement from 2001, and was initiated because of lack of consensus and understanding of appropriate patients suitable for targeted testing for A1AT deficiency, and for the use of A1AT augmentation therapy. Using revised guideline development methodology, the present clinical practice guideline document systematically reviews the published literature and provides an evidence-based update. The evidence supports the practice that targeted testing for A1AT deficiency be considered in individuals with COPD diagnosed before 65 years of age or with a smoking history of <20 pack years. The evidence also supports consideration of A1AT augmentation therapy in nonsmoking or exsmoking patients with COPD (forced expiratory volume in 1 s of 25% to 80% predicted attributable to emphysema and documented A1AT deficiency (level ≤11 μmol/L who are receiving optimal pharmacological and nonpharmacological therapies (including comprehensive case management and pulmonary rehabilitation because of benefits in computed tomography scan lung density and mortality.

  3. Optimal marker-strategy clinical trial design to detect predictive markers for targeted therapy.

    Science.gov (United States)

    Zang, Yong; Liu, Suyu; Yuan, Ying

    2016-07-01

    In developing targeted therapy, the marker-strategy design (MSD) provides an important approach to evaluate the predictive marker effect. This design first randomizes patients into non-marker-based or marker-based strategies. Patients allocated to the non-marker-based strategy are then further randomized to receive either the standard or targeted treatments, while patients allocated to the marker-based strategy receive treatments based on their marker statuses. Little research has been done on the statistical properties of the MSD, which has led to some widespread misconceptions and placed clinical researchers at high risk of using inefficient designs. In this article, we show that the commonly used between-strategy comparison has low power to detect the predictive effect and is valid only under a restrictive condition that the randomization ratio within the non-marker-based strategy matches the marker prevalence. We propose a Wald test that is generally valid and also uniformly more powerful than the between-strategy comparison. Based on that, we derive an optimal MSD that maximizes the power to detect the predictive marker effect by choosing the optimal randomization ratios between the two strategies and treatments. Our numerical study shows that using the proposed optimal designs can substantially improve the power of the MSD to detect the predictive marker effect. We use a lung cancer trial to illustrate the proposed optimal designs.

  4. PI3K and Akt as molecular targets for cancer therapy: current clinical outcomes

    Institute of Scientific and Technical Information of China (English)

    Ipsita PAL; Mahitosh MANDAL

    2012-01-01

    The PI3K-Akt pathway is a vital regulator of cell proliferation and survival.Alterations in the PIK3CA gene that lead to enhanced PI3K kinase activity have been reported in many human cancer types,including cancers of the colon,breast,brain,liver,stomach and lung.Deregulation of PI3K causes aberrant Akt activity.Therefore targeting this pathway could have implications for cancer treatment.The first generation PI3K-Akt inhibitors were proven to be highly effective with a low IC50,but later,they were shown to have toxic side effects and poor pharmacological properties and selectivity.Thus,these inhibitors were only effective in preclinical models.However,derivatives of these first generation inhibitors are much more selective and are quite effective in targeting the PI3K-Akt pathway,either alone or in combination.These second-generation inhibitors are essentially a specific chemical moiety that helps to form a strong hydrogen bond interaction with the PI3K/Akt molecule.The goal of this review is to delineate the current efforts that have been undertaken to inhibit the various components of the PI3K and Akt pathway in different types of cancer both in vitro and in vivo.Our focus here is on these novel therapies and their inhibitory effects that depend upon their chemical nature,as well as their development towards clinical trials.

  5. A target detection model predicting field observer performance in maritime scenes

    Science.gov (United States)

    Culpepper, Joanne B.; Wheaton, Vivienne C.

    2014-10-01

    The U.S. Army's target acquisition models, the ACQUIRE and Target Task Performance (TTP) models, have been employed for many years to assess the performance of thermal infrared sensors. In recent years, ACQUIRE and the TTP models have been adapted to assess the performance of visible sensors. These adaptations have been primarily focused on the performance of an observer viewing a display device. This paper describes an implementation of the TTP model to predict field observer performance in maritime scenes. Predictions of the TTP model implementation were compared to observations of a small watercraft taken in a field trial. In this field trial 11 Australian Navy observers viewed a small watercraft in an open ocean scene. Comparisons of the observed probability of detection to predictions of the TTP model implementation showed the normalised RSS metric overestimated the probability of detection. The normalised Pixel Contrast using a literature value for V50 yielded a correlation of 0.58 between the predicted and observed probability of detection. With a measured value of N50 or V50 for the small watercraft used in this investigation, this implementation of the TTP model may yield stronger correlation with observed probability of detection.

  6. Performance Enhancement of Underwater Target Tracking by Fusing Data of Array of Global Positioning System Sonobuoys

    Directory of Open Access Journals (Sweden)

    Ahmed El-Shafie

    2009-01-01

    Full Text Available Problem statement: An accurate knowledge of geographic positions of sonobuoys is critical for the conduct of antisubmarine warfare operations and detected target localization. Deployed from an airborne platform or a surface vessel, arrays of sonobuoys could be used to efficiently track and localize submarines. Lastly, some sonobuoys were being equipped with GPS for improving system accuracy and potentially allowing networked Sonobuoy positioning. However, the computation of the range using the propagation loss profile and the data of one sonobuoy usually leads to inaccurate target localization due to several effects and uncertainties. It was, alternatively, reported that if the target is within the detection rage of two or more sonobuoys, greatly improved target localization can be achieved. Approach: Aim of this research was to investigate the feasibility of fusing data from a distributed field of GPS sonobuoys to create an Artificial Intelligence (AI based model for the error of the range computation in case of the target being detected by only one sonobuoy. Proposed module was designed utilizing Adaptive Neuron-Fuzzy Inference Systems (ANFIS to estimate the range error associated with the computation using the propagation loss profile when the target is within the detection range of only one sonobuoy. The architecture of the proposed ANFIS system had two unique features. First was the real-time cross-validation applied during the update (training procedure of the ANFIS-based module while the target was detected by two sonobuoys and the range was computed. Second feature was the use of non-overlapping and moving window for the real-time implementation of the ANFIS-based data fusion module. Results: Performance of the proposed system was examined with simulation data considering different scenarios for both the array of GPS sonobuoys and the target. Results showed that the corrected positioning by one sonobuoy is completely following the

  7. Feasibility of using ultra-high field (7 T MRI for clinical surgical targeting.

    Directory of Open Access Journals (Sweden)

    Yuval Duchin

    Full Text Available The advantages of ultra-high magnetic field (7 Tesla MRI for basic science research and neuroscience applications have proven invaluable. Structural and functional MR images of the human brain acquired at 7 T exhibit rich information content with potential utility for clinical applications. However, (1 substantial increases in susceptibility artifacts, and (2 geometrical distortions at 7 T would be detrimental for stereotactic surgeries such as deep brain stimulation (DBS, which typically use 1.5 T images for surgical planning. Here, we explore whether these issues can be addressed, making feasible the use of 7 T MRI to guide surgical planning. Twelve patients with Parkinson's disease, candidates for DBS, were scanned on a standard clinical 1.5 T MRI and a 7 T MRI scanner. Qualitative and quantitative assessments of global and regional distortion were evaluated based on anatomical landmarks and transformation matrix values. Our analyses show that distances between identical landmarks on 1.5 T vs. 7 T, in the mid-brain region, were less than one voxel, indicating a successful co-registration between the 1.5 T and 7 T images under these specific imaging parameter sets. On regional analysis, the central part of the brain showed minimal distortion, while inferior and frontal areas exhibited larger distortion due to proximity to air-filled cavities. We conclude that 7 T MR images of the central brain regions have comparable distortions to that observed on a 1.5 T MRI, and that clinical applications targeting structures such as the STN, are feasible with information-rich 7 T imaging.

  8. Application of 212Pb for Targeted α-particle Therapy (TAT: Pre-clinical and Mechanistic Understanding through to Clinical Translation

    Directory of Open Access Journals (Sweden)

    Kwon Yong

    2015-08-01

    Full Text Available Targeted α-particle therapy (TAT, in which an α-particle emitting radionuclide is specifically directed to a biological target, is gaining more attention to treat cancers as new targets are validated. Bio-vectors such as monoclonal antibodies are able to selectively transport α-particles to destroy targeted cancer cells. TAT has the potential for an improved therapeutic ratio over β-particle targeted conjugate therapy. The short path length and the intense ionization path generated render α-emitters suitable for treatment and management of minimal disease such as micrometastases or residual tumor after surgical debulking. 212Pb is the longer-lived parent radionuclide of 212Bi and serves as an in vivo generator of 212Bi. 212Pb has demonstrated significant utility in both in vitro and in vivo models. Recent evaluation of 212Pb-TCMC-trastuzumab in a Phase I clinical trial has demonstrated the feasibility of 212Pb in TAT for the treatment of ovarian cancer patients. This review highlights progress in radionuclide production, radiolabeling chemistry, molecular mechanisms, and application of 212Pb to targeted pre-clinical and clinical radiation therapy for the management and treatment of cancer.

  9. Technology transfer from biomedical research to clinical practice: measuring innovation performance.

    Science.gov (United States)

    Balas, E Andrew; Elkin, Peter L

    2013-12-01

    Studies documented 17 years of transfer time from clinical trials to practice of care. Launched in 2002, the National Institutes of Health (NIH) translational research initiative needs to develop metrics for impact assessment. A recent White House report highlighted that research and development productivity is declining as a result of increased research spending while the new drugs output is flat. The goal of this study was to develop an expanded model of research-based innovation and performance thresholds of transfer from research to practice. Models for transfer of research to practice have been collected and reviewed. Subsequently, innovation pathways have been specified based on common characteristics. An integrated, intellectual property transfer model is described. The central but often disregarded role of research innovation disclosure is highlighted. Measures of research transfer and milestones of progress have been identified based on the Association of University Technology Managers 2012 performance reports. Numeric milestones of technology transfer are recommended at threshold (top 50%), target (top 25%), and stretch goal (top 10%) performance levels. Transfer measures and corresponding target levels include research spending to disclosure (0.81), patents to start-up (>0.1), patents to licenses (>2.25), and average per license income (>$48,000). Several limitations of measurement are described. Academic institutions should take strategic steps to bring innovation to the center of scholarly discussions. Research on research, particularly on pathways to disclosures, is needed to improve R&D productivity. Researchers should be informed about the technology transfer performance of their institution and regulations should better support innovators.

  10. Measurement of Clinical Performance of Nurses: A Literature Review.

    Science.gov (United States)

    Robb, Yvonne; Fleming, Valerie; Dietert, Christine

    2002-01-01

    A research review (n=12) yielded a number of tools for assessing nurses' clinical competence but none that is universally accepted. The review did identify methods that could be used to develop a useful instrument. (Contains 23 references.) (SK)

  11. Ratings of Residents' Clinical Competence and Performance on Certification Examination.

    Science.gov (United States)

    Norcinin, John J.; And Others

    1987-01-01

    A study of the correlation between certification test results and ratings of clinical competence for graduate medical students in internal medicine during a six-year period found strong correlations on both individual and general indicators of competence. (MSE)

  12. Distinct effects of positive and negative music on older adults' auditory target identification performances.

    Science.gov (United States)

    Vieillard, Sandrine; Bigand, Emmanuel

    2014-01-01

    Older adults, compared to younger adults, are more likely to attend to pleasant situations and avoid unpleasant ones. Yet, it is unclear whether such a phenomenon may be generalized to musical emotions. In this study, we investigated whether there is an age-related difference in how musical emotions are experienced and how positive and negative music influences attention performances in a target identification task. Thirty-one young and twenty-eight older adults were presented with 40 musical excerpts conveying happiness, peacefulness, sadness, and threat. While listening to music, participants were asked to rate their feelings and monitor each excerpt for the occurrence of an auditory target. Compared to younger adults, older adults reported experiencing weaker emotional activation when listening to threatening music and showed higher level of liking for happy music. Correct reaction times (RTs) for target identification were longer for threatening than for happy music in older adults but not in younger adults. This suggests that older adults benefit from a positive musical context and can regulate emotion elicited by negative music by decreasing attention towards it (and therefore towards the auditory target).

  13. How to (or not to) … measure performance against the Abuja target for public health expenditure.

    Science.gov (United States)

    Witter, Sophie; Jones, Alex; Ensor, Tim

    2014-07-01

    In 2001, African heads of state committed 'to set a target of allocating at least 15% of our annual budget to the improvement of the health sector'. This target has since been used as a benchmark to hold governments accountable. However, it was never followed by a set of guidelines as to how it should be measured in practice. This article sets out some of the areas of ambiguity and argues for an interpretation which focuses on actual expenditure, rather than budgets (which are theoretical), and which captures areas of spending that are subject to government discretion. These are largely domestic sources, but include budget support, which is externally derived but subject to Ministry of Finance sectoral allocation. Theoretical and practical arguments in favour of this recommendation are recommended using a case study from Sierra Leone. It is recommended that all discretionary spending by government is included in the numerator and denominator when calculating performance against the target, including spending by all ministries on health, social health insurance payments, debt relief funds and budget support. Conversely, all forms of private payment and earmarked aid should be excluded. The authors argue that the target, while an important vehicle for tracking political commitment to the sector, should be assessed intelligently by governments, which have legitimate wider public finance objectives of maximizing overall social returns, and should be complemented by a wider range of indicators, to avoid distortions.

  14. High-resolution 3D simulations of NIF ignition targets performed on Sequoia with HYDRA

    Science.gov (United States)

    Marinak, M. M.; Clark, D. S.; Jones, O. S.; Kerbel, G. D.; Sepke, S.; Patel, M. V.; Koning, J. M.; Schroeder, C. R.

    2015-11-01

    Developments in the multiphysics ICF code HYDRA enable it to perform large-scale simulations on the Sequoia machine at LLNL. With an aggregate computing power of 20 Petaflops, Sequoia offers an unprecedented capability to resolve the physical processes in NIF ignition targets for a more complete, consistent treatment of the sources of asymmetry. We describe modifications to HYDRA that enable it to scale to over one million processes on Sequoia. These include new options for replicating parts of the mesh over a subset of the processes, to avoid strong scaling limits. We consider results from a 3D full ignition capsule-only simulation performed using over one billion zones run on 262,000 processors which resolves surface perturbations through modes l = 200. We also report progress towards a high-resolution 3D integrated hohlraum simulation performed using 262,000 processors which resolves surface perturbations on the ignition capsule through modes l = 70. These aim for the most complete calculations yet of the interactions and overall impact of the various sources of asymmetry for NIF ignition targets. This work was performed under the auspices of the Lawrence Livermore National Security, LLC, (LLNS) under Contract No. DE-AC52-07NA27344.

  15. Study of the Relationship Between Nurse Self-Concept and Clinical Performance Among Nursing Students

    OpenAIRE

    Badiyepeymaie Jahromi; Kargar; Ramezanli

    2015-01-01

    Background Scholars believe that if nursing students appreciate the value of their services, their sense of professionalism will increase and performance will improve. Nevertheless, little is known about the relationship between nursing students’ professional self-concept and clinical performance. Objectives This study examines the relationship between nurse self-concept and clinical performance among nursing students. ...

  16. Performance limits for exo-clutter Ground Moving Target Indicator (GMTI) radar.

    Energy Technology Data Exchange (ETDEWEB)

    Doerry, Armin Walter

    2010-09-01

    The performance of a Ground Moving Target Indicator (GMTI) radar system depends on a variety of factors, many which are interdependent in some manner. It is often difficult to 'get your arms around' the problem of ascertaining achievable performance limits, and yet those limits exist and are dictated by physics. This report identifies and explores those limits, and how they depend on hardware system parameters and environmental conditions. Ultimately, this leads to a characterization of parameters that offer optimum performance for the overall GMTI radar system. While the information herein is not new to the literature, its collection into a single report hopes to offer some value in reducing the 'seek time'.

  17. 3D modeling and simulation of the thermal performance of solid cyclotron targets

    Energy Technology Data Exchange (ETDEWEB)

    Avila-Rodriguez, M.A.; Sader, J.A.; McQuarrie, S.A. [Alberta Univ., Edmonton PET Centre, Cross Cancer Institute, AB (Canada); McQuarrie, S.A. [Alberta Univ., Faculty of Medicine and Dentistry, Div. of Oncologic Imaging, Edmonton, AB (Canada)

    2007-07-01

    COMSOL Multiphysics was used to model and simulate the thermal performance of solid targets irradiated with charged particles. Parametric solutions for beam power densities in the range from 1.5 10{sup 5} to 1.5 10{sup 6} W/m{sup 2} and cooling water flow velocities from 0.2 to 4.0 m/s were obtained for different plate materials. Results showed that materials with a high thermal conductivity to heat capacity ratio behave better in cooling dynamic systems requiring fast dissipation of heat. Results also showed that water flow rates greater than 2.6 L/min do not noticeably improve the heat dissipation of solid targets irradiated with charged particles. (authors)

  18. Targeting temporomandibular disorder pain treatment to hormonal fluctuations: a randomized clinical trial.

    Science.gov (United States)

    Turner, Judith A; Mancl, Lloyd; Huggins, Kimberly Hanson; Sherman, Jeffrey J; Lentz, Gretchen; LeResche, Linda

    2011-09-01

    Mounting evidence supports the importance of hormonal fluctuations in temporomandibular disorder (TMD) pain among women. Stabilizing influential hormones or having a plan and skills for coping with hormonally related increases in TMD pain, therefore, may be beneficial for women with TMD pain. This randomized clinical trial evaluated the short- and long-term efficacy of 3 interventions for women with TMD pain: (1) dental hygienist-delivered pain self-management training (SMT; n=59); (2) the same dental hygienist-delivered pain self-management training, but with a focus on menstrual cycle-related changes in pain and other symptoms (targeted SMT, or TSMT; n=55); and (3) continuous oral contraceptive therapy (6-month trial) aimed at stabilizing hormones believed to be influential in TMD pain (COCT; n=57). Study participants completed outcome (pain, activity interference, depression) and process (pain beliefs, catastrophizing, coping effectiveness) measures before randomization, and 6 and 12months later. Intent-to-treat analyses supported the benefits of the SMT and TSMT interventions relative to COCT. Targeting the self-management treatment to menstrual cycle-related symptoms did not increase the treatment's efficacy. The benefits of the self-management interventions relative to COCT for pain and activity interference were statistically significant at 12 months, but not at 6 months, whereas the benefits for the process measures generally were apparent at both time points. COCT was associated with multiple adverse events (none serious). The study provides further support for long-term benefits of a safe, low-intensity (2 in-person sessions and 6 brief telephone contacts), dental hygienist-delivered self-management treatment for TMD pain.

  19. A clinically attainable dose of L-asparaginase targets glutamine addiction in lymphoid cell lines.

    Science.gov (United States)

    Sugimoto, Koichi; Suzuki, Hiroshi I; Fujimura, Tsutomu; Ono, Asami; Kaga, Naoko; Isobe, Yasushi; Sasaki, Makoto; Taka, Hikari; Miyazono, Kohei; Komatsu, Norio

    2015-11-01

    L-asparaginase (L-ASNase) is an important branch of chemotherapy for acute lymphoblastic leukemia (ALL) and some types of non-Hodgkin's lymphoma, including natural killer (NK)-cell lymphoma. Although it mediates hydrolysis of asparagine (Asn) and glutamine (Gln), which are variably required for cancer cell survival, the relative contribution of Asn and Gln depletion to the anti-tumor activity in therapeutic doses is unclear in ALL and malignant lymphoma. Here we demonstrate that L-ASNase exerts cytotoxicity through targeting the Gln addiction phenotype in lymphoid cell lines. A clinically attainable intermediate dose of L-ASNase induced massive apoptosis in ALL Jurkat and mantle cell lymphoma Jeko cell lines, while a low dose of L-ASNase effectively killed NK-cell lymphoma cells. In the lymphoid cell lines Jurkat and Jeco, deprivation of Gln but not Asn specifically suppressed cell growth and survival, and phenocopied the action of L-ASNase. L-ASNase treatment and Gln deprivation dramatically disrupted the refilling of the tricarboxylic acid (TCA) cycle by intracellular glutamate (Glu) and disturbed the mitochondrial integrity, which were alleviated by various anaplerotic TCA cycle intermediates, suggesting a direct contribution of glutaminase activity of L-ASNase. The action of L-ASNase differs between Jurkat cells and NK-cell lymphoma cells, according to their dependence on Gln and Asn. Furthermore, we observed that high expression of glutaminase GLS1 is associated with increased sensivity to L-ASNase in pediatric B lineage ALL. Our results redefine L-ASNase as a therapeutic agent targeting Gln addiction in certain lymphoid cells and offer an additional basis for predicting L-ASNase sensitivity and engineering selective L-ASNase derivatives for leukemia and lymphoma.

  20. Molecular targets of Chinese herbs: a clinical study of hepatoma based on network pharmacology

    Science.gov (United States)

    Gao, Li; Wang, Xiao-dong; Niu, Yang-yang; Duan, Dan-dan; Yang, Xue; Hao, Jian; Zhu, Cui-hong; Chen, Dan; Wang, Ke-xin; Qin, Xue-mei; Wu, Xiong-zhi

    2016-01-01

    Traditional Chinese medicine (TCM) has been used to treat tumors for years and has been demonstrated to be effective. However, the underlying molecular mechanisms of herbs remain unclear. This study aims to ascertain molecular targets of herbs prolonging survival time of patients with advanced hepatocellular carcinoma (HCC) based on network pharmacology, and to establish a research method for accurate treatment of TCM. The survival benefit of TCM treatment with Chinese herbal medicine (CHM) was proved by Kaplan–Meier method and Cox regression analysis among 288 patients. The correlation between herbs and survival time was performed by bivariate correlation analysis. Network pharmacology method was utilized to construct the active ingredient-target networks of herbs that were responsible for the beneficial effects against HCC. Cox regression analysis showed CHM was an independent favorable prognostic factor. The median survival time was 13 months and the 5-year overall survival rates were 2.61% in the TCM group, while there were 6 months, 0 in the non-TCM group. Correlation analysis demonstrated that 8 herbs closely associated with prognosis. Network pharmacology analysis revealed that the 8 herbs regulated multiple HCC relative genes, among which the genes affected proliferation (KRAS, AKT2, MAPK), metastasis (SRC, MMP), angiogenesis (PTGS2) and apoptosis (CASP3) etc. PMID:27143508

  1. EFFECTS OF MERGERS AND ACQUISITIONS ON FINANCIAL PERFORMANCE OF THE TARGET COMPANY

    Directory of Open Access Journals (Sweden)

    ADRIANA DUŢESCU

    2013-05-01

    Full Text Available Many studies revealed the fact that mergers and acquisitions are a risky business. Disregarding the M&A advisers’ fees, evaluations show that most of the companies completing M&A transactions disappoint to deliver on promised financial performance. But, as many would say, it is an investment and the highest risks produce the highest results - whether they're good or bad. Within this paper, we were intending to analyse the rate of success of relevant M&A transactions that took place in 2007 in Romania, by comparing the financial statements of the target companies before and after the acquisition, in the current economic context. The main objective of this study is to generally determine the successfulness of the M&A transactions, starting from assessing changes induced by the M&A transaction to the target company, with the help of three important financial ratios: profit margin, ROE and receivable collection period. Even though the study may present some bias, we have tried to be as objective as possible and not influence its outcome: that 80% of 10 most important private Mergers and Acquisitions taking place in Romania in 2007 and that meet several conditions: o The target is part of the consumer goods and services market (mainly trade and tourism and is an important player in its industry o The target is a Romanian private company, and its shares are not listed on the stock exchange o The acquirer is majority shareholder after the transaction The target company remained as a sole entity and was not integrated into the mother company after the transaction were not successful.

  2. One-megajoule, wetted-foam target-design performance for the National Ignition Facilitya)

    Science.gov (United States)

    Collins, T. J. B.; Marozas, J. A.; Betti, R.; Harding, D. R.; McKenty, P. W.; Radha, P. B.; Skupsky, S.; Goncharov, V. N.; Knauer, J. P.; McCrory, R. L.

    2007-05-01

    Wetted-foam, direct-drive target designs are a path to high-gain experiments on the National Ignition Facility (NIF) [J. Paisner et al., Laser Focus World 30, 75 (1994)]. Wetted-foam designs [S. Skupsky et al., in Inertial Fusion Sciences and Applications 2001, edited by K. Tanaka, D. D. Meyerhofer, and J. Meyer-ter-Vehn (Elsevier, Paris, 2002)] take advantage of the increased laser absorption provided by the higher-atomic-number elements in a target ablator composed of plastic foam saturated with deuterium-tritium (DT). The increased laser coupling allows more fuel to be driven with the same incident laser energy, resulting in increased hydrodynamic stability and target gain. A stability analysis of a 1-MJ design was performed using the two-dimensional hydrodynamic code DRACO [P. B. Radha et al., Phys. Plasmas 12, 032702 (2005)]. Simulations examining the effect of the expected levels of laser nonuniformities (single-beam and multiple-beam) and target nonuniformities (surface and ice roughness) have been performed. A nonuniformity-budget analysis has been constructed and suggests that two-dimensional (2D) smoothing by spectral dispersion (SSD) [S. Skupsky et al., J. Appl. Phys. 66, 3456 (1989)] is needed to reduce single-beam nonuniformities to levels sufficient for ignition to proceed. Two integrated 2D simulations with 0.75-μm initial ice roughness, multiple-beam nonuniformity, surface roughness, and imprint were completed, one with 2D SSD smoothing and one with 1D SSD. The former ignited and produced a gain of 32, while the latter failed to ignite. A third integrated 2D simulation with 1-μm initial ice roughness and an ice power-law spectral index of 1 was also completed and produced a gain of 27.

  3. Sustained effect of simulation-based ultrasound training on clinical performance

    DEFF Research Database (Denmark)

    Tolsgaard, Martin; Ringsted, C; Dreisler, E;

    2015-01-01

    was performed using a virtual-reality TVS simulator until an expert performance level was attained, and was followed by training on a pelvic mannequin. After 2 months of clinical training, one TVS examination was recorded for assessment of each resident's clinical performance (n = 26). Two ultrasound experts......OBJECTIVE: To study the effect of initial simulation-based transvaginal sonography (TVS) training compared with clinical training only, on the clinical performance of residents in obstetrics and gynecology (Ob-Gyn), assessed 2 months into their residency. METHODS: In a randomized study, new Ob...

  4. Cognitive Moral Development and Clinical Performance: Implications for Pharmacy Education.

    Science.gov (United States)

    Latif, David A.; Berger, Bruce A.

    1999-01-01

    A study explored the notion that moral reasoning skills are important to the provision of pharmaceutical care. It compared the moral reasoning skills of two classes of pharmacy students with those of practitioners who scored high on measures of pharmaceutical care and clinical decision making. Implications for pharmacy school admissions and…

  5. Performance of clinical mammography: a nationwide study from Denmark

    DEFF Research Database (Denmark)

    Jensen, Allan; Vejborg, Ilse; Severinsen, Niels;

    2006-01-01

    in Denmark in the year 2000 were collected and linked to cancer outcome. Use of the National Institute of Radiation Hygiene register for identification of radiology clinics ensured comprehensive nationwide registration. We used the final mammographic assessment at the end of the imaging work-up to determine...

  6. Real world clinical performance of the zotarolimus eluting coronary stent system in Chinese patients: a prospective,multicenter registry study

    Institute of Scientific and Technical Information of China (English)

    HAN Ya-ling; XU Kai; WANG Wei-min; HUO Yong; CHEN Ji-yan; XU Bo; YAN Hong-bing; WANG Le-feng; LI Wei-min; CONG Hong-liang; JING Quan-min; WANG Shou-li

    2011-01-01

    Background Early clinical trials with the Endeavor zotarolimus eluting stent (ZES) in western populations demonstrated low rates of target lesion revascularization with a favorable safety profile including low late stent thrombosis with up to 5 years of follow-up.The aim of this clinical registry study was to evaluate real world clinical performance of the ZES coronary system in Chinese patients.Methods The China Endeavor Registry is a prospective,multicenter registry assessing the safety of the ZES system in a real world patient population.It was conducted at 46 centers in China in routine treatment of patients with coronary artery stenosis,including patients with clinical characteristics or lesion types that are often excluded from randomized controlled trials.The registry included 2210 adult patients who underwent single-vessel or multi-vessel percutaneous coronary intervention.The primary end point was the rate of major adverse cardiac events (MACE) at 12 months.Results The 12-month rate of MACE for all patients in the registry was 3.03%.Cardiac death or myocardial infarction rate was 1.28% and target lesion revascularization rate was 1.66%,non-target lesion target vessel revascularization (TVR) was 0.52%,TVR was 2.18%,and target vessel failure was 3.22%.There was only one case of emergent cardiac bypass surgery.The 12-month overall incidence of all Academic Research Consortium (ARC)-defined stent thrombosis was 0.43%.Conclusion Mid-term results from the real-world China Endeavor Registry suggest that Endeavor ZES was safe and effective in Chinese patients.

  7. Current Molecular Targeted Therapy in Advanced Gastric Cancer: A Comprehensive Review of Therapeutic Mechanism, Clinical Trials, and Practical Application

    Directory of Open Access Journals (Sweden)

    Kaichun Li

    2016-01-01

    Full Text Available Despite the great progress in the treatment of gastric cancer, it is still the third leading cause of cancer death worldwide. Patients often miss the opportunity for a surgical cure, because the cancer has already developed into advanced cancer when identified. Compared to best supportive care, chemotherapy can improve quality of life and prolong survival time, but the overall survival is often short. Due to the molecular study of gastric cancer, new molecular targeted drugs have entered the clinical use. Trastuzumab, an antibody targeting human epidermal growth factor receptor 2 (HER2, can significantly improve survival in advanced gastric cancer patients with HER2 overexpression. Second-line treatment of advanced gastric cancer with ramucirumab, an antibody targeting VEGFR-2, alone or in combination with paclitaxel, has been proved to provide a beneficial effect. The VEGFR-2 tyrosine kinase inhibitor, apatinib, can improve the survival of advanced gastric cancer patients after second-line chemotherapy failure. Unfortunately, none of the EGFR targeting antibodies (cetuximab or panitumumab, VEGF targeting monoclonal antibodies (bevacizumab, mTOR inhibitor (everolimus, or HGF/MET pathway targeting drugs has a significant survival benefit. Many other clinical trials based on molecular markers are underway. This review will summarize targeted therapies for advanced gastric cancer.

  8. Review of novel therapeutic targets for improving heart failure treatment based on experimental and clinical studies

    Science.gov (United States)

    Bonsu, Kwadwo Osei; Owusu, Isaac Kofi; Buabeng, Kwame Ohene; Reidpath, Daniel Diamond; Kadirvelu, Amudha

    2016-01-01

    Heart failure (HF) is a major public health priority due to its epidemiological transition and the world’s aging population. HF is typified by continuous loss of contractile function with reduced, normal, or preserved ejection fraction, elevated vascular resistance, fluid and autonomic imbalance, and ventricular dilatation. Despite considerable advances in the treatment of HF over the past few decades, mortality remains substantial. Pharmacological treatments including β-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and aldosterone antagonists have been proven to prolong the survival of patients with HF. However, there are still instances where patients remain symptomatic, despite optimal use of existing therapeutic agents. This understanding that patients with chronic HF progress into advanced stages despite receiving optimal treatment has increased the quest for alternatives, exploring the roles of additional pathways that contribute to the development and progression of HF. Several pharmacological targets associated with pathogenesis of HF have been identified and novel therapies have emerged. In this work, we review recent evidence from proposed mechanisms to the outcomes of experimental and clinical studies of the novel pharmacological agents that have emerged for the treatment of HF. PMID:27350750

  9. Clinical investigation of TROP-2 as an independent biomarker and potential therapeutic target in colon cancer.

    Science.gov (United States)

    Zhao, Peng; Yu, Hai-Zheng; Cai, Jian-Hui

    2015-09-01

    Colon cancer is associated with a severe demographic and economic burden worldwide. The pathogenesis of colon cancer is highly complex and involves sequential genetic and epigenetic mechanisms. Despite extensive investigation, the pathogenesis of colon cancer remains to be elucidated. As the third most common type of cancer worldwide, the treatment options for colon cancer are currently limited. Human trophoblast cell‑surface marker (TROP‑2), is a cell‑surface transmembrane glycoprotein overexpressed by several types of epithelial carcinoma. In addition, TROP‑2 has been demonstrated to be associated with tumorigenesis and invasiveness in solid types of tumor. The aim of the present study was to investigate the protein expression of TROP‑2 in colon cancer tissues, and further explore the association between the expression of TROP‑2 and clinicopathological features of patients with colon cancer. The expression and localization of the TROP‑2 protein was examined using western blot analysis and immunofluorescence staining. Finally, the expression of TROP‑2 expression was correlated to conventional clinicopathological features of colon cancer using a χ2 test. The results revealed that TROP‑2 protein was expressed at high levels in the colon cancer tissues, which was associated with the development and pathological process of colon cancer. Therefore, TROP‑2 may be used as a biomarker to determine the clinical prognosis, and as a potential therapeutic target in colon cancer.

  10. Genetic markers as therapeutic target in rheumatoid arthritis: A game changer in clinical therapy?

    Science.gov (United States)

    Ali, A M Mohamed Thoufic; Vino, S

    2016-11-01

    Rheumatoid arthritis (RA) is a chronic, inflammatory, multi-systemic autoimmune disease unremitted by genetic and environmental factors. The factors are crucial but inadequate in the development of disease; however, these factors can be representative of potential therapeutic targets and response to clinical therapy. Insights into the contribution of genetic risk factors are currently in progress with studies querying the genetic variation, their role in gene expression of coding and non-coding genes and other mechanisms of disease. In this review, we describe the significance of genetic markers architecture of RA through genome-wide association studies and meta-analysis studies. Further, it also reveals the mechanism of disease pathogenesis investigated through the mutual findings of functional and genetic studies of individual RA-associated genes, which includes HLA-DRB1, HLA-DQB1, HLA-DPB1, PADI4, PTPN22, TRAF1-C5, STAT4 and C5orf30. However, the genetic background of RA remains to be clearly depicted. Prospective efforts of the post-genomic and functional genomic period can travel toward real possible assessment of the genetic effect on RA. The discovery of novel genes associated with the disease can be appropriate in identifying potential biomarkers, which could assist in early diagnosis and aggressive treatment.

  11. Balancing act. Using the clinic scorecard to improve practice performance.

    Science.gov (United States)

    Scanlan, Art

    2007-02-01

    The balanced scorecard is a strategic management system that impels managers to focus on the performance metrics that drive success. It measures the business process and links a management method for process improvement to strategic goals. A medical practice can use a balanced scorecard to improve operational performance and quality or service, which generates higher levels of patient satisfaction and better financial management.

  12. Investigation of measureable parameters that correlate with automatic target recognition performance in synthetic aperture sonar

    Science.gov (United States)

    Gazagnaire, Julia; Cobb, J. T.; Isaacs, Jason

    2015-05-01

    There is a desire in the Mine Counter Measure community to develop a systematic method to predict and/or estimate the performance of Automatic Target Recognition (ATR) algorithms that are detecting and classifying mine-like objects within sonar data. Ideally, parameters exist that can be measured directly from the sonar data that correlate with ATR performance. In this effort, two metrics were analyzed for their predictive potential using high frequency synthetic aperture sonar (SAS) images. The first parameter is a measure of contrast. It is essentially the variance in pixel intensity over a fixed partition of relatively small size. An analysis was performed to determine the optimum block size for this contrast calculation. These blocks were then overlapped in the horizontal and vertical direction over the entire image. The second parameter is the one-dimensional K-shape parameter. The K-distribution is commonly used to describe sonar backscatter return from range cells that contain a finite number of scatterers. An Ada-Boosted Decision Tree classifier was used to calculate the probability of classification (Pc) and false alarm rate (FAR) for several types of targets in SAS images from three different data sets. ROC curves as a function of the measured parameters were generated and the correlation between the measured parameters in the vicinity of each of the contacts and the ATR performance was investigated. The contrast and K-shape parameters were considered separately. Additionally, the contrast and K-shape parameter were associated with background texture types using previously labeled high frequency SAS images.

  13. Cervical radiculopathy: Study protocol of a randomised clinical trial evaluating the effect of mobilisations and exercises targeting the opening of intervertebral foramen [NCT01500044

    Directory of Open Access Journals (Sweden)

    Langevin Pierre

    2012-01-01

    Full Text Available Abstract Background Cervical radiculopathy is a common form of neck pain and has been shown to lead to severe disability. Clinical rehabilitation approaches for cervical radiculopathies commonly include exercise and manual therapy interventions targeting the opening of intervertebral foramen, but evidence regarding their effectiveness is scarce. The primary objective of this randomised clinical trial is to compare, in terms of pain and disability, a rehabilitation program targeting the opening of intervertebral foramen to a conventional rehabilitation program, for patients presenting acute or subacute cervical radiculopathies. The hypothesis is that the rehabilitation program targeting the opening of intervertebral foramen will be significantly more effective in reducing pain and disability than the conventional rehabilitation program. Methods/Design This study is a double-blind (participants and evaluators blinded randomised clinical trial that will allow the comparison of patients with a cervical radiculopathy randomly assigned to one of two groups: one group will receive a 4-week rehabilitation program targeting the opening of intervertebral foramen, and the second group will receive a 4-week conventional rehabilitation program. Thirty-six subjects with cervical radiculopathy will be recruited from participating medical and physiotherapy clinics and will be evaluated at baseline, at the end of the 4-week program and four weeks following the end of the program. The primary outcome measure will be the validated Neck Disability Index questionnaire. Secondary outcome measures will include the short version of the Disabilities of the Arm, Shoulder and Hand questionnaire, a numerical pain rating scale, cervicothoracic mobility and patients' perceived global rating of change. During the 4-week rehabilitation program, each participant will take part in eight physiotherapy treatment sessions (2 session/week and will perform a home exercise program. A

  14. Clinical effects of pranayama on performance of rifle shooters

    Directory of Open Access Journals (Sweden)

    Amte Snehal Shekhar, Mistry Hetal M

    2014-07-01

    Full Text Available Background: Yoga has an enormous scientifically proven effect on man’s physical and psychological functioning. Pranayama constitute the most vital aspects of yoga. Various methods of pranayama have a sound scientific basis and are traditionally believed to produce equilibrium between psychic and somatic aspects of bodily functions. The link between body and mind is obligatory for the better performance of sports persons. Aim: The aim of the study is to find out the effect of pranayama on the performance of Rifle shooters by measuring the parameters like-breath holding time, lung functional capacity and shooting performance. Method: 52 state level shooters subjects were chosen from 2 centres between the age group of 15-30years. Out of them, 26 shooters were given training in the techniques of pranayama for 3weeks.The other 26 subjects served as control i.e. with out Pranayama training. Variables like shooting performance, breath holding time (BHT, peak expiratory flow rate (PEFR, respiratory rate (RR and pulse rate (PR were measured in both the groups. Results: The study showed highly significant improvement in all the five variables shooting performance (in mm, BHT, PEFR, RR and PR with p value of 3.62E-05, 2.78E-07, 1.31E-09, 0.013, 3.40E-04respectively. Conclusion: So it can be concluded that pranayama is efficacious for better performance of Rifle shooters and should be included in their training practice.

  15. HaloPlex Targeted Resequencing for Mutation Detection in Clinical Formalin-Fixed, Paraffin-Embedded Tumor Samples.

    Science.gov (United States)

    Moens, Lotte N J; Falk-Sörqvist, Elin; Ljungström, Viktor; Mattsson, Johanna; Sundström, Magnus; La Fleur, Linnéa; Mathot, Lucy; Micke, Patrick; Nilsson, Mats; Botling, Johan

    2015-11-01

    In recent years, the advent of massively parallel next-generation sequencing technologies has enabled substantial advances in the study of human diseases. Combined with targeted DNA enrichment methods, high sequence coverage can be obtained for different genes simultaneously at a reduced cost per sample, creating unique opportunities for clinical cancer diagnostics. However, the formalin-fixed, paraffin-embedded (FFPE) process of tissue samples, routinely used in pathology departments, results in DNA fragmentation and nucleotide modifications that introduce a number of technical challenges for downstream biomolecular analyses. We evaluated the HaloPlex target enrichment system for somatic mutation detection in 80 tissue fractions derived from 20 clinical cancer cases with paired tumor and normal tissue available in both FFPE and fresh-frozen format. Several modifications to the standard method were introduced, including a reduced target fragment length and two strand capturing. We found that FFPE material can be used for HaloPlex-based target enrichment and next-generation sequencing, even when starting from small amounts of DNA. By specifically capturing both strands for each target fragment, we were able to reduce the number of false-positive errors caused by FFPE-induced artifacts and lower the detection limit for somatic mutations. We believe that the HaloPlex method presented here will be broadly applicable as a tool for somatic mutation detection in clinical cancer settings.

  16. Associating Drugs, Targets and Clinical Outcomes into an Integrated Network Affords a New Platform for Computer-Aided Drug Repurposing

    DEFF Research Database (Denmark)

    Oprea, Tudor; Nielsen, Sonny Kim; Ursu, Oleg

    2011-01-01

    benefit from an integrated, semantic-web compliant computer-aided drug repurposing (CADR) effort, one that would enable deep data mining of associations between approved drugs (D), targets (T), clinical outcomes (CO) and SE. We report preliminary results from text mining and multivariate statistics, based...

  17. Immunoscintigraphy as Potential Tool in the Clinical Evaluation of HER2/neu Targeted Therapy

    NARCIS (Netherlands)

    Dijkers, Eli C. F.; de Vries, Elisabeth G. E.; Kosterink, Jos G. W.; Brouwers, Adrienne H.; Hooge, Marjolijn N. Lub-de

    2008-01-01

    Many new targeted anticancer drugs have been developed. In order for these drugs to be effective, the tumor target has to be present during treatment. Currently there are only a few biomarkers available to help the physician select the appropriate targeted drug for the patient and often tumor tissue

  18. The flexible requirement system for grading of clinical performance of undergraduate dental students.

    Science.gov (United States)

    ElBadrawy, H; Korayem, M

    2007-11-01

    A new grading system is presented for evaluating and grading dental students' clinical competence and performance in paediatric dentistry at the undergraduate level. The Flexible Requirements System is a clinical competence evaluation system designed to address some of the common deficiencies of other requirements-based performance evaluation systems, by utilising a unique method of collecting and manipulating certain measurements of student performance in various groups of clinical procedures. The system aimed to incorporate adequate flexibility in its requirements to afford students fair and equal opportunities, whilst maintaining adherence to departmental clinical competence criteria and standards.

  19. Modified distal shoe appliance--fabrication and clinical performance.

    Science.gov (United States)

    Gujjar, Kumar Raghav; Indushekar, K R; Amith, H V; Sharma, Shefali Li

    2012-01-01

    When the primary second molar is prematurely lost, mesial movement and migration of the permanent first molar often occurs. This is one of the most difficult problems of the developing dentition confronted by pediatric dentists. Use of a space maintainer that will guide the permanent first molar into its normal position is indicated. In cases with bilateral premature loss of primary molars, the conventional design of distal shoe poses a variety of problems and, therefore, necessitates a customized design for the eruption guidance of permanent first molars. The purpose of this case report is to discuss an innovative design of a distal shoe appliance, which was used with good clinical results.

  20. A study of clinical performance of nurses who recently completed the comprehensive basic nursing course

    Directory of Open Access Journals (Sweden)

    B. B. Ntombela

    1996-05-01

    Full Text Available A study was conducted to assess clinical performance of registered nurses who had recently completed the new comprehensive basic nursing course. This regional project was undertaken because of controversy surrounding clinical competence of the graduates/diplomates of the new regulation course. Senior qualified nurses gave their views according to Likert Scale statements and open-ended questions. Findings were that the sample was of the opinion that clinical performance of the new graduates/diplomates falls short of expectations.

  1. Transition to clinical training : influence of pre-clinical knowledge and skills, and consequences for clinical performance

    NARCIS (Netherlands)

    van Hell, Elisabeth A.; Kuks, Jan B. M.; Schonrock-Adema, Johanna; van Lohuizen, Mirjam T.; Cohen-Schotanus, Janke

    2008-01-01

    CONTEXT Many students experience a tough transition from pre-clinical to clinical training and previous studies suggest that this may constrict students' progress. However, clear empirical evidence of this is lacking. The aim of this study was to determine: whether the perceived difficulty of transi

  2. Critical heat flux performance of hypervapotrons proposed for use in the ITER divertor vertical target

    Science.gov (United States)

    Youchison, Dennis L.; Marshall, Theron D.; McDonald, Jimmie M.; Lutz, Thomas J.; Watson, Robert D.; Driemeyer, Daniel E.; Kubik, David L.; Slattery, Kevin T.; Hellwig, Theodore H.

    1997-12-01

    Task T-222 of the International Thermonuclear Experimental Reactor (ITER) program addresses the manufacturing and testing of permanent components for use in the ITER divertor. Thermal-hydraulic and critical heat flux performance of the heat sinks proposed for use in the divertor vertical target are part of subtask T-222.4. As part of this effort, two single channel, medium-scale, bare copper alloy, hypervapotron mock-ups were designed by Sandia National Laboratories and McDonnell Douglas Aerospace (MDA), fabricated at MDA and tested at Sandia' Plasma Materials Test Facility using the EB-1200 electron beam system. The objectives of our effort were to develop the design and manufacturing procedures required for construction of robust HHF components, verify thermal-hydraulic, thermomechanical and CHF performance under ITER relevant conditions, and perform analyses of HHF data to identify design guidelines, failure criteria and possibly modify any applicable CHF correlations. This paper describes the design, fabrication and finite elements modeling of two types of hypervapotrons, a common version already in use at JET and a new attached- fin design. HHF test data on the attached-fin hypervapotron will be used to compare the CHF performance under uniform heating profiles on long heated lengths to that of localized, highly peaked, off-nominal profiles.

  3. Critical heat flux performance of hypervapotrons proposed for use in the ITER divertor vertical target

    Energy Technology Data Exchange (ETDEWEB)

    Youchison, D.L.; Marshall, T.D.; McDonald, J.M.; Lutz, T.J.; Watson, R.D. [Sandia National Labs., Albuquerque, NM (United States); Driemeyer, D.E. Kubik, D.L.; Slattery, K.T.; Hellwig, T.H. [McDonnell Douglas Aerospace, St. Louis, MO (United States)

    1997-09-01

    Task T-222 of the International Thermonuclear Experimental Reactor (ITER) program addresses the manufacturing and testing of permanent components for use in the ITER divertor. Thermalhydraulic and critical heat flux performance of the heat sinks proposed for use in the divertor vertical target are part of subtask T-222.4. As part of this effort, two single channel, medium scale, bare copper alloy, hypervapotron mockups were designed, fabricated, and tested using the EB-1200 electron beam system. The objectives of the effort were to develop the design and manufacturing procedures required for construction of robust high heat flux (HHF) components, verify thermalhydraulic, thermomechanical and critical heat flux (CHF) performance under ITER relevant conditions, and perform analyses of HHF data to identify design guidelines and failure criteria and possibly modify any applicable CHF correlations. The design, fabrication, and finite element modeling of two types of hypervapotrons are described; a common version already in use at the Joint European Torus (JET) and a new attached fin design. HHF test data on the attached fin hypervapotron will be used to compare the CHF performance under uniform heating profiles on long heated lengths with that of localized, highly peaked, off nominal profiles.

  4. Locoregional extension patterns of nasopharyngeal carcinoma and suggestions for clinical target volume delineation

    Institute of Scientific and Technical Information of China (English)

    Wen-Fei Li; Jun Ma; Ying Sun; Mo Chen; Ling-Long Tang; Li-Zhi Liu; Yan-Ping Mao; Lei Chen; Guan-Qun Zhou; Li Li

    2012-01-01

    Clinical target volume (CTV) delineation is crucial for tumor control and normal tissue protection.This study aimed to define the Iocoregional extension patterns of nasopharyngeal carcinoma (NPC) and to improve CTV delineation.Magnetic resonance imaging scans of 2366 newly diagnosed NPC patients were reviewed.According to incidence rates of tumor invasion,the anatomic sites surrounding the nasopharynx were classified into high-risk (>30%),medium-risk (5%-30%),and low-risk (<5%) groups.The lymph node (LN) level was determined according to the Radiation Therapy Oncology Group guidelines,which were further categorized into the upper neck (retropharyngeal region and level Ⅱ),middle neck (levels Ⅲ and Va),and lower neck (levels IV and Vb and the supraclavicular fossa).The high-risk anatomic sites were adjacent to the nasopharynx,whereas those at medium-or low-risk were separated from the nasopharynx.If the high-risk anatomic sites were involved,the rates of tumor invasion into the adjacent medium-risk sites increased; if not,the rates were significantly lower (P < 0.01).Among the 1920 (81.1%) patients with positive LN,the incidence rates of LN metastasis in the upper,middle,and lower neck were 99.6%,30.2%,and 7.2%,respectively,and skip metastasis happened in only 1.2% of patients.In the 929 patients who had unilateral upper neck involvement,the rates of contralateral middle neck and lower neck involvement were 1.8% and 0.4%,respectively.Thus,local disease spreads stepwise from proximal sites to distal sites,and LN metastasis spreads from the upper neck to the lower neck.Individualized CTV delineation for NPC may be feasible.

  5. Reliable and Valid Assessment of Clinical Bronchoscopy Performance

    DEFF Research Database (Denmark)

    Konge, Lars; Larsen, Klaus Richter; Clementsen, Paul

    2012-01-01

    : The interrater reliability was high, with Cronbach's a = 0.86. Assessment of 3 bronchoscopies by a single rater had a generalizability coefficient of 0.84. The correlation between experience and performance was good (Pearson correlation = 0.76). There were significant differences between the groups for all...

  6. Seeking value in Medicare: performance measurement for clinical professionals.

    Science.gov (United States)

    Sprague, Lisa

    2013-10-30

    The Medicare program, despite its reputation of being a bill payer with little regard to the worth of the services it buys, has begun to put in place a range of programs aimed at assessing quality and value, with more to come. Attention to resource use and cost is nascent. The issues are complex, and it is no surprise that there is a level of contention between providers and regulators, even though both profess commitment to improved quality. This paper summarizes the quality and value programs that apply to physicians and other clinical professionals, as well as programs designed to encourage the adoption of technology to support quality improvement. Participation in all is voluntary. However, a decision not to participate increasingly carries a financial penalty, as Congress (and, by extension, the U.S. Department of Health and Human Services, or HHS) tries to encourage behavior it cannot force.

  7. Quantitative performance of a quadrupole-orbitrap-MS in targeted LC-MS determinations of small molecules.

    Science.gov (United States)

    Grund, Baptiste; Marvin, Laure; Rochat, Bertrand

    2016-05-30

    High-resolution mass spectrometry (HRMS) has been associated with qualitative and research analysis and QQQ-MS with quantitative and routine analysis. This view is now challenged and for this reason, we have evaluated the quantitative LC-MS performance of a new high-resolution mass spectrometer (HRMS), a Q-orbitrap-MS, and compared the results obtained with a recent triple-quadrupole MS (QQQ-MS). High-resolution full-scan (HR-FS) and MS/MS acquisitions have been tested with real plasma extracts or pure standards. Limits of detection, dynamic range, mass accuracy and false positive or false negative detections have been determined or investigated with protease inhibitors, tyrosine kinase inhibitors, steroids and metanephrines. Our quantitative results show that today's available HRMS are reliable and sensitive quantitative instruments and comparable to QQQ-MS quantitative performance. Taking into account their versatility, user-friendliness and robustness, we believe that HRMS should be seen more and more as key instruments in quantitative LC-MS analyses. In this scenario, most targeted LC-HRMS analyses should be performed by HR-FS recording virtually "all" ions. In addition to absolute quantifications, HR-FS will allow the relative quantifications of hundreds of metabolites in plasma revealing individual's metabolome and exposome. This phenotyping of known metabolites should promote HRMS in clinical environment. A few other LC-HRMS analyses should be performed in single-ion-monitoring or MS/MS mode when increased sensitivity and/or detection selectivity will be necessary.

  8. Optical ensemble analysis of intraocular lens performance through a simulated clinical trial with ZEMAX.

    Science.gov (United States)

    Zhao, Huawei

    2009-01-01

    A ZEMAX model was constructed to simulate a clinical trial of intraocular lenses (IOLs) based on a clinically oriented Monte Carlo ensemble analysis using postoperative ocular parameters. The purpose of this model is to test the feasibility of streamlining and optimizing both the design process and the clinical testing of IOLs. This optical ensemble analysis (OEA) is also validated. Simulated pseudophakic eyes were generated by using the tolerancing and programming features of ZEMAX optical design software. OEA methodology was verified by demonstrating that the results of clinical performance simulations were consistent with previously published clinical performance data using the same types of IOLs. From these results we conclude that the OEA method can objectively simulate the potential clinical trial performance of IOLs.

  9. The Effects of Highlighting, Validity, and Feature Type on Air-to-Ground Target Acquisition Performance.

    Science.gov (United States)

    2007-11-02

    cultura I taget Target type Validity X target X leadin interaction on initial response time (highlighted trials) WRONG HIGHLIGHTING ÖU - M ea...natural - leadin cultural ndurd cultura taget I taget Target type Figure 3.10: Validity X lead-in X Target interaction Confirmation time A

  10. Performance Comparison of Hybrid GA-PSO Based Tuned IMMs for Maneuver Target Tracking

    Directory of Open Access Journals (Sweden)

    Ravi Kumar Jatoth

    2013-11-01

    Full Text Available Target tracking is very important field of research as it has wider applications in defense as well as civilian applications. Kalman filter is generally used for such applications. When the process and measurements are non linear extensions of Kalman filters like Extended Kalman Filter, Unscented Kalman Filters are widely used. UKF can give estimations up to second order characteristics of random process. The target is maneuvering and switching among different models like constant velocity (CV, constant acceleration (CA or constant turn (CT, Interactive Multiple Models (IMM are employed. Implementation of IMM filters for any application is difficult because of initialization of Kalman filter i,e, tuning of filter has to be performed before applying to real time situations. It demands prior estimations of Noise covariance matrices which are left for engineering intuitions. This paper presents the nonlinear state estimation using IMM and tuning of the filter is done using bio-inspired algorithms like PSO GA and Hybrid GA-PSO.

  11. Performance of combined clinical mammography and needle biopsy: a nationwide study from Denmark

    DEFF Research Database (Denmark)

    Jensen, Allan; Rank, Fritz; Dyreborg, Uffe

    2006-01-01

    Clinical mammography and needle biopsy are key tools for non-operative assessment of breast lesions. We evaluated the performance of all combined tests undertaken in Denmark in 2000. Clinical mammography and needle biopsy data were collected and linked to final cancer outcome, to determine...... sensitivity, specificity, and predictive values of clinical mammography, needle biopsy, and combined test. In 2000, 6709 combined tests were performed in 36 mammography clinics in Denmark. The combined test was consistently more sensitive than any single test, increasing the proportion of women correctly...

  12. Emotional intelligence and clinical interview performance of dental students.

    Science.gov (United States)

    Hannah, Annette; Lim, Bee T; Ayers, Kathryn M S

    2009-09-01

    One hundred and sixteen third-year dental students participating in a consultation skills course in Dunedin, New Zealand, completed a standardized psychometric Social Skills Inventory (SSI) and were assessed by tutors, simulated patients, and themselves. Students with higher social skills abilities obtained higher performance scores and demonstrated better interview structure. Patients reported being more likely to return to students for a dental consultation following the second interview, and students' consultation skills were rated (by tutors, patients, and students) higher at the end of the course than the beginning. Female students had higher global social skills abilities and were more emotionally expressive and sensitive than male students, while the latter had better emotional control. Female students performed better in the first interview than male students, but there was no significant gender difference in the second interview. Tutor and simulated patient ratings suggested that a consultation skills course can increase the ability of students in general, and English as a second language students in particular, to relate to their patients, manage anxiety, identify ethical issues, and recognize significant psychosocial issues that lead to more accurate diagnosis and treatment processes, ensuring the effective delivery of patient-centered dental education.

  13. The impact of selected contextual factors on experts' clinical reasoning performance (does context impact clinical reasoning performance in experts?).

    NARCIS (Netherlands)

    Durning, S.J.; Artino, A.R.; Boulet, J.R.; Dorrance, K.; Vleuten, C.P.M. van der; Schuwirth, L.

    2012-01-01

    Context specificity, or the variation in a participant's performance from one case, or situation, to the next, is a recognized problem in medical education. However, studies have not explored the potential reasons for context specificity in experts using the lens of situated cognition and cognitive

  14. The Impact of Selected Contextual Factors on Experts' Clinical Reasoning Performance (Does Context Impact Clinical Reasoning Performance in Experts?)

    Science.gov (United States)

    Durning, Steven J.; Artino, Anthony R.; Boulet, John R.; Dorrance, Kevin; van der Vleuten, Cees; Schuwirth, Lambert

    2012-01-01

    Context specificity, or the variation in a participant's performance from one case, or situation, to the next, is a recognized problem in medical education. However, studies have not explored the potential reasons for context specificity in experts using the lens of situated cognition and cognitive load theories (CLT). Using these theories, we…

  15. Detection of Clostridium tetani in human clinical samples using tetX specific primers targeting the neurotoxin.

    Science.gov (United States)

    Ganesh, Madhu; Sheikh, Nasira K; Shah, Pooja; Mehetre, Gajanan; Dharne, Mahesh S; Nagoba, Basavraj S

    2016-01-01

    Tetanus resulting from ear injury remains an important health problem, particularly in the developing world. We report the successful detection of Clostridium tetani using tetX specific primers targeting the Cl. tetani neurotoxin. The sample was obtained from an ear discharge of a case of otogenic tetanus in a 2-year-old male child. Based on the culture results of the ear discharge, Gram staining and virulence testing by genotyping, a diagnosis of tetanus was confirmed. This is the first report from India on the successful detection of Cl. tetani in a human clinical sample using tetX specific primers targeting the Cl. tetani neurotoxin.

  16. Current status on performance of CT colonography and clinical indications

    Energy Technology Data Exchange (ETDEWEB)

    Laghi, Andrea, E-mail: andrea.laghi@uniroma1.it [Department of Radiological Sciences, Oncology and Pathology Sapienza – Università di Roma, Polo Pontino, I.C.O.T. Hospital, Via Franco Faggiana 43, 04100 Latina (Italy); Rengo, Marco [Department of Radiological Sciences, Oncology and Pathology Sapienza – Università di Roma, Polo Pontino, I.C.O.T. Hospital, Via Franco Faggiana 43, 04100 Latina (Italy); Graser, Anno [InstitutfürKlinische Radiologie, Klinikumder Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistr. 15, 81377 München (Germany); Iafrate, Franco [Department of Radiological Sciences, Oncology and Pathology Sapienza – Università di Roma, Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome (Italy)

    2013-08-15

    CT colonography (CTC) is a robust and reliable imaging test of the colon. Accuracy for the detection of colorectal cancer (CRC) is as high as conventional colonoscopy (CC). Identification of polyp is size dependent, with large lesions (≥10 mm) accurately detected and small lesions (6–9 mm) identified with moderate to good sensitivity. Recent studies show good sensitivity for the identification of nonpolypoid (flat) lesions as well. Current CTC indications include the evaluation of patients who had undergone a previous incomplete CC or those who are unfit for CC (elderly and frail individuals, patients with underlying severe clinical conditions, or with contraindication to sedation). CTC can also be efficiently used in the assessment of diverticular disease (excluding patients with acute diverticulitis, where the exam should be postponed), before laparoscopic surgery for CRC (to have an accurate localization of the lesion), in the evaluation of colonic involvement in the case of deep pelvic endometriosis (replacing barium enema). CTC is also a safe procedure in patients with colostomy. For CRC screening, CTC should be considered an opportunistic screening test (not available for population, or mass screening) to be offered to asymptomatic average-risk individuals, of both genders, starting at age 50. The use in individuals with positive family history should be discussed with the patient first. Absolute contraindication is to propose CTC for surveillance of genetic syndromes and chronic inflammatory bowel diseases (in particular, ulcerative colitis). The use of CTC in the follow-up after surgery for CRC is achieving interesting evidences despite the fact that literature data are still relatively weak in terms of numerosity of the studied populations. In patients who underwent previous polypectomy CTC cannot be recommended as first test because debate is still open. It is desirable that in the future CTC would be the first-line and only diagnostic test for

  17. Three-year randomised clinical trial to evaluate the clinical performance, quantitative and qualitative wear patterns of hybrid composite restorations.

    Science.gov (United States)

    Palaniappan, Senthamaraiselvi; Elsen, Liesbeth; Lijnen, Inge; Peumans, Marleen; Van Meerbeek, Bart; Lambrechts, Paul

    2010-08-01

    The aim of the study was to compare the clinical performance, quantitative and qualitative wear patterns of conventional hybrid (Tetric Ceram), micro-filled hybrid (Gradia Direct Posterior) and nano-hybrid (Tetric EvoCeram, TEC) posterior composite restorations in a 3-year randomised clinical trial. Sixteen Tetric Ceram, 17 TEC and 16 Gradia Direct Posterior restorations were placed in human molars and evaluated at baseline, 6, 12, 24 and 36 months of clinical service according to US Public Health Service criteria. The gypsum replicas at each recall were used for 3D laser scanning to quantify wear, and the epoxy resin replicas were observed under scanning electron microscope to study the qualitative wear patterns. After 3 years of clinical service, the three hybrid restorative materials performed clinically well in posterior cavities. Within the observation period, the nano-hybrid and micro-hybrid restorations evolved better in polishability with improved surface gloss retention than the conventional hybrid counterpart. The three hybrid composites showed enamel-like vertical wear and cavity-size dependant volume loss magnitude. Qualitatively, while the micro-filled and nano-hybrid composite restorations exhibited signs of fatigue similar to the conventional hybrid composite restorations at heavy occlusal contact area, their light occlusal contact areas showed less surface pitting after 3 years of clinical service.

  18. Promising targets and current clinical trials in metastatic non-squamous NSCLC

    Directory of Open Access Journals (Sweden)

    Alona eZer

    2014-11-01

    Full Text Available Lung adenocarcinoma is the most rapidly increasing subtype of lung cancer today. With the discovery of EGFR mutations and ALK rearrangements and targeted therapy, personalized medicine has become a reality for patients with lung adenocarcinoma. Here we review potential additional targets and novel therapies of interest in lung adenocarcinoma including targets within the cell surface (receptor tyrosine kinases EGFR, HER2, RET, ROS1, MET, TRK, targets in intracellular pathways (ALK, RAS-RAF-MEK, PI3K-AKT-PTEN, WNT, nuclear targets such as PARP, HSP90 and histone deacetylase, and selected pathways in the tumour environment. With the evolving ability to identify specific molecular aberrations in patient tumours in routine practice, our ability to further personalize therapy in lung adenocarcinoma is rapidly expanding.

  19. Effect of Target Configuration on the Neutronic Performance of the Gas-Cooled ADS

    CERN Document Server

    Biss, K; Shetty, N; Nabbi, R

    2013-01-01

    With the utilization of nuclear energy transuranic elements like Pu, Am and Cm are produced causing high, long term radioactivity and radio toxicity, respectively. To reduce the radiological impact on the environment and to the repository Partitioning and Transmutation is considered as an efficient way. In this respect comprehensive research works are performed at different research institutes worldwide. The results show that the transmutation of TRU is achieved with fast neutrons due to the higher fission probability. Based on Accelerator Driven Systems (ADS) those neutrons are used in a particular system, in which mainly liquid metal eutectic (lead bismuth) is used as coolant. The neutronic performance of an ADS system based on gas cooling was studied in this work by using the simulation tool MCNPX. The usage of the Monte-Carlo method in MCNPX allows the simulation of the physical processes in a 3D-model of the core. In dependence of the spallation target material and design several parameters like the mult...

  20. Performance of genotype-MTBDR test directly on clinical specimens

    Directory of Open Access Journals (Sweden)

    Gülden Yılmaz

    2012-12-01

    Full Text Available Objectives: Most important point for the control and effective treatment of multidrug resistant tuberculosis (MDR-TBis early diagnosis and rapid determination of the resistance. The aim of this study is to assess the performance of theGenotype-MTBDR assay applied directly on sputum samples and compare the results with those obtained by DNA sequencingand phenotypic susceptibility testing.Materials and methods: Between November 2005 and February 2006, 93 smear and culture positive sputum sampleswere included in the study. Drug susceptibility results for rifampin (RIF and isoniazid (INH, obtained by proportionmethod on L-J medium, Genotype-MTBDR and DNA sequencing were compared.Results: The rate of concordance between the results of the Genotype-MTBDR and DNA sequencing was 93.5% and96.7% for RIF and INH, respectively. Moreover, Genotype-MTBDR detected all the RIF (24 and INH (18 resistant strainsobtained by sequencing (100%. Compared to the DNA sequencing method; the sensitivity, specificity, positive predictiveand negative predictive value for RIF and INH were 100%, 91.3%, 80%, 100% and 100%, 96%, 85.7%, 100% respectively.Conclusion: Genotype-MTBDR, one of molecular assays, distinctly shortens the time for diagnosis and detection of resistanceto INH and RIF, essential for management of MDR-TB. The test appears to have good sensitivity and specificitywhen also used directly on sputum specimens. J Microbiol Infect Dis 2012; 2(4: 135-141Key words: Mycobacterium tuberculosis; drug resistance; genotype-MTBDR.

  1. Development of the Computerized Model of Performance-Based Measurement System to Measure Nurses' Clinical Competence.

    Science.gov (United States)

    Liou, Shwu-Ru; Liu, Hsiu-Chen; Tsai, Shu-Ling; Cheng, Ching-Yu; Yu, Wei-Chieh; Chu, Tsui-Ping

    2016-04-01

    Critical thinking skills and clinical competence are for providing quality patient care. The purpose of this study is to develop the Computerized Model of Performance-Based Measurement system based on the Clinical Reasoning Model. The system can evaluate and identify learning needs for clinical competency and be used as a learning tool to increase clinical competency by using computers. The system includes 10 high-risk, high-volume clinical case scenarios coupled with questions testing clinical reasoning, interpersonal, and technical skills. Questions were sequenced to reflect patients' changing condition and arranged by following the process of collecting and managing information, diagnosing and differentiating urgency of problems, and solving problems. The content validity and known-groups validity was established. The Kuder-Richardson Formula 20 was 0.90 and test-retest reliability was supported (r = 0.78). Nursing educators can use the system to understand students' needs for achieving clinical competence, and therefore, educational plans can be made to better prepare students and facilitate their smooth transition to a future clinical environment. Clinical nurses can use the system to evaluate their performance-based abilities and weakness in clinical reasoning. Appropriate training programs can be designed and implemented to practically promote nurses' clinical competence and quality of patient care.

  2. Review of the Interaction Between Body Composition and Clinical Outcomes in Metastatic Renal Cell Cancer Treated With Targeted Therapies

    Directory of Open Access Journals (Sweden)

    Steven M Yip

    2016-03-01

    Full Text Available Treatment of metastatic renal cell cancer (mRCC currently focuses on inhibition of the vascular endothelial growth factor pathway and the mammalian target of rapamycin (mTOR pathway. Obesity confers a higher risk of RCC. However, the influence of obesity on clinical outcomes in mRCC in the era of targeted therapy is less clear. This review focuses on the impact of body composition on targeted therapy outcomes in mRCC. The International Metastatic Renal Cell Carcinoma Database Consortium database has the largest series of patients evaluating the impact of body mass index (BMI on outcomes in mRCC patients treated with targeted therapy. Overall survival was significantly improved in overweight patients (BMI ≥ 25 kg/m2, and this observation was externally validated in patients who participated in Pfizer trials. In contrast, sarcopenia is consistently associated with increased toxicity to inhibitors of angiogenesis and mTOR. Strengthening patients with mRCC and sarcopenia, through a structured exercise program and dietary intervention, may improve outcomes in mRCC treated with targeted therapies. At the same time, the paradox of obesity being a risk factor for RCC while offering a better overall survival in response to targeted therapy needs to be further evaluated.

  3. Targeted nanoparticles for image-guided treatment of triple-negative breast cancer: clinical significance and technological advances.

    Science.gov (United States)

    Miller-Kleinhenz, Jasmine M; Bozeman, Erica N; Yang, Lily

    2015-01-01

    Effective treatment of triple-negative breast cancer (TNBC) with its aggressive tumor biology, highly heterogeneous tumor cells, and poor prognosis requires an integrated therapeutic approach that addresses critical issues in cancer therapy. Multifunctional nanoparticles with the abilities of targeted drug delivery and noninvasive imaging for monitoring drug delivery and responses to therapy, such as theranostic nanoparticles, hold great promise toward the development of novel therapeutic approaches for the treatment of TNBC using a single therapeutic platform. The biological and pathological characteristics of TNBC provide insight into several potential molecular targets for current and future nanoparticle-based therapeutics. Extensive tumor stroma, highly proliferative cells, and a high rate of drug resistance are all barriers that must be appropriately addressed in order for these nanotherapeutic platforms to be effective. Utilization of the enhanced permeability and retention effect coupled with active targeting of cell surface receptors expressed by TNBC cells, and tumor-associated endothelial cells, stromal fibroblasts, and macrophages is likely to overcome such barriers to facilitate more effective drug delivery. An in-depth summary of current studies investigating targeted nanoparticles in preclinical TNBC mouse and human xenograft models is presented. This review aims to outline the current status of nanotherapeutic options for TNBC patients, identification of promising molecular targets, challenges associated with the development of targeted nanotherapeutics, the research done by our group as well as by others, and future perspectives on the nanomedicine field and ways to translate current preclinical studies into the clinic.

  4. Is clinical competence perceived differently for student daily performance on the wards versus clerkship grading?

    Science.gov (United States)

    Wimmers, Paul F; Kanter, Steven L; Splinter, Ted A W; Schmidt, Henk G

    2008-12-01

    Clinical rotations play an important role in the medical curriculum and are considered crucial for student learning. However, competencies that should be learned can differ from those that are assessed. In order to explore which competencies are considered important for daily performance of student on the wards and to what extent clinical teachers consider the same competencies important for clerkship grading, a survey that consisted of 21 different student characteristics was administered to clinical teachers. Two independent factor analyses using structural equation modeling were conducted to abstract underlying latent relationships among the different student characteristics and to define a clinical competence profile for daily performance of students on the wards and clerkship grading. Differences between the degree of importance for student daily ward performance and clerkship grading are considered and discussed. The results of the survey indicate that the degree of importance of competencies are rated different for daily performance of students on the wards and clerkship grades. Competencies related to the diagnostic process are more important for clerkship grading, whereas interpersonal skills, professional qualities, and motivation are more important for daily ward performance. It is concluded that the components of clinical competence considered important for adequate performance are not necessarily in alignment with what is required for grading. Future research should focus on an explanation why clinical educators think differently about the importance of competencies for student examination in contrast to what is required for adequate daily performance on the wards.

  5. Base rate of performance invalidity among non-clinical undergraduate research participants.

    Science.gov (United States)

    Silk-Eglit, Graham M; Stenclik, Jessica H; Gavett, Brandon E; Adams, Jason W; Lynch, Julie K; Mccaffrey, Robert J

    2014-08-01

    Neuropsychological research frequently uses non-clinical undergraduate participants to evaluate neuropsychological tests. However, a recent study by An and colleagues (2012, Archives of Clinical Neuropsychology, 27, 849-857) called into question that the extent to which the interpretation of these participants' performance on neuropsychological tests is valid. This study found that in a sample of 36 participants, 55.6% exhibited performance invalidity at an initial session and 30.8% exhibited performance invalidity at a follow-up session. The current study attempted to replicate these findings in a larger, more representative sample using a more rigorous methodology. Archival data from 133 non-clinical undergraduate research participants were analyzed. Participants were classified as performance invalid if they failed any one PVT. In the current sample, only 2.26% of participants exhibited performance invalidity. Thus, concerns regarding insufficient effort and performance invalidity when using undergraduate research participants appear to be overstated.

  6. NCI Requests Targets for Monoclonal Antibody Production and Characterization - Office of Cancer Clinical Proteomics Research

    Science.gov (United States)

    In an effort to provide well-characterized monoclonal antibodies to the scientific community, NCI's Antibody Characterization Program requests cancer-related protein targets for affinity production and distribution.

  7. Targeted therapies in cancer - challenges and chances offered by newly developed techniques for protein analysis in clinical tissues.

    Science.gov (United States)

    Malinowsky, K; Wolff, C; Gündisch, S; Berg, D; Becker, Kf

    2010-12-19

    In recent years, new anticancer therapies have accompanied the classical approaches of surgery and radio- and chemotherapy. These new forms of treatment aim to inhibit specific molecular targets namely altered or deregulated proteins, which offer the possibility of individualized therapies.The specificity and efficiency of these new approaches, however, bring about a number of challenges. First of all, it is essential to specifically identify and quantify protein targets in tumor tissues for the reasonable use of such targeted therapies. Additionally, it has become even more obvious in recent years that the presence of a target protein is not always sufficient to predict the outcome of targeted therapies. The deregulation of downstream signaling molecules might also play an important role in the success of such therapeutic approaches. For these reasons, the analysis of tumor-specific protein expression profiles prior to therapy has been suggested as the most effective way to predict possible therapeutic results. To further elucidate signaling networks underlying cancer development and to identify new targets, it is necessary to implement tools that allow the rapid, precise, inexpensive and simultaneous analysis of many network components while requiring only a small amount of clinical material.Reverse phase protein microarray (RPPA) is a promising technology that meets these requirements while enabling the quantitative measurement of proteins. Together with recently developed protocols for the extraction of proteins from formalin-fixed, paraffin-embedded (FFPE) tissues, RPPA may provide the means to quantify therapeutic targets and diagnostic markers in the near future and reliably screen for new protein targets.With the possibility to quantitatively analyze DNA, RNA and protein from a single FFPE tissue sample, the methods are available for integrated patient profiling at all levels of gene expression, thus allowing optimal patient stratification for

  8. Targeted therapies in cancer - challenges and chances offered by newly developed techniques for protein analysis in clinical tissues

    Directory of Open Access Journals (Sweden)

    K Malinowsky, C Wolff, S Gündisch, D Berg, KF Becker

    2011-01-01

    Full Text Available In recent years, new anticancer therapies have accompanied the classical approaches of surgery and radio- and chemotherapy. These new forms of treatment aim to inhibit specific molecular targets namely altered or deregulated proteins, which offer the possibility of individualized therapies.The specificity and efficiency of these new approaches, however, bring about a number of challenges. First of all, it is essential to specifically identify and quantify protein targets in tumor tissues for the reasonable use of such targeted therapies. Additionally, it has become even more obvious in recent years that the presence of a target protein is not always sufficient to predict the outcome of targeted therapies. The deregulation of downstream signaling molecules might also play an important role in the success of such therapeutic approaches. For these reasons, the analysis of tumor-specific protein expression profiles prior to therapy has been suggested as the most effective way to predict possible therapeutic results. To further elucidate signaling networks underlying cancer development and to identify new targets, it is necessary to implement tools that allow the rapid, precise, inexpensive and simultaneous analysis of many network components while requiring only a small amount of clinical material.Reverse phase protein microarray (RPPA is a promising technology that meets these requirements while enabling the quantitative measurement of proteins. Together with recently developed protocols for the extraction of proteins from formalin-fixed, paraffin-embedded (FFPE tissues, RPPA may provide the means to quantify therapeutic targets and diagnostic markers in the near future and reliably screen for new protein targets.With the possibility to quantitatively analyze DNA, RNA and protein from a single FFPE tissue sample, the methods are available for integrated patient profiling at all levels of gene expression, thus allowing optimal patient stratification

  9. Clinical problems with the performance of euthanasia and physician-assisted suicide in The Netherlands

    NARCIS (Netherlands)

    J.H. Groenewoud (Hanny); A. van der Heide (Agnes); B.D. Onwuteaka-Philipsen (Bregje); D.L. Willems (Dick); P.J. van der Maas (Paul); G. van der Wal (Gerrit)

    2000-01-01

    textabstractBACKGROUND AND METHODS: The characteristics and frequency of clinical problems with the performance of euthanasia and physician-assisted suicide are uncertain. We analyzed data from two studies of euthanasia and physician-assisted suicide in The Netherlands

  10. Is Clinical Competence Perceived Differently for Student Daily Performance on the Wards versus Clerkship Grading?

    Science.gov (United States)

    Wimmers, Paul F.; Kanter, Steven L.; Splinter, Ted A. W.; Schmidt, Henk G.

    2008-01-01

    Clinical rotations play an important role in the medical curriculum and are considered crucial for student learning. However, competencies that should be learned can differ from those that are assessed. In order to explore which competencies are considered important for daily performance of student on the wards and to what extent clinical teachers…

  11. Poorly Performing Physicians: Does the Script Concordance Test Detect Bad Clinical Reasoning?

    Science.gov (United States)

    Goulet, Francois; Jacques, Andre; Gagnon, Robert; Charlin, Bernard; Shabah, Abdo

    2010-01-01

    Introduction: Evaluation of poorly performing physicians is a worldwide concern for licensing bodies. The College des Medecins du Quebec currently assesses the clinical competence of physicians previously identified with potential clinical competence difficulties through a day-long procedure called the Structured Oral Interview (SOI). Two peer…

  12. Clinical Observed Performance Evaluation: A Prospective Study in Final Year Students of Surgery

    Science.gov (United States)

    Markey, G. C.; Browne, K.; Hunter, K.; Hill, A. D.

    2011-01-01

    We report a prospective study of clinical observed performance evaluation (COPE) for 197 medical students in the pre-qualification year of clinical education. Psychometric quality was the main endpoint. Students were assessed in groups of 5 in 40-min patient encounters, with each student the focus of evaluation for 8 min. Each student had a series…

  13. Impact of tDCS on Performance and Learning of Target Detection: Interaction with Stimulus Characteristics and Experimental Design

    Science.gov (United States)

    Coffman, B. A.; Trumbo, M. C.; Flores, R. A.; Garcia, C. M.; van der Merwe, A. J.; Wassermann, E. M.; Weisend, M. P.; Clark, V. P.

    2012-01-01

    We have previously found that transcranial direct current stimulation (tDCS) over right inferior frontal cortex (RIFC) enhances performance during learning of a difficult visual target detection task (Clark et al., 2012). In order to examine the cognitive mechanisms of tDCS that lead to enhanced performance, here we analyzed its differential…

  14. Study of the Relationship Between Nurse Self-Concept and Clinical Performance Among Nursing Students

    Directory of Open Access Journals (Sweden)

    Badiyepeymaie Jahromi

    2015-09-01

    Full Text Available Background Scholars believe that if nursing students appreciate the value of their services, their sense of professionalism will increase and performance will improve. Nevertheless, little is known about the relationship between nursing students’ professional self-concept and clinical performance. Objectives This study examines the relationship between nurse self-concept and clinical performance among nursing students. Patients and Methods This cross-sectional analytical study employed the census method. The sample comprised 86 senior and junior nursing students at Jahrom university of medical sciences. Nurse self-concept and clinical performance were measured by using the nurses’ self-concept questionnaire (NSCQ, and the 6-dimension scale of nurse performance (6-DSNP, respectively. Results The mean and standard deviation of nurse self-concept and clinical performance scores were 5.46 ± 1.11 and 2.94 ± 1.45, respectively. Nurse self-concept was related to clinical performance (r = 0.24, P = 0.02. Total NSCQ scores were significantly related to four of the 6-DSNP dimensions: planning and evaluation, interpersonal relations and communication, critical care, and leadership. Conclusions Attempts should be made to enhance students’ nurse self-concept during their education. Counseling, improving public respect for nurses, and implementing measures to enhance students’ professional self-concept are essential for improving their performance.

  15. Grading the performance of clinical skills: lessons to be learned from the performing arts.

    Science.gov (United States)

    Roberts, Deborah

    2011-08-01

    The drift towards competency based nurse interventions has seen a growth in concern regarding the most appropriate methods of assessment of such competencies. Nurse educators and practitioners alike are struggling with the concept of measuring the performance of nursing skills; due to an uneasy relationship between competence, capability, intuition and expertise. Different currencies of value may be ascribed to the assessment of nursing practice, resulting in the use of subjective judgements together with the development of assessment criteria which have different weightings, depending on the values of the assessor. Within the performing arts, students' practice performance is also assessed, with seemingly many similarities between applying value to performance in dance or theatre and nursing. Within performing arts assessment a balancing act is also being played out between academic education and professional training (where complex performances are notoriously hard to evaluate). This paper explores the nature of assessment within the performing arts and makes suggestions regarding their application within the context of nurse education. If nursing is indeed a blend of art and science, then it seems sensible to look to the performing arts to see if lessons could be learned.

  16. Determining the lymph node clinical target volume of upper esophageal carcinoma with computed tomography

    Directory of Open Access Journals (Sweden)

    Li Minghuan

    2013-01-01

    Full Text Available Radiation is an important modality for cervical and upper-thoracic esophageal squamous cell carcinoma (ESCC. Delineating the lymph node clinical target volume (CTVn for EC remains a challenging task. The present paper retrospectively analyzes the distribution of affected lymph nodes of cervical and upper thoracic ESCC on CT images to provide a reference for determination of CTVn. The cases of untreated cervical or upper-thoracic ESCC patients with regional lymph node metastases at diagnosis were retrospectively analyzed. CT scans were done to assess the extent of circumferential involvement and the local-regional lymph node status. Based on the CT criteria (cervical, mediastinal and upper abdominal lymph nodes were considered to be positive for malignancy when they were larger than 8-12 mm in short-axis diameter according to different station respectively. Detailed lymph node stations were recorded for every case and the distribution information of loco-regional node metastasis for these patients was analyzed. A total of 256 patients were diagnosed with node metastasis and qualified for the study, including 206 men and 50 women (age range 37-85 years, median 60. This included 205 upper thoracic cases and 51 of cervical lesion. The length of the primary tumors ranged from 1.0 cm to 9.0 cm, median 4.5 cm. The size of the enlarged lymph nodes ranged from 0.8 to 5.0 cm median 1.4 cm, mean 1.61 cm. The number of involved stations ranged from 1 to 7 median 2. The lymph node stations, with an involved probability of 10% or more, included the upper and middle neck, supraclavicular and lower neck, upper paraesophageal and upper paratracheal area for cervical lesions, and the supraclavicular and lower neck, upper paraesophageal, upper paratracheal, lower paratracheal, aortopulmonary and subcarinal areas for upper thoracic EC, respectively. The mid-upper neck nodes were more likely to be involved in cervical EC than thoracic EC (X 2 test, p=0.000. Fewer

  17. Survey and visual detection of Zaire ebolavirus in clinical samples targeting the nucleoprotein gene in Sierra Leone

    Directory of Open Access Journals (Sweden)

    Jing Yuan

    2015-12-01

    Full Text Available Ebola virus (EBOV can lead to severe hemorrhagic fever with a high risk of death in humans and other primates. To guide treatment and prevent spread of the viral infection, a rapid and sensitive detection method is required for clinical samples. Here, we described and evaluated a reverse transcription loop-mediated isothermal amplification (RT-LAMP method to detect Zaire ebolavirus using the nucleoprotein gene (NP as a target sequence. Two different techniques were used, a calcein/Mn2+ complex chromogenic method and real-time turbidity monitoring. The RT-LAMP assay detected the NP target sequence with a limit of 4.56 copies/μL within 45 min under 61°C, a similar even or increase in sensitivity than that of real-time reverse transcription-polymerase chain reaction (RT-PCR. Additionally, all pseudoviral particles or non- Zaire EBOV genomes were negative for LAMP detection, indicating that the assay was highly specific for EBOV. To appraise the availability of the RT-LAMP method for use in clinical diagnosis of EBOV, of 417 blood or swab samples collected from patients with clinically suspected infections in Sierra Leone, 307 were identified for RT-LAMP-based surveillance of EBOV. Therefore, the highly specific and sensitive RT-LAMP method allows the rapid detection of EBOV, and is a suitable tool for clinical screening, diagnosis, and primary quarantine purposes.

  18. Improving mapping and SNP-calling performance in multiplexed targeted next-generation sequencing

    Directory of Open Access Journals (Sweden)

    ElSharawy Abdou

    2012-08-01

    Full Text Available Abstract Background Compared to classical genotyping, targeted next-generation sequencing (tNGS can be custom-designed to interrogate entire genomic regions of interest, in order to detect novel as well as known variants. To bring down the per-sample cost, one approach is to pool barcoded NGS libraries before sample enrichment. Still, we lack a complete understanding of how this multiplexed tNGS approach and the varying performance of the ever-evolving analytical tools can affect the quality of variant discovery. Therefore, we evaluated the impact of different software tools and analytical approaches on the discovery of single nucleotide polymorphisms (SNPs in multiplexed tNGS data. To generate our own test model, we combined a sequence capture method with NGS in three experimental stages of increasing complexity (E. coli genes, multiplexed E. coli, and multiplexed HapMap BRCA1/2 regions. Results We successfully enriched barcoded NGS libraries instead of genomic DNA, achieving reproducible coverage profiles (Pearson correlation coefficients of up to 0.99 across multiplexed samples, with Conclusions We recommend applying our general ‘two-step’ mapping approach for more efficient SNP discovery in tNGS. Our study has also shown the benefit of computing inter-sample SNP-concordances and inspecting read alignments in order to attain more confident results.

  19. [Drug delivery systems to target the anterior segment of the eye: fundamental bases and clinical applications].

    Science.gov (United States)

    Behar-Cohen, F

    2002-05-01

    The development of new drug delivery systems to target the anterior segment of the eye may offer many advantages: to increase the biodisponibility of the drug, to allow the penetration of drug that cannot be formulated as solutions, to obtain constant and sustained drug release, to achieve higher local concentrations without systemic effects, to target more specifically one tissue or cell type, to reduce the frequency of instillation and therefore increase the observance and comfort of the patient while reducing side effects of frequent instillation. Several approaches are developed, aiming to increase the corneal contact time by modified formulation or reservoir systems, or by increasing the tissue permeability using iontophoresis. To date, no ocular drug delivery system is ideal for all purposes. To maximize treatment efficacy, careful evaluation of the specific pathological condition, the targeted Intraocular tissue and the location of the most severe pathology must be made before selecting the method of delivery most suitable for each individual patient.

  20. Strengthening the Role of Ocular Pathology in Clinical Thinking Training Targeting for House Staff

    Institute of Scientific and Technical Information of China (English)

    Yungang Ding; Wenxin Zhang; Xiaohui Liu; Jianxian Lin; Jianliang Zheng; Yongping Li

    2011-01-01

    Ocular pathology serves as one vital branch subject of histopathology, and also as a basic ocular science analysing the pathogenesis of eye disease,the regular pattern of disease progress,and ocular morphology,tissue metabolism and functional changes noted during the onset of ocular diseases.The underlying purpose lies in revealing and investigating the mechanism of such diseases and the nature of lesions,providing essential theoretical evidence to diagnosis and treatment of eye diseases.ocular pathology acts as a bridge connecting basic and clinical medical science1.Clinical ophthalmologists,especially junior house staff,should attach importance to ocular pathology,understand,be familiar with,and master basic knowledge in ocular pathological subject to cultivate sound clinical thinking and analytical ability and to improve comprehensive diagnosis and treatment efficacy in clinical setting.

  1. Metaplastic breast cancer: clinical overview and molecular aberrations for potential targeted therapy.

    Science.gov (United States)

    Abouharb, Sausan; Moulder, Stacy

    2015-03-01

    Metaplastic breast cancer is a rare subtype of invasive mammary carcinoma, with an aggressive behavior and usually poor outcome. Responses to systemic chemotherapy are suboptimal compared to patients with standard invasive ductal carcinoma. Limited data are available in regards to best treatment modalities, including chemotherapy. This review gives an overview of metaplastic breast cancer and its clinical and pathologic characteristics, in addition to treatment strategies, clinical trials, and future directions.

  2. Concepts and targets in triple-negative breast cancer: recent results and clinical implications.

    Science.gov (United States)

    Saha, Poornima; Nanda, Rita

    2016-09-01

    Triple-negative breast cancer (TNBC) is a heterogeneous disease in which tumors are defined by lack of expression of the estrogen receptor (ER), the progesterone receptor (PR), and the human epidermal growth factor receptor 2 (HER2) receptor. No targeted therapies are available for the treatment of TNBC, and chemotherapy remains the standard of care. Gene expression profiling has identified six distinct molecular subtypes of TNBC. The identification of novel targets, coupled with the development of therapies for different subsets of TNBC, holds great promise for the future treatment of this aggressive form of breast cancer. This review focuses on novel therapies in development for the treatment of TNBC.

  3. Using a mesoscale ensemble to predict forecast error and perform targeted observation

    Institute of Scientific and Technical Information of China (English)

    DU Jun; YU Rucong; CUI Chunguang; LI Jun

    2014-01-01

    Using NCEP short range ensemble forecast (SREF) system, demonstrated two fundamental on-going evolu-tions in numerical weather prediction (NWP) are through ensemble methodology. One evolution is the shift from traditional single-value deterministic forecast to flow-dependent (not statistical) probabilistic forecast to address forecast uncertainty. Another is from a one-way observation-prediction system shifting to an in-teractive two-way observation-prediction system to increase predictability of a weather system. In the first part, how ensemble spread from NCEP SREF predicting ensemble-mean forecast error was evaluated over a period of about a month. The result shows that the current capability of predicting forecast error by the 21-member NCEP SREF has reached to a similar or even higher level than that of current state-of-the-art NWP models in predicting precipitation, e.g., the spatial correlation between ensemble spread and absolute fore-cast error has reached 0.5 or higher at 87 h (3.5 d) lead time on average for some meteorological variables. This demonstrates that the current operational ensemble system has already had preliminary capability of predicting the forecast error with usable skill, which is a remarkable achievement as of today. Given the good spread-skill relation, the probability derived from the ensemble was also statistically reliable, which is the most important feature a useful probabilistic forecast should have. The second part of this research tested an ensemble-based interactive targeting (E-BIT) method. Unlike other mathematically-calculated objec-tive approaches, this method is subjective or human interactive based on information from an ensemble of forecasts. A numerical simulation study was performed to eight real atmospheric cases with a 10-member, bred vector-based mesoscale ensemble using the NCEP regional spectral model (RSM, a sub-component of NCEP SREF) to prove the concept of this E-BIT method. The method seems to work most

  4. A review on pro- and anti-angiogenic factors as targets of clinical intervention

    NARCIS (Netherlands)

    Bouis, D; Kusumanto, Y; Meijer, C; Mulder, NH; Hospers, GAP

    2006-01-01

    Angiogenesis plays an important role in physiology and pathology. It is a tightly regulated process, influenced by the microenvironment and modulated by a multitude of pro- and anti-angiogenic factors. A thorough understanding of the angiogenic process may lead to novel therapies to target ischemic

  5. Immunological and Clinical Effects of Vaccines Targeting p53-Overexpressing Malignancies

    NARCIS (Netherlands)

    Vermeij, R.; Leffers, N.; van der Burg, S. H.; Melief, C. J.; Daemen, T.; Nijman, H. W.

    2011-01-01

    Approximately 50% of human malignancies carry p53 mutations, which makes it a potential antigenic target for cancer immunotherapy. Adoptive transfer with p53-specific cytotoxic T-lymphocytes (CTL) and CD4(+) T-helper cells eradicates p53-overexpressing tumors in mice. Furthermore, p53 antibodies and

  6. Cutaneous Adverse Events of Targeted Anticancer Therapy: A Review of Common Clinical Manifestations and Management

    Directory of Open Access Journals (Sweden)

    Pei-Han Kao

    2015-12-01

    The management of these side effects can be categorized into prophylaxis and reactive treatment. Systemic antibiotics and topical corticosteroid could possibly prevent or alleviate symptoms caused by EGFR inhibitors. The prevention of sun exposure is recommended to all patients on targeted therapy, and emollients and lubricants can be used to relieve and improve the hand-foot skin reaction.

  7. Gene therapy for cardiovascular disease: advances in vector development, targeting, and delivery for clinical translation.

    Science.gov (United States)

    Rincon, Melvin Y; VandenDriessche, Thierry; Chuah, Marinee K

    2015-10-01

    Gene therapy is a promising modality for the treatment of inherited and acquired cardiovascular diseases. The identification of the molecular pathways involved in the pathophysiology of heart failure and other associated cardiac diseases led to encouraging preclinical gene therapy studies in small and large animal models. However, the initial clinical results yielded only modest or no improvement in clinical endpoints. The presence of neutralizing antibodies and cellular immune responses directed against the viral vector and/or the gene-modified cells, the insufficient gene expression levels, and the limited gene transduction efficiencies accounted for the overall limited clinical improvements. Nevertheless, further improvements of the gene delivery technology and a better understanding of the underlying biology fostered renewed interest in gene therapy for heart failure. In particular, improved vectors based on emerging cardiotropic serotypes of the adeno-associated viral vector (AAV) are particularly well suited to coax expression of therapeutic genes in the heart. This led to new clinical trials based on the delivery of the sarcoplasmic reticulum Ca(2+)-ATPase protein (SERCA2a). Though the first clinical results were encouraging, a recent Phase IIb trial did not confirm the beneficial clinical outcomes that were initially reported. New approaches based on S100A1 and adenylate cyclase 6 are also being considered for clinical applications. Emerging paradigms based on the use of miRNA regulation or CRISPR/Cas9-based genome engineering open new therapeutic perspectives for treating cardiovascular diseases by gene therapy. Nevertheless, the continuous improvement of cardiac gene delivery is needed to allow the use of safer and more effective vector doses, ultimately bringing gene therapy for heart failure one step closer to reality.

  8. Performances and stability of a 2.4 ton Gd organic liquid scintillator target for antineutrino detection

    CERN Document Server

    Barabanov, I R; Cattadori, C; Danilov, N A; Di Vacri, A; Krilov, Yu S; Ioannucci, L; Yanovich, E A; Aglietta, M; Bonardi, A; Bruno, G; Fulgione, W; Kemp, E; Malguin, A S; Porta, A; Selvi, M

    2008-01-01

    In this work we report the performances and the chemical and physical properties of a (2 x 1.2) ton organic liquid scintillator target doped with Gd up to ~0.1%, and the results of a 2 year long stability survey. In particular we have monitored the amount of both Gd and primary fluor actually in solution, the optical and fluorescent properties of the Gd-doped liquid scintillator (GdLS) and its performances as a neutron detector, namely neutron capture efficiency and average capture time. The experimental survey is ongoing, the target being continuously monitored. After two years from the doping time the performances of the Gd-doped liquid scintillator do not show any hint of degradation and instability; this conclusion comes both from the laboratory measurements and from the "in-tank" measurements. This is the largest stable Gd-doped organic liquid scintillator target ever produced and continuously operated for a long period.

  9. 77 FR 30016 - Clinical Study Design and Performance of Hospital Glucose Sensors

    Science.gov (United States)

    2012-05-21

    ... Sensors AGENCY: Food and Drug Administration, HHS. ACTION: Notice of public meeting; request for comments... Study Design and Performance of Hospital Glucose Sensors.'' The purpose of this public meeting is to discuss clinical study design considerations and performance metrics for innovative glucose...

  10. The Relationship between Emotional Intelligence, Self-Efficacy, and Clinical Performance in Associate Degree Nursing Students

    Science.gov (United States)

    Rice, Eileen W.

    2013-01-01

    The purpose of this study was to explore self-efficacy, an individual's beliefs about his or her ability to perform a series of tasks, and emotional intelligence, an individual's ability to perceive, use, understand, and manage emotions, as predictors for successful clinical performance in nursing students. The participants were 49 female and 7…

  11. Attainment of multifactorial treatment targets among the elderly in a lipid clinic

    Institute of Scientific and Technical Information of China (English)

    Fotios Barkas; Evangelos Liberopoulos; Eleftherios Klouras; Angelos Liontos; Moses Elisaf

    2015-01-01

    Objective To examine target attainment of lipid-lowering, antihypertensive and antidiabetic treatment in the elderly in a specialist set-ting of a University Hospital in Greece. Methods This was a retrospective study including consecutive subjects≥65 years old (n=465) with a follow-up ≥ 3 years. Low-density lipoprotein cholesterol (LDL-C), blood pressure (BP) and glycated hemoglobin (HbA1c) goal achievement were recorded according to European Society of Cardiology/European Atherosclerosis Society (ESC/EAS), European Society of Hypertension (ESH)/ESC and European Association for the Study of Diabetes (EASD) guidelines. Results The LDL-C targets were attained by 27%, 48%and 62%of very high, high and moderate risk patients, respectively. Those receiving statin+ezetimibe achieved higher rates of LDL-C goal achievement compared with those receiving statin monotherapy (48%vs. 33%, P<0.05). Of the diabetic sub-jects, 71%had BP<140/85 mmHg, while 78%of those without diabetes had BP<140/90 mmHg. A higher proportion of the non-diabetic individuals (86%) had BP<150/90 mmHg. Also, a higher proportion of those with diabetes had HbA1c<8%rather than<7%(88%and 47%, respectively). Of note, almost one out of three non-diabetic individuals and one out of ten diabetic individuals had achieved all three treatment targets. Conclusions Even in a specialist setting of a University Hospital, a high proportion of the elderly remain at suboptimal LDL-C, BP and HbA1c levels. The use of drug combinations could improve multifactorial treatment target attainment, while less strict tar-gets could be more easily achieved in this population.

  12. A review on two previous divertor target concepts for DEMO: mutual impact between structural design requirements and materials performance

    Science.gov (United States)

    You, Jeong-Ha

    2015-09-01

    Development of a diverter target with a sufficient capability of power exhaust is a crucial prerequisite for the realization of a fusion power plant. While the design and technology for divertor target has been successfully developed for ITER, the applicability of this concept is not necessarily assured yet for DEMO mainly because the neutron irradiation dose expected for the DEMO divertor will be an order of magnitude higher than that of the ITER divertor. The possible embrittlement of structural heat sink materials due to irradiation is likely to restrict the structural performance and the operational flexibility of a target component to a considerable extent. For judgment of design feasibility of a target concept a quantitative evaluation of the thermal and structure mechanical performance is needed. In this article, a review on two representative target design concepts considered for the DEMO divertor is presented. Emphasis is put on the mutual impact between the design requirements and the performance of structural materials. Water-cooled and helium-cooled concepts are discussed considering two baseline heat sink materials, CuCrZr alloy and tungsten, respectively. Conclusions are derived from the critical features of the heat sink performance in terms of structural reliability, design/material interface and further R&D needs.

  13. REAL TIME PCR IDENTIFICATION FOR TARGET ADJUNCTIVE ANTIBIOTIC THERAPY OF SEVERE CHRONIC PERIODONTITIS. PART I - CLINICAL RESULTS.

    Directory of Open Access Journals (Sweden)

    Kamen Kotsilkov

    2014-10-01

    Full Text Available INTRODUCTION: The periodontal pathology is of great social importance due to the vast distribution in the human population. The adjunctive antibiotic administration could improve the healing in such cases but the latest data of the continuingly growing antibiotic resistance requires more precise approaches of antibiotic selection. The contemporary molecular diagnostic methods could offer the required precision for the microbiological identification in order to achieve better control of the periodontitis. OBJECTIVE: The aim of this study is to compare the microbiological effectiveness of adjunctive antibiotic administration with the mechanical periodontal therapy. METHODS: 30 patients with severe chronic periodontitis were enrolled in this study and were divided in 3 groups: Control group – with mechanical debridement only. Test group 1 – with combined adjunctive antibiotic administration using Amoxicillin+ Metronidazole. Test group 2 – with target antibiotic administration according to the resuts from the Real Time PCR identification. RESULTS: A considerable improvement of the periodontal status was reported in all treatment groups. The most positive results were in the group with target antibiotic administration were all tested clinical parameters showed the best improvement with statistically significant changes in sites with PD7mm and CAL>5mm. CONCLUSION: The adjunctive antibiotic administration demonstrates better clinical effectiveness concerning the reduction of the severely affected sites in cases with severe generalized chronic periodontitis compared to the mechanical therapy alone. From all examined groups the target approach has statistically significant better results. These results suggest that this approach is recommended in cases with high prevalence of deep pockets.

  14. Target Area design basis and system performance for the National Ignition Facility. Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    Tobin, M.; Karpenko, V.; Hagans, K.; Anderson, A.; Latkowski, J.; Warren, R. [Lawrence Livermore National Lab., CA (United States); Wavrik, R.; Garcia, R.; Boyes, J. [Sandia National Labs., Albuquerque, NM (United States)

    1994-10-01

    The NIF Target Area is designed to confine the ICF target experiments leading up to and including fusion ignition and gain. The Target Area will provide appropriate in-chamber conditions before, during, and after each shot. The repeated introduction of large amounts of laser energy into the chamber and emission of fusion energy from targets represents a new challenge in ICF facility design. Prior to a shot, the facility provides proper illumination geometry, target chamber vacuum, and a stable platform for the target and its diagnostics. During a shot, the impact of the energy introduced into the chamber is minimized, and workers and the public are protected from excessive prompt radiation doses. After the shot, the residual radioactivation is managed to allow required accessibility. Tritium and other radioactive wastes are confined and disposed of. Diagnostic data is also retrieved, and the facility is readied for the next shot. The Target Area will accommodate yields up to 20 MJ, and its design lifetime is 30 years. The Target Area provides the personnel access needed to support the use precision diagnostics. The annual shot mix for design purposes is shown. Designing to this experimental envelope ensures the ability and flexibility to move through the experimental campaign to ignition efficiently.

  15. Spatial facilitation by a high-performance dragonfly target-detecting neuron.

    Science.gov (United States)

    Nordström, Karin; Bolzon, Douglas M; O'Carroll, David C

    2011-08-23

    Many animals visualize and track small moving targets at long distances-be they prey, approaching predators or conspecifics. Insects are an excellent model system for investigating the neural mechanisms that have evolved for this challenging task. Specialized small target motion detector (STMD) neurons in the optic lobes of the insect brain respond strongly even when the target size is below the resolution limit of the eye. Many STMDs also respond robustly to small targets against complex stationary or moving backgrounds. We hypothesized that this requires a complex mechanism to avoid breakthrough responses by background features, and yet to adequately amplify the weak signal of tiny targets. We compared responses of dragonfly STMD neurons to small targets that begin moving within the receptive field with responses to targets that approach the same location along longer trajectories. We find that responses along longer trajectories are strongly facilitated by a mechanism that builds up slowly over several hundred milliseconds. This allows the neurons to give sustained responses to continuous target motion, thus providing a possible explanation for their extraordinary sensitivity.

  16. Translating Research on Myoelectric Control into Clinics-Are the Performance Assessment Methods Adequate?

    Science.gov (United States)

    Vujaklija, Ivan; Roche, Aidan D; Hasenoehrl, Timothy; Sturma, Agnes; Amsuess, Sebastian; Farina, Dario; Aszmann, Oskar C

    2017-01-01

    Missing an upper limb dramatically impairs daily-life activities. Efforts in overcoming the issues arising from this disability have been made in both academia and industry, although their clinical outcome is still limited. Translation of prosthetic research into clinics has been challenging because of the difficulties in meeting the necessary requirements of the market. In this perspective article, we suggest that one relevant factor determining the relatively small clinical impact of myocontrol algorithms for upper limb prostheses is the limit of commonly used laboratory performance metrics. The laboratory conditions, in which the majority of the solutions are being evaluated, fail to sufficiently replicate real-life challenges. We qualitatively support this argument with representative data from seven transradial amputees. Their ability to control a myoelectric prosthesis was tested by measuring the accuracy of offline EMG signal classification, as a typical laboratory performance metrics, as well as by clinical scores when performing standard tests of daily living. Despite all subjects reaching relatively high classification accuracy offline, their clinical scores varied greatly and were not strongly predicted by classification accuracy. We therefore support the suggestion to test myocontrol systems using clinical tests on amputees, fully fitted with sockets and prostheses highly resembling the systems they would use in daily living, as evaluation benchmark. Agreement on this level of testing for systems developed in research laboratories would facilitate clinically relevant progresses in this field.

  17. Mechanistic validation of a clinical lead stapled peptide that reactivates p53 by dual HDM2 and HDMX targeting.

    Science.gov (United States)

    Wachter, F; Morgan, A M; Godes, M; Mourtada, R; Bird, G H; Walensky, L D

    2016-10-10

    Hydrocarbon-stapled peptides that display key residues of the p53 transactivation domain have emerged as bona fide clinical candidates for reactivating the tumor suppression function of p53 in cancer by dual targeting of the negative regulators HDM2 and HDMX. A recent study questioned the mechanistic specificity of such stapled peptides based on interrogating their capacity to disrupt p53/HDM2 and p53/HDMX complexes in living cells using a new recombinase enhanced bimolecular luciferase complementation platform (ReBiL). Here, we directly evaluate the cellular uptake, intracellular targeting selectivity and p53-dependent cytotoxicity of the clinical prototype ATSP-7041. We find that under standard serum-containing tissue culture conditions, ATSP-7041 achieves intracellular access without membrane disruption, dose-dependently dissociates both p53/HDM2 and p53/HDMX complexes but not an unrelated protein complex in long-term ReBiL experiments, and is selectively cytotoxic to cancer cells bearing wild-type p53 by inducing a surge in p53 protein level. These studies underscore the importance of a thorough stepwise approach, including consideration of the time-dependence of cellular uptake and intracellular distribution, in evaluating and advancing stapled peptides for clinical translation.Oncogene advance online publication, 10 October 2016; doi:10.1038/onc.2016.361.

  18. Targeted testing with diethylthiourea often reveals clinically relevant allergic contact dermatitis caused by neoprene rubber

    DEFF Research Database (Denmark)

    Dall, Anne B-H; Andersen, Klaus Ejner; Mortz, Charlotte G

    2012-01-01

    Background. Diethylthiourea is widely used in the rubber industry, particularly in neoprene rubber, and may cause allergic contact dermatitis. However, as thiourea allergens are not part of the European baseline series, the diagnosis of allergic contact dermatitis caused by thiourea compounds......, and positive reactions were found in 15% (13/88). Thus, 15% (37/239) had positive patch test reactions to diethylthiourea, all with current clinical relevance and all strong. Conclusion. Clinical suspicion of neoprene rubber allergy and subsequent aimed patch testing with diethylthiourea give a high yield...

  19. FY2014 FES (Fusion Energy Sciences) Theory & Simulation Performance Target, Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Fu, Guoyong [Princeton Plasma Physics Lab. (PPPL), Princeton, NJ (United States); Budny, Robert [Princeton Plasma Physics Lab. (PPPL), Princeton, NJ (United States); Gorelenkov, Nikolai [Princeton Plasma Physics Lab. (PPPL), Princeton, NJ (United States); Poli, Francesca [Princeton Plasma Physics Lab. (PPPL), Princeton, NJ (United States); Chen, Yang [Univ. of Colorado, Boulder, CO (United States); McClenaghan, Joseph [Univ. of California, Irvine, CA (United States); Lin, Zhihong [Univ. of California, Irvine, CA (United States); Spong, Don [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Bass, Eric [Univ. of California, San Diego, CA (United States); Waltz, Ron [General Atomics, San Diego, CA (United States)

    2014-10-14

    We report here the work done for the FY14 OFES Theory Performance Target as given below: "Understanding alpha particle confinement in ITER, the world's first burning plasma experiment, is a key priority for the fusion program. In FY 2014, determine linear instability trends and thresholds of energetic particle-driven shear Alfven eigenmodes in ITER for a range of parameters and profiles using a set of complementary simulation models (gyrokinetic, hybrid, and gyrofluid). Carry out initial nonlinear simulations to assess the effects of the unstable modes on energetic particle transport". In the past year (FY14), a systematic study of the alpha-driven Alfven modes in ITER has been carried out jointly by researchers from six institutions involving seven codes including the transport simulation code TRANSP (R. Budny and F. Poli, PPPL), three gyrokinetic codes: GEM (Y. Chen, Univ. of Colorado), GTC (J. McClenaghan, Z. Lin, UCI), and GYRO (E. Bass, R. Waltz, UCSD/GA), the hybrid code M3D-K (G.Y. Fu, PPPL), the gyro-fluid code TAEFL (D. Spong, ORNL), and the linear kinetic stability code NOVA-K (N. Gorelenkov, PPPL). A range of ITER parameters and profiles are specified by TRANSP simulation of a hybrid scenario case and a steady-state scenario case. Based on the specified ITER equilibria linear stability calculations are done to determine the stability boundary of alpha-driven high-n TAEs using the five initial value codes (GEM, GTC, GYRO, M3D-K, and TAEFL) and the kinetic stability code (NOVA-K). Both the effects of alpha particles and beam ions have been considered. Finally, the effects of the unstable modes on energetic particle transport have been explored using GEM and M3D-K.

  20. FY2014 FES (Fusion Energy Sciences) Theory & Simulation Performance Target, Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Fu, Guoyong [Princeton Plasma Physics Lab. (PPPL), Princeton, NJ (United States); Budny, Robert [Princeton Plasma Physics Lab. (PPPL), Princeton, NJ (United States); Gorelenkov, Nikolai [Princeton Plasma Physics Lab. (PPPL), Princeton, NJ (United States); Poli, Francesca [Princeton Plasma Physics Lab. (PPPL), Princeton, NJ (United States); Chen, Yang [Univ. of Colorado, Boulder, CO (United States); McClenaghan, Joseph [Univ. of California, Irvine, CA (United States); Lin, Zhihong [Univ. of California, Irvine, CA (United States); Spong, Don [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Bass, Eric [Univ. of California, San Diego, CA (United States); Waltz, Ron [General Atomics, San Diego, CA (United States)

    2014-10-14

    We report here the work done for the FY14 OFES Theory Performance Target as given below: "Understanding alpha particle confinement in ITER, the world's first burning plasma experiment, is a key priority for the fusion program. In FY 2014, determine linear instability trends and thresholds of energetic particle-driven shear Alfven eigenmodes in ITER for a range of parameters and profiles using a set of complementary simulation models (gyrokinetic, hybrid, and gyrofluid). Carry out initial nonlinear simulations to assess the effects of the unstable modes on energetic particle transport". In the past year (FY14), a systematic study of the alpha-driven Alfven modes in ITER has been carried out jointly by researchers from six institutions involving seven codes including the transport simulation code TRANSP (r. Budny and F. Poli, PPPL), three gyrokinetic codes: GEM (Y. Chen, Univ. of Colorado), GTC (J. McClenaghan, Z. Lin, UCI), and GYRO (E. Bass, R. Waltz, UCSD/GA), the hybrid code M3D-K (G.Y. Fu, PPPL), the gyro-fluid code TAEFL (D. Spong, ORNL), and the linear kinetic stability code NOVA-K (N. Gorelenkov, PPPL). A range of ITER parameters and profiles are specified by TRANSP simulation of a hybrid scenario case and a steady state scenario case. Based on the specified ITER equilibria linear stability calculations are done to determine the stability boundary of alpha-driven high-n TAEs using the five initial value codes (GEM, GTC, GYRO, M3D-K, and TAEFL) and the kinetic stability code (NOVA-K). Both the effects of alpha particles and beam ions have been considered. Finally the effects of the unstable modes on energetic particle transport have been explored using GEM and M3D-K.

  1. Potential clinical insights into microRNAs and their target genes in esophageal carcinoma.

    Science.gov (United States)

    Li, Su Q; Wang, He M; Cao, Xiu F

    2011-12-01

    Esophageal carcinoma (EC) are characterized by dysregulation of microRNAs, which play an important roles as a posttranscriptional regulators in protein synthesis, and are involved in cellular processes, such as proliferation, apoptosis, and differentiation. Recently, altered miRNAs expression has been comprehensively studied in EC by high-throughput technology. Increased understanding of miRNAs target genes and their potential regulatory mechanisms have clarified the miRNAs activities and may provide exciting opportunities for cancer diagnosis and miRNA-based genetherapy. Here, we reviewed the most recently discovered miRNA target genes, with particular emphasis on the deciphering of their possible mechanisms and the potential roles in miRNAs-based tumour therapeutics.

  2. Clinical Development of Gamitrinib, a Novel Mitochondrial-Targeted Small Molecule Hsp90 Inhibitor

    Science.gov (United States)

    2015-09-01

    trophoblast, an actively invasive tissue at the interface between fetal and maternal circulation [30], whereas expression of this molecule in the adult...chondrial survivin (3). Furthermore, reconstitution of survivin-depleted PC3 cells with adenovirus ( pAd ) encoding mitochondrial-targeted survivin (3... pAd - mt-SVV) stimulated O2 consumption (Fig. 2G). In contrast, PC3 cells transfected with nontargeting siRNA and reconstituted with pAd -mt-survivin

  3. Role of Clinical Pharmacology in the Development and Approval of Immunotherapies Targeting Immune Checkpoints.

    Science.gov (United States)

    Rahman, A

    2016-12-01

    Immune surveillance plays a critical role in preventing the development and progression of cancer. Immune modulators, such as interferon-gamma or interleukin-2, have been a part of the cancer treatment armament over the past few decades. However, new understandings regarding the role of the costimulatory and coinhibitory molecules associated with T-cells and antigen-presenting cells as well as tumor necrosis factor receptors and ligands have ushered the new era of immunotherapy for cancer treatment. We now know that primary cancer cells evade screening by the innate immune system, proliferate, and form metastases by upregulating immune inhibitory pathways referred to as immune checkpoints. The recent development of therapies that target immune checkpoints, such as cytotoxic T lymphocyte antigen 4, programmed cell death 1, programmed cell death ligand 1, indoleamine 2,3-dioxygenase, T-cell immunoglobulin and mucin domain 3, and lymphocyte activation gene 3 precisely target the immune system and give new hope for treating various types of cancer. In select marker-enriched populations, immunotherapies provide high response rates as well as durable responses in terms of progression-free survival and overall survival. Numerous factors, such as patient's immune system, the expression of targets on both immune and cancer cells, maintenance of an effective drug exposure, and tolerability to these agents may play a role in this unique observation.

  4. Recurrence pattern of squamous cell carcinoma in the midthoracic esophagus: implications for the clinical target volume design of postoperative radiotherapy

    Directory of Open Access Journals (Sweden)

    Wang X

    2016-10-01

    stations 2, 4, 5, and 7 LNs should be delineated as clinical target volume of postoperative prophylactic irradiation, and upper abdominal LNs should be excluded. While for midthoracic ESCC with three or more positive nodes, upper abdominal LNs should also be included. The length of tumor and histological differentiation should be considered comprehensively to design the clinical target volume for radiotherapy. Keywords: esophagus cancer, radiotherapy, recurrence and metastasis, clinical target volume

  5. Impacts of Refraction Index Mismatch on Performance of Target Detection and Imaging by Using Flat LHM Lens

    Institute of Scientific and Technical Information of China (English)

    FANG Jie-Ran; GONG Yu; DONG Xiao-Ting; WANG Gang

    2008-01-01

    Refraction index mismatch between flat left-handed metamaterial(LHM)lens and its surrounding medium generally destroys the focusing of flat LHM lens and degrades the performance of near-field target detection by usingflat LHM lens.For LHM lens of refraction index mismatch within±30%,numerical simulations demonstrate that lenses with large refraction index may suffer less resolution degradation than lenses with small refraction index,and the enhancement of refocused microwave backscattered from target can be subsided bly up to approximately 5.5 dB.The refraction index mismatch will also shift the target position in the reconstructed image so that theoretical prediction of target position needs to be modified.

  6. Clinical performance of a light-cured denture base material compared to polymethylmethacrylate--a randomized clinical study.

    Science.gov (United States)

    Gohlke-Wehrße, Hanna-Lena; Giese-Kraft, Katja; Wöstmann, Bernd

    2012-06-01

    The aim of this study was to evaluate the clinical long-term performance of a visible light-cured resin (VLCR) denture base material and to compare it to a well-established polymethylmethacrylate (PMMA)-based denture acrylic in a randomized split-mouth clinical long-term study. One hundred removable partial dentures in 90 patients, with at least two saddles each, were investigated. One saddle was made of VLCR, while the other was made of PMMA at random. Plaque adhesion, tissue reaction, and technical parameters of the dentures were assessed 6, 12, and 18 months after treatment. Statistical analysis was performed using the Wilcoxon rank-sum test. Though VLCR showed higher plaque adhesion than PMMA after 6, 12, and 18 months (p denture acrylic and metal and the boundary between denture acrylic and denture tooth PMMA was rated higher than VLCR. The surface quality of the upper side of the denture saddles showed no significant differences (p > 0.05). Neither VLCR nor PMMA showed discoloration at any point in time (p > 0.05). It can be concluded that VLCR is a viable alternative for the production of removable dentures. Especially in patients with hypersensitivities to PMMA, VLCR is particularly suitable for clinical use.

  7. Quality Research in Radiation Oncology Analysis of Clinical Performance Measures in the Management of Gastric Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Goodman, Karyn A., E-mail: goodmank@mskcc.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Khalid, Najma [Quality Research in Radiation Oncology, American College of Radiology Clinical Research Center, Philadelphia, Pennsylvania (United States); Kachnic, Lisa A. [Department of Radiation Oncology, Boston University Medical Center, Boston, Massachusetts (United States); Minsky, Bruce D. [Department of Radiation Oncology, University of Texas MD, Anderson Cancer Center, Houston, Texas (United States); Crozier, Cheryl; Owen, Jean B. [Quality Research in Radiation Oncology, American College of Radiology Clinical Research Center, Philadelphia, Pennsylvania (United States); Devlin, Phillip M. [Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women' s Hospital, Boston, Massachusetts (United States); Thomas, Charles R. [Department of Radiation Medicine, Knight Cancer Institute at the Oregon Health and Science University, Portland, Oregon (United States)

    2013-02-01

    Background: The specific aim was to determine national patterns of radiation therapy (RT) practice in patients treated for stage IB-IV (nonmetastatic) gastric cancer (GC). Methods and Materials: A national process survey of randomly selected US RT facilities was conducted which retrospectively assessed demographics, staging, geographic region, practice setting, and treatment by using on-site record review of eligible GC cases treated from 2005 to 2007. Three clinical performance measures (CPMs), (1) use of computed tomography (CT)-based treatment planning; (2) use of dose volume histograms (DVHs) to evaluate RT dose to the kidneys and liver; and (3) completion of RT within the prescribed time frame; and emerging quality indicators, (i) use of intensity modulated RT (IMRT); (ii) use of image-guided tools (IGRT) other than CT for RT target delineation; and (iii) use of preoperative RT, were assessed. Results: CPMs were computed for 250 eligible patients at 45 institutions (median age, 62 years; 66% male; 60% Caucasian). Using 2000 American Joint Committee on Cancer criteria, 13% of patients were stage I, 29% were stage II, 32% were stage IIIA, 10% were stage IIIB, and 12% were stage IV. Most patients (43%) were treated at academic centers, 32% were treated at large nonacademic centers, and 25% were treated at small to medium sized facilities. Almost all patients (99.5%) underwent CT-based planning, and 75% had DVHs to evaluate normal tissue doses to the kidneys and liver. Seventy percent of patients completed RT within the prescribed time frame. IMRT and IGRT were used in 22% and 17% of patients, respectively. IGRT techniques included positron emission tomography (n=20), magnetic resonance imaging (n=1), respiratory gating and 4-dimensional CT (n=22), and on-board imaging (n=10). Nineteen percent of patients received preoperative RT. Conclusions: This analysis of radiation practice patterns for treating nonmetastatic GC indicates widespread adoption of CT

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

    OpenAIRE

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

    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 p...

  9. Developing clinical practice guidelines: target audiences, identifying topics for guidelines, guideline group composition and functioning and conflicts of interest.

    Science.gov (United States)

    Eccles, Martin P; Grimshaw, Jeremy M; Shekelle, Paul; Schünemann, Holger J; Woolf, Steven

    2012-07-04

    Clinical practice guidelines are one of the foundations of efforts to improve health care. In 1999, we authored a paper about methods to develop guidelines. Since it was published, the methods of guideline development have progressed both in terms of methods and necessary procedures and the context for guideline development has changed with the emergence of guideline clearing houses and large scale guideline production organisations (such as the UK National Institute for Health and Clinical Excellence). It therefore seems timely to, in a series of three articles, update and extend our earlier paper. In this first paper we discuss: the target audience(s) for guidelines and their use of guidelines; identifying topics for guidelines; guideline group composition (including consumer involvement) and the processes by which guideline groups function and the important procedural issue of managing conflicts of interest in guideline development.

  10. Developing clinical practice guidelines: target audiences, identifying topics for guidelines, guideline group composition and functioning and conflicts of interest

    Directory of Open Access Journals (Sweden)

    Eccles Martin P

    2012-07-01

    Full Text Available Abstract Clinical practice guidelines are one of the foundations of efforts to improve health care. In 1999, we authored a paper about methods to develop guidelines. Since it was published, the methods of guideline development have progressed both in terms of methods and necessary procedures and the context for guideline development has changed with the emergence of guideline clearing houses and large scale guideline production organisations (such as the UK National Institute for Health and Clinical Excellence. It therefore seems timely to, in a series of three articles, update and extend our earlier paper. In this first paper we discuss: the target audience(s for guidelines and their use of guidelines; identifying topics for guidelines; guideline group composition (including consumer involvement and the processes by which guideline groups function and the important procedural issue of managing conflicts of interest in guideline development.

  11. CLINICAL EXPERIENCE WITH USTEKINUMAB IN THE TREATMENT OF EARLY PSORIATIC ARTHRITIS USING TREAT-TO-TARGET STRATEGY

    Directory of Open Access Journals (Sweden)

    E. Yu. Loginova

    2015-01-01

    Full Text Available The new Treat-to-Target (T2T strategy in the treatment of early psoriatic arthritis (PsA is aimed at achieving remission or low disease activity. As of now, the new biological agent ustekinumb (UST, anti-interleukin (IL 12/23 monoclonal antibodies, was used to treat psoriasis and PsA. The paper presents clinical observations of the efficacy of UST in early PsA treated according T2T strategy. The described clinical cases demonstrate that use of UST 45 mg both alone and in combination with methotrexate for early PsA with moderate and high activity reduced manifestations of peripheral arthritis and psoriasis, promoting rapid achievement of remission or minimal disease activity. Overall, UST is well tolerated by the patients.

  12. Vascular-targeted photodynamic of prostate cancer phase with Tookad for recurrent prostate cancer following radiation therapy: initial clinical studies

    Science.gov (United States)

    Weersink, Robert A.; Wilson, Brian C.; Bogaards, Arjen; Gertner, Mark R.; Davidson, Sean R. H.; Haider, Masoom A.; Elhilali, Mostafa; Trachtenberg, John

    2007-02-01

    We report on the first clinical application of vascular-targeted photodynamic therapy using a bacteriopheophorbide derivative, Tookad, in patients with localized prostate cancer following external beam radiation therapy. Patients received either escalating intravenous drug doses at a fixed light dose or escalated light doses at the highest photosensitizer dose. Two cylindrically diffusing fibers were placed transperineally in the prostate, along with light monitoring fibers in the prostate, urethra and rectum. Treatment response was assessed with 7-day gadolinium-enhanced T1-weighted MRI and 6-month biopsy. Lesion formation was strongly drug and light dose-dependent, with an apparent threshold response. Early biochemical and MRI responses support the clinical potential of TOOKAD-PDT to treat locally-recurrent prostate cancer.

  13. Performance of target irradiation in a high-power laser with a continuous phase plate and spectral dispersion.

    Science.gov (United States)

    Jiang, Xiujuan; Li, Jinghui; Wu, Rong; Zhu, Zhengtao; Zhou, Shenlei; Lin, Zunqi

    2013-11-01

    We report on the performance of target irradiation at the SG-II high-power laser facility with a continuous phase plate (CPP) and the technique of smoothing by spectral dispersion (SSD). Simulative and experimental results are presented, where the irradiation uniformity and energy concentration of the target spots are analyzed. The results show that the designed CPP can focus the spot energy into the desired region and shape a profile with steep edge and flat top, but the actual performance of the fabricated CPP needs some improvements. It is also proved that the CPP is insensitive to the long-scale wavefront distortion in the incident beam. The one-dimensional SSD configuration evidently works in smoothing the fine-scale intensity modulation inside the target spot.

  14. Comprehensive molecular pathology analysis of small bowel adenocarcinoma reveals novel targets with potential for clinical utility.

    Science.gov (United States)

    Alvi, Muhammad A; McArt, Darragh G; Kelly, Paul; Fuchs, Marc-Aurel; Alderdice, Matthew; McCabe, Clare M; Bingham, Victoria; McGready, Claire; Tripathi, Shailesh; Emmert-Streib, Frank; Loughrey, Maurice B; McQuaid, Stephen; Maxwell, Perry; Hamilton, Peter W; Turkington, Richard; James, Jacqueline A; Wilson, Richard H; Salto-Tellez, Manuel

    2015-08-28

    Small bowel accounts for only 0.5% of cancer cases in the US but incidence rates have been rising at 2.4% per year over the past decade. One-third of these are adenocarcinomas but little is known about their molecular pathology and no molecular markers are available for clinical use. Using a retrospective 28 patient matched normal-tumor cohort, next-generation sequencing, gene expression arrays and CpG methylation arrays were used for molecular profiling. Next-generation sequencing identified novel mutations in IDH1, CDH1, KIT, FGFR2, FLT3, NPM1, PTEN, MET, AKT1, RET, NOTCH1 and ERBB4. Array data revealed 17% of CpGs and 5% of RNA transcripts assayed to be differentially methylated and expressed respectively (p clinically exploitable markers.

  15. Targeted NGS meets expert clinical characterization: Efficient diagnosis of spastic paraplegia type 11.

    Science.gov (United States)

    Castro-Fernández, Cristina; Arias, Manuel; Blanco-Arias, Patricia; Santomé-Collazo, Luis; Amigo, Jorge; Carracedo, Ángel; Sobrido, Maria-Jesús

    2015-06-01

    Next generation sequencing (NGS) is transforming the diagnostic approach for neurological disorders, since it allows simultaneous analysis of hundreds of genes, even based on just a broad, syndromic patient categorization. However, such an approach bears a high risk of incidental and uncertain genetic findings. We report a patient with spastic paraplegia whose comprehensive neurological and imaging examination raised a high clinical suspicion of SPG11. Thus, although our NGS pipeline for this group of disorders includes gene panel and exome sequencing, in this sample only the spatacsin gene region was captured and subsequently searched for mutations. Two probably pathogenic variants were quickly and clearly identified, confirming the diagnosis of SPG11. This case illustrates how combination of expert clinical characterization with highly oriented NGS protocols leads to a fast, cost-efficient diagnosis, minimizing the risk of findings with unclear significance.

  16. Targeted NGS meets expert clinical characterization: Efficient diagnosis of spastic paraplegia type 11

    Directory of Open Access Journals (Sweden)

    Cristina Castro-Fernández

    2015-06-01

    Full Text Available Next generation sequencing (NGS is transforming the diagnostic approach for neurological disorders, since it allows simultaneous analysis of hundreds of genes, even based on just a broad, syndromic patient categorization. However, such an approach bears a high risk of incidental and uncertain genetic findings. We report a patient with spastic paraplegia whose comprehensive neurological and imaging examination raised a high clinical suspicion of SPG11. Thus, although our NGS pipeline for this group of disorders includes gene panel and exome sequencing, in this sample only the spatacsin gene region was captured and subsequently searched for mutations. Two probably pathogenic variants were quickly and clearly identified, confirming the diagnosis of SPG11. This case illustrates how combination of expert clinical characterization with highly oriented NGS protocols leads to a fast, cost-efficient diagnosis, minimizing the risk of findings with unclear significance.

  17. Toward intracellular targeted delivery of cancer therapeutics: progress and clinical outlook for brain tumor therapy.

    Science.gov (United States)

    Pandya, Hetal; Debinski, Waldemar

    2012-08-01

    A number of anti-cancer drugs have their targets localized to particular intracellular compartments. These drugs reach the targets mainly through diffusion, dependent on biophysical and biochemical forces that allow cell penetration. This means that both cancer cells and normal cells will be subjected to such diffusion; hence many of these drugs, like chemotherapeutics, are potentially toxic and the concentration achieved at the site of their action is often suboptimal. The same relates to radiation that indiscriminately affects normal and diseased cells. However, nature-designed systems enable compounds present in the extracellular environment to end up inside the cell and even travel to more specific intracellular compartments. For example, viruses and bacterial toxins can more or less specifically recognize eukaryotic cells, enter these cells, and direct some protein portions to designated intracellular areas. These phenomena have led to creative thinking, such as employing viruses or bacterial toxins for cargo delivery to cells and, more specifically, to cancer cells. Proteins can be genetically engineered in order to not only mimic what viruses and bacterial toxins can do, but also to add new functions, extending or changing the intracellular routes. It is possible to make conjugates or, more preferably, single-chain proteins that recognize cancer cells and deliver cargo inside the cells, even to the desired subcellular compartment. These findings offer new opportunities to deliver drugs/labels only to cancer cells and only to their site of action within the cells. The development of such dual-specificity vectors for targeting cancer cells is an attractive and potentially safer and more efficacious way of delivering drugs. We provide examples of this approach for delivering brain cancer therapeutics, using a specific biomarker on glioblastoma tumor cells.

  18. Review of novel therapeutic targets for improving heart failure treatment based on experimental and clinical studies

    OpenAIRE

    Bonsu KO; Owusu IK; Buabeng KO; Reidpath DD; Kadirvelu A

    2016-01-01

    Kwadwo Osei Bonsu,1,2 Isaac Kofi Owusu,3 Kwame Ohene Buabeng,4 Daniel Diamond Reidpath,1 Amudha Kadirvelu1 1School of Medicine and Health Sciences, Monash University Sunway Campus, Jalan Lagoon Selatan, Bandar Sunway, Subang Jaya, Selangor, Malaysia; 2Accident and Emergency Directorate, Komfo Anokye Teaching Hospital, 3Department of Medicine, 4Department of Clinical and Social Pharmacy, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana Ab...

  19. Targeting Cognitive Frailty: Clinical and Neurobiological Roadmap for a Single Complex Phenotype.

    Science.gov (United States)

    Panza, Francesco; Seripa, Davide; Solfrizzi, Vincenzo; Tortelli, Rosanna; Greco, Antonio; Pilotto, Alberto; Logroscino, Giancarlo

    2015-01-01

    Late-life cognitive disorders may be prevented by influencing age-related conditions such as frailty, characterized by decreased resistance to stressors and increased risk for adverse health outcomes. In the present review article, we examined clinical and epidemiological studies investigating the possible role of different frailty models in modulating the risk of Alzheimer's disease (AD), dementia, vascular dementia (VaD), mild cognitive impairment (MCI), and late-life cognitive impairment/decline that have been published over the past 3 years. Both deficit accumulation and physical frailty models were associated with late-life cognitive impairment/decline, incident dementia, AD, MCI, VaD, non-AD dementias, and AD pathology, proposing cognitive frailty as a new clinical construct with coexisting physical frailty and cognitive impairment in nondemented older subjects. Two subtypes of this new clinical condition have been recently proposed: "potentially reversible" cognitive frailty and "reversible" cognitive frailty. The physical factors should be physical prefrailty and frailty, while the cognitive impairment of potentially reversible cognitive frailty should be MCI (Clinical Dementia rating Scale = 0.5), while the cognitive impairment of reversible cognitive frailty should be pre-MCI Subjective Cognitive Decline (SCD), as recently proposed by the SCD Initiative Working Group. The mechanisms underlying the cognitive-frailty link are multifactorial and vascular, inflammatory, nutritional, and metabolic influences may be of major relevance. Considering both physical frailty and cognition as a single complex phenotype may be crucial in the prevention of dementia and its subtypes with secondary preventive trials on cognitive frail older subjects.

  20. Evaluating the performance of clinical pharmacy faculty: putting the ACCP template to use.

    Science.gov (United States)

    Schumock, G T; Crawford, S Y; Giusto, D A; Hutchinson, R A

    1993-01-01

    The responsibilities of clinical faculty members are often multifaceted and may include direct patient care, didactic and experiential teaching, research, and administrative duties. Specialization, poorly defined standards of care, and lack of direct supervision have traditionally made performance evaluation difficult. We implemented a method to evaluate clinical faculty as they carried out patient care activities using a revised template for the evaluation of a clinical pharmacist developed by the American College of Clinical Pharmacy Clinical Practice Affairs Committee. In addition, it allows individuals to report and evaluate their own performance in the areas of patient care, instructional activity, university and public service, research and scholarly activities, and administrative duties. Teaching evaluations from clerkship students and residents are also submitted and assessed during the annual interview. To determine the usefulness of the evaluation, including the template, we surveyed the opinions of clinical faculty (nontenured) at four primary practice sites (response rate 92%). Mean scores for responses suggested agreement with statements as to the merits of the evaluation system; however, there was some variation among practice sites. Incorporating the template into a broad evaluation system was effective in facilitating improved job performance and career development. Adaptation of the template may be practice site dependent and should be coordinated by a participative approach. Additional assessment may be facilitated by physician, nurse, or peer evaluation.

  1. Neuronal nicotinic receptors as novel targets for inflammation and neuroprotection:mechanistic considerations and clinical relevance

    Institute of Scientific and Technical Information of China (English)

    Merouane BENGHEKIF

    2009-01-01

    A number of studies have confirmed the potential for neuronal nicotinic acetylcholine receptor (NNR)-mediated neuro- protection and, more recently, its anti-inflammatory effects. The mechanistic overlap between these pathways and the ubiquitous effects observed following diverse insults suggest that NNRs modulate fundamental pathways involved in cell survival. These results have wide-reaching implications for the design of experimental therapeutics that regulate inflamma- tory and anti-apoptotic responses through NNRs and represent an initial step toward understanding the benefits of novel therapeutic strategies for the management of central nervous system disorders that target neuronal survival and associated inflammatory processes.

  2. Students’ performance in the different clinical skills assessed in OSCE: what does it reveal?

    Directory of Open Access Journals (Sweden)

    Joong Hiong Sim

    2015-02-01

    Full Text Available Introduction: The purpose of this study was to compare students’ performance in the different clinical skills (CSs assessed in the objective structured clinical examination. Methods: Data for this study were obtained from final year medical students’ exit examination (n=185. Retrospective analysis of data was conducted using SPSS. Means for the six CSs assessed across the 16 stations were computed and compared. Results: Means for history taking, physical examination, communication skills, clinical reasoning skills (CRSs, procedural skills (PSs, and professionalism were 6.25±1.29, 6.39±1.36, 6.34±0.98, 5.86±0.99, 6.59±1.08, and 6.28±1.02, respectively. Repeated measures ANOVA showed there was a significant difference in the means of the six CSs assessed [F(2.980, 548.332=20.253, p<0.001]. Pairwise multiple comparisons revealed significant differences between the means of the eight pairs of CSs assessed, at p<0.05. Conclusions: CRSs appeared to be the weakest while PSs were the strongest, among the six CSs assessed. Students’ unsatisfactory performance in CRS needs to be addressed as CRS is one of the core competencies in medical education and a critical skill to be acquired by medical students before entering the workplace. Despite its challenges, students must learn the skills of clinical reasoning, while clinical teachers should facilitate the clinical reasoning process and guide students’ clinical reasoning development.

  3. Targeting immune response with therapeutic vaccines in premalignant lesions and cervical cancer: hope or reality from clinical studies.

    Science.gov (United States)

    Vici, P; Pizzuti, L; Mariani, L; Zampa, G; Santini, D; Di Lauro, L; Gamucci, T; Natoli, C; Marchetti, P; Barba, M; Maugeri-Saccà, M; Sergi, D; Tomao, F; Vizza, E; Di Filippo, S; Paolini, F; Curzio, G; Corrado, G; Michelotti, A; Sanguineti, G; Giordano, A; De Maria, R; Venuti, A

    2016-10-01

    Human papillomavirus (HPV) is widely known as a cause of cervical cancer (CC) and cervical intraepithelial neoplasia (CIN). HPVs related to cancer express two main oncogenes, i.e. E6 and E7, considered as tumorigenic genes; their integration into the host genome results in the abnormal regulation of cell cycle control. Due to their peculiarities, these oncogenes represent an excellent target for cancer immunotherapy. In this work the authors highlight the potential use of therapeutic vaccines as safe and effective pharmacological tools in cervical disease, focusing on vaccines that have reached the clinical trial phase. Many therapeutic HPV vaccines have been tested in clinical trials with promising results. Adoptive T-cell therapy showed clinical activity in a phase II trial involving advanced CC patients. A phase II randomized trial showed clinical activity of a nucleic acid-based vaccine in HPV16 or HPV18 positive CIN. Several trials involving peptide-protein-based vaccines and live-vector based vaccines demonstrated that these approaches are effective in CIN as well as in advanced CC patients. HPV therapeutic vaccines must be regarded as a therapeutic option in cervical disease. The synergic combination of HPV therapeutic vaccines with radiotherapy, chemotherapy, immunomodulators or immune checkpoint inhibitors opens a new and interesting scenario in this disease.

  4. Do Targeted Written Comments and the Rubric Method of Delivery Affect Performance on Future Human Physiology Laboratory Reports?

    Science.gov (United States)

    Clayton, Zachary S.; Wilds, Gabriel P.; Mangum, Joshua E.; Hocker, Austin D.; Dawson, Sierra M.

    2016-01-01

    We investigated how students performed on weekly two-page laboratory reports based on whether the grading rubric was provided to the student electronically or in paper form and the inclusion of one- to two-sentence targeted comments. Subjects were registered for a 289-student, third-year human physiology class with laboratory and were randomized…

  5. Student and faculty performance in clinical simulations with access to a searchable information resource.

    Science.gov (United States)

    Abraham, V A; Friedman, C P; Wildemuth, B M; Downs, S M; Kantrowitz, P J; Robinson, E N

    1999-01-01

    In this study we explore how students' use of an easily accessible and searchable database affects their performance in clinical simulations. We do this by comparing performance of students with and without database access and compare these to a sample of faculty members. The literature supports the fact that interactive information resources can augment a clinician's problem solving ability in small clinical vignettes. We have taken the INQUIRER bacteriological database, containing detailed information on 63 medically important bacteria in 33 structured fields, and incorporated it into a computer-based clinical simulation. Subjects worked through the case-based clinical simulations with some having access to the INQUIRER information resource. Performance metrics were based on correct determination of the etiologic agent in the simulation and crosstabulated with student access of the information resource; more specifically it was determined whether the student displayed the database record describing the etiologic agent. Chi-square tests show statistical significance for this relationship (chi 2 = 3.922; p = 0.048). Results support the idea that students with database access in a clinical simulation environment can perform at a higher level than their counterparts who lack access to such information, reflecting favorably on the use of information resources in training environments.

  6. A Public-Private Partnership Improves Clinical Performance In A Hospital Network In Lesotho.

    Science.gov (United States)

    McIntosh, Nathalie; Grabowski, Aria; Jack, Brian; Nkabane-Nkholongo, Elizabeth Limakatso; Vian, Taryn

    2015-06-01

    Health care public-private partnerships (PPPs) between a government and the private sector are based on a business model that aims to leverage private-sector expertise to improve clinical performance in hospitals and other health facilities. Although the financial implications of such partnerships have been analyzed, few studies have examined the partnerships' impact on clinical performance outcomes. Using quantitative measures that reflected capacity, utilization, clinical quality, and patient outcomes, we compared a government-managed hospital network in Lesotho, Africa, and the new PPP-managed hospital network that replaced it. In addition, we used key informant interviews to help explain differences in performance. We found that the PPP-managed network delivered more and higher-quality services and achieved significant gains in clinical outcomes, compared to the government-managed network. We conclude that health care public-private partnerships may improve hospital performance in developing countries and that changes in management and leadership practices might account for differences in clinical outcomes.

  7. Clinical diagnostic value of Molybdenum Target X-ray combined with four Serum tumor markers in the detection of Mastocarcinoma

    Institute of Scientific and Technical Information of China (English)

    Ding-Hua Xu; Chun-Xian Cai; Guang-Xue Huang

    2015-01-01

    Objective: To explore the clinical diagnostic value of Molybdenum Target X-ray combined with serum CA15-3, CA125, CEA and CYFRA21-1 tumor markers in the detection of Mastocarcinoma. Method:90 cases confirmed by surgery pathology diagnosis according to the diagnosis of breast nodules disease patients were divided into benign tumor group (n=32) and breast cancer group (n=58), all patients were with preoperative line of molybdenum target X-ray radiography examination; Another group chose healthy women of our hospital for check-up in 56 cases as the control group, electrochemiluminescence immunoassay detection of three groups of participants were four kinds of serum tumor markers level, evaluation of single and combined testing the sensitivity of the diagnosis of breast cancer, specific degree, positive predictive value and negative predictive value. Results: CA15-3, CA125, CEA and CYFRA21-1 in breast cancer group were significantly higher than that of the control group and benign tumor group, the difference was statistically significant (all P0.05); Molybdenum target X-ray slice of the sensitivity of the diagnosis of breast cancer was higher, but the specific degree was low, and lower the sensitivity of the serum tumor markers in the diagnosis of breast cancer, the specific degree was higher, the molybdenum target X-ray slice joint the sensitivity of the four tumor markers in the diagnosis of breast cancer was 89.66%, 78.13%. Conclusions: The combined Mastocarcinoma detection of Molybdenum Target X-ray with serum CA15-3, CA125, CEA and CYFRA21-1 tumor markers can improve the detective rate and plays an important role in Mastocarcinoma early detection.

  8. A comparative study based on image quality and clinical task performance for CT reconstruction algorithms in radiotherapy.

    Science.gov (United States)

    Li, Hua; Dolly, Steven; Chen, Hsin-Chen; Anastasio, Mark A; Low, Daniel A; Li, Harold H; Michalski, Jeff M; Thorstad, Wade L; Gay, Hiram; Mutic, Sasa

    2016-07-08

    CT image reconstruction is typically evaluated based on the ability to reduce the radiation dose to as-low-as-reasonably-achievable (ALARA) while maintaining acceptable image quality. However, the determination of common image quality metrics, such as noise, contrast, and contrast-to-noise ratio, is often insufficient for describing clinical radiotherapy task performance. In this study we designed and implemented a new comparative analysis method associating image quality, radiation dose, and patient size with radiotherapy task performance, with the purpose of guiding the clinical radiotherapy usage of CT reconstruction algorithms. The iDose4 iterative reconstruction algorithm was selected as the target for comparison, wherein filtered back-projection (FBP) reconstruction was regarded as the baseline. Both phantom and patient images were analyzed. A layer-adjustable anthropomorphic pelvis phantom capable of mimicking 38-58 cm lateral diameter-sized patients was imaged and reconstructed by the FBP and iDose4 algorithms with varying noise-reduction-levels, respectively. The resulting image sets were quantitatively assessed by two image quality indices, noise and contrast-to-noise ratio, and two clinical task-based indices, target CT Hounsfield number (for electron density determination) and structure contouring accuracy (for dose-volume calculations). Additionally, CT images of 34 patients reconstructed with iDose4 with six noise reduction levels were qualitatively evaluated by two radiation oncologists using a five-point scoring mechanism. For the phantom experiments, iDose4 achieved noise reduction up to 66.1% and CNR improvement up to 53.2%, compared to FBP without considering the changes of spatial resolution among images and the clinical acceptance of reconstructed images. Such improvements consistently appeared across different iDose4 noise reduction levels, exhibiting limited interlevel noise (< 5 HU) and target CT number variations (< 1 HU). The radiation

  9. A comparative study based on image quality and clinical task performance for CT reconstruction algorithms in radiotherapy.

    Science.gov (United States)

    Li, Hua; Dolly, Steven; Chen, Hsin-Chen; Anastasio, Mark A; Low, Daniel A; Li, Harold H; Michalski, Jeff M; Thorstad, Wade L; Gay, Hiram; Mutic, Sasa

    2016-07-01

    CT image reconstruction is typically evaluated based on the ability to reduce the radiation dose to as-low-as-reasonably-achievable (ALARA) while maintaining acceptable image quality. However, the determination of common image quality metrics, such as noise, contrast, and contrast-to-noise ratio, is often insufficient for describing clinical radiotherapy task performance. In this study we designed and implemented a new comparative analysis method associating image quality, radiation dose, and patient size with radiotherapy task performance, with the purpose of guiding the clinical radiotherapy usage of CT reconstruction algorithms. The iDose4iterative reconstruction algorithm was selected as the target for comparison, wherein filtered back-projection (FBP) reconstruction was regarded as the baseline. Both phantom and patient images were analyzed. A layer-adjustable anthropomorphic pelvis phantom capable of mimicking 38-58 cm lateral diameter-sized patients was imaged and reconstructed by the FBP and iDose4 algorithms with varying noise-reduction-levels, respectively. The resulting image sets were quantitatively assessed by two image quality indices, noise and contrast-to-noise ratio, and two clinical task-based indices, target CT Hounsfield number (for electron density determination) and structure contouring accuracy (for dose-volume calculations). Additionally, CT images of 34 patients reconstructed with iDose4 with six noise reduction levels were qualitatively evaluated by two radiation oncologists using a five-point scoring mechanism. For the phantom experiments, iDose4 achieved noise reduction up to 66.1% and CNR improvement up to 53.2%, compared to FBP without considering the changes of spatial resolution among images and the clinical acceptance of reconstructed images. Such improvements consistently appeared across different iDose4 noise reduction levels, exhibiting limited interlevel noise (<5 HU) and target CT number variations (<1 HU). The radiation

  10. Emotional Intelligence in Internal Medicine Residents: Educational Implications for Clinical Performance and Burnout.

    Science.gov (United States)

    Satterfield, Jason; Swenson, Sara; Rabow, Michael

    2009-01-01

    We measured emotional intelligence (EQ; the ability to perceive, understand, and manage emotions in the self and others) in a sample of 28 internal medicine residents at the beginning and end of an academic year. EQ scores increased significantly over the course of the year. Higher EQ scores at the end of the year were significantly related to higher ratings for overall clinical performance and medical interviewing. Higher EQ scores also correlated with lower levels of burnout. Results suggest that clinically significant changes in EQ can occur over the course of medical training. Further study should determine if and how educational interventions can affect EQ, EQ-related performance, and burnout.

  11. An intensive nurse-led, multi-interventional clinic is more successful in achieving vascular risk reduction targets than standard diabetes care.

    LENUS (Irish Health Repository)

    MacMahon Tone, J

    2009-06-01

    The aim of this research was to determine whether an intensive, nurse-led clinic could achieve recommended vascular risk reduction targets in patients with type 2 diabetes as compared to standard diabetes management.

  12. Effective Clinical Supervision in Substance Use Disorder Treatment Programs and Counselor Job Performance.

    Science.gov (United States)

    Rothrauff-Laschober, Tanja C; Eby, Lillian Turner de Tormes; Sauer, Julia B

    2013-01-01

    When mental health counselors have limited and/or inadequate training in substance use disorders (SUDs), effective clinical supervision (ECS) may advance their professional development. The purpose of the current study was to investigate whether ECS is related to the job performance of SUD counselors. Data were obtained in person via paper-and-pencil surveys from 392 matched SUD counselor-clinical supervisor dyads working in 27 SUD treatment organizations across the United States. ECS was rated by counselors and measured with five multi-item scales (i.e., sponsoring counselors' careers, providing challenging assignments, role modeling, accepting/confirming counselors' competence, overall supervisor task proficiency). Clinical supervisors rated counselors' job performance, which was measured with two multi-item scales (i.e., task performance, performance within supervisory relationship). Using mixed-effects models, we found that most aspects of ECS are related to SUD counselor job performance. Thus, ECS may indeed enhance counselors' task performance and performance within the supervisory relationship, and, as a consequence, offset limited formal SUD training.

  13. Gene Dosage Analysis in a Clinical Environment: Gene-Targeted Microarrays as the Platform-of-Choice

    Directory of Open Access Journals (Sweden)

    Donald R. Love

    2013-03-01

    Full Text Available The role of gene deletion and duplication in the aetiology of disease has become increasingly evident over the last decade. In addition to the classical deletion/duplication disorders diagnosed using molecular techniques, such as Duchenne Muscular Dystrophy and Charcot-Marie-Tooth Neuropathy Type 1A, the significance of partial or whole gene deletions in the pathogenesis of a large number single-gene disorders is becoming more apparent. A variety of dosage analysis methods are available to the diagnostic laboratory but the widespread application of many of these techniques is limited by the expense of the kits/reagents and restrictive targeting to a particular gene or portion of a gene. These limitations are particularly important in the context of a small diagnostic laboratory with modest sample throughput. We have developed a gene-targeted, custom-designed comparative genomic hybridisation (CGH array that allows twelve clinical samples to be interrogated simultaneously for exonic deletions/duplications within any gene (or panel of genes on the array. We report here on the use of the array in the analysis of a series of clinical samples processed by our laboratory over a twelve-month period. The array has proven itself to be robust, flexible and highly suited to the diagnostic environment.

  14. Combined targeting of EGFR-dependent and VEGF-dependent pathways: rationale, preclinical studies and clinical applications.

    Science.gov (United States)

    Tortora, Giampaolo; Ciardiello, Fortunato; Gasparini, Giampietro

    2008-09-01

    Cellular heterogeneity, redundancy of molecular pathways and effects of the microenvironment contribute to the survival, motility and metastasis of cells in solid tumors. It is unlikely that tumors are entirely dependent on only one abnormally activated signaling pathway; consequently, treatment with an agent that interferes with a single target may be insufficient. Combined blockade of functionally linked and relevant multiple targets has become an attractive therapeutic strategy. The EGFR and ERBB2 (HER2) pathways and VEGF-dependent angiogenesis have a pivotal role in cancer pathogenesis and progression. Robust experimental evidence has shown that these pathways are functionally linked and has demonstrated a suggested role for VEGF in the acquired resistance to anti-ERBB drugs when these receptors are pharmacologically blocked. Combined inhibition of ERBB and VEGF signaling interferes with a molecular feedback loop responsible for acquired resistance to anti-ERBB agents and promotes apoptosis while ablating tumor-induced angiogenesis. To this aim, either two agents highly selective against VEGF and ERBB respectively, or, alternatively, a single multitargeted agent, can be used. Preclinical studies have proven the efficacy of both these approaches and early clinical studies have provided encouraging results. This Review discusses the experimental rationale for, preclinical studies of and clinical trials on combined blockade of ERBB and VEGF signaling.

  15. Targeting intensive versus conventional glycaemic control for type 1 diabetes mellitus: a systematic review with meta-analyses and trial sequential analyses of randomised clinical trials

    OpenAIRE

    Kähler, Pernille; Grevstad, Berit; Almdal, Thomas; Gluud, Christian; Wetterslev, Jørn; Vaag, Allan; Hemmingsen, Bianca

    2014-01-01

    Objective To assess the benefits and harms of targeting intensive versus conventional glycaemic control in patients with type 1 diabetes mellitus. Design A systematic review with meta-analyses and trial sequential analyses of randomised clinical trials. Data sources The Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded and LILACS to January 2013. Study selection Randomised clinical trials that prespecified different targets of glycaemic control in participants at any age with...

  16. What is the relationship between emotional intelligence and dental student clinical performance?

    Science.gov (United States)

    Victoroff, Kristin Zakariasen; Boyatzis, Richard E

    2013-04-01

    Emotional intelligence has emerged as a key factor in differentiating average from outstanding performers in managerial and leadership positions across multiple business settings, but relatively few studies have examined the role of emotional intelligence in the health care professions. The purpose of this study was to examine the relationship between emotional intelligence (EI) and dental student clinical performance. All third- and fourth-year students at a single U.S. dental school were invited to participate. Participation rate was 74 percent (100/136). Dental students' EI was assessed using the Emotional Competence Inventory-University version (ECI-U), a seventy-two-item, 360-degree questionnaire completed by both self and other raters. The ECI-U measured twenty-two EI competencies grouped into four clusters (Self-Awareness, Self-Management, Social Awareness, and Relationship Management). Clinical performance was assessed using the mean grade assigned by clinical preceptors. This grade represents an overall assessment of a student's clinical performance including diagnostic and treatment planning skills, time utilization, preparation and organization, fundamental knowledge, technical skills, self-evaluation, professionalism, and patient management. Additional variables were didactic grade point average (GPA) in Years 1 and 2, preclinical GPA in Years 1 and 2, Dental Admission Test academic average and Perceptual Ability Test scores, year of study, age, and gender. Multiple linear regression analyses were conducted. The Self-Management cluster of competencies (b=0.448, pemotional self-control, achievement orientation, initiative, trustworthiness, conscientiousness, adaptability, and optimism. In this sample, dental students' EI competencies related to Self-Management were significant predictors of mean clinical grade assigned by preceptors. Emotional intelligence may be an important predictor of clinical performance, which has important implications for

  17. The molecular, cellular and clinical consequences of targeting the estrogen receptor following estrogen deprivation therapy.

    Science.gov (United States)

    Fan, Ping; Maximov, Philipp Y; Curpan, Ramona F; Abderrahman, Balkees; Jordan, V Craig

    2015-12-15

    During the past 20 years our understanding of the control of breast tumor development, growth and survival has changed dramatically. The once long forgotten application of high dose synthetic estrogen therapy as the first chemical therapy to treat any cancer has been resurrected, refined and reinvented as the new biology of estrogen-induced apoptosis. High dose estrogen therapy was cast aside once tamoxifen, from its origins as a failed "morning after pill", was reinvented as the first targeted therapy to treat any cancer. The current understanding of the mechanism of estrogen-induced apoptosis is described as a consequence of acquired resistance to long term antihormone therapy in estrogen receptor (ER) positive breast cancer. The ER signal transduction pathway remains a target for therapy in breast cancer despite "antiestrogen" resistance, but becomes a regulator of resistance. Multiple mechanisms of resistance come into play: Selective ER modulator (SERM) stimulated growth, growth factor/ER crosstalk, estrogen-induced apoptosis and mutations of ER. But it is with the science of estrogen-induced apoptosis that the next innovation in women's health will be developed. Recent evidence suggests that the glucocorticoid properties of medroxyprogesterone acetate blunt estrogen-induced apoptosis in estrogen deprived breast cancer cell populations. As a result breast cancer develops during long-term hormone replacement therapy (HRT). A new synthetic progestin with estrogen-like properties, such as the 19 nortestosterone derivatives used in oral contraceptives, will continue to protect the uterus from unopposed estrogen stimulation but at the same time, reinforce apoptosis in vulnerable populations of nascent breast cancer cells.

  18. Recommendations for high-risk clinical target volume definition with computed tomography for three-dimensional image-guided brachytherapy in cervical cancer patients.

    Science.gov (United States)

    Ohno, Tatsuya; Wakatsuki, Masaru; Toita, Takafumi; Kaneyasu, Yuko; Yoshida, Ken; Kato, Shingo; Li, Noriko; Tokumaru, Sunao; Ikushima, Hitoshi; Uno, Takashi; Noda, Shin-Ei; Kazumoto, Tomoko; Harima, Yoko

    2016-11-10

    Our purpose was to develop recommendations for contouring the computed tomography (CT)-based high-risk clinical target volume (CTVHR) for 3D image-guided brachytherapy (3D-IGBT) for cervical cancer. A 15-member Japanese Radiation Oncology Study Group (JROSG) committee with expertise in gynecological radiation oncology initiated guideline development for CT-based CTVHR (based on a comprehensive literature review as well as clinical experience) in July 2014. Extensive discussions occurred during four face-to-face meetings and frequent email communication until a consensus was reached. The CT-based CTVHR boundaries were defined by each anatomical plane (cranial-caudal, lateral, or anterior-posterior) with or without tumor progression beyond the uterine cervix at diagnosis. Since the availability of magnetic resonance imaging (MRI) with applicator insertion for 3D planning is currently limited, T2-weighted MRI obtained at diagnosis and just before brachytherapy without applicator insertion was used as a reference for accurately estimating the tumor size and topography. Furthermore, utilizing information from clinical examinations performed both at diagnosis and brachytherapy is strongly recommended. In conclusion, these recommendations will serve as a brachytherapy protocol to be used at institutions with limited availability of MRI for 3D treatment planning.

  19. Molecular and Clinical Aspects of the Target Therapy with the Calcimimetic Cinacalcet in the Treatment of Parathyroid Tumors.

    Science.gov (United States)

    Mingione, Alessandra; Verdelli, Chiara; Terranegra, Annalisa; Soldati, Laura; Corbetta, Sabrina

    2015-01-01

    Parathyroid tumors are almost invariably associated with parathormone (PTH) hypersecretion resulting in primary (PHPT) or secondary (SHPT) hyperparathyroidism. PHPT is the third most common endocrine disorder with a prevalence of 1-2% in post-menopausal women; SHPT is a major complication of chronic kidney failure, the prevalence of which is increasing. The calciumsensing receptor (CASR) is the key molecule regulating PTH synthesis and release from the parathyroid cells in response to changes in extracellular calcium concentrations. A potent calcimimetic, cinacalcet, has been developed in the last ten years and made available for medical treatment of both PHPT and SHPT. Cinacalcet has been demonstrated to be effective in inhibiting PTH secretion, though the drug fails to normalize PTH release, both in PHPT and SHPT patients with different degrees of disease severity, including patients with parathyroid carcinomas and with MEN1-related parathyroid tumors. Here we reviewed the molecular aspects of CASR target therapy and the effect of the CASR gene single nucleotide polymorphisms. Clinical data concerning the efficacy and safety of cinacalcet in controlling hyperparathyroidism are reported, focusing on the treatment of the different types of parathyroid tumors. Finally, limits of this target therapy are analyzed, pointing out the lack of efficacy in improving kidney and bone morbidities in PHPT and cardiovascular diseases in SHPT. Though cinacalcet is a target therapeutic option for parathyroid tumors, further approaches are warranted to fully control these metabolic disorders and the underlying tumors.

  20. Treatment of Non-Small Cell Lung Cancer (NSCLC) Using CT in Combination with a PET Examination to Minimize the Clinical Target Volume of the Mediastinum

    Institute of Scientific and Technical Information of China (English)

    Yusheng Shi; Xiaogang Deng; Longhua Chen

    2007-01-01

    OBJECTIVE To decrease radiation injury of the esophagus and lungs by utilizing a CT scan in combination with PET tumor imaging in order to minimize the clinical target area of locally advanced non-small cell lung cancer, without preventive radiation on the lymphatic drainage area. METHODS Of 76 patients with locally advanced non-small cell lung cancer (NSCLC), 32 received a PET examination before radiotherapy. Preventive radiation was not conducted in the mediastinum area without lymphatic metastasis, which was confirmed by CT and PET. For the other 44 patients, preventive radiation was performed in the lymphatic drainage area. PET examinations showed that the clinical target volume of the patients was decreased on average to about one third. The radiation therapy for patients of the two groups was the same, I.e. The dose for accelerated fractionated irradiation was 3 Gy/time and 5 time/week. The preventive dose was 42 to 45 Gy/time, 14 to 15 time/week, with 3-week treatment, and the therapeutic dose was 60 to 63 Gy/time, 20 to 21 time/week, with a period of 4 to 5 weeks.RESULTS The rate of missed lymph nodes beyond the irradiation field was 6.3% and 4.5% respectively in the group with and without PET examination (P = 0.831). The incidence of acute radioactive esophagitis was 15.6 % and 45.5% in the two groups respectively (P = 0.006). The incidence of acute radiation pneumonia and long-term pulmonary fibrosis in the two groups was 6.3% and 9.1%, and 68.8% and 75.0%, respectively (P = 0.982 and P = 0.547).CONCLUSION The recurrence rate in the lymph nodes beyond the target area was not increased after minimizing the clinical target volume (CTV), whereas radioactive injury to the lungs and esophageal injury was reduced, and especially with a significant decrease in the rate of acute radioactive esophagitis. The method of CT in combination with PET for minimizing the mediastinal CTV is superior to the conventional preventive radiation of the mediastinum.

  1. Performance Comparison of EKF/UKF/CKF for the Tracking of Ballistic Target

    Directory of Open Access Journals (Sweden)

    Wu Guang-bin

    2012-11-01

    Full Text Available This paper considers three well know nonlinear Kalman Filters for the tracking of a ballistic target. Extended Kalman Filter (EKF, Unscented Kalman Filter (UKF, and the Cubature Kalman Filter (CKF are applied for estimating the position, velocity and the ballistic coefficient of the ballistic target. The theory formulation and computer simulation has been done for the comparison of the three nonlinear Kalman Filters. Results show that all of them can accomplish the estimation task, but the UKF and CKF both have higher accuracy and less computation cost than the EKF.

  2. Clinical Validation and Implementation of a Targeted Next-Generation Sequencing Assay to Detect Somatic Variants in Non-Small Cell Lung, Melanoma, and Gastrointestinal Malignancies

    Science.gov (United States)

    Fisher, Kevin E.; Zhang, Linsheng; Wang, Jason; Smith, Geoffrey H.; Newman, Scott; Schneider, Thomas M.; Pillai, Rathi N.; Kudchadkar, Ragini R.; Owonikoko, Taofeek K.; Ramalingam, Suresh S.; Lawson, David H.; Delman, Keith A.; El-Rayes, Bassel F.; Wilson, Malania M.; Sullivan, H. Clifford; Morrison, Annie S.; Balci, Serdar; Adsay, N. Volkan; Gal, Anthony A.; Sica, Gabriel L.; Saxe, Debra F.; Mann, Karen P.; Hill, Charles E.; Khuri, Fadlo R.; Rossi, Michael R.

    2017-01-01

    We tested and clinically validated a targeted next-generation sequencing (NGS) mutation panel using 80 formalin-fixed, paraffin-embedded (FFPE) tumor samples. Forty non-small cell lung carcinoma (NSCLC), 30 melanoma, and 30 gastrointestinal (12 colonic, 10 gastric, and 8 pancreatic adenocarcinoma) FFPE samples were selected from laboratory archives. After appropriate specimen and nucleic acid quality control, 80 NGS libraries were prepared using the Illumina TruSight tumor (TST) kit and sequenced on the Illumina MiSeq. Sequence alignment, variant calling, and sequencing quality control were performed using vendor software and laboratory-developed analysis workflows. TST generated ≥500× coverage for 98.4% of the 13,952 targeted bases. Reproducible and accurate variant calling was achieved at ≥5% variant allele frequency with 8 to 12 multiplexed samples per MiSeq flow cell. TST detected 112 variants overall, and confirmed all known single-nucleotide variants (n = 27), deletions (n = 5), insertions (n = 3), and multinucleotide variants (n = 3). TST detected at least one variant in 85.0% (68/80), and two or more variants in 36.2% (29/80), of samples. TP53 was the most frequently mutated gene in NSCLC (13 variants; 13/32 samples), gastrointestinal malignancies (15 variants; 13/25 samples), and overall (30 variants; 28/80 samples). BRAF mutations were most common in melanoma (nine variants; 9/23 samples). Clinically relevant NGS data can be obtained from routine clinical FFPE solid tumor specimens using TST, benchtop instruments, and vendor-supplied bioinformatics pipelines. PMID:26801070

  3. A memetic algorithm for path planning of curvature-constrained UAVs performing surveillance of multiple ground targets

    Institute of Scientific and Technical Information of China (English)

    Zhang Xing; Chen Jie; Xin Bin; Peng Zhihong

    2014-01-01

    The problem of generating optimal paths for curvature-constrained unmanned aerial vehicles (UAVs) performing surveillance of multiple ground targets is addressed in this paper. UAVs are modeled as Dubins vehicles so that the constraints of UAVs’ minimal turning radius can be taken into account. In view of the effective surveillance range of the sensors equipped on UAVs, the problem is formulated as a Dubins traveling salesman problem with neighborhood (DTSPN). Considering its prohibitively high computational complexity, the Dubins paths in the sense of terminal heading relaxation are introduced to simplify the calculation of the Dubins distance, and a boundary-based encoding scheme is proposed to determine the visiting point of every target neighborhood. Then, an evolutionary algorithm is used to derive the optimal Dubins tour. To further enhance the quality of the solutions, a local search strategy based on approximate gradient is employed to improve the visiting points of target neighborhoods. Finally, by a minor modification to the individual encoding, the algorithm is easily extended to deal with other two more sophisticated DTSPN variants (multi-UAV scenario and multiple groups of targets scenario). The performance of the algorithm is demonstrated through comparative experiments with other two state-of-the-art DTSPN algorithms identified in literature. Numerical simulations exhibit that the algorithm proposed in this paper can find high-quality solutions to the DTSPN with lower computational cost and produce significantly improved performance over the other algorithms.

  4. A memetic algorithm for path planning of curvature-constrained UAVs performing surveillance of multiple ground targets

    Directory of Open Access Journals (Sweden)

    Zhang Xing

    2014-06-01

    Full Text Available The problem of generating optimal paths for curvature-constrained unmanned aerial vehicles (UAVs performing surveillance of multiple ground targets is addressed in this paper. UAVs are modeled as Dubins vehicles so that the constraints of UAVs’ minimal turning radius can be taken into account. In view of the effective surveillance range of the sensors equipped on UAVs, the problem is formulated as a Dubins traveling salesman problem with neighborhood (DTSPN. Considering its prohibitively high computational complexity, the Dubins paths in the sense of terminal heading relaxation are introduced to simplify the calculation of the Dubins distance, and a boundary-based encoding scheme is proposed to determine the visiting point of every target neighborhood. Then, an evolutionary algorithm is used to derive the optimal Dubins tour. To further enhance the quality of the solutions, a local search strategy based on approximate gradient is employed to improve the visiting points of target neighborhoods. Finally, by a minor modification to the individual encoding, the algorithm is easily extended to deal with other two more sophisticated DTSPN variants (multi-UAV scenario and multiple groups of targets scenario. The performance of the algorithm is demonstrated through comparative experiments with other two state-of-the-art DTSPN algorithms identified in literature. Numerical simulations exhibit that the algorithm proposed in this paper can find high-quality solutions to the DTSPN with lower computational cost and produce significantly improved performance over the other algorithms.

  5. Development and clinical performance of high throughput loop-mediated isothermal amplification for detection of malaria

    OpenAIRE

    Perera, Rushini S.; Ding, Xavier C; Tully, Frank; Oliver, James; Bright, Nigel; Bell, David; Chiodini, Peter L; Gonzalez, Iveth J.; Spencer D Polley

    2017-01-01

    Background Accurate and efficient detection of sub-microscopic malaria infections is crucial for enabling rapid treatment and interruption of transmission. Commercially available malaria LAMP kits have excellent diagnostic performance, though throughput is limited by the need to prepare samples individually. Here, we evaluate the clinical performance of a newly developed high throughput (HTP) sample processing system for use in conjunction with the Eiken malaria LAMP kit. Methods The HTP syst...

  6. Correlation between clinical performance and degree of conversion of resin cements: a literature review

    Science.gov (United States)

    DE SOUZA, Grace; BRAGA, Roberto Ruggiero; CESAR, Paulo Francisco; LOPES, Guilherme Carpena

    2015-01-01

    Resin-based cements have been frequently employed in clinical practice to lute indirect restorations. However, there are numerous factors that may compromise the clinical performance of those cements. The aim of this literature review is to present and discuss some of the clinical factors that may affect the performance of current resin-based luting systems. Resin cements may have three different curing mechanisms: chemical curing, photo curing or a combination of both. Chemically cured systems are recommended to be used under opaque or thick restorations, due to the reduced access of the light. Photo-cured cements are mainly indicated for translucent veneers, due to the possibility of light transmission through the restoration. Dual-cured are more versatile systems and, theoretically, can be used in either situation, since the presence of both curing mechanisms might guarantee a high degree of conversion (DC) under every condition. However, it has been demonstrated that clinical procedures and characteristics of the materials may have many different implications in the DC of currently available resin cements, affecting their mechanical properties, bond strength to the substrate and the esthetic results of the restoration. Factors such as curing mechanism, choice of adhesive system, indirect restorative material and light-curing device may affect the degree of conversion of the cement and, therefore, have an effect on the clinical performance of resin-based cements. Specific measures are to be taken to ensure a higher DC of the luting system to be used. PMID:26398507

  7. Correlation between clinical performance and degree of conversion of resin cements: a literature review

    Directory of Open Access Journals (Sweden)

    Grace DE SOUZA

    2015-08-01

    Full Text Available AbstractResin-based cements have been frequently employed in clinical practice to lute indirect restorations. However, there are numerous factors that may compromise the clinical performance of those cements. The aim of this literature review is to present and discuss some of the clinical factors that may affect the performance of current resin-based luting systems. Resin cements may have three different curing mechanisms: chemical curing, photo curing or a combination of both. Chemically cured systems are recommended to be used under opaque or thick restorations, due to the reduced access of the light. Photo-cured cements are mainly indicated for translucent veneers, due to the possibility of light transmission through the restoration. Dual-cured are more versatile systems and, theoretically, can be used in either situation, since the presence of both curing mechanisms might guarantee a high degree of conversion (DC under every condition. However, it has been demonstrated that clinical procedures and characteristics of the materials may have many different implications in the DC of currently available resin cements, affecting their mechanical properties, bond strength to the substrate and the esthetic results of the restoration. Factors such as curing mechanism, choice of adhesive system, indirect restorative material and light-curing device may affect the degree of conversion of the cement and, therefore, have an effect on the clinical performance of resin-based cements. Specific measures are to be taken to ensure a higher DC of the luting system to be used.

  8. Correlation between clinical performance and degree of conversion of resin cements: a literature review.

    Science.gov (United States)

    De Souza, Grace; Braga, Roberto Ruggiero; Cesar, Paulo Francisco; Lopes, Guilherme Carpena

    2015-01-01

    Resin-based cements have been frequently employed in clinical practice to lute indirect restorations. However, there are numerous factors that may compromise the clinical performance of those cements. The aim of this literature review is to present and discuss some of the clinical factors that may affect the performance of current resin-based luting systems. Resin cements may have three different curing mechanisms: chemical curing, photo curing or a combination of both. Chemically cured systems are recommended to be used under opaque or thick restorations, due to the reduced access of the light. Photo-cured cements are mainly indicated for translucent veneers, due to the possibility of light transmission through the restoration. Dual-cured are more versatile systems and, theoretically, can be used in either situation, since the presence of both curing mechanisms might guarantee a high degree of conversion (DC) under every condition. However, it has been demonstrated that clinical procedures and characteristics of the materials may have many different implications in the DC of currently available resin cements, affecting their mechanical properties, bond strength to the substrate and the esthetic results of the restoration. Factors such as curing mechanism, choice of adhesive system, indirect restorative material and light-curing device may affect the degree of conversion of the cement and, therefore, have an effect on the clinical performance of resin-based cements. Specific measures are to be taken to ensure a higher DC of the luting system to be used.

  9. Targeted treatment in primary care for low back pain: the treatment system and clinical training programmes used in the IMPaCT Back study (ISRCTN 55174281)

    OpenAIRE

    Sowden, Gail; Hill, Jonathan C.; Konstantinou, Kika; Khanna, Meenee; Main, Chris J.; Salmon, Paula; Somerville, Simon; Wathall, Simon; Foster, Nadine E.

    2011-01-01

    Background. The IMPaCT Back study (IMplementation to improve Patient Care through Targeted treatment for Back pain) is a quality improvement study which aims to investigate the effects of introducing and supporting a subgrouping for targeted treatment system for patients with low back pain (LBP) in primary care. This paper details the subgrouping for targeted treatment system and the clinical training and mentoring programmes aimed at equipping clinicians to deliver it. The subgrouping and ta...

  10. Performance of OSL dosimeters in clinical beams from mammography; Desempenho de dosimetros OSL em feixes clinicos empregados na mamografia

    Energy Technology Data Exchange (ETDEWEB)

    Oliveira, Caio V.; Cabete, Henrique V.; Alves, Fatima F.R.; Pires, Silvio R.; Medeiros, Regina B.; Freitas, Marcelo B. [Universidade Federal de Sao Paulo (HSP/EPM/UNIFESP), SP (Brazil). Escola Paulista de Medicina; Malthez, Anna Luiza M.C. [Universidade Estadual de Campinas (CPG/FEEC/UNICAMP), Campinas, SP (Brazil). Faculdade de Engenharia Eletrica e de Computacao. Programa de Pos-Graduacao

    2015-08-15

    The search for the relationship between dose and mammography image is critical to the quality of clinical practice. In this sense, dosimetry using optically stimulated luminescent detectors (OSLD) is configured as alternative to traditional methods and allows on-site dose checks received by patients. This study aimed to verify the performance of OSL dosimeters in clinical beams typically used in mammography. For this, aluminum oxide detectors, especially designed to reduce interference on the image quality, were exposed to radiation beam combining targets and filters of a mammography equipment with digital imaging system. In addition were also employed lithium fluoride detectors irradiated under the same conditions, together with a ionization chamber for determination of dose values. A homogeneous acrylic phantom was designed and used for simulating different breast and also determine internal dose values under the irradiation conditions. The results allowed the determination of calibration factors (OSL signal x dose) of the exposed detectors to the radiation beams typically used in clinical practice. The phantom images and the comparison between TL and OSL responses suggest the possibility of routine use of the OSL dosimetry system in mammography. (author)

  11. Performance of a Liner-on-Target Injector for Staged Z-Pinch Experiments

    Science.gov (United States)

    Conti, F.; Valenzuela, J. C.; Narkis, J.; Krasheninnikov, I.; Beg, F.; Wessel, F. J.; Ruskov, E.; Rahman, H. U.; McGee, E.

    2016-10-01

    We present the design and characterization of a compact liner-on-target injector, used in the Staged Z-pinch experiments conducted on the UNR-NTF Zebra Facility. Previous experiments and analysis indicate that high-Z gas liners produce a uniform and efficient implosion on a low-Z target plasma. The liner gas shell is produced by an annular solenoid valve and a converging-diverging nozzle designed to achieve a collimated, supersonic, Mach-5 flow. The on-axis target is produced by a coaxial plasma gun, where a high voltage pulse is applied to ionize neutral gas and accelerate the plasma by the J-> × B-> force. Measurements of the liner and target dynamics, resolved by interferometry in space and time, fast imaging, and collection of the emitted light, are presented. The results are compared to the predictions from Computational Fluid Dynamics and MHD simulations that model the injector. Optimization of the design parameters, for upcoming Staged Z-pinch experiments, will be discussed. Advanced Research Projects Agency - Energy, DE-AR0000569.

  12. Effects of Rifle Handling, Target Acquisition, and Trigger Control on Simulated Shooting Performance

    Science.gov (United States)

    2014-05-06

    performance with the M16A1 rifle. Study 1. A validation of the artificial intelligence direct fire weapons research test bed. Orlando, FL: U.S...communication and superior performance in skilled marksmen: An EEG coherence analysis. Journal of Sport and Exercise Psychology. 25(2... PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) 8. PERFORMING ORGANIZATION REPORT NUMBER 9. SPONSORING/MONITORING AGENCY NAME(S) AND ADDRESS(ES

  13. The Correlation of Learning Styles with Student Performance In Academic and Clinical Course Work.

    Science.gov (United States)

    Cunningham, M. Jo; Trickey, Becki A.

    1983-01-01

    The purpose of this study was to determine any correlation between learning styles and performance in the academic and clinical course work of occupational therapy students at the Medical University of South Carolina. (Availability: RAM Associates LTD., P.O. Box N, Laurel, MD 20707) (SSH)

  14. Optimizing clinical performance and geometrical robustness of a new electrode device for intracranial tumor electroporation

    DEFF Research Database (Denmark)

    Mahmood, Faisal; Gehl, Julie

    2011-01-01

    and genes to intracranial tumors in humans, and demonstrate a method to optimize the design (i.e. geometry) of the electrode device prototype to improve both clinical performance and geometrical tolerance (robustness). We have employed a semiempirical objective function based on constraints similar to those...

  15. Diagnostic performance of amyloid A protein quantification in fat tissue of patients with clinical AA amyloidosis

    NARCIS (Netherlands)

    Hazenberg, Bouke P. C.; Bijzet, Johannes; Limburg, Pieter C.; Skinner, Martha; Hawkins, Philip N.; Butrimiene, Irena; Livneh, Avi; Lesnyak, Olga; Nasonov, Evgeney L.; Filipowicz-Sosnowska, Anna; Guel, Ahmet; Merlini, Giampaolo; Wiland, Piotr; Oezdogan, Huri; Gorevic, Peter D.; Ben Maiz, Hedi; Benson, Merrill D.; Direskeneli, Haner; Kaarela, Kalevi; Garceau, Denis; Hauck, Wendy; van Rijswijk, Martin

    2007-01-01

    Objective. Amyloid A protein quantification in fat tissue is a new immunochemical method for detecting AA amyloidosis, a rare but serious disease. The objective was to assess diagnostic performance in clinical AA amyloidosis. Methods. Abdominal subcutaneous fat tissue of patients with AA amyloidosis

  16. Age-Related Decline and Diagnostic Performance of More and Less Prevalent Clinical Cases

    Science.gov (United States)

    St-Onge, Christina; Landry, Marjolaine; Xhignesse, Marianne; Voyer, Gilles; Tremblay-Lavoie, Stéphanie; Mamede, Sílvia; Schmidt, Henk; Rikers, Remy

    2016-01-01

    Since cognitive abilities have been shown to decrease with age, it is expected that older physicians would not perform as well as their younger counterparts on clinical cases unless their expertise can counteract the cognitive effects of aging. However, studies on the topic have shown contradictory results. This study aimed to further investigate…

  17. Adapting Objective Structured Clinical Examinations to Assess Social Work Students' Performance and Reflections

    Science.gov (United States)

    Bogo, Marion; Regehr, Cheryl; Logie, Carmen; Katz, Ellen; Mylopoulos, Maria; Regehr, Glenn

    2011-01-01

    The development of standardized, valid, and reliable methods for assessment of students' practice competence continues to be a challenge for social work educators. In this study, the Objective Structured Clinical Examination (OSCE), originally used in medicine to assess performance through simulated interviews, was adapted for social work to…

  18. Clinical study on the changes of the tumor target volume and organs at risk in helical tomotherapy for nasopharyngeal carcinoma

    Institute of Scientific and Technical Information of China (English)

    LU Na; FENG Lin-chun; CAI Bo-ning; HOU Jun; WANG Yun-lai; XIE Chuan-bin

    2012-01-01

    Background Helical tomotherapy (HT) is a new image-guided intensity-modulated radiation therapy (IMRT).The aim of this study was to evaluate the changes in the target volume and organs at risk (OARs) of patients with nasopharyngeal carcinoma (NPC) during helical tomotherapy.Methods Forty-three patients with NPC and treated via HT from March 2008 to January 2010 were reviewed retrospectively.Repeated CT scanning and plan adaptation were conducted at the 20th fraction during radiotherapy.The volumetric differences between the two scans were evaluated for nasopharyngeal tumor and retro- pharyngeal lymph nodes (GTVnx),neck lymph nodes (GTVnd),and parotid glands,as well as the axial diameter of the head.Results The median interval between the two scans was 25 days (23-28 days).The volumetric decrease in GTVnx was 30.1% (median,29.8%) and in GTVnd 41.6% (median,45.9%).The variation in the GTVnd volume was correlated with the weight loss of the patient.The volume of the left parotid gland decreased by 35.5% (median,33.4%) and of the right parotid glands decreased by 36.8% (median,33.5%).The axial diameter of the head decreased by 9.39% (median,9.1%).Conclusions The target volume and OARs of patients with NPC varied considerably during HT.These changes may have potential dosimetric effects on the target volume and/or OARs and influence the clinical outcome.Repeated CT scanning and replanning during the HT for NPC patients with a large target volume or an obvious weight loss are recommended.

  19. Attenuation of multi-targeted proliferation-linked signaling by 3,3'-diindolylmethane (DIM): from bench to clinic.

    Science.gov (United States)

    Banerjee, Sanjeev; Kong, Dejuan; Wang, Zhiwei; Bao, Bin; Hillman, Gilda G; Sarkar, Fazlul H

    2011-01-01

    Emerging evidence provide credible support in favor of the potential role of bioactive products derived from ingesting cruciferous vegetables such as broccoli, brussel sprouts, cauliflower and cabbage. Among many compounds, 3,3'-diindolylmethane (DIM) is generated in the acidic environment of the stomach following dimerization of indole-3-carbinol (I3C) monomers present in these classes of vegetables. Both I3C and DIM have been investigated for their use in preventing, inhibiting, and reversing the progression of cancer - as a chemopreventive agent. In this review, we summarize an updated, wide-ranging pleiotropic anti-tumor and biological effects elicited by DIM against tumor cells. It is unfeasible to point one single target as basis of cellular target of action of DIM. We emphasize key cellular and molecular events that are effectively modulated in the direction of inducing apoptosis and suppressing cell proliferation. Collectively, DIM orchestrates signaling through Ah receptor, NF-κB/Wnt/Akt/mTOR pathways impinging on cell cycle arrest, modulation of key cytochrome P450 enzymes, altering angiogenesis, invasion, metastasis and epigenetic behavior of cancer cells. The ability of DIM to selectively induce tumor cells to undergo apoptosis has been observed in preclinical models, and thus it has been speculated in improving the therapeutic efficacy of other anticancer agents that have diverse molecular targets. Consequently, DIM has moved through preclinical development into Phase I clinical trials, thereby suggesting that DIM could be a promising and novel agent either alone or as an adjunct to conventional therapeutics such as chemo-radio and targeted therapies. An important development has been the availability of DIM formulation with superior bioavailability for humans. Therefore, DIM appears to be a promising chemopreventive agent or chemo-radio-sensitizer for the prevention of tumor recurrence and/or for the treatment of human malignancies.

  20. Chemotherapies and targeted therapies in advanced hepatocellular carcinoma: from laboratory to clinic.

    Science.gov (United States)

    Voiculescu, Mihai; Winkler, Robert E; Moscovici, Marius; Neuman, Manuela G

    2008-09-01

    Chronic liver diseases alone or in conjunction with other risk factors result in increased liver damage leading to inflammation and fibrosis of the liver and rising rates of liver cirrhosis, hepatic decompensation and hepatocellular carcinoma (HCC). This review will address the determinants of liver injury at the initiation of the tumor and the risk factors for rapid disease progression. Regardless of the etiology, the unifying feature of these tumors are their propensity to arise upon a background of inflammation and fibrosis. Liver disease is often associated with enhanced hepatocyte apoptosis, which is the case in viral and autoimmune hepatitis, cholestatic diseases, and metabolic disorders. Disruption of apoptosis is responsible for HCC. The mechanisms by which apoptosis occurs in the liver might provide insights into HCC and suggest possible treatments. We aim to better understand the factors that distinguish a relatively long course of HCC from one with rapid progression. We will accomplish this task with three integrated ideas: 1 - the role of epidemiology in establishing the risk factors of co-morbidity with alcohol and hepatitis viruses; 2 - the role of apoptosis and anti-apoptotic signals in the progression of HCC; and 3 - the role of new advancements that have emerged in the field of molecular-directed chemotherapeutics in HCC in recent years. This review will also aim to describe the molecular targeted therapies of non-resectable HCC and the ways of effective combination in this otherwise chemo-resistant tumor.

  1. Long‐Term Post‐CABG Survival: Performance of Clinical Risk Models Versus Actuarial Predictions

    Science.gov (United States)

    Carr, Brendan M.; Romeiser, Jamie; Ruan, Joyce; Gupta, Sandeep; Seifert, Frank C.; Zhu, Wei

    2015-01-01

    Abstract Background/aim Clinical risk models are commonly used to predict short‐term coronary artery bypass grafting (CABG) mortality but are less commonly used to predict long‐term mortality. The added value of long‐term mortality clinical risk models over traditional actuarial models has not been evaluated. To address this, the predictive performance of a long‐term clinical risk model was compared with that of an actuarial model to identify the clinical variable(s) most responsible for any differences observed. Methods Long‐term mortality for 1028 CABG patients was estimated using the Hannan New York State clinical risk model and an actuarial model (based on age, gender, and race/ethnicity). Vital status was assessed using the Social Security Death Index. Observed/expected (O/E) ratios were calculated, and the models' predictive performances were compared using a nested c‐index approach. Linear regression analyses identified the subgroup of risk factors driving the differences observed. Results Mortality rates were 3%, 9%, and 17% at one‐, three‐, and five years, respectively (median follow‐up: five years). The clinical risk model provided more accurate predictions. Greater divergence between model estimates occurred with increasing long‐term mortality risk, with baseline renal dysfunction identified as a particularly important driver of these differences. Conclusions Long‐term mortality clinical risk models provide enhanced predictive power compared to actuarial models. Using the Hannan risk model, a patient's long‐term mortality risk can be accurately assessed and subgroups of higher‐risk patients can be identified for enhanced follow‐up care. More research appears warranted to refine long‐term CABG clinical risk models. doi: 10.1111/jocs.12665 (J Card Surg 2016;31:23–30) PMID:26543019

  2. Simplified clinical prediction scores to target viral load testing in adults with suspected first line treatment failure in Phnom Penh, Cambodia.

    Directory of Open Access Journals (Sweden)

    Johan van Griensven

    Full Text Available BACKGROUND: For settings with limited laboratory capacity, 2013 World Health Organization (WHO guidelines recommend targeted HIV-1 viral load (VL testing to identify virological failure. We previously developed and validated a clinical prediction score (CPS for targeted VL testing, relying on clinical, adherence and laboratory data. While outperforming the WHO failure criteria, it required substantial calculation and review of all previous laboratory tests. In response, we developed four simplified, less error-prone and broadly applicable CPS versions that can be done 'on the spot'. METHODOLOGY/PRINCIPAL: Findings From May 2010 to June 2011, we validated the original CPS in a non-governmental hospital in Phnom Penh, Cambodia applying the CPS to adults on first-line treatment >1 year. Virological failure was defined as a single VL >1000 copies/ml. The four CPSs included CPS1 with 'current CD4 count' instead of %-decline-from-peak CD4; CPS2 with hemoglobin measurements removed; CPS3 having 'decrease in CD4 count below baseline value' removed; CPS4 was purely clinical. Score development relied on the Spiegelhalter/Knill-Jones method. Variables independently associated with virological failure with a likelihood ratio ≥ 1.5 or ≤ 0.67 were retained. CPS performance was evaluated based on the area-under-the-ROC-curve (AUROC and 95% confidence intervals (CI. The CPSs were validated in an independent dataset. A total of 1490 individuals (56.6% female, median age: 38 years (interquartile range (IQR 33-44; median baseline CD4 count: 94 cells/µL (IQR 28-205, median time on antiretroviral therapy 3.6 years (IQR 2.1-5.1, were included. Forty-five 45 (3.0% individuals had virological failure. CPS1 yielded an AUROC of 0.69 (95% CI: 0.62-0.75 in validation, CPS2 an AUROC of 0.68 (95% CI: 0.62-0.74, and CPS3, an AUROC of 0.67 (95% CI: 0.61-0.73. The purely clinical CPS4 performed poorly (AUROC-0.59; 95% CI: 0.53-0.65. CONCLUSIONS: Simplified CPSs retained

  3. Targeting CXCR1 on breast cancer stem cells: signaling pathways and clinical application modelling.

    Science.gov (United States)

    Brandolini, Laura; Cristiano, Loredana; Fidoamore, Alessia; De Pizzol, Maria; Di Giacomo, Erica; Florio, Tiziana Marilena; Confalone, Giuseppina; Galante, Angelo; Cinque, Benedetta; Benedetti, Elisabetta; Ruffini, Pier Adelchi; Cifone, Maria Grazia; Giordano, Antonio; Alecci, Marcello; Allegretti, Marcello; Cimini, Annamaria

    2015-12-22

    In breast cancer it has been proposed that the presence of cancer stem cells may drive tumor initiation, progression and recurrences. IL-8, up-regulated in breast cancer, and associated with poor prognosis, increases CSC self-renewal in cell line models. It signals via two cell surface receptors, CXCR1 and CXCR2. Recently, the IL-8/CXCR1 axis was proposed as an attractive pathway for the design of specific therapies against breast cancer stem cells. Reparixin, a powerful CXCR1 inhibitor, was effective in reducing in vivo the tumour-initiating population in several NOD/SCID mice breast cancer models, showing that the selective targeting of CXCR1 and the combination of reparixin and docetaxel resulted in a concomitant reduction of the bulk tumour mass and CSC population. The available data indicate that IL-8, expressed by tumour cells and induced by chemotherapeutic treatment, is a key regulator of the survival and self-renewal of the population of CXCR1-expressing CSC. Consequently, this investigation on the mechanism of action of the reparixin/paclitaxel combination, was based on the observation that reparixin treatment contained the formation of metastases in several experimental models. However, specific data on the formation of breast cancer brain metastases, which carry remarkable morbidity and mortality to a substantial proportion of advanced breast cancer patients, have not been generated. The obtained data indicate a beneficial use of the drug combination reparixin and paclitaxel to counteract brain tumour metastasis due to CSC, probably due to the combined effects of the two drugs, the pro-apoptotic action of paclitaxel and the cytostatic and anti-migratory effects of reparixin.

  4. Bound analysis of target displacement for seismic performance assessment of buildings

    Institute of Scientific and Technical Information of China (English)

    JIA Li-zhe; DUAN Zhong-dong; LU Qin-nian

    2008-01-01

    The earthquake demand spectrum is often assumed as the average spectrum in the seismic design code or based upon probabilistic models to take into account the uncertainties of ground motion. The average spectrum can not deal with the uncertainty of earthquake excitation. Furthermore, results of probabilistic analy-sis are suspicious when information describing the uncertainty is inadequate. Considering the uncertainties of peak acceleration of ground motion and characteristic period of response spectra using a double bounded convex set model, the bounds of the design spectrum and the demand spectrum were obtained based on Chinese seismiccode. Then the convex analysis method was integrated into the capacity spectrum procedure to study the bound characteristics of target displacement. Finally, the target displacement was derived with an interval, and it is more objective and robust with respect to probabilistic perspective.

  5. Performance of targeted screening for the identification of hypertension in children.

    Science.gov (United States)

    Bloetzer, Clemens; Bovet, Pascal; Paccaud, Fred; Burnier, Michel; Chiolero, Arnaud

    2017-04-01

    Targeted screening of hypertension in childhood might be more efficient than universal screening. We estimated the sensitivity, specificity, negative and positive predictive values of combined parental history of hypertension and overweight/obesity for the diagnosis of hypertension in 5207 children aged 10-14 years. Children had hypertension if they had sustained elevated blood pressure over three separate visits. The prevalence of hypertension was 2.2%. 14% of children were overweight or obese, 20% had a positive history of hypertension in at least one parent and 30% had either or both conditions. Targeted screening of hypertension to children with either overweight/obesity or with hypertensive parents limits the proportion of children (30%) to screen and identifies up to 65% of all hypertensive cases.

  6. Effects of TEL Confusers on Operator Target Acquisition Performance with SAR Imagery

    Science.gov (United States)

    1998-12-01

    processing known as the theory of signal detection (TSD) (Gescheider, 1985; Green & Swets, 1966; Macmillan & Creelman , 1991; Wilson, 1992). A TSD...localizations (Hacker & Ratcliff, 1979; Macmillan & Creelman , 1991). The index of bias in a target localization task provides a measure of the operator’s...of correct localizations substituted for hits (Macmillan & Creelman , 1991). Receiver Operating Characteristic Curves. In addition to the calculation

  7. Ranging and target detection performance through lossy media using an ultrawideband S-band through-wall sensing noise radar

    Science.gov (United States)

    Smith, Sonny; Narayanan, Ram M.

    2013-05-01

    An S-band noise radar has been developed for through-wall ranging and tracking of targets. Ranging to target is achieved by the cross-correlation between the time-delayed reflected return signal and the replica of the transmit signal; both are bandlimited ultrawideband (UWB) noise signals. Furthermore, successive scene subtraction allows for target tracking using the range profiles created by the cross-correlation technique. In this paper, we explore the performance of the radar system for target detection through varied, lossy media (e.g. a 4-inch thick brick wall and an 8-inch thick cinder-block wall) via correlation measurements using the S-band radar system. Moreover, we present a qualitative analysis of the S-band noise radar as operated under disparate testing configurations (i.e. different walls, targets, and distances.) with different antennas (e.g. dual polarized horns, helical antennas with different ground planes, etc.). In addition, we discuss key concepts of the noise radar design, considerations for an antenna choice, as well as experimental results for a few scenarios.

  8. Performance-based quality specifications: the relationship between process critical control parameters, critical quality attributes, and clinical performance.

    Science.gov (United States)

    Short, Steven M; Cogdill, Robert P; Drennen, James K; Anderson, Carl A

    2011-04-01

    The quality of pharmaceutical products is currently evaluated through a series of tests that do not explicitly communicate the clinical consequences of product variability. A previously published risk simulation platform was used to generate quantitative estimates of inefficacy and toxicity for 288 uniform lots of extended-release theophylline tablets displaying various levels of content uniformity and dissolution variability. These data were used to evaluate the univariate specifications utilized in the United States Pharmacopeia (USP) and . Simulation revealed that the specifications are too lenient for content uniformity, both in terms of inefficacy and toxicity, whereas the criteria for dissolution testing are too strict for inefficacy and inaccurate for toxicity. The USP tests also failed to pinpoint the clinical interaction between content uniformity and dissolution variability. Additionally, the simulation platform was used to define the underlying relationship between product quality attributes and clinical performance. Here, content uniformity and Weibull dissolution time constants were used as inputs to the design spaces, which were conditioned on quantitative estimates of inefficacy and toxicity. This methodology enhances the information content of the design space by omitting quality surrogates (e.g., dissolution, moisture content) that are utilized in current design space practices.

  9. Pre-clinical evaluation of a novel CEA-targeting near-infrared fluorescent tracer delineating colorectal and pancreatic tumors

    Science.gov (United States)

    Boonstra, Martin C.; Tolner, Berend; Schaafsma, Boudewijn E.; Boogerd, Leonora S.F.; Prevoo, Hendrica A.J.M; Bhavsar, Guarav; Kuppen, Peter J.K.; Sier, Cornelis F.M.; Bonsing, Bert A.; Frangioni, John V.; van de Velde, Cornelis J.H.; Chester, Kerry A.; Vahrmeijer, Alexander L.

    2016-01-01

    Surgery is the cornerstone of oncologic therapy with curative intent. However, identification of tumor cells in the resection margins is difficult, resulting in non-radical resections, increased cancer recurrence and subsequent decreased patient survival. Novel imaging techniques that aid in demarcating tumor margins during surgery are needed. Overexpression of carcinoembryonic antigen (CEA) is found in the majority of gastro-intestinal carcinomas, including colorectal and pancreas. We developed ssSM3E/800CW, a novel CEA-targeted near-infrared fluorescent (NIRF) tracer, based on a disulphide stabilized single-chain antibody fragment (ssScFv), to visualize colorectal and pancreatic tumors in a clinically translatable setting. The applicability of the tracer was tested for cell and tissue binding characteristics and dosing using immunohistochemistry, flow cytometry, cell-based plate assays and orthotopic colorectal (HT-29, well differentiated) and pancreatic (BXPC-3, poorly differentiated) xenogeneic human-mouse models. NIRF signals were visualized using the clinically compatible FLARE™ imaging system. Calculated clinically relevant doses of ssSM3E/800CW selectively accumulated in colorectal and pancreatic tumors/cells, with highest tumor-to-background ratios of 5.1±0.6 at 72 h post-injection, which proved suitable for intra-operative detection and delineation of tumor boarders and small (residual) tumor-nodules in mice, between 8 h and 96 h post-injection. Ex vivo fluorescence imaging and pathologic examination confirmed tumor-specificity and the distribution of the tracer. Our results indicate that ssSM3E/800CW shows promise as a diagnostic tool to recognize colorectal and pancreatic cancers for fluorescent-guided surgery applications. If successful translated clinically, this tracer could help improve the completeness of surgery and thus survival. PMID:25895046

  10. Performance evaluation of the ADVIA 2120 hematology analyzer: an international multicenter clinical trial.

    Science.gov (United States)

    Harris, Neil; Jou, Josep Maria; Devoto, Gianluigi; Lotz, J; Pappas, James; Wranovics, David; Wilkinson, Mary; Fletcher, Suzanne R; Kratz, Alexander

    2005-01-01

    Automated cell counters are widely used in modern clinical laboratories to provide reliable, fast, and cost-effective complete blood counts (CBCs), white blood cell differentials, and reticulocyte measurements. In addition, some advanced instruments provide novel parameters, such as the hemoglobin content of reticulocytes or the percentage of hypochromic cells, and are capable of analysis of a variety of body fluids. Bayer recently introduced the ADVIA 2120 system as an automation-ready cell counter for mid- to high-volume testing in the clinical laboratory. This instrument, which builds on the established technology of the ADVIA 120 system, operates with a cyanide-free method for hemoglobin measurement, has a new user interface, and can routinely analyze biological fluid samples in addition to blood. We used 749 samples from 6 worldwide trial sites to evaluate the clinical performance of this new device. Accuracy of the ADVIA 2120 system versus its predecessor model, the ADVIA 120 system, was excellent for all CBC and white cell differential parameters and reticulocyte counts (all correlation coefficients except for basophils >0.9). Correlation of the white cell differential with the standard manual method and within-run precision of the ADVIA 2120 system also was very good. Use of the novel cyanide-free method for hemoglobin measurement had no clinically significant impact on hemoglobin results, even in patients with hemoglobinopathies. We concluded that the ADVIA 2120 system has clinically equivalent performance to the ADVIA 120 system.

  11. Effect of metabolic abnormalities on cognitive performance and clinical symptoms in schizophrenia

    Directory of Open Access Journals (Sweden)

    Wysokiński, Adam

    2013-12-01

    Full Text Available Aim. The objective of this study is to determine whether and how metabolic abnormalities are associated with clinical symptoms and cognitive performance in schizophrenia. Methods. 46 adult patients with schizophrenia taking first- or second generation antipsychotics were included in the study. The following data were collected: BMI, abdominal circumference, lipid panel and blood glucose, blood pressure and treatment of comorbidities. Clinical symptoms were assessed using PANSS, CDSS, CGI and SAS scales. Cognitive performance was assessed using CNS Vital Signs computerized battery of tests: Verbal Memory test, Visual Memory test, Finger Tapping Test, Symbol Digit Coding, Stroop Test, Shifting Attention Test, and Continuous Performance Test. Results. Dyslipidemia, raised LDL and raised blood glucose levels were the best predictors of more severe clinical symptoms (PANSS, PANSS P, PANSS G, CGI and lower neurocognitive index, worse cognitive flexibility, executive functions, complex attention composite memory, verbal memory, slower reaction time and worse performance in SAT, CPT, ST tests. Obesity was associated with worse results in VBM, VIM, FTT, SDC tests. Raised blood pressure was associated with improvements in all cognitive domains and better performance in SAT, CPT, ST tests. Discussion. There are several weak associations between severity of clinical symptoms and metabolic abnormalities. Most of these were for blood glucose levels and raised blood glucose. Lipids and glucose abnormalities are the best predictors of deteriorated cognitive performance. Contrary to previous observations, raised blood pressure was associated with better results in cognitive tests. Conclusions. These findings indicate that cognitive impairment and metabolic abnormalities may be linked in patients with schizophrenia

  12. Camptothecin targets WRN protein: mechanism and relevance in clinical breast cancer.

    Science.gov (United States)

    Shamanna, Raghavendra A; Lu, Huiming; Croteau, Deborah L; Arora, Arvind; Agarwal, Devika; Ball, Graham; Aleskandarany, Mohammed A; Ellis, Ian O; Pommier, Yves; Madhusudan, Srinivasan; Bohr, Vilhelm A

    2016-03-22

    Werner syndrome protein (WRN) is a RecQ helicase that participates in DNA repair, genome stability and cellular senescence. The five human RecQ helicases, RECQL1, Bloom, WRN, RECQL4 and RECQL5 play critical roles in DNA repair and cell survival after treatment with the anticancer drug camptothecin (CPT). CPT derivatives are widely used in cancer chemotherapy to inhibit topoisomerase I and generate DNA double-strand breaks during replication. Here we studied the effects of CPT on the stability and expression dynamics of human RecQ helicases. In the cells treated with CPT, we observed distinct effects on WRN compared to other human RecQ helicases. CPT altered the cellular localization of WRN and induced its degradation by a ubiquitin-mediated proteasome pathway. WRN knockdown cells as well as CPT treated cells became senescent and stained positive for senescence-associated β-galactosidase at a higher frequency compared to control cells. However, the senescent phenotype was attenuated by ectopic expression of WRN suggesting functional implication of WRN degradation in CPT treated cells. Approximately 5-23% of breast cancer tumors are known to respond to CPT-based chemotherapy. Interestingly, we found that the extent of CPT-induced WRN degradation correlates with increasing sensitivity of breast cancer cells to CPT. The abundance of WRN decreased in CPT-treated sensitive cells; however, WRN remained relatively stable in CPT-resistant breast cancer cells. In a large clinical cohort of breast cancer patients, we find that WRN and topoisomerase I expression correlate with an aggressive tumor phenotype and poor prognosis. Our novel observations suggest that WRN abundance along with CPT-induced degradation could be a promising strategy for personalizing CPT-based cancer chemotherapeutic regimens.

  13. Influence of Anesthesiology Residents' Noncognitive Skills on the Occurrence of Critical Incidents and the Residents' Overall Clinical Performances.

    Science.gov (United States)

    Rhoton, M. Frances; And Others

    1991-01-01

    Analysis of medical residents' clinical performances in five teaching hospital anesthesiology departments revealed that noncognitive performance in some areas was a powerful predictor of overall clinical performance and was related to the occurrence of critical incidents. Noncognitive predictors included conscientiousness, management, confidence,…

  14. Mutation Profiling of Clinically Advanced Cancers Using Next-Generation Sequencing for Targeted Therapy: A Lifespan Experience.

    Science.gov (United States)

    Friedman, Kenneth; Resnick, Murray B; Safran, Howard

    2015-10-01

    The application of modern molecular tests such as next-generation sequencing (NGS) to human malignancies has led to better understanding of tumor biology and the design of targeted molecular therapies. In the research setting, important genomic alterations in tumors have been discovered with potential therapeutic implications but data regarding the impact of this technology in a real world oncology practice is limited. As a result, we decided to review the results of NGS in 144 advanced-stage cancer patients referred to the oncology practices of Lifespan-affiliated centers in Rhode Island. Most cancers revealed genomic alterations in genes commonly mutated in cancer. However, several unexpected genomic alterations were discovered in certain cancers with potential therapeutic intervention. Most cancers contained "actionable" genomic alterations despite being of advanced stage. Our experience demonstrates that application of NGS in the clinical setting contributes both to increasing the therapeutic armamentarium as well as our understanding of tumor biology.

  15. Targeting, Segmenting and Positioning the Market for College Students to Increase Customer Satisfaction and Overall Performance

    Science.gov (United States)

    Wright, Robert E.

    2008-01-01

    Numerous studies have explored the relationship between marketing efforts and firm financial performance. Studies have looked at potential lifetime value of customers, to demonstrate the value of keeping customers. Various other studies have looked at the relationship between customer satisfaction and firm performance. However, few studies have…

  16. Factors influencing nursing students' academic and clinical performance and attrition: an integrative literature review.

    Science.gov (United States)

    Pitt, Victoria; Powis, David; Levett-Jones, Tracy; Hunter, Sharyn

    2012-11-01

    Predicted workforce shortages have resulted in government initiatives to increase student numbers in preregistration nursing education. In tandem schools of nursing need to ensure students' progress and complete. The aim of this review was to identify factors that influence preregistration nursing students' academic performance, clinical performance and attrition. An integrative review of both quantitative and qualitative literature was conducted using validated appraisal checklists. The review included studies published from 1999 to 2011 in the databases: MEDLINE, CINAHL, Proquest nursing, Proquest Education (via Proquest 5000), ERIC, Journals@Ovid, PsychINFO and ScienceDirect. Studies were categorised according to their impact on academic progression, clinical progression and attrition. Forty four studies were found; most used quantitative methodologies. The review identified that few studies explored factors that impact on students' clinical performance. The four categories that potentially impact on nursing students' academic performance and attrition were: demographic, academic, cognitive and personality/behavioural factors. The challenge for universities committed to students' success is to develop strategies aimed at addressing these factors that are appropriate to specific contexts and student cohorts.

  17. Associating Drugs, Targets and Clinical Outcomes into an Integrated Network Affords a New Platform for Computer-Aided Drug Repurposing.

    Science.gov (United States)

    Oprea, Tudor I; Nielsen, Sonny Kim; Ursu, Oleg; Yang, Jeremy J; Taboureau, Olivier; Mathias, Stephen L; Kouskoumvekaki, Lrene; Sklar, Larry A; Bologa, Cristian G

    2011-03-14

    Finding new uses for old drugs is a strategy embraced by the pharmaceutical industry, with increasing participation from the academic sector. Drug repurposing efforts focus on identifying novel modes of action, but not in a systematic manner. With intensive data mining and curation, we aim to apply bio- and cheminformatics tools using the DRUGS database, containing 3,837 unique small molecules annotated on 1,750 proteins. These are likely to serve as drug targets and antitargets (i.e., associated with side effects, SE). The academic community, the pharmaceutical sector and clinicians alike could benefit from an integrated, semantic-web compliant computer-aided drug repurposing (CADR) effort, one that would enable deep data mining of associations between approved drugs (D), targets (T), clinical outcomes (CO) and SE. We report preliminary results from text mining and multivariate statistics, based on 7,684 approved drug labels, ADL (Dailymed) via text mining. From the ADL corresponding to 988 unique drugs, the "adverse reactions" section was mapped onto 174 SE, then clustered via principal component analysis into a 5x5 self-organizing map that was integrated into a Cytoscape network of SE-D-T-CO. This type of data can be used to streamline drug repurposing and may result in novel insights that can lead to the identification of novel drug actions.

  18. Targeted High Performance Liquid Chromatography Tandem Mass Spectrometry-based Metabolomics differentiates metabolic syndrome from obesity.

    Science.gov (United States)

    Zhong, Fanyi; Xu, Mengyang; Bruno, Richard S; Ballard, Kevin D; Zhu, Jiangjiang

    2017-04-01

    Both obesity and the metabolic syndrome are risk factors for type 2 diabetes and cardiovascular disease. Identification of novel biomarkers are needed to distinguish metabolic syndrome from equally obese individuals in order to direct them to early interventions that reduce their risk of developing further health problems. We utilized mass spectrometry-based targeted metabolic profiling of 221 metabolites to evaluate the associations between metabolite profiles and established metabolic syndrome criteria (i.e. elevated waist circumference, hypertension, elevated fasting glucose, elevated triglycerides, and low high-density lipoprotein cholesterol) in plasma samples from obese men ( n = 29; BMI = 35.5 ± 5.2 kg/m(2)) and women ( n = 40; 34.9 ± 6.7 kg/m(2)), of which 26 met the criteria for metabolic syndrome (17 men and 9 women). Compared to obese individuals without metabolic syndrome, univariate statistical analysis and partial least squares discriminant analysis showed that a specific group of metabolites from multiple metabolic pathways (i.e. purine metabolism, valine, leucine and isoleucine degradation, and tryptophan metabolism) were associated with the presence of metabolic syndrome. Receiver operating characteristic curves generated based on the PLS-DA models showed excellent areas under the curve (0.85 and 0.96, for metabolites only model and enhanced metabolites model, respectively), high specificities (0.86 and 0.93), and good sensitivities (0.71 and 0.91). Moreover, principal component analysis revealed that metabolic profiles can be used to further differentiate metabolic syndrome with 3 versus 4-5 metabolic syndrome criteria. Collectively, these findings support targeted metabolomics approaches to distinguish metabolic syndrome from obesity alone, and to stratify metabolic syndrome status based on the number of criteria met. Impact statement We utilized mass spectrometry-based targeted metabolic profiling of 221 metabolites to

  19. Significant alterations in reported clinical practice associated with increased oversight of organ transplant center performance.

    Science.gov (United States)

    Schold, Jesse D; Arrington, Charlotte J; Levine, Greg

    2010-09-01

    In the past several years, emphasis on quality metrics in the field of organ transplantation has increased significantly, largely because of the new conditions of participation issued by the Centers for Medicare and Medicaid Services. These regulations directly associate patients' outcomes and measured performance of centers with the distribution of public funding to institutions. Moreover, insurers and marketing ventures have used publicly available outcomes data from transplant centers for business decision making and advertisement purposes. We gave a 10-question survey to attendees of the Transplant Management Forum at the 2009 meeting of the United Network for Organ Sharing to ascertain how centers have responded to the increased oversight of performance. Of 63 responses, 55% indicated a low or near low performance rating at their center in the past 3 years. Respondents from low-performing centers were significantly more likely to indicate increased selection criteria for candidates (81% vs 38%, P = .001) and donors (77% vs 31%, P < .001) as well as alterations in clinical protocols (84% vs 52%, P = .007). Among respondents indicating lost insurance contracts (31%), these differences were also highly significant. Based on respondents' perceptions, outcomes of performance evaluations are associated with significant changes in clinical practice at transplant centers. The transplant community and policy makers should practice vigilance that performance evaluations and regulatory oversight do not inadvertently lead to diminished access to care among viable candidates or decreased transplant volume.

  20. A Prospective Pathologic Study to Define the Clinical Target Volume for Partial Breast Radiation Therapy in Women With Early Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Nguyen, Brandon T., E-mail: Brandon.Nguyen@act.gov.au [Department of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria (Australia); Canberra Hospital, Radiation Oncology Department, Garran, ACT (Australia); Deb, Siddhartha [Department of Anatomical Pathology, Peter MacCallum Cancer Centre, East Melbourne, Victoria (Australia); Victorian Cancer Biobank, Cancer Council of Victoria, Carlton, Victoria (Australia); Fox, Stephen [Department of Anatomical Pathology, Peter MacCallum Cancer Centre, East Melbourne, Victoria (Australia); Hill, Prudence [Department of Anatomical Pathology, St. Vincent' s Hospital Melbourne, Fitzroy, Victoria (Australia); Collins, Marnie [Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, East Melbourne, Victoria (Australia); Chua, Boon H. [Department of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria (Australia); University of Melbourne, Parkville, Victoria (Australia)

    2012-12-01

    Purpose: To determine an appropriate clinical target volume for partial breast radiation therapy (PBRT) based on the spatial distribution of residual invasive and in situ carcinoma after wide local excision (WLE) for early breast cancer or ductal carcinoma in situ (DCIS). Methods and Materials: We performed a prospective pathologic study of women potentially eligible for PBRT who had re-excision and/or completion mastectomy after WLE for early breast cancer or DCIS. A pathologic assessment protocol was used to determine the maximum radial extension (MRE) of residual carcinoma from the margin of the initial surgical cavity. Women were stratified by the closest initial radial margin width: negative (>1 mm), close (>0 mm and {<=}1 mm), or involved. Results: The study population was composed of 133 women with a median age of 59 years (range, 27-82 years) and the following stage groups: 0 (13.5%), I (40.6%), II (38.3%), and III (7.5%). The histologic subtypes of the primary tumor were invasive ductal carcinoma (74.4%), invasive lobular carcinoma (12.0%), and DCIS alone (13.5%). Residual carcinoma was present in the re-excision and completion mastectomy specimens in 55.4%, 14.3%, and 7.2% of women with an involved, close, and negative margin, respectively. In the 77 women with a noninvolved radial margin, the MRE of residual disease, if present, was {<=}10 mm in 97.4% (95% confidence interval 91.6-99.5) of cases. Larger MRE measurements were significantly associated with an involved margin (P<.001), tumor size >30 mm (P=.03), premenopausal status (P=.03), and negative progesterone receptor status (P=.05). Conclusions: A clinical target volume margin of 10 mm would encompass microscopic residual disease in >90% of women potentially eligible for PBRT after WLE with noninvolved resection margins.

  1. Midwives’ Clinical Reasons for Performing Episiotomies in the Kurdistan Region; Are they evidence-based?

    Directory of Open Access Journals (Sweden)

    Hamdia M. Ahmed

    2014-08-01

    Full Text Available Objectives: An episiotomy is one of the most common obstetric surgical procedures and is performed mainly by midwives. The decision to perform an episiotomy depends on related clinical factors. This study aimed to find out midwives’ reasons for performing episiotomies and to identify the relationship between these reasons and the demographic characteristics of the midwives. Methods: This cross-sectional study was conducted between 1st July and 30th September 2013 in three governmental maternity teaching hospitals in the three main cities of the Kurdistan Region of Iraq. All of the midwives who had worked in the delivery rooms of these hospitals for at least one year were invited to participate in the study (n = 53. Data were collected through interviews with midwives as well as via a questionnaire constructed for the purpose of the study. The questionnaire sought to determine: midwives’ demographic characteristics; type of episiotomy performed; authority of the decision to perform the procedure, and reasons for performing episiotomies. Results: The main clinical reasons reported by midwives for performing an episiotomy were: macrosomia/large fetus (38, 71.7%, breech delivery (31, 58.5%, shoulder dystocia (29, 54.7%, anticipated perineal tear (27, 50.9% and fetal distress (27, 50.9%. There was a significant association between the frequency of these reasons and midwives’ total experience in delivery rooms as well as their levels of education. Conclusion: Most of the reasons given by the midwives for performing episiotomies were not evidencebased. Age, years of experience, specialties and level of education also had an effect on midwives’ reasons for performing episiotomies.

  2. Effect of Compound Sulfadiazine Suspension on Growth Performance of Broiler in Clinical Efficacy Trial

    Directory of Open Access Journals (Sweden)

    Leilei Wang

    2014-04-01

    Full Text Available Compound Sulfadiazine suspension is used mainly to prevent and cure E. coli, Salmonella infection of chicken in veterinary clinical application. Effect of compound Sulfadiazine suspension on growth performance of broiler in clinical efficacy trial was studied in the study. One hundred eighty 15-day-old broilers were divided randomly into six groups, blank control group, negative control group, Trisulmixos gavage group, Trisulmixos drinking group, Sufuning gavage group and Sufuning drinking group, respectively. There were three repeating treatments in each group and ten broilers in each treatment. Results showed that compound Sulfadiazine suspension can promote the feed conversion rate of broiler when curing E. coli, Salmonella infection of chicken. Both from the perspective of efficacy and from the perspective of growth performance, giving drug by gavage were more effective than giving by drinking. When two products of Compound Sulfadiazine suspension were compared, the indicators of Sufuning were a little better Trisulmixos.

  3. Common problems of clinical performance examination in breastfeeding instruction for nursing baccalaureate students.

    Science.gov (United States)

    Chiu, Fang-Hui; Gau, Meei-Ling; Kuo, Sue-Chen; Chung, Ue-Lin

    2003-06-01

    The purpose of this study was to investigate the problems commonly seen in the clinical breastfeeding practice of undergraduate nursing students. The criterion for clinical performance examination was the instructional ability index for breastfeeding determined from the competency-based clinical performance examination in maternity nursing, a model developed by Chung et al. (2001). Simple random sampling was used to access 60 participants from the 213 baccalaureate students from the second year of a nursing department who had completed obstetric nursing education. The average age of the subjects was 20.73 years. Most subjects did not have experience either in breastfeeding or in instructing others about breastfeeding. The pass rate in the clinical examination was 26.67 % (n=16), and the difference was only in obstetrics nursing practicum scores and days of practice between pass and fail, with no significant difference in demographic data. The most common mistakes found during breastfeeding instruction by students included distinguishing the infant consciousness state fit for feeding, knowing when to stop feeding, identifying when the baby is hungry or satisfactied via behavioral cues, maternal posture (cradle and football holds, and side-lying), latching on techniques, assisting mother to correctly remove infant from the breast, and overriding test categories such as sepsis, interpersonal relationship, health teaching, physical jeopardy, and bonding. The results of this study can be used by instructors to improve their teaching design in breastfeeding education, as well as by undergraduate students of nursing departments to advance their ability to instruct others about breastfeeding.

  4. Material fundamentals and clinical performance of plasma-sprayed hydroxyapatite coatings: a review.

    Science.gov (United States)

    Sun, L; Berndt, C C; Gross, K A; Kucuk, A

    2001-01-01

    The clinical use of plasma-sprayed hydroxyapatite (HA) coatings on metal implants has aroused as many controversies as interests over the last decade. Although faster and stronger fixation and more bone growth have been revealed, the performance of HA-coated implants has been doubted. This article will initially address the fundamentals of the material selection, design, and processing of the HA coating and show how the coating microstructure and properties can be a good predictor of the expected behavior in the body. Further discussion will clarify the major concerns with the clinical use of HA coatings and introduce a comprehensive review concerning the outcomes experienced with respect to clinical practice over the past 5 years. A reflection on the results indicates that HA coatings can promote earlier and stronger fixation but exhibit a durability that can be related to the coating quality. Specific relationships between coating quality and clinical performance are being established as characterization methods disclose more information about the coating.

  5. A computer-assisted protocol for endovascular target interventions using a clinical MRI system for controlling untethered microdevices and future nanorobots.

    Science.gov (United States)

    Martel, Sylvain; Mathieu, Jean-Baptiste; Felfoul, Ouajdi; Chanu, Arnaud; Aboussouan, Eric; Tamaz, Samer; Pouponneau, Pierre; Yahia, L'Hocine; Beaudoin, Gilles; Soulez, Gilles; Mankiewicz, Martin

    2008-11-01

    The possibility of automatically navigating untethered microdevices or future nanorobots to conduct target endovascular interventions has been demonstrated by our group with the computer-controlled displacement of a magnetic sphere along a pre-planned path inside the carotid artery of a living swine. However, although the feasibility of propelling, tracking and performing real-time closed-loop control of an untethered ferromagnetic object inside a living animal model with a relatively close similarity to human anatomical conditions has been validated using a standard clinical Magnetic Resonance Imaging (MRI) system, little information has been published so far concerning the medical and technical protocol used. In fact, such a protocol developed within technological and physiological constraints was a key element in the success of the experiment. More precisely, special software modules were developed within the MRI software environment to offer an effective tool for experimenters interested in conducting such novel interventions. These additional software modules were also designed to assist an interventional radiologist in all critical real-time aspects that are executed at a speed beyond human capability, and include tracking, propulsion, event timing and closed-loop position control. These real-time tasks were necessary to avoid a loss of navigation control that could result in serious injury to the patient. Here, additional simulation and experimental results for microdevices designed to be targeted more towards the microvasculature have also been considered in the identification, validation and description of a specific sequence of events defining a new computer-assisted interventional protocol that provides the framework for future target interventions conducted in humans.

  6. Do targeted written comments and the rubric method of delivery affect performance on future human physiology laboratory reports?

    Science.gov (United States)

    Clayton, Zachary S; Wilds, Gabriel P; Mangum, Joshua E; Hocker, Austin D; Dawson, Sierra M

    2016-09-01

    We investigated how students performed on weekly two-page laboratory reports based on whether the grading rubric was provided to the student electronically or in paper form and the inclusion of one- to two-sentence targeted comments. Subjects were registered for a 289-student, third-year human physiology class with laboratory and were randomized into four groups related to rubric delivery and targeted comments. All students received feedback via the same detailed grading rubric. At the end of the term, subjects provided consent and a self-assessment of their rubric viewing rate and preferences. There were no differences in laboratory report scores between groups (P = 0.86), although scores did improve over time (P < 0.01). Students receiving targeted comments self-reported viewing their rubric more often than students that received no comments (P = 0.02), but the viewing rate was independent of the rubric delivery method (P = 0.15). Subjects with high rubric viewing rates did not have higher laboratory report grades than subjects with low viewing rates (P = 0.64). When asked about their preference for the future, 43% of respondents preferred the same method again (electronic or paper rubric) and 25% had no preference. We conclude that although student laboratory report grades improved over time, the rate and degree of improvement were not related to rubric delivery method or to the inclusion of targeted comments.

  7. National turnaround time survey: professional consensus standards for optimal performance and thresholds considered to compromise efficient and effective clinical management.

    Science.gov (United States)

    McKillop, Derek J; Auld, Peter

    2017-01-01

    Background Turnaround time can be defined as the time from receipt of a sample by the laboratory to the validation of the result. The Royal College of Pathologists recommends that a number of performance indicators for turnaround time should be agreed with stakeholders. The difficulty is in arriving at a goal which has some evidence base to support it other than what may simply be currently achievable technically. This survey sought to establish a professional consensus on the goals and meaning of targets for laboratory turnaround time. Methods A questionnaire was circulated by the National Audit Committee to 173 lead consultants for biochemistry in the UK. The survey asked each participant to state their current target turnaround time for core investigations in a broad group of clinical settings. Each participant was also asked to provide a professional opinion on what turnaround time would pose an unacceptable risk to patient safety for each departmental category. A super majority (2/3) was selected as the threshold for consensus. Results The overall response rate was 58% ( n = 100) with a range of 49-72% across the individual Association for Clinical Biochemistry and Laboratory Medicine regions. The consensus optimal turnaround time for the emergency department was 2 h considered unacceptable. The times for general practice and outpatient department were 48 h and for Wards 12 h, respectively. Conclusions We consider that the figures provide a useful benchmark of current opinion, but clearly more empirical standards will have to develop alongside other aspects of healthcare delivery.

  8. Targeting the Use of Pooled HIV RNA Screening to Reduce Cost in Health Department STD Clinics: New York City, 2009–2011

    Science.gov (United States)

    Pathela, Preeti; Pirillo, Robert; Blank, Susan

    2015-01-01

    Objective Staff at public New York City sexually transmitted disease (STD) clinics screen patients for acute HIV infection (AHI) using pooled nucleic acid amplification tests. AHI screening is expensive but important for populations at high risk of acquiring HIV. We analyzed if targeting AHI screening in STD clinics could reduce program costs while maintaining AHI case detection. Methods From January 2009 through May 2010, we screened all patients with negative rapid HIV tests for AHI. Using risk information on cases detected during this universal screening period, we developed criteria for targeted AHI screening and compared case yields and testing costs during 12 months of universal screening (June 2009 through May 2010) vs. 12 months of targeted screening (June 2010 through May 2011). Results During the defined period of universal screening, we identified 40 AHI cases, and during targeted screening, we identified 35 AHI cases. Because of targeting efforts, the number needed to test to find one AHI case dropped from 1,631 to 254. With targeted screening, it cost an average of $4,535 per case detected and 39.3 cases were detected per 10,000 specimens; using universal screening, $29,088 was spent per case detected and 6.1 cases were detected per 10,000 specimens processed. Conclusion Targeted screening identified similar numbers of AHI cases as when screening all clinic patients seeking HIV testing, but at one-seventh the cost. PMID:25552758

  9. Improving performance in golf: current research and implications from a clinical perspective

    Directory of Open Access Journals (Sweden)

    Kerrie Evans

    2015-10-01

    Full Text Available ABSTRACTGolf, a global sport enjoyed by people of all ages and abilities, involves relatively long periods of low intensity exercise interspersed with short bursts of high intensity activity. To meet the physical demands of full swing shots and the mental and physical demands of putting and walking the course, it is frequently recommended that golfers undertake golf-specific exercise programs. Biomechanics, motor learning, and motor control research has increased the understanding of the physical requirements of the game, and using this knowledge, exercise programs aimed at improving golf performance have been developed. However, while it is generally accepted that an exercise program can improve a golfer's physical measurements and some golf performance variables, translating the findings from research into clinical practice to optimise an individual golfer's performance remains challenging. This paper discusses how biomechanical and motor control research has informed current practice and discusses how emerging sophisticated tools and research designs may better assist golfers improve their performance.

  10. Targeted Help for Spoken Dialogue Systems: Intelligent Feedback Improves Naive Users' Performance

    Science.gov (United States)

    Hockey, Beth Ann; Lemon, Oliver; Campana, Ellen; Hiatt, Laura; Aist, Gregory; Hieronymous, Jim; Gruenstein, Alexander; Dowding, John

    2003-01-01

    We present experimental evidence that providing naive users of a spoken dialogue system with immediate help messages related to their out-of-coverage utterances improves their success in using the system. A grammar-based recognizer and a Statistical Language Model (SLM) recognizer are run simultaneously. If the grammar-based recognizer suceeds, the less accurate SLM recognizer hypothesis is not used. When the grammar-based recognizer fails and the SLM recognizer produces a recognition hypothesis, this result is used by the Targeted Help agent to give the user feed-back on what was recognized, a diagnosis of what was problematic about the utterance, and a related in-coverage example. The in-coverage example is intended to encourage alignment between user inputs and the language model of the system. We report on controlled experiments on a spoken dialogue system for command and control of a simulated robotic helicopter.

  11. INFLUENCE OF STOCHASTIC NOISE STATISTICS ON KALMAN FILTER PERFORMANCE BASED ON VIDEO TARGET TRACKING

    Institute of Scientific and Technical Information of China (English)

    Chen Ken; Napolitano; Zhang Yun; Li Dong

    2010-01-01

    The system stochastic noises involved in Kalman filtering are preconditioned on being ideally white and Gaussian distributed. In this research,efforts are exerted on exploring the influence of the noise statistics on Kalman filtering from the perspective of video target tracking quality. The correlation of tracking precision to both the process and measurement noise covariance is investigated; the signal-to-noise power density ratio is defined; the contribution of predicted states and measured outputs to Kalman filter behavior is discussed; the tracking precision relative sensitivity is derived and applied in this study case. The findings are expected to pave the way for future study on how the actual noise statistics deviating from the assumed ones impacts on the Kalman filter optimality and degradation in the application of video tracking.

  12. High performance ZnO:Al films deposited on PET substrates using facing target sputtering

    Energy Technology Data Exchange (ETDEWEB)

    Guo, Tingting [Solar Film Laboratory, School of Physics and Nuclear Energy Engineering, Beihang University, Beijing 100191 (China); Dong, Guobo, E-mail: wavedong@buaa.edu.cn [Solar Film Laboratory, School of Physics and Nuclear Energy Engineering, Beihang University, Beijing 100191 (China); Gao, Fangyuan; Xiao, Yu [Solar Film Laboratory, School of Physics and Nuclear Energy Engineering, Beihang University, Beijing 100191 (China); Chen, Qiang [Key Laboratory of Micro-nano Measurement-Manipulation and Physics (Ministry of Education), School of Physics and Nuclear Energy Engineering, Beihang University, Beijing 100191 (China); Diao, Xungang [Solar Film Laboratory, School of Physics and Nuclear Energy Engineering, Beihang University, Beijing 100191 (China)

    2013-10-01

    ZnO:Al (ZAO) thin films have been deposited on flexible PET substrates using a plasma damage-free facing target sputtering system at room temperature. The structure, surface morphology, electrical and optical properties were investigated as a function of working power. All the samples have a highly preferred orientation of the c-axis perpendicular to the PET substrate and have a high quality surface. With increased working power, the carrier concentration changes slightly, the mobility increases at the beginning and decreases after it reaches a maximum value, in line with electrical conductivity. The figure of merit has been significantly improved with increasing of the working power. Under the optimized condition, the lowest resistivity of 1.3 × 10{sup −3} Ω cm with a sheet resistance of 29 Ω/□ and the relative visible transmittance above 93% in the visible region were obtained.

  13. Performance comparison of multi-detector detection statistics in targeted compact binary coalescence GW search

    CERN Document Server

    Haris, K

    2016-01-01

    Global network of advanced Interferometric gravitational wave (GW) detectors are expected to be on-line soon. Coherent observation of GW from a distant compact binary coalescence (CBC) with a network of interferometers located in different continents give crucial information about the source such as source location and polarization information. In this paper we compare different multi-detector network detection statistics for CBC search. In maximum likelihood ratio (MLR) based detection approaches, the likelihood ratio is optimized to obtain the best model parameters and the best likelihood ratio value is used as statistic to make decision on the presence of signal. However, an alternative Bayesian approach involves marginalization of the likelihood ratio over the parameters to obtain the average likelihood ratio. We obtain an analytical expression for the Bayesian statistic using the two effective synthetic data streams for targeted search of non-spinning compact binary systems with an uninformative prior on...

  14. Can anterior cruciate ligament reconstruction be performed routinely in day clinic?

    Science.gov (United States)

    De Beule, J; Vandenneucker, H; Claes, S; Bellemans, J

    2014-09-01

    Anterior cruciate ligament reconstruction is performed as an outpatient procedure in selected cases. Whether it can be safely performed on a routine basis in day clinic remains unclear. Our hypothesis was that routinely performing outpatient anterior cruciate ligament reconstruction would be equally safe as compared to inpatient procedures. A cohort of 355 patients who underwent outpatient primary reconstruction was analysed at an average follow-up of 3.8 years. Four patients (1.1%) could not be discharged or were readmitted within 24 hours. The 1-month readmission rate was 1.4%. The overall complication rate was 12.1% (43 cases) of which 4.2% (15 patients) occurred within the first 30 days. Performing anterior cruciate ligament reconstructions routinely in day clinic is associated with almost negligible readmission rates and has similar complication rates as for standard in-hospital anterior cruciate ligament reconstructions. Outpatient anterior cruciate ligament reconstructions can therefore be safely performed without specific preoperative patient selection protocols.

  15. Comparison of wear and clinical performance between amalgam, composite and open sandwich restorations: 2-year results.

    Science.gov (United States)

    Sachdeo, A; Gray, Gordon B; Sulieman, M A; Jagger, Daryll C

    2004-03-01

    There has been some disquiet over the use of mercury containing restorative materials. The most commonly used alternative is composite resin but this has the potential disadvantage associated with wear and marginal leakage, which in turn, has proven to result in secondary caries and sensitivity. To overcome the shortcomings of a directly placed composite restoration, the glass-ionomer/composite open sandwich technique was introduced followed by the subsequent introduction of compomer systems. The aims of this study were to evaluate the wear and clinical performance of a control group of amalgam restorations compared with that of a group of posterior composite resin restorations fillings and a group of compomer/composite open sandwich restorations placed by a single general dental practitioner. The duration of the study was 2 years. One hundred and thirty three (71.4%) patients were successfully recalled and the wear and clinical performance of each restoration after 6, 12 and 24 months was measured, indirectly. There was no statistically significant difference recorded between the groups at 6 months or 1 year (p > 0.05). However, at the end of the 2-year study, there was a significantly lower rate of wear recorded for the control amalgam restorations compared with other two groups (p = 0.033). There was no statistically significant difference in wear recorded between the two groups of tooth-coloured restorations (p > 0.05). With regards to clinical performance of the restorations, occlusal and proximal contacts in each group of restoration remained satisfactory throughout the study.

  16. Prevalence of outsourcing and perception of clinical nutrition managers on performance of health care dietetics services.

    Science.gov (United States)

    Kwon, Junehee; Yoon, Barbara J H

    2003-08-01

    A nationwide survey of clinical dietitians and clinical nutrition managers was conducted to assess the prevalence of outsourcing in health care dietetics services and to evaluate perceived performance of dietetics services. A questionnaire was developed, validated by an expert panel, and pilot tested prior to data collection. Members of the Clinical Nutrition Management Dietetic Practice Group (N=1,668) were selected as the study sample. Of 431 respondents, 152 (35.3%) indicated that management of both patient and cafeteria foodservices was outsourced. When mean scores of perceived performance ratings were compared using t test, respondents from self-operated facilities rated several items related to patient and cafeteria food quality and material and human resource utilization higher than respondents at contract-managed facilities. No significant differences were found in performance related to decision-making process, buying power, or training programs. Results suggest that careful weighing of advantages and disadvantages of outsourcing is needed before making decisions regarding outsourcing dietetics services.

  17. Is medical perspective on clinical governance practices associated with clinical units’ performance and mortality? A cross-sectional study through a record-linkage procedure

    Directory of Open Access Journals (Sweden)

    Guido Sarchielli

    2016-07-01

    Full Text Available Objective: Assessment of the knowledge and application as well as perceived utility by doctors of clinical governance tools in order to explore their impact on clinical units’ performance measured through mortality rates and efficiency indicators. Methods: This research is a cross-sectional study with a deterministic record-linkage procedure. The sample includes n = 1250 doctors (n = 249 chiefs of clinical units; n = 1001 physicians working in six public hospitals located in the Emilia-Romagna Region in Italy. Survey instruments include a checklist and a research-made questionnaire which were used for data collection about doctors’ knowledge and application as well as perceived utility of clinical governance tools. The analysis was based on clinical units’ performance indicators which include patients’ mortality, extra-region active mobility rate, average hospital stay, bed occupancy, rotation and turnover rates, and the comparative performance index as efficiency indicators. Results: The clinical governance tools are known and applied differently in all the considered clinical units. Significant differences emerged between roles and organizational levels at which the medical leadership is carried out. The levels of knowledge and application of clinical governance practices are correlated with the clinical units’ efficiency indicators (bed occupancy rate, bed turnover interval, and extra-region mobility. These multiple linear regression analyses highlighted that the clinical governance knowledge and application is correlated with clinical units’ mortality rates (odds ratio, −8.677; 95% confidence interval, −16.654, −0.700. Conclusion: The knowledge and application, as well as perceived utility by medical professionals of clinical governance tools, are associated with the mortality rates of their units and with some efficiency indicators. However, the medical frontline staff seems to not consider homogeneously useful

  18. Key Performance Indicators and Target Values for Multi-Megawatt Offshore Turbines

    DEFF Research Database (Denmark)

    Chaviaropoulos, Panagiotis K.; Natarajan, Anand; Jensen, Peter Hjuler

    2014-01-01

    This work is in the context of the FP7 Innwind.EU Project whose objective is the high performance innovative design of beyond state-of-the-art 10-20 MW offshore wind turbines. The assessment of innovation necessitates a framework where different designs can be compared against a reference...... on the basis of key performance indicators (KPIs). Following the European Wind Industrial Initiative the Levelized Cost of Electricity (LCOE) and its driving components are investigated, while quantifying the sensitivity of LCOE to its constituent factors. Methods whereby innovation in design can reduce...

  19. Performance of Propofol Target-Controlled Infusion Models in the Obese : Pharmacokinetic and Pharmacodynamic Analysis

    NARCIS (Netherlands)

    Cortinez, Luis I.; De la Fuente, Natalia; Eleveld, Douglas J.; Oliveros, Ana; Crovari, Fernando; Sepulveda, Pablo; Ibacache, Mauricio; Solari, Sandra

    2014-01-01

    BACKGROUND: Obesity is associated with important physiologic changes that can potentially affect the pharmacokinetic (PK) and pharmacodynamic (PD) profile of anesthetic drugs. We designed this study to assess the predictive performance of 5 currently available propofol PK models in morbidly obese pa

  20. Effects of ongoing task context and target typicality on prospective memory performance: the importance of associative cueing

    Science.gov (United States)

    Nowinski, Jessica Lang; Dismukes, Key R.

    2005-01-01

    Two experiments examined whether prospective memory performance is influenced by contextual cues. In our automatic activation model, any information available at encoding and retrieval should aid recall of the prospective task. The first experiment demonstrated an effect of the ongoing task context; performance was better when information about the ongoing task present at retrieval was available at encoding. Performance was also improved by a strong association between the prospective memory target as it was presented at retrieval and the intention as it was encoded. Experiment 2 demonstrated boundary conditions of the ongoing task context effect, which implicate the association between the ongoing and prospective tasks formed at encoding as the source of the context effect. The results of this study are consistent with predictions based on automatic activation of intentions.

  1. Examination of Performance Management Targets in Case of an International Corporation’s Eastern Hungarian Operating Unit

    Directory of Open Access Journals (Sweden)

    Nemeth Zoltan

    2016-06-01

    Full Text Available Nowadays, due to the social and economic changes, the human is already the main resource which determines the successfulness of corporations. The expertise in managing the human resources is a key factor of competitiveness therefore it has become a strategic question. Primary aim of the treatise is to outline the most important principles, targets and peculiarities of performance management system, which is a central element of human resource management, as well as its interconnectedness with the individual performance evaluation and human resource development through the mirror of one of today’s biggest Hungarian economic corporations. We aimed to explore, by means of document analysis as well as methods of case study and interview, how the targets of performance management are used for increasing the economic productivity, preserving the competitiveness, retaining and enhancing the satisfaction of workers. It can be stated that the PM system was continuously improved in case of the organization examined because the corporate goals and the expected performances were adjusted to the changing market demands over time but, at the same time the goal of differentiation has remained unchanged. Each worker evaluates his/her performance individually, the base of which is the extent of contribution to the corporate results. Based on the results, it can overall be stated that such a well-functioning performance management system is applied in the operating unit of the corporation examined which is strongly supported by the organizational culture and which contributes to the joint fulfilment of personal as well as organizational goals.

  2. Multi-laboratory evaluations of the performance of Catellicoccus marimammalium PCR assays developed to target gull fecal sources

    Science.gov (United States)

    Sinigalliano, Christopher D.; Ervin, Jared S.; Van De Werfhorst, Laurie C.; Badgley, Brian D.; Ballestée, Elisenda; Bartkowiaka, Jakob; Boehm, Alexandria B.; Byappanahalli, Muruleedhara N.; Goodwin, Kelly D.; Gourmelon, Michèle; Griffith, John; Holden, Patricia A.; Jay, Jenny; Layton, Blythe; Lee, Cheonghoon; Lee, Jiyoung; Meijer, Wim G.; Noble, Rachel; Raith, Meredith; Ryu, Hodon; Sadowsky, Michael J.; Schriewer, Alexander; Wang, Dan; Wanless, David; Whitman, Richard; Wuertz, Stefan; Santo Domingo, Jorge W.

    2013-01-01

    Here we report results from a multi-laboratory (n = 11) evaluation of four different PCR methods targeting the 16S rRNA gene of Catellicoccus marimammalium originally developed to detect gull fecal contamination in coastal environments. The methods included a conventional end-point PCR method, a SYBR® Green qPCR method, and two TaqMan® qPCR methods. Different techniques for data normalization and analysis were tested. Data analysis methods had a pronounced impact on assay sensitivity and specificity calculations. Across-laboratory standardization of metrics including the lower limit of quantification (LLOQ), target detected but not quantifiable (DNQ), and target not detected (ND) significantly improved results compared to results submitted by individual laboratories prior to definition standardization. The unit of measure used for data normalization also had a pronounced effect on measured assay performance. Data normalization to DNA mass improved quantitative method performance as compared to enterococcus normalization. The MST methods tested here were originally designed for gulls but were found in this study to also detect feces from other birds, particularly feces composited from pigeons. Sequencing efforts showed that some pigeon feces from California contained sequences similar to C. marimammalium found in gull feces. These data suggest that the prevalence, geographic scope, and ecology of C. marimammalium in host birds other than gulls require further investigation. This study represents an important first step in the multi-laboratory assessment of these methods and highlights the need to broaden and standardize additional evaluations, including environmentally relevant target concentrations in ambient waters from diverse geographic regions.

  3. Targeted proteomics coming of age - SRM, PRM and DIA performance evaluated from a core facility perspective.

    Science.gov (United States)

    Kockmann, Tobias; Trachsel, Christian; Panse, Christian; Wahlander, Asa; Selevsek, Nathalie; Grossmann, Jonas; Wolski, Witold E; Schlapbach, Ralph

    2016-08-01

    Quantitative mass spectrometry is a rapidly evolving methodology applied in a large number of omics-type research projects. During the past years, new designs of mass spectrometers have been developed and launched as commercial systems while in parallel new data acquisition schemes and data analysis paradigms have been introduced. Core facilities provide access to such technologies, but also actively support the researchers in finding and applying the best-suited analytical approach. In order to implement a solid fundament for this decision making process, core facilities need to constantly compare and benchmark the various approaches. In this article we compare the quantitative accuracy and precision of current state of the art targeted proteomics approaches single reaction monitoring (SRM), parallel reaction monitoring (PRM) and data independent acquisition (DIA) across multiple liquid chromatography mass spectrometry (LC-MS) platforms, using a readily available commercial standard sample. All workflows are able to reproducibly generate accurate quantitative data. However, SRM and PRM workflows show higher accuracy and precision compared to DIA approaches, especially when analyzing low concentrated analytes.

  4. 5-year clinical performance of resin composite versus resin modified glass ionomer restorative system in non-carious cervical lesions

    DEFF Research Database (Denmark)

    Franco, Eduardo Batista; Benetti, Ana Raquel; Ishikiriama, Sérgio Kiyoshi

    2006-01-01

    To comparatively assess the 5-year clinical performance of a 1-bottle adhesive and resin composite system with a resin-modified glass ionomer restorative in non-carious cervical lesions.......To comparatively assess the 5-year clinical performance of a 1-bottle adhesive and resin composite system with a resin-modified glass ionomer restorative in non-carious cervical lesions....

  5. Therapeutic potential of PRL-3 targeting and clinical significance of PRL-3 genomic amplification in gastric cancer

    Directory of Open Access Journals (Sweden)

    Nishimiya Hiroshi

    2011-04-01

    Full Text Available Abstract Background Phosphatase of regenerating liver-3 (PRL-3 has deserved attention as a crucial molecule in the multiple steps of metastasis. In the present study, we examined the mechanisms regulating PRL-3 expression, and assessed the clinical potential of PRL-3-targeted therapy in gastric cancer. Methods PRL-3 genomic amplification was analyzed using quantitative-polymerase chain reaction and/or fluorescence in situ hybridization in 77 primary gastric tumors. The anticancer activity of PRL-3 inhibitor (1-4-bromo-2-benzylidene rhodanine treatment was evaluated against cancer cells with different genetic and expression status. Results PRL-3 genomic amplification was closely concordant with high level of its protein expression in cell lines, and was found in 20% (8/40 among human primary tumors with its expression, which were all stage III/IV disease (40%, 8/20, but in none (0/37 among those without expression. Additionally, PRL-3 genomic amplification was associated with metastatic lymph node status, leading to advanced stage and thereby poor outcomes in patients with lymph node metastasis (P = 0.021. PRL-3 small interfering RNA robustly repressed metastatic properties, including cell proliferation, invasion, and anchorage-independent colony formation. Although neither PRL-3 genomic amplification nor expression level was responsible for the sensitivity to PRL-3 inhibitor treatment, the inhibitor showed dose-dependent anticancer efficacy, and remarkably induced apoptosis on all the tested cell lines with PRL-3 expression. Conclusions We have for the first time, demonstrated that PRL-3 genomic amplification is one of the predominant mechanisms inducing its expression, especially in more advanced stage, and that PRL-3-targeted therapy may have a great potential against gastric cancer with its expression.

  6. Performance Evaluation of Target Detection with a Near-Space Vehicle-Borne Radar in Blackout Condition.

    Science.gov (United States)

    Li, Yanpeng; Li, Xiang; Wang, Hongqiang; Deng, Bin; Qin, Yuliang

    2016-01-06

    Radar is a very important sensor in surveillance applications. Near-space vehicle-borne radar (NSVBR) is a novel installation of a radar system, which offers many benefits, like being highly suited to the remote sensing of extremely large areas, having a rapidly deployable capability and having low vulnerability to electronic countermeasures. Unfortunately, a target detection challenge arises because of complicated scenarios, such as nuclear blackout, rain attenuation, etc. In these cases, extra care is needed to evaluate the detection performance in blackout situations, since this a classical problem along with the application of an NSVBR. However, the existing evaluation measures are the probability of detection and the receiver operating curve (ROC), which cannot offer detailed information in such a complicated application. This work focuses on such requirements. We first investigate the effect of blackout on an electromagnetic wave. Performance evaluation indexes are then built: three evaluation indexes on the detection capability and two evaluation indexes on the robustness of the detection process. Simulation results show that the proposed measure will offer information on the detailed performance of detection. These measures are therefore very useful in detecting the target of interest in a remote sensing system and are helpful for both the NSVBR designers and users.

  7. Performance Evaluation of Target Detection with a Near-Space Vehicle-Borne Radar in Blackout Condition

    Directory of Open Access Journals (Sweden)

    Yanpeng Li

    2016-01-01

    Full Text Available Radar is a very important sensor in surveillance applications. Near-space vehicle-borne radar (NSVBR is a novel installation of a radar system, which offers many benefits, like being highly suited to the remote sensing of extremely large areas, having a rapidly deployable capability and having low vulnerability to electronic countermeasures. Unfortunately, a target detection challenge arises because of complicated scenarios, such as nuclear blackout, rain attenuation, etc. In these cases, extra care is needed to evaluate the detection performance in blackout situations, since this a classical problem along with the application of an NSVBR. However, the existing evaluation measures are the probability of detection and the receiver operating curve (ROC, which cannot offer detailed information in such a complicated application. This work focuses on such requirements. We first investigate the effect of blackout on an electromagnetic wave. Performance evaluation indexes are then built: three evaluation indexes on the detection capability and two evaluation indexes on the robustness of the detection process. Simulation results show that the proposed measure will offer information on the detailed performance of detection. These measures are therefore very useful in detecting the target of interest in a remote sensing system and are helpful for both the NSVBR designers and users.

  8. [Performance evaluation of VITEK 2 system in meropenem susceptibility testing of clinical Pseudomonas aeruginosa isolates].

    Science.gov (United States)

    Acuner, Ibrahim Cağatay; Bayramoğlu, Gülçin; Birinci, Asuman; Cekiç Cihan, Ciğdem; Bek, Yüksel; Durupınar, Belma

    2011-07-01

    Pseudomonas aeruginosa is an important opportunistic pathogen associated with various community-acquired or nosocomial infections. Multi-drug resistant P.aeruginosa strains increasingly cause epidemics and spread in various hospital wards and geographic regions. Carbapenems are among the most effective antimicrobials in the treatment of multi-drug resistant P.aeruginosa infections, and meropenem is the most successful among alternatives in initial therapy. Particularly in severe infections, inappropriate or inadequate initial antimicrobial therapy is independently associated with adverse clinical and economic outcomes. Availability of accurate and rapid susceptibility testing is a priority. Most of the automated microbiology systems can provide rapid results within 8 to 12 hours. In comparison to standard methods, problems in the antimicrobial susceptibility testing of particular microorganisms and antimicrobial agents have been reported for automated microbiology systems. Failures have been reported previously especially in the susceptibility testing of P.aeruginosa versus carbapenem. Most of these studies are designed according to the Food and Drug Administration (FDA, USA) performance analysis scheme (Class II Special Controls Guidance Document: Antimicrobial Susceptibility Test Systems) in a simplified form. However, there are many lacking issues in the design of most of these studies. Among these, insufficient sample size, use of inappropriate reference method, lack of reproducibility testing, and inadequate distribution of study isolates in interpretative categories are of notice. There are only few studies in the literature that evaluate the performance of automated systems in antimicrobial susceptibility testing of carbapenems in clinical P.aeruginosa isolates with a sufficient sample size (n ? 100). However, most of these studies still have one or more major deficiencies in the study design. Furthermore, none of these studies evaluate the performance of

  9. Are process performance measures associated with clinical outcomes among patients with hip fractures?

    DEFF Research Database (Denmark)

    Kristensen, Pia Kjaer; Thillemann, Theis Muncholm; Søballe, Kjeld;

    2016-01-01

    OBJECTIVES: To examine the association between process performance measures and clinical outcome among patients with hip fracture. DESIGN: Nationwide, population-based follow-up study. SETTING: Public Danish hospitals. PARTICIPANTS: A total of 25 354 patients 65 years or older who were admitted...... and length of stay (LOS). RESULTS: Fulfilling 75-100% of the relevant process performance measures was associated with lower 30-day mortality (22.6% vs. 8.5%, adjusted odds ratio (OR) 0.31 (95% CI: 0.28-0.35)) and lower odds for readmission (21.7% vs. 17.4%, adjusted OR 0.78 (95% CI: 0.70-0.87)). The overall...... with a hip fracture in Denmark between 2010 and 2013. INTERVENTION: The process performance measures, including systematic pain assessment, early mobilization, basic mobility assessment at arrival and at discharge, post-discharge rehabilitation program, anti-osteoporotic medication and prevention of future...

  10. Clinical Validation of Atlas-Based Auto-Segmentation of Multiple Target Volumes and Normal Tissue (Swallowing/Mastication) Structures in the Head and Neck

    Energy Technology Data Exchange (ETDEWEB)

    Teguh, David N. [Department of Radiation Oncology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands); Levendag, Peter C., E-mail: p.levendag@erasmusmc.nl [Department of Radiation Oncology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands); Voet, Peter W.J.; Al-Mamgani, Abrahim [Department of Radiation Oncology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands); Han Xiao; Wolf, Theresa K.; Hibbard, Lyndon S. [Elekta-CMS Software, Maryland Heights, MO 63043 (United States); Nowak, Peter; Akhiat, Hafid; Dirkx, Maarten L.P.; Heijmen, Ben J.M.; Hoogeman, Mischa S. [Department of Radiation Oncology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands)

    2011-11-15

    Purpose: To validate and clinically evaluate autocontouring using atlas-based autosegmentation (ABAS) of computed tomography images. Methods and Materials: The data from 10 head-and-neck patients were selected as input for ABAS, and neck levels I-V and 20 organs at risk were manually contoured according to published guidelines. The total contouring times were recorded. Two different ABAS strategies, multiple and single subject, were evaluated, and the similarity of the autocontours with the atlas contours was assessed using Dice coefficients and the mean distances, using the leave-one-out method. For 12 clinically treated patients, 5 experienced observers edited the autosegmented contours. The editing times were recorded. The Dice coefficients and mean distances were calculated among the clinically used contours, autocontours, and edited autocontours. Finally, an expert panel scored all autocontours and the edited autocontours regarding their adequacy relative to the published atlas. Results: The time to autosegment all the structures using ABAS was 7 min/patient. No significant differences were observed in the autosegmentation accuracy for stage N0 and N+ patients. The multisubject atlas performed best, with a Dice coefficient and mean distance of 0.74 and 2 mm, 0.67 and 3 mm, 0.71 and 2 mm, 0.50 and 2 mm, and 0.78 and 2 mm for the salivary glands, neck levels, chewing muscles, swallowing muscles, and spinal cord-brainstem, respectively. The mean Dice coefficient and mean distance of the autocontours vs. the clinical contours was 0.8 and 2.4 mm for the neck levels and salivary glands, respectively. For the autocontours vs. the edited autocontours, the mean Dice coefficient and mean distance was 0.9 and 1.6 mm, respectively. The expert panel scored 100% of the autocontours as a 'minor deviation, editable' or better. The expert panel scored 88% of the edited contours as good compared with 83% of the clinical contours. The total editing time was 66 min

  11. High Performance Computing and Storage Requirements for Nuclear Physics: Target 2017

    Energy Technology Data Exchange (ETDEWEB)

    Gerber, Richard; Wasserman, Harvey

    2015-01-20

    In April 2014, NERSC, ASCR, and the DOE Office of Nuclear Physics (NP) held a review to characterize high performance computing (HPC) and storage requirements for NP research through 2017. This review is the 12th in a series of reviews held by NERSC and Office of Science program offices that began in 2009. It is the second for NP, and the final in the second round of reviews that covered the six Office of Science program offices. This report is the result of that review

  12. High Performance Computing and Storage Requirements for Nuclear Physics: Target 2017

    Energy Technology Data Exchange (ETDEWEB)

    Gerber, Richard [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Wasserman, Harvey [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2014-04-30

    In April 2014, NERSC, ASCR, and the DOE Office of Nuclear Physics (NP) held a review to characterize high performance computing (HPC) and storage requirements for NP research through 2017. This review is the 12th in a series of reviews held by NERSC and Office of Science program offices that began in 2009. It is the second for NP, and the final in the second round of reviews that covered the six Office of Science program offices. This report is the result of that review

  13. Feasibility and Merits of Performing Preclinical Imaging on Clinical Radiology and Nuclear Medicine Systems

    Directory of Open Access Journals (Sweden)

    Mehmet Bilgen

    2013-01-01

    Full Text Available Aim. Researchers have limited access to systems dedicated to imaging small laboratory animals. This paper aims to investigate the feasibility and merits of performing preclinical imaging on clinical systems. Materials and Methods. Scans were performed on rat and mouse models of diseases or injuries on four radiology systems, tomosynthesis, computed tomography (CT, positron emission tomography/computed tomography (PET-CT, and Magnetic Resonance Imaging (MRI, based on the availability at the author’s institute. Results. Tomosysthesis delineated soft tissue anatomy and hard tissue structure with superb contrast and spatial resolution at minimal scan time and effort. CT allowed high resolution volumetric visualization of bones. Molecular imaging with PET was useful for detecting cancerous tissue in mouse but at the expense of poor resolution. MRI depicted abnormal or intervened tissue at quality and resolution sufficient for experimental studies. The paper discussed limitations of the clinical systems in preclinical imaging as well as challenges regarding the need of additional gadgets, modifications, or upgrades required for longitudinally scanning animals under anesthesia while monitoring their vital signs. Conclusion. Clinical imaging technologies can potentially make cost-effective and efficient contributions to preclinical efforts in obtaining anatomical, structural, and functional information from the underlying tissue while minimally compromising the data quality in certain situations.

  14. Evaluating assisted target recognition performance: an assessment of DARPA's SAIP system

    Science.gov (United States)

    Irvine, John M.

    1999-08-01

    New advanced imaging systems will soon be capable of collecting enormous volumes of imagery, placing a significant burden on the imagery analysts (IAs) that exploit these data. ATRs and other image understanding tools offer a way to assist IAs in exploiting large volumes of imagery more effectively and efficiently. The Defense Advanced Research Project Agency (DARPA) Semi-Automated IMINT Processing (SAIP) Program focuses on these technologies to assist IAs in the timely exploitation of SAR imagery. The SAIP system is an integrated set of imagery exploitation tools designed to improve the capability of the IA to support military missions in a tactical environment. To assess the utility of the SAIP technology, a mix of live and playback exercises were conducted. IAs exploited the imagery with the assistance of the SAIP technology. As a benchmark for comparison, the same imagery was exploited in an operational exploitation system without the benefit of SAIP assistance. This paper presents the methodology for assessing exploitation performance and discusses issues related to scoring exploitation performance. The results of a recent assessment event illustrate the issues and provide guidance for future work in this area.

  15. Correlating animal and human phase Ia/Ib clinical data with CALAA-01, a targeted, polymer-based nanoparticle containing siRNA

    OpenAIRE

    Zuckerman, Jonathan E.; Gritli, Ismael; Tolcher, Anthony; Heidel, Jeremy D.; Lim, Dean; Morgan, Robert; Chmielowski, Bartosz; Ribas, Antoni; Davis, Mark E.; Yen, Yun

    2014-01-01

    Nanoparticle-based experimental therapeutics are currently being investigated in numerous human clinical trials. CALAA-01 is a targeted, polymer-based nanoparticle containing small interfering RNA (siRNA) and, to our knowledge, was the first RNA interference (RNAi)–based, experimental therapeutic to be administered to cancer patients. Here, we report the results from the initial phase I clinical trial where 24 patients with different cancers were treated with CALAA-01 and...

  16. Exploring the Process of Energy Generation in Pathophysiology by Targeted Metabolomics: Performance of a Simple and Quantitative Method

    Science.gov (United States)

    Riera-Borrull, Marta; Rodríguez-Gallego, Esther; Hernández-Aguilera, Anna; Luciano, Fedra; Ras, Rosa; Cuyàs, Elisabet; Camps, Jordi; Segura-Carretero, Antonio; Menendez, Javier A.; Joven, Jorge; Fernández-Arroyo, Salvador

    2016-01-01

    Abnormalities in mitochondrial metabolism and regulation of energy balance contribute to human diseases. The consequences of high fat and other nutrient intake, and the resulting acquired mitochondrial dysfunction, are essential to fully understand common disorders, including obesity, cancer, and atherosclerosis. To simultaneously and noninvasively measure and quantify indirect markers of mitochondrial function, we have developed a method based on gas chromatography coupled to quadrupole-time of flight mass spectrometry and an electron ionization interface, and validated the system using plasma from patients with peripheral artery disease, human cancer cells, and mouse tissues. This approach was used to increase sensibility in the measurement of a wide dynamic range and chemical diversity of multiple intermediate metabolites used in energy metabolism. We demonstrate that our targeted metabolomics method allows for quick and accurate identification and quantification of molecules, including the measurement of small yet significant biological changes in experimental samples. The apparently low process variability required for its performance in plasma, cell lysates, and tissues allowed a rapid identification of correlations between interconnected pathways. Our results suggest that delineating the process of energy generation by targeted metabolomics can be a valid surrogate for predicting mitochondrial dysfunction in biological samples. Importantly, when used in plasma, targeted metabolomics should be viewed as a robust and noninvasive source of biomarkers in specific pathophysiological scenarios.

  17. Catheter-based flow measurements in hemodialysis fistulas - Bench testing and clinical performance

    DEFF Research Database (Denmark)

    Heerwagen, Søren T; Lönn, Lars; Schroeder, Torben V;

    2012-01-01

    Purpose: The purpose of this study was to perform bench and clinical testing of a catheter-based intravascular system capable of measuring blood flow in hemodialysis vascular accesses during endovascular procedures. Methods: We tested the Transonic ReoCath Flow Catheter System which uses...... of agreement between results from the ReoCath Flow Catheter System and the reference flowmeter. Clinical precision, expressed as the mean coefficient of variation, was 5.9% and 4.7% for the antegrade and retrograde catheters, respectively. Flow measurements were significantly affected by the distance between...... a stenosis and the tip of a retrograde catheter with the effect being proportional to the degree of stenosis. There was no systematic bias between measurers. Conclusions: The Reocath Flow Catheter System was found to be accurate and precise. Reliable results require careful attention to catheter placement...

  18. Clinical Safety and Immunogenicity of Tumor-Targeted, Plant-Made Id-KLH Conjugate Vaccines for Follicular Lymphoma

    Directory of Open Access Journals (Sweden)

    Daniel Tusé

    2015-01-01

    Full Text Available We report the first evaluation of plant-made conjugate vaccines for targeted treatment of B-cell follicular lymphoma (FL in a Phase I safety and immunogenicity clinical study. Each recombinant personalized immunogen consisted of a tumor-derived, plant-produced idiotypic antibody (Ab hybrid comprising the hypervariable regions of the tumor-associated light and heavy Ab chains, genetically grafted onto a common human IgG1 scaffold. Each immunogen was produced in Nicotiana benthamiana plants using twin magnICON vectors expressing the light and heavy chains of the idiotypic Ab. Each purified Ab was chemically linked to the carrier protein keyhole limpet hemocyanin (KLH to form a conjugate vaccine. The vaccines were administered to FL patients over a series of ≥6 subcutaneous injections in conjunction with the adjuvant Leukine (GM-CSF. The 27 patients enrolled in the study had previously received non-anti-CD20 cytoreductive therapy followed by ≥4 months of immune recovery prior to first vaccination. Of 11 patients who became evaluable at study conclusion, 82% (9/11 displayed a vaccine-induced, idiotype-specific cellular and/or humoral immune response. No patients showed serious adverse events (SAE related to vaccination. The fully scalable plant-based manufacturing process yields safe and immunogenic personalized FL vaccines that can be produced within weeks of obtaining patient biopsies.

  19. An Algorithm for Glaucoma Screening in Clinical Settings and Its Preliminary Performance Profile

    Directory of Open Access Journals (Sweden)

    S-Farzad Mohammadi

    2013-01-01

    Full Text Available Purpose: To devise and evaluate a screening algorithm for glaucoma in clinical settings. Methods: Screening included examination of the optic disc for vertical cupping (≥0.4 and asymmetry (≥0.15, Goldmann applanation tonometry (≥21 mmHg, adjusted or unadjusted for central corneal thickness, and automated perimetry. In the diagnostic step, retinal nerve fiber layer imaging was performed using scanning laser polarimetry. Performance of the screening protocol was assessed in an eye hospital-based program in which 124 non-physician personnel aged 40 years or above were examined. A single ophthalmologist carried out the examinations and in equivocal cases, a glaucoma subspecialist′s opinion was sought. Results: Glaucoma was diagnosed in six cases (prevalence 4.8%; 95% confidence interval, 0.01-0.09 of whom five were new. The likelihood of making a definite diagnosis of glaucoma for those who were screened positively was 8.5 times higher than the estimated baseline risk for the reference population; the positive predictive value of the screening protocol was 30%. Screening excluded 80% of the initial population. Conclusion: Application of a formal screening protocol (such as our algorithm or its equivalent in clinical settings can be helpful in detecting new cases of glaucoma. Preliminary performance assessment of the algorithm showed its applicability and effectiveness in detecting glaucoma among subjects without any visual complaint.

  20. 56-month clinical performance of Class I and II resin composite restorations

    Directory of Open Access Journals (Sweden)

    Flavia Bittencourt Pazinatto

    2012-06-01

    Full Text Available OBJECTIVE: This study evaluated the 56-month clinical performance of Class I and II resin composite restorations. Filtek P60 was compared with Filtek Z250, which are both indicated for posterior restorations but differ in terms of handling characteristics. The null hypothesis tested was that there is no difference in the clinical performance of the two resin composites in posterior teeth. MATERIAL AND METHODS: Thirty-three patients were treated by the same operator, who prepared 48 Class I and 42 Class II cavities, which were restored with Single Bond/Filtek Z250 or Single Bond/Filtek P60 restorative systems. Restorations were evaluated by two independent examiners at baseline and after 56 months, using the modified USPHS criteria. Data were analyzed statistically using Chi-square and Fisher's Exact tests (a=0.05. RESULTS: After 56 months, 25 patients (31 Class I and 36 Class II were analyzed. A 3% failure rate occurred due to secondary caries and excessive loss of anatomic form for P60. For both restorative systems, there were no significant differences in secondary caries and postoperative sensitivity. However, significant changes were observed with respect to anatomic form, marginal discoloration, and marginal adaptation. Significant decreases in surface texture were observed exclusively for the Z250 restorations. CONCLUSIONS: Both restorative systems can be used for posterior restorations and can be expected to perform well in the oral environment.

  1. Performance of informative priors skeptical of large treatment effects in clinical trials: A simulation study.

    Science.gov (United States)

    Pedroza, Claudia; Han, Weilu; Truong, Van Thi Thanh; Green, Charles; Tyson, Jon E

    2015-12-13

    One of the main advantages of Bayesian analyses of clinical trials is their ability to formally incorporate skepticism about large treatment effects through the use of informative priors. We conducted a simulation study to assess the performance of informative normal, Student-t, and beta distributions in estimating relative risk (RR) or odds ratio (OR) for binary outcomes. Simulation scenarios varied the prior standard deviation (SD; level of skepticism of large treatment effects), outcome rate in the control group, true treatment effect, and sample size. We compared the priors with regards to bias, mean squared error (MSE), and coverage of 95% credible intervals. Simulation results show that the prior SD influenced the posterior to a greater degree than the particular distributional form of the prior. For RR, priors with a 95% interval of 0.50-2.0 performed well in terms of bias, MSE, and coverage under most scenarios. For OR, priors with a wider 95% interval of 0.23-4.35 had good performance. We recommend the use of informative priors that exclude implausibly large treatment effects in analyses of clinical trials, particularly for major outcomes such as mortality.

  2. A High Performance Computing Study of a Scalable FISST-Based Approach to Multi-Target, Multi-Sensor Tracking

    Science.gov (United States)

    Hussein, I.; Wilkins, M.; Roscoe, C.; Faber, W.; Chakravorty, S.; Schumacher, P.

    2016-09-01

    Finite Set Statistics (FISST) is a rigorous Bayesian multi-hypothesis management tool for the joint detection, classification and tracking of multi-sensor, multi-object systems. Implicit within the approach are solutions to the data association and target label-tracking problems. The full FISST filtering equations, however, are intractable. While FISST-based methods such as the PHD and CPHD filters are tractable, they require heavy moment approximations to the full FISST equations that result in a significant loss of information contained in the collected data. In this paper, we review Smart Sampling Markov Chain Monte Carlo (SSMCMC) that enables FISST to be tractable while avoiding moment approximations. We study the effect of tuning key SSMCMC parameters on tracking quality and computation time. The study is performed on a representative space object catalog with varying numbers of RSOs. The solution is implemented in the Scala computing language at the Maui High Performance Computing Center (MHPCC) facility.

  3. Real-time and offline performance of pattern recognition myoelectric control using a generic electrode grid with targeted muscle reinnervation patients.

    Science.gov (United States)

    Tkach, Dennis C; Young, Aaron J; Smith, Lauren H; Rouse, Elliott J; Hargrove, Levi J

    2014-07-01

    Targeted muscle reinnervation (TMR) is a surgical technique that creates myoelectric prosthesis control sites for high-level amputees. The electromyographic (EMG) signal patterns provided by the reinnervated muscles are well-suited for pattern recognition control. Pattern recognition allows for control of a greater number of degrees of freedom (DOF) than the conventional, EMG amplitude-based approach. Previous pattern recognition studies have shown benefit in placing electrodes directly over the reinnervated muscles. Localizing the optimal TMR locations is inconvenient and time consuming. In this contribution, we demonstrate that a clinically practical grid arrangement of electrodes yields real-time control performance that is equivalent to, or better than, the site-specific electrode placement for simultaneous control of multiple DOFs using pattern recognition. Additional findings indicate that grid-like electrode arrangement yields significantly lower classification errors for classifiers with a large number of movement classes ( > 9). These findings suggest that a grid electrode arrangement can be effectively used to control a multi-DOF upper limb prosthesis while reducing the time and effort associated with fitting the prosthesis due to clinical localization of control sites on amputee patients.

  4. The American Society for Clinical Pathology resident in-service examination: does resident performance provide insight into the effectiveness of clinical pathology education?

    Science.gov (United States)

    McKenna, Barbara J

    2007-06-01

    The resident in-service examination in pathology is an in-training exercise that is taken by virtually all pathology residents in the United States as well as by some participants in Canada, Ireland, and Lebanon. Although all of the anatomic pathology topics in the examination, with only one exception-forensic pathology, show significant improvement in scores over the 4 years of residency training, three areas of clinical pathology training (laboratory administration, clinical chemistry, and microbiology) show significantly lower improvement in performance over the years of residency training. By contrast, transfusion medicine, hematopathology and the special topics section of the examination all demonstrate improved performance by residents over time. While the reason behind these differences must remain speculative at this time, these findings suggest that measures to improve effectiveness in clinical pathology training might be suggested by examining the differences between residency training practices between higher and lower performing areas of clinical pathology.

  5. Clinical observed performance evaluation: a prospective study in final year students of surgery.

    LENUS (Irish Health Repository)

    Markey, G C

    2010-06-24

    We report a prospective study of clinical observed performance evaluation (COPE) for 197 medical students in the pre-qualification year of clinical education. Psychometric quality was the main endpoint. Students were assessed in groups of 5 in 40-min patient encounters, with each student the focus of evaluation for 8 min. Each student had a series of assessments in a 25-week teaching programme. Over time, several clinicians from a pool of 16 surgical consultants and registrars evaluated each student by direct observation. A structured rating form was used for assessment data. Variance component analysis (VCA), internal consistency and inter-rater agreement were used to estimate reliability. The predictive and convergent validity of COPE in relation to summative OSCE, long case, and overall final examination was estimated. Median number of COPE assessments per student was 7. Generalisability of a mean score over 7 COPE assessments was 0.66, equal to that of an 8 x 7.5 min station final OSCE. Internal consistency was 0.88-0.97 and inter-rater agreement 0.82. Significant correlations were observed with OSCE performance (R = 0.55 disattenuated) and long case (R = 0.47 disattenuated). Convergent validity was 0.81 by VCA. Overall final examination performance was linearly related to mean COPE score with standard error 3.7%. COPE permitted efficient serial assessment of a large cohort of final year students in a real world setting. Its psychometric quality compared well with conventional assessments and with other direct observation instruments as reported in the literature. Effect on learning, and translation to clinical care, are directions for future research.

  6. Effect of structure on sensing performance of a target induced signaling probe shifting DNA-based (TISPS-DNA) sensor.

    Science.gov (United States)

    Yu, Xiang; Yu, Zhigang; Li, Fengqin; Xu, Yanmei; He, Xunjun; Xu, Lan; Shi, Wenbing; Zhang, Guiling; Yan, Hong

    2017-05-15

    A type of "signal on" displacement-based sensors named target induced signaling probe shifting DNA-based (TISPS-DNA) sensor were developed for a designated DNA detection. The signaling mechanism of the signaling probe (SP) shifting different from the classical conformation/flexibility change mode endows the sensor with high sensitivity. Through using thiolated or no thiolated capturing probe (CP), two 3-probe sensing structures, sensor-1 and sensor-2, were designed and constructed. The systematical comparing research results show that both sensors exhibit some similarities or big differences in sensing performance. On the one hand, the similarity in structures determines the similarity in some aspects of signaling mechanism, background signal, signal changing form, anti-fouling ability and versatility; on the other hand, the slight difference in structures also results in two opposite hybridization modes of gradual increasing resistance and gradual decreasing resistance which can affect the hybridization efficiency between the assistant probe (AP) and the SP, further producing some big differences in sensing performance, for example, apparently different signal enhancement (SE) change, point mutation discrimination ability and response speed. Under the optimized fabrication and detection conditions, both sensors feature high sensitivity for target DNAs with the detection limits of ∼10 fM for sensor-1 and ∼7 fM for sensor-2, respectively. Among many acquired sensing virtues, the sensor-1 shows a peculiar specificity adjustability which is also a highlight in this work.

  7. Simulation-based mastery learning with deliberate practice improves clinical performance in spinal anesthesia.

    Science.gov (United States)

    Udani, Ankeet D; Macario, Alex; Nandagopal, Kiruthiga; Tanaka, Maria A; Tanaka, Pedro P

    2014-01-01

    Introduction. Properly performing a subarachnoid block (SAB) is a competency expected of anesthesiology residents. We aimed to determine if adding simulation-based deliberate practice to a base curriculum improved performance of a SAB. Methods. 21 anesthesia residents were enrolled. After baseline assessment of SAB on a task-trainer, all residents participated in a base curriculum. Residents were then randomized so that half received additional deliberate practice including repetition and expert-guided, real-time feedback. All residents were then retested for technique. SABs on all residents' next three patients were evaluated in the operating room (OR). Results. Before completing the base curriculum, the control group completed 81% of a 16-item performance checklist on the task-trainer and this increased to 91% after finishing the base curriculum (P < 0.02). The intervention group also increased the percentage of checklist tasks properly completed from 73% to 98%, which was a greater increase than observed in the control group (P < 0.03). The OR time required to perform SAB was not different between groups. Conclusions. The base curriculum significantly improved resident SAB performance. Deliberate practice training added a significant, independent, incremental benefit. The clinical impact of the deliberate practice intervention in the OR on patient care is unclear.

  8. Simulation-Based Mastery Learning with Deliberate Practice Improves Clinical Performance in Spinal Anesthesia

    Directory of Open Access Journals (Sweden)

    Ankeet D. Udani

    2014-01-01

    Full Text Available Introduction. Properly performing a subarachnoid block (SAB is a competency expected of anesthesiology residents. We aimed to determine if adding simulation-based deliberate practice to a base curriculum improved performance of a SAB. Methods. 21 anesthesia residents were enrolled. After baseline assessment of SAB on a task-trainer, all residents participated in a base curriculum. Residents were then randomized so that half received additional deliberate practice including repetition and expert-guided, real-time feedback. All residents were then retested for technique. SABs on all residents’ next three patients were evaluated in the operating room (OR. Results. Before completing the base curriculum, the control group completed 81% of a 16-item performance checklist on the task-trainer and this increased to 91% after finishing the base curriculum (P<0.02. The intervention group also increased the percentage of checklist tasks properly completed from 73% to 98%, which was a greater increase than observed in the control group (P<0.03. The OR time required to perform SAB was not different between groups. Conclusions. The base curriculum significantly improved resident SAB performance. Deliberate practice training added a significant, independent, incremental benefit. The clinical impact of the deliberate practice intervention in the OR on patient care is unclear.

  9. Budget goal commitment, clinical managers' use of budget information and performance.

    Science.gov (United States)

    Macinati, Manuela S; Rizzo, Marco G

    2014-08-01

    Despite the importance placed on accounting as a means to influence performance in public healthcare, there is still a lot to be learned about the role of management accounting in clinical managers' work behavior and their link with organizational performance. The article aims at analyzing the motivational role of budgetary participation and the intervening role of individuals' mental states and behaviors in influencing the relationship between budgetary participation and performance. According to the goal-setting theory, SEM technique was used to test the relationships among variables. The data were collected by a survey conducted in an Italian hospital. The results show that: (i) budgetary participation does not directly influence the use of budget information, but the latter is encouraged by the level of budget goal commitment which, as a result, is influenced by the positive motivational consequences of participative budgeting; (ii) budget goal commitment does not directly influence performance, but the relationship is mediated by the use of budget information. This study contributes to health policy and management accounting literature and has significant policy implications. Mainly, the findings prove that the introduction of business-like techniques in the healthcare sector can improve performance if attitudinal and behavioral variables are adequately stimulated.

  10. High-performance genetically targetable optical neural silencing by light-driven proton pumps.

    Science.gov (United States)

    Chow, Brian Y; Han, Xue; Dobry, Allison S; Qian, Xiaofeng; Chuong, Amy S; Li, Mingjie; Henninger, Michael A; Belfort, Gabriel M; Lin, Yingxi; Monahan, Patrick E; Boyden, Edward S

    2010-01-07

    The ability to silence the activity of genetically specified neurons in a temporally precise fashion would provide the opportunity to investigate the causal role of specific cell classes in neural computations, behaviours and pathologies. Here we show that members of the class of light-driven outward proton pumps can mediate powerful, safe, multiple-colour silencing of neural activity. The gene archaerhodopsin-3 (Arch) from Halorubrum sodomense enables near-100% silencing of neurons in the awake brain when virally expressed in the mouse cortex and illuminated with yellow light. Arch mediates currents of several hundred picoamps at low light powers, and supports neural silencing currents approaching 900 pA at light powers easily achievable in vivo. Furthermore, Arch spontaneously recovers from light-dependent inactivation, unlike light-driven chloride pumps that enter long-lasting inactive states in response to light. These properties of Arch are appropriate to mediate the optical silencing of significant brain volumes over behaviourally relevant timescales. Arch function in neurons is well tolerated because pH excursions created by Arch illumination are minimized by self-limiting mechanisms to levels comparable to those mediated by channelrhodopsins or natural spike firing. To highlight how proton pump ecological and genomic diversity may support new innovation, we show that the blue-green light-drivable proton pump from the fungus Leptosphaeria maculans (Mac) can, when expressed in neurons, enable neural silencing by blue light, thus enabling alongside other developed reagents the potential for independent silencing of two neural populations by blue versus red light. Light-driven proton pumps thus represent a high-performance and extremely versatile class of 'optogenetic' voltage and ion modulator, which will broadly enable new neuroscientific, biological, neurological and psychiatric investigations.

  11. Predicting Anxiety Among Patients In LPU Clinical Dispensary During Dental Treatment: Towards Student’s Clinical Performance Enhancement

    Directory of Open Access Journals (Sweden)

    Maribel D. Mayuga-Barrion

    2013-12-01

    Full Text Available The study aimed to determine the respondents’ profile in terms of age, gender, frequency of dental visit, and type of patient whether dental phobic or not; to determine the dental anxiety of patients in LPU dental dispensary; to identify the causes and severity of anxiety of the patients in LPU dental dispensary; to determine if there is a significant difference between the respondents’ demographic profile and their level of anxiety; and lastly, to propose a program that will help the patients cope with dental anxiety and a program that will enhance the students’ clinical performance. The study used the descriptive research design with the combination of content analysis of documents and related materials. Results showed that majority of the respondents belonged to age range of 14-18 years old range whereas for gender or sex, majority who avail of the clinic’s services are males. This is because women are more afraid than men in terms of dental problems. Further, younger people are more afraid than older ones. The weighted mean distribution of the level of anxiety showed that the level of anxiety of patients varies on moderately to not anxious. Feeling or experiencing pain during dental treatment ranked first followed by the fear or worry of not working the proposed treatment and thirdly, the dentist is in a hurry while treating also made the patients moderately anxious. Overall, the level of anxiety of patients is moderately anxious. Probing to asses gum disease, dislike the numb feeling and injection were the top three causes of dental anxiety. Only type of patient shows significant difference, thus the null hypothesis of no significant difference on the level of anxiety when grouped according to profile variables is rejected. This means that the level of anxiety of both phobic and not phobic differs.

  12. WAIS-III Matrix Reasoning test performance in a mixed clinical sample.

    Science.gov (United States)

    Dugbartey, A T; Sanchez, P N; Rosenbaum, J G; Mahurin, R K; Davis, J M; Townes, B D

    1999-11-01

    This study examined the relationship between the Matrix Reasoning subtest (MRT) of the WAIS-III and a selected number of neuropsychological tests in a heterogeneous clinical sample of English-speaking American (n = 41), and non-English-speaking immigrant (n = 14) adults. A moderate association between the Halstead Category Test and the MRT (-.58) was found in the English-speaking sample. Multiple regression analysis revealed a significant association between measures of verbal abstract reasoning and verbal fluency, and performance on the MRT. Among the immigrant sample, the MRT was also found to be significantly associated with verbal fluency task performance, as well as with the Comprehensive Test of Nonverbal Intelligence. Correlational analyses therefore suggest a strong verbal mediation element in the MRT, and that labeling it a nonverbal task may be misleading.

  13. Confidence level in performing clinical procedures among medical officers in nonspecialist government hospitals in Penang, Malaysia.

    Science.gov (United States)

    Othman, Mohamad Sabri; Merican, Hassan; Lee, Yew Fong; Ch'ng, Kean Siang; Thurairatnam, Dharminy

    2015-03-01

    A prospective cross-sectional study was conducted at 3 government hospitals over 6 months to evaluate the confidence level of medical officers (MOs) to perform clinical procedure in nonspecialist government hospitals in Penang. An anonymous self-administered questionnaire in English was designed based on the elective and emergency procedures stated in the houseman training logbook. The questionnaire was distributed to the MOs from Penang State Health Department through the respective hospital directors and returned to Penang State Health Department on completion. The results showed that there was statistically significant difference between those who had undergone 12 months and 24 months as houseman in performing both elective and emergency procedures. MOs who had spent 24 months as housemen expressed higher confidence level than those who had only 12 months of experience. We also found that the confidence level was statistically and significantly influenced by visiting specialist and working together with cooperative experienced paramedics.

  14. Can Clinical Assessment of Locomotive Body Function Explain Gross Motor Environmental Performance in Cerebral Palsy?

    Science.gov (United States)

    Sanz Mengibar, Jose Manuel; Santonja-Medina, Fernando; Sanchez-de-Muniain, Paloma; Canteras-Jordana, Manuel

    2016-03-01

    Gross Motor Function Classification System has discriminative purposes but does not assess short-term therapy goals. Locomotion Stages (LS) classify postural body functions and independent activity components. Assessing the relation between Gross Motor Function Classification System level and Locomotion Stages will make us understand if clinical assessment can explain and predict motor environmental performance in cerebral palsy. A total of 462 children were assessed with both scales. High reliability and strong negative correlation (-0.908) for Gross Motor Function Classification System and Locomotion Stages at any age was found. Sensitivity was 83%, and specificity and positive predictive value were 100% within the same age range. Regression analysis showed detailed probabilities for the realization of the Gross Motor Function Classification System depending on the Locomotion Stages and the age group. Postural body function measure with Locomotion Stages is reliable, sensitive, and specific for gross motor function and able to predict environmental performance.

  15. TGLF Recalibration for ITER Standard Case Parameters FY2015: Theory and Simulation Performance Target Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Candy, J. [General Atomics, San Diego, CA (United States)

    2015-12-01

    This work was motivated by the observation, as early as 2008, that GYRO simulations of some ITER operating scenarios exhibited nonlinear zonal-flow generation large enough to effectively quench turbulence inside r /a ~ 0.5. This observation of flow-dominated, low-transport states persisted even as more accurate and comprehensive predictions of ITER profiles were made using the state-of-the-art TGLF transport model. This core stabilization is in stark contrast to GYRO-TGLF comparisons for modern-day tokamaks, for which GYRO and TGLF are typically in very close agreement. So, we began to suspect that TGLF needed to be generalized to include the effect of zonal-flow stabilization in order to be more accurate for the conditions of reactor simulations. While the precise cause of the GYRO-TGLF discrepancy for ITER parameters was not known, it was speculated that closeness to threshold in the absence of driven rotation, as well as electromagnetic stabilization, created conditions more sensitive the self-generated zonal-flow stabilization than in modern tokamaks. Need for nonlinear zonal-flow stabilization: To explore the inclusion of a zonal-flow stabilization mechanism in TGLF, we started with a nominal ITER profile predicted by TGLF, and then performed linear and nonlinear GYRO simulations to characterize the behavior at and slightly above the nominal temperature gradients for finite levels of energy transport. Then, we ran TGLF on these cases to see where the discrepancies were largest. The predicted ITER profiles were indeed near to the TGLF threshold over most of the plasma core in the hybrid discharge studied (weak magnetic shear, q > 1). Scanning temperature gradients above the TGLF power balance values also showed that TGLF overpredicted the electron energy transport in the low-collisionality ITER plasma. At first (in Q3), a model of only the zonal-flow stabilization (Dimits shift) was attempted. Although we were able to construct an ad hoc model of the zonal

  16. TGLF Recalibration for ITER Standard Case Parameters FY2015: Theory and Simulation Performance Target Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Candy, J. [General Atomics, San Diego, CA (United States)

    2015-12-01

    This work was motivated by the observation, as early as 2008, that GYRO simulations of some ITER operating scenarios exhibited nonlinear zonal-flow generation large enough to effectively quench turbulence inside r /a ~ 0.5. This observation of flow-dominated, low-transport states persisted even as more accurate and comprehensive predictions of ITER profiles were made using the state-of-the-art TGLF transport model. This core stabilization is in stark contrast to GYRO-TGLF comparisons for modern-day tokamaks, for which GYRO and TGLF are typically in very close agreement. So, we began to suspect that TGLF needed to be generalized to include the effect of zonal-flow stabilization in order to be more accurate for the conditions of reactor simulations. While the precise cause of the GYRO-TGLF discrepancy for ITER parameters was not known, it was speculated that closeness to threshold in the absence of driven rotation, as well as electromagnetic stabilization, created conditions more sensitive the self-generated zonal-flow stabilization than in modern tokamaks. Need for nonlinear zonal-flow stabilization: To explore the inclusion of a zonal-flow stabilization mechanism in TGLF, we started with a nominal ITER profile predicted by TGLF, and then performed linear and nonlinear GYRO simulations to characterize the behavior at and slightly above the nominal temperature gradients for finite levels of energy transport. Then, we ran TGLF on these cases to see where the discrepancies were largest. The predicted ITER profiles were indeed near to the TGLF threshold over most of the plasma core in the hybrid discharge studied (weak magnetic shear, q > 1). Scanning temperature gradients above the TGLF power balance values also showed that TGLF overpredicted the electron energy transport in the low-collisionality ITER plasma. At first (in Q3), a model of only the zonal-flow stabilization (Dimits shift) was attempted. Although we were able to construct an ad hoc model of the zonal

  17. Physical Performance and Clinical Outcomes in Dialysis Patients: A Secondary Analysis of the Excite Trial

    Directory of Open Access Journals (Sweden)

    Claudia Torino

    2014-07-01

    Full Text Available Background/Aims: Scarce physical activity predicts shorter survival in dialysis patients. However, the relationship between physical (motor fitness and clinical outcomes has never been tested in these patients. Methods: We tested the predictive power of an established metric of motor fitness, the Six-Minute Walking Test (6MWT, for death, cardiovascular events and hospitalization in 296 dialysis patients who took part in the trial EXCITE (ClinicalTrials.gov Identifier: NCT01255969. Results: During follow up 69 patients died, 90 had fatal and non-fatal cardiovascular events, 159 were hospitalized and 182 patients had the composite outcome. In multivariate Cox models - including the study allocation arm and classical and non-classical risk factors - an increase of 20 walked metres during the 6MWT was associated to a 6% reduction of the risk for the composite end-point (P=0.001 and a similar relationship existed between the 6MWT, mortality (PConclusions: Poor physical performance predicts a high risk of mortality, cardiovascular events and hospitalizations in dialysis patients. Future studies, including phase-2 EXCITE, will assess whether improving motor fitness may translate into better clinical outcomes in this high risk population.

  18. Secretome Prediction of Two M. tuberculosis Clinical Isolates Reveals Their High Antigenic Density and Potential Drug Targets

    Science.gov (United States)

    Cornejo-Granados, Fernanda; Zatarain-Barrón, Zyanya L.; Cantu-Robles, Vito A.; Mendoza-Vargas, Alfredo; Molina-Romero, Camilo; Sánchez, Filiberto; Del Pozo-Yauner, Luis; Hernández-Pando, Rogelio; Ochoa-Leyva, Adrián

    2017-01-01

    The Excreted/Secreted (ES) proteins play important roles during Mycobacterium tuberculosis invasion, virulence, and survival inside the host and they are a major source of immunogenic proteins. However, the molecular complexity of the bacillus cell wall has made difficult the experimental isolation of the total bacterial ES proteins. Here, we reported the genomes of two Beijing genotype M. tuberculosis clinical isolates obtained from patients from Vietnam (isolate 46) and South Africa (isolate 48). We developed a bioinformatics pipeline to predict their secretomes and observed that ~12% of the genome-encoded proteins are ES, being PE, PE-PGRS, and PPE the most abundant protein domains. Additionally, the Gene Ontology, KEGG pathways and Enzyme Classes annotations supported the expected functions for the secretomes. The ~70% of an experimental secretome compiled from literature was contained in our predicted secretomes, while only the 34–41% of the experimental secretome was contained in the two previously reported secretomes for H37Rv. These results suggest that our bioinformatics pipeline is better to predict a more complete set of ES proteins in M. tuberculosis genomes. The predicted ES proteins showed a significant higher antigenic density measured by Abundance of Antigenic Regions (AAR) value than the non-ES proteins and also compared to random constructed secretomes. Additionally, we predicted the secretomes for H37Rv, H37Ra, and two M. bovis BCG genomes. The antigenic density for BGG and for isolates 46 and 48 was higher than the observed for H37Rv and H37Ra secretomes. In addition, two sets of immunogenic proteins previously reported in patients with tuberculosis also showed a high antigenic density. Interestingly, mice infected with isolate 46 showed a significant lower survival rate than the ones infected with isolate 48 and both survival rates were lower than the one previously reported for the H37Rv in the same murine model. Finally, after a

  19. Clinical performance - a reflection of damage accumulation in ceramic dental crowns

    Energy Technology Data Exchange (ETDEWEB)

    Rekow, D.E. [Univ. of Medicine and Dentistry of New Jersey, Newark, NJ (United States). Dept. of Orthodontics; Thompson, V.P. [Univ. of Medicine and Dentistry of New Jersey, Newark, NJ (United States). New Jersey Dental School

    2001-07-01

    All-ceramic dental crowns have tremendous appeal for patients - their esthetics nearly match those of natural teeth. Unfortunately, the most esthetic materials are brittle and, consequently, are vulnerable to damage relating to shaping which is exacerbated during cyclic loading during normal chewing. Clinical performance of all-ceramic dental prostheses are directly dependent on damage introduced during fabrication and during fatigue loading associated with function. The accumulation of damage results in unacceptably high failure rates (where failure is defined as a complete fracture requiring replacement of the prosthesis). The relation between shaping damage and fatigue damage on clinical performance of all-ceramic dental crowns was investigated. Materials used commercially for all-ceramic crowns and investigated in this study included a series of different microstructures of machinable glass ceramics (Corning), aluminas and porcelains (Vita Zahnfabrik), and zirconia (Norton). As monolithic materials, strong, tough, fatigue-resistant materials are not sufficiently esthetic for crowns. Crowns fabricated from monolithic esthetic materials have high failure rates. Layering ceramics could provide acceptable strength through management of damage accumulation. (orig.)

  20. Diagnostic tests for influenza and other respiratory viruses: determining performance specifications based on clinical setting.

    Science.gov (United States)

    Takahashi, Hiroshi; Otsuka, Yoshihito; Patterson, Bruce K

    2010-06-01

    The lack of sensitivity of rapid immunoassays in detecting the novel 2009 H1N1 influenza virus infection has led to recommendations on influenza diagnostic testing for clinicians treating patients as well as advising clinicians on testing decisions. Studies have also shown that rapid immunoassays for seasonal influenza virus show considerable variability in performance characteristics, based on age of patient, prevalence of disease, course of infection, and the quality of the kit used. While public health authorities are currently focused on influenza virus diagnostics, a lack of sensitivity of rapid immunoassays for other viral respiratory pathogens has been widely reported, such as the very limited value of rapid immunoassays for the detection of respiratory syncytial virus in adults. In light of the lack of sensitivity of diagnostic tests for suspected 2009 H1N1 influenza virus infection, as well as their variable performance characteristics for seasonal influenza virus, a number of recommendations have been made by public health authorities advising clinicians on the need for clinical judgment as an important part of testing and treatment decisions as well as reliance on local epidemiologic and surveillance data. With the availability of new molecular methodologies that are user-friendly and allow the front-line physician as well as hospital infection control programs to significantly improve respiratory viral diagnostics, there is a need to carefully determine the most optimal diagnostic testing methodology based on the clinical setting. This review will describe the historical, current, and changing dynamics of respiratory virus infection diagnostics.

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Carmen Ballesteros-Meseguer

    2016-01-01

    Full Text Available 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.

  3. Contemporary analysis of erectile, voiding, and oncologic outcomes following primary targeted cryoablation of the prostate for clinically localized prostate cancer

    Directory of Open Access Journals (Sweden)

    Christopher J. Diblasio

    2008-08-01

    Full Text Available PURPOSE: To evaluate erectile function (EF and voiding function following primary targeted cryoablation of the prostate (TCAP for clinically localized prostate cancer (CaP in a contemporary cohort. MATERIALS AND METHODS: We retrospectively reviewed all patients treated between 2/2000-5/2006 with primary TCAP. Variables included age, Gleason sum, pre-TCAP prostate specific antigen (PSA, prostate volume, clinical stage, pre-TCAP hormonal ablation, pre-TCAP EF and American Urologic Association Symptom Score (AUASS. EF was recorded as follows: 1 = potent; 2 = sufficient for intercourse; 3 = partial/insufficient; 4 = minimal/insufficient; 5 = none. Voiding function was analyzed by comparing pre/post-TCAP AUASS. Statistical analysis utilized SAS software with p < 0.05 considered significant. RESULTS: After exclusions, 78 consecutive patients were analyzed with a mean age of 69.2 years and follow-up 39.8 months. Thirty-five (44.9% men reported pre-TCAP EF level of 1-2. Post-TCAP, 9 of 35 (25.7% regained EF of level 1-2 while 1 (2.9% achieved level 3 EF. Median pre-TCAP AUASS was 8.75 versus 7.50 postoperatively (p = 0.39. Six patients (7.7% experienced post-TCAP urinary incontinence. Lower pre-TCAP PSA (p = 0.008 and higher Gleason sum (p = 0.002 were associated with higher post-TCAP AUASS while prostate volume demonstrated a trend (p = 0.07. Post-TCAP EF and stable AUASS were not associated with increased disease-recurrence (p = 0.24 and p = 0.67, respectively. CONCLUSIONS: Stable voiding function was observed post-TCAP, with an overall incontinence rate of 7.7%. Further, though erectile dysfunction is common following TCAP, 25.7% of previously potent patients demonstrated erections suitable for intercourse. While long-term data is requisite, consideration should be made for prospective evaluation of penile rehabilitation following primary TCAP.

  4. Stepped care targeting psychological distress in head and neck and lung cancer patients: a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Krebber Anne-Marie H

    2012-05-01

    Full Text Available Abstract Background Psychological distress is common in cancer survivors. Although there is some evidence on effectiveness of psychosocial care in distressed cancer patients, referral rate is low. Lack of adequate screening instruments in oncology settings and insufficient availability of traditional models of psychosocial care are the main barriers. A stepped care approach has the potential to improve the efficiency of psychosocial care. The aim of the study described herein is to evaluate efficacy of a stepped care strategy targeting psychological distress in cancer survivors. Methods/design The study is designed as a randomized clinical trial with 2 treatment arms: a stepped care intervention programme versus care as usual. Patients treated for head and neck cancer (HNC or lung cancer (LC are screened for distress using OncoQuest, a computerized touchscreen system. After stratification for tumour (HNC vs. LC and stage (stage I/II vs. III/IV, 176 distressed patients are randomly assigned to the intervention or control group. Patients in the intervention group will follow a stepped care model with 4 evidence based steps: 1. Watchful waiting, 2. Guided self-help via Internet or a booklet, 3. Problem Solving Treatment administered by a specialized nurse, and 4. Specialized psychological intervention or antidepressant medication. In the control group, patients receive care as usual which most often is a single interview or referral to specialized intervention. Primary outcome is the Hospital Anxiety and Depression Scale (HADS. Secondary outcome measures are a clinical level of depression or anxiety (CIDI, quality of life (EQ-5D, EORTC QLQ-C30, QLQ-HN35, QLQ-LC13, patient satisfaction with care (EORTC QLQ-PATSAT, and costs (health care utilization and work loss (TIC-P and PRODISQ modules. Outcomes are evaluated before and after intervention and at 3, 6, 9 and 12 months after intervention. Discussion Stepped care is a system of delivering and

  5. Definition of high-performance membranes - from the clinical point of view.

    Science.gov (United States)

    Saito, Akira

    2011-01-01

    Global knowledge of the molecular target of uremic toxins (UTs) was significantly different in the 1980s than it is now. In 1971, Babb et al. hypothesized that UTs such as neurotoxin existed in mid-sized molecules ranging from 300 to 3,000 Da. In the 1980s, larger molecular weight substances > 5,000 Da were targeted for removal, as well as small and medium size toxins in Japan, while urea was considered a surrogate marker of UTs, and Kt/V for urea was used as a measure of dialysis dose in the USA. In Japan, albumin-bound toxins in addition to low-molecular-weight proteins were targeted for removal as glomerular filtration in the normal kidney. As binding capacity of albumin is significantly lowered and, on the other hand, the α-helical content of albumin also lowered in uremic patients because of binding of UTs to albumin, a small amount of albumin should be removed to stimulate the synthesis of new albumin. KF101 C-2 (EVAL) used as a high-performance dialysis membrane (HPM) at the first step, in which approximately 7 g of albumin is removed per dialysis session. It resulted in lowered plasma albumin levels in hemodialysis patients, although accumulated levels of low-molecular-weight proteins were significantly lowered. Therefore, the Japanese Society of Dialysis Therapy has recommended limitation of albumin removal to < 3 g/session by the second generation of HPMs. Many different HPMs have been developed since the Japanese Society of HPM was first organized in 1985. Approximately 98% of the dialyzers used in Japan employ HPMs. New technology is required to suppress fouling on the surface and in the pores of HPMs. This would maintain permeation of inflammatory cytokines during dialysis sessions.

  6. Performance of thirteen clinical rules to distinguish bacterial and presumed viral meningitis in Vietnamese children.

    Directory of Open Access Journals (Sweden)

    Nguyen Tien Huy

    Full Text Available BACKGROUND AND PURPOSE: Successful outcomes from bacterial meningitis require rapid antibiotic treatment; however, unnecessary treatment of viral meningitis may lead to increased toxicities and expense. Thus, improved diagnostics are required to maximize treatment and minimize side effects and cost. Thirteen clinical decision rules have been reported to identify bacterial from viral meningitis. However, few rules have been tested and compared in a single study, while several rules are yet to be tested by independent researchers or in pediatric populations. Thus, simultaneous test and comparison of these rules are required to enable clinicians to select an optimal diagnostic rule for bacterial meningitis in settings and populations similar to ours. METHODS: A retrospective cross-sectional study was conducted at the Infectious Department of Pediatric Hospital Number 1, Ho Chi Minh City, Vietnam. The performance of the clinical rules was evaluated by area under a receiver operating characteristic curve (ROC-AUC using the method of DeLong and McNemar test for specificity comparison. RESULTS: Our study included 129 patients, of whom 80 had bacterial meningitis and 49 had presumed viral meningitis. Spanos's rule had the highest AUC at 0.938 but was not significantly greater than other rules. No rule provided 100% sensitivity with a specificity higher than 50%. Based on our calculation of theoretical sensitivity and specificity, we suggest that a perfect rule requires at least four independent variables that posses both sensitivity and specificity higher than 85-90%. CONCLUSIONS: No clinical decision rules provided an acceptable specificity (>50% with 100% sensitivity when applying our data set in children. More studies in Vietnam and developing countries are required to develop and/or validate clinical rules and more very good biomarkers are required to develop such a perfect rule.

  7. The intra- and inter-rater reliability of five clinical muscle performance tests in patients with and without neck pain

    DEFF Research Database (Denmark)

    Sørensen, Tina Juul; Langberg, Henning; Enoch, Flemming;

    2013-01-01

    trials are often performed. However, when muscle performance tests are applied in the clinical setting, clinicians often only conduct a muscle performance test once as repeated testing may produce fatigue and pain, thus variation in test results. We aimed to investigate whether cervical muscle...

  8. Mapping Patterns of Ipsilateral Supraclavicular Nodal Metastases in Breast Cancer: Rethinking the Clinical Target Volume for High-risk Patients

    Energy Technology Data Exchange (ETDEWEB)

    Jing, Hao [Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); Wang, Shu-Lian, E-mail: wsl20040118@yahoo.com [Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); Li, Jing; Xue, Mei; Xiong, Zu-Kun [Department of Radiology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); Jin, Jing; Wang, Wei-Hu; Song, Yong-Wen; Liu, Yue-Ping; Ren, Hua; Fang, Hui; Yu, Zi-Hao; Liu, Xin-Fan [Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); Li, Ye-Xiong, E-mail: yexiong12@163.com [Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China)

    2015-10-01

    Purpose: To map the location of metastatic supraclavicular (SCV) lymph nodes (LNMs) in breast cancer patients with SCV node involvement and determine whether and where the radiation therapy clinical target volume (CTV) of this region could be modified in high-risk subsets. Methods and Materials: Fifty-five patients with metastatic SCV LNMs were eligible for geographic mapping and atlas coverage analysis. All LNMs and their epicenters were registered proportionally by referencing the surrounding landmarks onto simulation computed tomography images of a standard patient. CTVs based on selected SCV atlases, including the one by the Radiation Therapy Oncology Group (RTOG) were contoured. A modified SCV CTV was tried and shown to have better involved-node coverage and thus theoretically improved prophylaxis in this setting. Results: A total of 50 (91%) and 45 (81.8%) patients had LNMs in the medial and lateral SCV subregions, respectively. Also, 36 patients (65.5%) had LNMs located at the junction of the jugular-subclavian veins. All nodes were covered in only 25.5% to 41.8% of patients by different atlases. The RTOG atlas covered all nodes in 25.5% of patients. Stratified by the nodes in all the patients as a whole, 49.2% to 81.3% were covered, and the RTOG atlas covered 62.6%. The lateral and posterior borders were the most overlooked locations. Modification by extending the borders to natural anatomic barriers allowed the new CTV to cover all the nodes in 81.8% of patients and encompass 96.1% of all the nodes. Conclusions: According to the distribution of SCV LNMs, the extent of existing atlases might not be adequate for potential metastatic sites in certain groups of patients. The extension of the lateral and posterior CTV borders in high-risk or recurrent patients might be a reasonable approach for increasing coverage. However, additional data in more homogeneous populations with localized disease are needed before routine application.

  9. A pixellated γ-camera based on CdTe detectors clinical interests and performances

    Science.gov (United States)

    Chambron, J.; Arntz, Y.; Eclancher, B.; Scheiber, Ch; Siffert, P.; Hage Hali, M.; Regal, R.; Kazandjian, A.; Prat, V.; Thomas, S.; Warren, S.; Matz, R.; Jahnke, A.; Karman, M.; Pszota, A.; Nemeth, L.

    2000-07-01

    A mobile gamma camera dedicated to nuclear cardiology, based on a 15 cm×15 cm detection matrix of 2304 CdTe detector elements, 2.83 mm×2.83 mm×2 mm, has been developed with a European Community support to academic and industrial research centres. The intrinsic properties of the semiconductor crystals - low-ionisation energy, high-energy resolution, high attenuation coefficient - are potentially attractive to improve the γ-camera performances. But their use as γ detectors for medical imaging at high resolution requires production of high-grade materials and large quantities of sophisticated read-out electronics. The decision was taken to use CdTe rather than CdZnTe, because the manufacturer (Eurorad, France) has a large experience for producing high-grade materials, with a good homogeneity and stability and whose transport properties, characterised by the mobility-lifetime product, are at least 5 times greater than that of CdZnTe. The detector matrix is divided in 9 square units, each unit is composed of 256 detectors shared in 16 modules. Each module consists in a thin ceramic plate holding a line of 16 detectors, in four groups of four for an easy replacement, and holding a special 16 channels integrated circuit designed by CLRC (UK). A detection and acquisition logic based on a DSP card and a PC has been programmed by Eurorad for spectral and counting acquisition modes. Collimators LEAP and LEHR from commercial design, mobile gantry and clinical software were provided by Siemens (Germany). The γ-camera head housing, its general mounting and the electric connections were performed by Phase Laboratory (CNRS, France). The compactness of the γ-camera head, thin detectors matrix, electronic readout and collimator, facilitates the detection of close γ sources with the advantage of a high spatial resolution. Such an equipment is intended to bedside explorations. There is a growing clinical requirement in nuclear cardiology to early assess the extent of an

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

    Science.gov (United States)

    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.

  11. Retrospective Analysis of Indication of Bone Scintigraphy Performed in Our Clinic

    Directory of Open Access Journals (Sweden)

    Fusun Aydogan

    2014-03-01

    Full Text Available Aim: Bone scintigraphy is one of the commonly used radionuclide imaging and it is successfully used in the diagnosis and follow-up of many diseases. The aim of this study is to determine the indications and filming protocols of bone scintigraphy which was performed in our clinic. Material and Method: Two hundred and fifty two patients (132 male, 120 female who was performed bone scintigprapy in our clinic between December 2011 and June 2013 included the study. Mean age was 50.1±20.2 years. Scintigraphic protocols were made in two ways as late static whole body imaging and three-phase bone scintigraphy according to the type of the diseases. Indications of scintigraphies and scintigraphic protocols were detected. Results: Bone scintigraphy was performed for diagnosis and monitoring of metastatic bone disease to 102 patients (40,5 %, for orthopedic applications to 57 patients (22,6 %, for diagnosis and monitoring of primary bone tumors to 29 patients (11,5 %, for diagnosis of osteomyelitis to 17 patients (6,7 %, for differential diagnosis of infection and loosening of the prosthesis to 12 patients (4,8 %, investigate the viability of the graft in 14 patients (4,6 %, for rheumatologic diseases to 9 patients (3,6 %, for investigate the pathological vertebral fractures and osteoporosis to 4 patients (1,6 %, for diagnosis the metabolic bone disease to 2 patients (0,8 %, for diagnosis of otitis externa to 5 patients (1,98 % and for for suspicion of malignancy to 1 patient (0,4 %. Late static whole body imaging protocol was applied to 136 patients (54 % and three-phase imaging protocol was applied to 116 patients (46 %. Discussion: The most common use of bone scintigraphy is the diagnosis and follow-up of metastatic bone disease. It is followed by reasons such as orthopedic applications, monitoring and diagnosis of primary bone tumors and diagnosis of osteomyelitis.

  12. Why peer assessment helps to improve clinical performance in undergraduate physical therapy education : A mixed methods design

    NARCIS (Netherlands)

    Maas, Marjo; Sluijsmans, Dominique; Wees, Philip van der; Heerkens, Yvonne; Nijhuis-van der Sanden, Maria; Vleuten, Cees van der

    2014-01-01

    Background: Peer Assessment (PA) in health professions education encourages students to develop a critical attitude towards their own and their peers’ performance. We designed a PA task to assess students' clinical skills (including reasoning, communication, physical examination and treatment skills

  13. Why peer assessment helps to improve clinical performance in undergraduate physical therapy education: a mixed methods design

    NARCIS (Netherlands)

    Maas, M.J.M.; Sluijsmans, D.M.; Wees, P.J. van der; Heerkens, Y.F.; Nijhuis-Van der Sanden, M.W.; Vleuten, C.P.M. van der

    2014-01-01

    BACKGROUND: Peer Assessment (PA) in health professions education encourages students to develop a critical attitude towards their own and their peers' performance. We designed a PA task to assess students' clinical skills (including reasoning, communication, physical examination and treatment skills

  14. Formative Assessment of Procedural Skills: Students' Responses to the Objective Structured Clinical Examination and the Integrated Performance Procedural Instrument

    Science.gov (United States)

    Nestel, Debra; Kneebone, Roger; Nolan, Carmel; Akhtar, Kash; Darzi, Ara

    2011-01-01

    Assessment of clinical skills is a critical element of undergraduate medical education. We compare a traditional approach to procedural skills assessment--the Objective Structured Clinical Examination (OSCE) with the Integrated Performance Procedural Instrument (IPPI). In both approaches, students work through "stations" or…

  15. Improvements in cognition, quality of life, and physical performance with clinical Pilates in multiple sclerosis: a randomized controlled trial.

    Science.gov (United States)

    Küçük, Fadime; Kara, Bilge; Poyraz, Esra Çoşkuner; İdiman, Egemen

    2016-03-01

    [Purpose] The aim of this study was to determine the effects of clinical Pilates in multiple sclerosis patients. [Subjects and Methods] Twenty multiple sclerosis patients were enrolled in this study. The participants were divided into two groups as the clinical Pilates and control groups. Cognition (Multiple Sclerosis Functional Composite), balance (Berg Balance Scale), physical performance (timed performance tests, Timed up and go test), tiredness (Modified Fatigue Impact scale), depression (Beck Depression Inventory), and quality of life (Multiple Sclerosis International Quality of Life Questionnaire) were measured before and after treatment in all participants. [Results] There were statistically significant differences in balance, timed performance, tiredness and Multiple Sclerosis Functional Composite tests between before and after treatment in the clinical Pilates group. We also found significant differences in timed performance tests, the Timed up and go test and the Multiple Sclerosis Functional Composite between before and after treatment in the control group. According to the difference analyses, there were significant differences in Multiple Sclerosis Functional Composite and Multiple Sclerosis International Quality of Life Questionnaire scores between the two groups in favor of the clinical Pilates group. There were statistically significant clinical differences in favor of the clinical Pilates group in comparison of measurements between the groups. Clinical Pilates improved cognitive functions and quality of life compared with traditional exercise. [Conclusion] In Multiple Sclerosis treatment, clinical Pilates should be used as a holistic approach by physical therapists.

  16. Towards Building High Performance Medical Image Management System for Clinical Trials.

    Science.gov (United States)

    Wang, Fusheng; Lee, Rubao; Zhang, Xiaodong; Saltz, Joel

    2011-01-01

    Medical image based biomarkers are being established for therapeutic cancer clinical trials, where image assessment is among the essential tasks. Large scale image assessment is often performed by a large group of experts by retrieving images from a centralized image repository to workstations to markup and annotate images. In such environment, it is critical to provide a high performance image management system that supports efficient concurrent image retrievals in a distributed environment. There are several major challenges: high throughput of large scale image data over the Internet from the server for multiple concurrent client users, efficient communication protocols for transporting data, and effective management of versioning of data for audit trails. We study the major bottlenecks for such a system, propose and evaluate a solution by using a hybrid image storage with solid state drives and hard disk drives, RESTful Web Services based protocols for exchanging image data, and a database based versioning scheme for efficient archive of image revision history. Our experiments show promising results of our methods, and our work provides a guideline for building enterprise level high performance medical image management systems.

  17. A novel, volumizing cosmetic formulation significantly improves the appearance of target Glabellar lines, nasolabial folds, and crow's feet in a double-blind, vehicle-controlled clinical trial.

    Science.gov (United States)

    Farris, Patricia K; Edison, Brenda L; Weinkauf, Ronni L; Green, Barbara A

    2014-01-01

    Facial lines and wrinkles are caused by many factors including constant exposure to external elements, such as UV rays, as well as the dynamic nature of facial expression. Many cosmetic products and procedures provide global improvement to aging skin, whereas injectable therapies are frequently utilized to diminish specific, target wrinkles. Despite their broad availability, some patients are unwilling to undergo injectables and would benefit from an effective topical option. A noninvasive option to volumize target wrinkle areas could also extend benefits of commonly used cosmetic anti-aging products. To this end, a two-step formulation containing the novel, cosmetic anti-aging ingredient, N-acetyl tyrosinamide, was developed for use on targeted wrinkle areas. The tolerability and efficacy of the serum plus cream were tested for 16 weeks in women with moderate facial photodamage on predetermined wrinkle areas (glabellar lines, nasolabial folds, under eye lines, and lateral canthal (crow's feet) wrinkles) in a single-center, randomized, double-blind, vehicle-controlled, clinical trial. Seventy women (47 Active group, 23 Vehicle group) completed the study. Digital photography, clinical grading, ultrasound and self-assessment scores confirmed improvement to wrinkle areas. The topical cosmetic formulation was statistically superior (Pcosmetic formulation reduced the appearance of wrinkles and increased skin elasticity thus providing an effective anti-aging option for target wrinkle areas. This study suggests that in addition to its use as monotherapy for reducing targeted lines and wrinkles this cosmetic formulation may be also serve as an adjuvant to injectable therapies.

  18. Military target task performance after wavefront-guided (WFG) and wavefront-optimized (WFO) photorefractive keratectomy (PRK)

    Science.gov (United States)

    Maurer, Tana; Deaver, Dawne; Howell, Christopher; Moyer, Steve; Nguyen, Oanh; Mueller, Greg; Ryan, Denise; Sia, Rose K.; Stutzman, Richard; Pasternak, Joseph; Bower, Kraig

    2014-06-01

    Major decisions regarding life and death are routinely made on the modern battlefield, where visual function of the individual soldier can be of critical importance in the decision-making process. Glasses in the combat environment have considerable disadvantages: degradation of short term visual performance can occur as dust and sweat accumulate on lenses during a mission or patrol; long term visual performance can diminish as lenses become increasingly scratched and pitted; during periods of intense physical trauma, glasses can be knocked off the soldier's face and lost or broken. Although refractive surgery offers certain benefits on the battlefield when compared to wearing glasses, it is not without potential disadvantages. As a byproduct of refractive surgery, elevated optical aberrations can be induced, causing decreases in contrast sensitivity and increases in the symptoms of glare, halos, and starbursts. Typically, these symptoms occur under low light level conditions, the same conditions under which most military operations are initiated. With the advent of wavefront aberrometry, we are now seeing correction not only of myopia and astigmatism but of other, smaller optical aberrations that can cause the above symptoms. In collaboration with the Warfighter Refractive Eye Surgery Program and Research Center (WRESP-RC) at Fort Belvoir and Walter Reed National Military Medical Center (WRNMMC), the overall objective of this study is to determine the impact of wavefront guided (WFG) versus wavefront-optimized (WFO) photorefractive keratectomy (PRK) on military task visual performance. Psychophysical perception testing was conducted before and after surgery to measure each participant's performance regarding target detection and identification using thermal imagery. The results are presented here.

  19. What clinical activities do advanced-practice registered dietitian nutritionists perform? Results of a Delphi study.

    Science.gov (United States)

    Brody, Rebecca A; Byham-Gray, Laura; Touger-Decker, Riva; Passannante, Marian R; Rothpletz Puglia, Pamela; O'Sullivan Maillet, Julie

    2014-05-01

    Activities performed by advanced-practice registered dietitian nutritionists (RDNs) have yet to be clearly elucidated. The study aimed to gain consensus on the practice activities of advanced-practice RDNs who provide direct clinical nutrition care. A three-round Delphi study was conducted. Purposive sampling identified 117 RDN experts working as clinicians and/or managers in direct care settings that met inclusion criteria for advanced-level practice. In Round 1, 85 experts provided open-ended advanced-level practice activities linked to the Nutrition Care Process sections. Using content analysis, the responses were coded into activity statements. In Round 2, experts rated the essentiality of these activities. In Round 3, experts re-rated statements not reaching consensus while viewing their previous rating, the group median, and comments. Median ratings of 1.0 to 3.0 were defined as essential, 4.0 were neither essential nor nonessential, and 5.0 to 7.0 were nonessential. Consensus was reached when the interquartile range of responses to each question was <2.0. Seventy-six (89.4%) experts completed all rounds. From 770 comments, 129 activity statements were generated. All statements reached consensus: 97.7% as essential; 0.8% as nonessential; and 1.5% as neither. Of essential activities, 67.5% were highly essential with limited variability (median=1.0; interquartile range≤2.0). Advanced-practice RDNs' tasks are patient-centered and reflect complex care; involve a comprehensive and discriminating approach; are grounded in advanced knowledge and expertise in clinical nutrition; include use of advanced interviewing, education, and counseling strategies; and require communication with patient, families, and the health care team. The high-level of consensus from experts suggest advanced-level clinical nutrition practice exists and can be defined.

  20. Pemetrexed clinical studies in performance status 2 patients with non-small cell lung cancer (Review).

    Science.gov (United States)

    Zinner, Ralph; Visseren-Grul, Carla; Spigel, David R; Obasaju, Coleman

    2016-01-01

    Because poor performance status (PS) is an independent prognostic factor in non-small cell lung cancer (NSCLC), PS scores are widely used by oncologists to make treatment decisions. Advanced NSCLC patients with an Eastern Cooperative Oncology Group PS of 2 have poor prognoses and are frequently excluded from clinical trials. This article reviews the efficacy and safety of pemetrexed in this patient group. We identified English-language literature (through March 2015) involving completed and ongoing studies through searches of PubMed, meeting abstracts, ClinicalTrials.gov and the European Clinical Trials Register; search terms included 'pemetrexed,' 'NSCLC' and 'PS2'. Only studies reporting ≥1 subset analysis of PS2 patients receiving pemetrexed were chosen. Our search identified a total of ten pemetrexed studies in PS2 patients. Eight studies included only chemonaive patients, one study included both chemonaive patients and patients with one prior chemotherapy regimen and one study included only patients with one prior regimen. In subset analyses in these studies, PS2 patients had worse outcomes than PS0-1 patients regardless of treatment. In a phase 3 study, chemonaive advanced NSCLC patients with PS2 receiving pemetrexed‑carboplatin versus pemetrexed experienced improved overall survival [hazard ratio (HR)=0.62; P=0.001], progression-free survival (HR=0.46; Pstudies, PS2 patients treated with pemetrexed plus carboplatin as first-line therapy had improved response rates and survival. Additional research on PS2 patients is needed.

  1. Clinical performance of seven prescreening tools for osteoporosis in Iranian postmenopausal women.

    Science.gov (United States)

    Keshtkar, Abbas; Tabatabaie, Omidreza; Matin, Nassim; Mohammadi, Zahra; Ebrahimi, Mehdi; Khashayar, Patricia; Asadi, Mojgan

    2015-12-01

    This study was designed to evaluate seven prescreening osteoporosis models in postmenopausal Iranian women. This study was performed on 8644 postmenopausal women who have been referred for bone mineral densitometry (BMD) in BMD center of Shariati hospital in Tehran between 2001 and 2011. Diagnostic properties of seven prescreening instruments were evaluated. With regard to area under curve (AUC), these models have low accuracy (AUC ≤ 0.65). Considering only femoral neck or total femur area, these models had low accuracy but were more sensitive. Except for three models with sensitivities of ≤65 % in both osteoporosis and fracture threshold, other models were around 70 % sensitive. However, these models were not considered clinically useful regarding their positive predictive values (PPV) especially in BMDs ≤02.5. With regard to different measures of diagnostic property, none of these models were good screening tools for osteoporosis or fracture threshold. Although some of them are sensitive, considering other measures such as PPV indicates that they are not completely useful for clinical use. Attempts should be made for developing newer prescreening methods and calibration of the existing models with regard to the studied population.

  2. Clinical usefulness of carotid arterial wave intensity in assessing left ventricular systolic and early diastolic performance.

    Science.gov (United States)

    Ohte, Nobuyuki; Narita, Hitomi; Sugawara, Motoaki; Niki, Kiyomi; Okada, Takashi; Harada, Akimitsu; Hayano, Junichiro; Kimura, Genjiro

    2003-07-01

    Wave intensity (WI) is a novel hemodynamic index, which is defined as (d P/d t) x (d U/d t) at any site of the circulation, where d P/d t and d U/d t are the derivatives of blood pressure and velocity with respect to time, respectively. However, the pathophysiological meanings of this index have not been fully elucidated in the clinical setting. Accordingly, we investigated this issue in 64 patients who underwent invasive evaluation of left ventricular (LV) function. WI was obtained at the right carotid artery using a color Doppler system for blood velocity measurement combined with an echo-tracking method for detecting vessel diameter changes. The vessel diameter changes were automatically converted to pressure waveforms by calibrating its peak and minimum values by systolic and diastolic brachial blood pressures. The WI of the patients showed two sharp positive peaks. The first peak was found at the very early phase of LV ejection, while the second peak was observed near end-ejection. The magnitude of the first peak of WI significantly correlated with the maximum rate of LV pressure rise (LV max. d P/d t) (r = 0.74, P WI significantly correlated with the time constant of LV relaxation (r = -0.77, P WI reflects LV contractile performance, and the amplitude of the second peak of WI is determined by LV behavior during the period from late systole to isovolumic relaxation. WI is a noninvasively obtained, clinically useful parameter for the evaluation of LV systolic and early diastolic performance at the same time.

  3. Clinical performance and skill retention after simulation-based education for nephrology fellows.

    Science.gov (United States)

    Ahya, Shubhada N; Barsuk, Jeffrey H; Cohen, Elaine R; Tuazon, Jennifer; McGaghie, William C; Wayne, Diane B

    2012-07-01

    We previously demonstrated that simulation-based education (SBE) improved temporary hemodialysis catheter (THDC) insertion skills by nephrology fellows. SBE, featuring deliberate practice and rigorous achievement standards, was a powerful method to enhance THDC insertion skills in nephrology fellows. However, experts have called for further research to evaluate skill transfer from the simulated environment to actual clinical care and skill retention. This is a prospective observational cohort study of THDC insertion skills. Twelve nephrology fellows from three academic centers in Chicago were evaluated using a skills checklist from July 2008 to June 2009. Simulator-trained fellows were tested after the SBE intervention and expected to meet or exceed a minimum passing score (MPS) set by an expert panel. To assess transfer of skill to clinical care, three simulator-trained fellows were assessed at 6 months on actual patient THDC insertions using the checklist. To assess retention of skill, 11 of 12 simulator-trained fellows were reassessed at 1 year using the checklist and central venous catheter simulator. Outcomes were determined by THDC insertion skill performance. Simulator-trained fellows scored similarly during 6-month THDC insertions on actual patients and immediate posttest (M = 86.2%, SD = 22.3% vs. M = 93.5%, SD = 5.3%, p = 0.32). However, 1 year after SBE, simulated THDC insertion scores were significantly lower than at immediate posttest (M = 73.4%, SD = 22.2% vs. M = 93.5%, SD = 5.3%, p = 0.01). Our results show that nephrology fellows who completed SBE displayed high levels of performance during THDC insertions on actual patients 6 months later. At 1 year, there was statistically significant skills decay. We recommend booster training at 6 months.

  4. Technical and clinical breast cancer screening performance indicators for computed radiography versus direct digital radiography

    Energy Technology Data Exchange (ETDEWEB)

    Bosmans, Hilde; Lemmens, Kim; Zanca, Federica; Ongeval, Chantal van; Steen, Andre van [University Hospitals Leuven, Department of Radiology, Leuven (Belgium); Hauwere, An de; Thierens, Hubert [Ghent University, QCC, Ghent (Belgium); Herck, Koen van; Bleyen, Luc; Mortier, Griet [Ghent University, Centrum voor Preventie en Vroegtijdige Opsporing van Kanker, Department of Public Health, Ghent (Belgium); Martens, Patrick [Vroegtijdige Opsporing Borstklierkanker West-Vlaanderen vzw, Bruges (Belgium); Putte, Gretel vande; Kellen, Eliane; Limbergen, Erik van [Leuven University Center of Cancer Screening, Leuven (Belgium)

    2013-10-15

    To compare technical and clinical screening performance parameters between computed radiography (CR) and direct digital radiography (DR) systems. The number of women screened with CR was 73,008 and with DR 116,945. Technical and patient dose survey data of 25 CR and 37 DR systems were available. Technical performance was expressed by threshold thickness values at the mean glandular dose (MGD) level of routine practice. Clinical indicators included recall rate (RR), cancer detection rate (CDR), percentage of ductal carcinoma in situ (DCIS), percentage of cancers with T-scores smaller than 1 cm and positive predictive value (PPV). Contrast threshold values for the 0.1-mm gold disk were 1.44 {mu}m (SD 0.13 {mu}m) for CR and 1.20 {mu}m (SD 0.13 {mu}m for DR). MGD was 2.16 mGy (SD 0.36 mGy) and 1.35 mGy (SD 0.32 mGy) for CR and DR respectively. We obtained for CR, respectively DR, the following results: RR in the first round of 5.48 % versus 5.61 %; RR in subsequent rounds of 2.52 % versus 2.65 %; CDR of 0.52 % versus 0.53 %; DCIS of 0.08 % versus 0.11 %; a rate of cancers with T-scores smaller than 1 cm of 0.11 % versus 0.11 %; PPV of 18.45 % versus 18.64 %; none of them was significantly different. Our screening indicators are reassuring for the use of CR and DR, with CR operating at 60 % higher MGD. (orig.)

  5. Monte-Carlo model development for evaluation of current clinical target volume definition for heterogeneous and hypoxic glioblastoma

    Science.gov (United States)

    Moghaddasi, L.; Bezak, E.; Harriss-Phillips, W.

    2016-05-01

    Clinical target volume (CTV) determination may be complex and subjective. In this work a microscopic-scale tumour model was developed to evaluate current CTV practices in glioblastoma multiforme (GBM) external radiotherapy. Previously, a Geant4 cell-based dosimetry model was developed to calculate the dose deposited in individual GBM cells. Microscopic extension probability (MEP) models were then developed using Matlab-2012a. The results of the cell-based dosimetry model and MEP models were combined to calculate survival fractions (SF) for CTV margins of 2.0 and 2.5 cm. In the current work, oxygenation and heterogeneous radiosensitivity profiles were incorporated into the GBM model. The genetic heterogeneity was modelled using a range of α/β values (linear-quadratic model parameters) associated with different GBM cell lines. These values were distributed among the cells randomly, taken from a Gaussian-weighted sample of α/β values. Cellular oxygen pressure was distributed randomly taken from a sample weighted to profiles obtained from literature. Three types of GBM models were analysed: homogeneous-normoxic, heterogeneous-normoxic, and heterogeneous-hypoxic. The SF in different regions of the tumour model and the effect of the CTV margin extension from 2.0-2.5 cm on SFs were investigated for three MEP models. The SF within the beam was increased by up to three and two orders of magnitude following incorporation of heterogeneous radiosensitivities and hypoxia, respectively, in the GBM model. However, the total SF was shown to be overdominated by the presence of tumour cells in the penumbra region and to a lesser extent by genetic heterogeneity and hypoxia. CTV extension by 0.5 cm reduced the SF by a maximum of 78.6  ±  3.3%, 78.5  ±  3.3%, and 77.7  ±  3.1% for homogeneous and heterogeneous-normoxic, and heterogeneous hypoxic GBMs, respectively. Monte-Carlo model was developed to quantitatively evaluate SF for genetically

  6. Monte-Carlo model development for evaluation of current clinical target volume definition for heterogeneous and hypoxic glioblastoma.

    Science.gov (United States)

    Moghaddasi, L; Bezak, E; Harriss-Phillips, W

    2016-05-07

    Clinical target volume (CTV) determination may be complex and subjective. In this work a microscopic-scale tumour model was developed to evaluate current CTV practices in glioblastoma multiforme (GBM) external radiotherapy. Previously, a Geant4 cell-based dosimetry model was developed to calculate the dose deposited in individual GBM cells. Microscopic extension probability (MEP) models were then developed using Matlab-2012a. The results of the cell-based dosimetry model and MEP models were combined to calculate survival fractions (SF) for CTV margins of 2.0 and 2.5 cm. In the current work, oxygenation and heterogeneous radiosensitivity profiles were incorporated into the GBM model. The genetic heterogeneity was modelled using a range of α/β values (linear-quadratic model parameters) associated with different GBM cell lines. These values were distributed among the cells randomly, taken from a Gaussian-weighted sample of α/β values. Cellular oxygen pressure was distributed randomly taken from a sample weighted to profiles obtained from literature. Three types of GBM models were analysed: homogeneous-normoxic, heterogeneous-normoxic, and heterogeneous-hypoxic. The SF in different regions of the tumour model and the effect of the CTV margin extension from 2.0-2.5 cm on SFs were investigated for three MEP models. The SF within the beam was increased by up to three and two orders of magnitude following incorporation of heterogeneous radiosensitivities and hypoxia, respectively, in the GBM model. However, the total SF was shown to be overdominated by the presence of tumour cells in the penumbra region and to a lesser extent by genetic heterogeneity and hypoxia. CTV extension by 0.5 cm reduced the SF by a maximum of 78.6  ±  3.3%, 78.5  ±  3.3%, and 77.7  ±  3.1% for homogeneous and heterogeneous-normoxic, and heterogeneous hypoxic GBMs, respectively. Monte-Carlo model was developed to quantitatively evaluate SF for genetically

  7. Relationship between clinical fieldwork educator performance and health professional students' perceptions of their practice education learning environments.

    Science.gov (United States)

    Brown, Ted; Williams, Brett; Lynch, Marty

    2013-12-01

    The Dundee Ready Education Environment Measure, Clinical Teaching Effectiveness Instrument, and Clinical Learning Environment Inventory were completed by 548 undergraduate students (54.5% response rate) enrolled in eight health professional bachelor degree courses. Regression analysis was used to investigate the significant predictors of the Clinical Teaching Effectiveness Instrument with the Dundee Ready Education Environment Measure and Clinical Learning Environment Inventory subscales as independent variables. The results indicated that the Dundee Ready Education Environment Measure and Clinical Learning Environment Inventory Actual version subscale scores explained 44% of the total variance in the Clinical Teaching Effectiveness Instrument score. The Dundee Ready Education Environment Measure subscale Academic Self-Perception explained 1.1% of the variance in the Clinical Teaching Effectiveness Instrument score. The Clinical Learning Environment Inventory Actual subscales accounted for the following variance percentages in the Clinical Teaching Effectiveness Instrument score: personalization, 1.1%; satisfaction, 1.7%; task orientation, 5.1%; and innovation, 6.2%. Aspects of the clinical learning environment appear to be predictive of the effectiveness of the clinical teaching that students experience. Fieldwork educator performance might be a significant contributing factor toward student skill development and practitioner success.

  8. Performing meta-analysis with incomplete statistical information in clinical trials

    Directory of Open Access Journals (Sweden)

    Hunter Anthony

    2008-08-01

    Full Text Available Abstract Background Results from clinical trials are usually summarized in the form of sampling distributions. When full information (mean, SEM about these distributions is given, performing meta-analysis is straightforward. However, when some of the sampling distributions only have mean values, a challenging issue is to decide how to use such distributions in meta-analysis. Currently, the most common approaches are either ignoring such trials or for each trial with a missing SEM, finding a similar trial and taking its SEM value as the missing SEM. Both approaches have drawbacks. As an alternative, this paper develops and tests two new methods, the first being the prognostic method and the second being the interval method, to estimate any missing SEMs from a set of sampling distributions with full information. A merging method is also proposed to handle clinical trials with partial information to simulate meta-analysis. Methods Both of our methods use the assumption that the samples for which the sampling distributions will be merged are randomly selected from the same population. In the prognostic method, we predict the missing SEMs from the given SEMs. In the interval method, we define intervals that we believe will contain the missing SEMs and then we use these intervals in the merging process. Results Two sets of clinical trials are used to verify our methods. One family of trials is on comparing different drugs for reduction of low density lipprotein cholesterol (LDL for Type-2 diabetes, and the other is about the effectiveness of drugs for lowering intraocular pressure (IOP. Both methods are shown to be useful for approximating the conventional meta-analysis including trials with incomplete information. For example, the meta-analysis result of Latanoprost versus Timolol on IOP reduction for six months provided in 1 was 5.05 ± 1.15 (Mean ± SEM with full information. If the last trial in this study is assumed to be with partial information

  9. Application of Target Management Mode in Clinical Teaching of Nursing Undergraduates%目标管理模式在护理本科生临床实践教学中的运用

    Institute of Scientific and Technical Information of China (English)

    梅思娟; 段培蓓

    2012-01-01

    Objective To explore a teaching and managing method to improve nursing undergraduates' comprehensive clinical competence. Methods In this study, experiment group involved 40 nursing undergraduates and in their clinical practice, target management mode was applied. The general target for clinical practice was established based on students' comprehensive clinical competence which was identified through Delphi consulting. Meanwhile, another 40 nursing undergraduates were concluded in control group. The integrated clinical competence were identified through objective structured clinical examination and thesis review. Results Students in experiment group performed better in terms of nursing assessment, case analysis and nursing skills (P<0.05). Conclusion The application of target management mode in nursing clinical teaching is beneficial to the improvement of nursing undergraduates comprehensive clinical competence.%目的 探讨提高护理专业学生临床实践综合能力的教学与管理方法.方法 对2010年6月-2011年4月的实习本科护生40名(观察组),在其临床实践教学中实施目标管理模式,通过德尔菲(Delphi)函询法界定本科护生临床综合能力并将其作为本科护生临床实习的总目标,每个专科围绕临床实践总目标制定并实施专科阶段目标.采用历史对照,以2009年6月-2010年4月具有良好可比性,沿用传统实习带教方法 的40 名实习本科护生作为对照组.采用客观结构化临床考试及专业论文评审方法 衡量护生临床综合能力.结果 观察组护生在客观结构化临床考试中的护理评估能力、病例分析能力、技能操作等成绩均优于对照组护生,差异有统计学意义(P<0.05).结论 护理临床教学中实施目标管理模式有利于提高护生的临床实践综合能力.

  10. Clinical performance of Class I nanohybrid composite restorations with resin-modified glass-ionomer liner and flowable composite liner: A randomized clinical trial

    Science.gov (United States)

    Suhasini, Krishtipati; Madhusudhana, Koppolu; Suneelkumar, Chinni; Lavanya, Anumula; Chandrababu, K. S.; Kumar, Perisetty Dinesh

    2016-01-01

    Background: Liners play a vital role in minimizing polymerization shrinkage stress by elastic bonding concept and increase the longevity and favorable outcome for composite restorations. Aims: The aim of this study was to evaluate the clinical performance of nanohybrid composite restorations using resin-modified glass-ionomer and flowable composite liners. Settings and Design: A single-centered, double-blinded randomized clinical trial, with split-mouth design and equal allocation ratio that was conducted in the Department of Conservative Dentistry and Endodontics. Materials and Methods: In forty patients, a total of eighty Class I restorations were placed with resin-modified glass-ionomer cement (RMGIC) liner (FUJI II LC, GC America) in one group and flowable composite liner (smart dentin replacement/SDR, Dentsply Caulk, Milford, DE, USA) in another group. All restorations were clinically evaluated by two examiners, immediately (baseline), 3, 6, and 12 months using US Public Health Service modified criteria. Statistical Analysis Used: Statistical analysis was performed using McNemar's test (P < 0.05). Results: There was no significant difference in the color match, marginal discoloration, surface roughness, and marginal adaptation. Restorations with RMGIC liner group show 20% Bravo scores on anatomic form at 12 months but are still clinically acceptable. Conclusion: Nanohybrid composite restorations with RMGIC (Fuji II LC) and flowable composite liner (SDR) demonstrated clinically acceptable performance after 12 months. PMID:27994310

  11. MIMO声呐目标检测性能分析%Analysis of MIMO sonar target detection performance

    Institute of Scientific and Technical Information of China (English)

    王福钋; 潘悦; 王永刚

    2012-01-01

    重点研究MIMO声呐的目标检测性能,为MIMO声呐布阵方式和工作模式等的选择提供理论依据.通过理论分析给出了MIMO声呐接收机工作特性(ROC)曲线的表达式,分别包括并列式和分布式MIMO声呐,同时给出了相控阵、SIMO和MISO等形式声呐的ROC表达式.通过示例比较了相同情况下并列式MIMO声呐、分布式MIMO声呐、相控阵声呐和常规多基地声呐的ROC曲线.结果表明,相同条件下相控阵声呐波束指向方向上的目标检测概率高于并列式MIMO声呐,做脉冲积累的并列式MIMO声呐可以得到与相控阵声呐相同的检测性能,低信噪比时并列式MIMO声呐和相控阵声呐的目标检测概率高于分布式MIMO声呐,高信噪比时分布式MIMO声呐可以得到较高的检测概率,采用多个发射阵元的分布式MIMO声呐性能优于使用一个发射阵元的常规多基地声呐.%Target detection performances of MIMO sonar are studied in this paper. They are one of the theoretic foundations of elements placement and work pattern. Receiver Expressions of Receiver Operating Characteristics ( ROC ) curves are given through theoretical analysis. Including collocated MIMO sonar and distributed MIMO sonar. Expressions of ROC curves such as phase array sonar, SIMO sonar and MISO sonar are also given. ROC curve comparisons of collocated MIMO sonar, distributed MIMO sonar, phase array sonar and multi-base sonar are given in the same condition. Results indicate that target detection performance of phase array sonar in the beam direction is better than collocated MIMO sonar. Collocated MIMO sonar with pulse accumulation can get the same performance as the phase array sonar. Performances of collocated MIMO sonar and phase array sonar are better than distributed MIMO sonar in low SNR condition. In high SNR condition, distributed MIMO sonar can get a better performance. Performance of distributed MIMO sonar with multiple transmitting notes is better than

  12. A statistical analysis protocol for the time-differentiated target temperature management after out-of-hospital cardiac arrest (TTH48) clinical trial

    DEFF Research Database (Denmark)

    Kirkegaard, Hans; Pedersen, Asger Roer; Pettilä, Ville;

    2016-01-01

    BACKGROUND: The TTH48 trial aims to determine whether prolonged duration (48 hours) of targeted temperature management (TTM) at 33 (±1) °C results in better neurological outcomes compared to standard duration (24 hours) after six months in comatose out-of-hospital cardiac arrest (OHCA) patients...... predetermine covariates for adjusted analyses and pre-specify sub-groups for sensitivity analyses. This pre-planned SAP will reduce analysis bias and add validity to the findings of this trial on the effect of length of TTM on important clinical outcomes after cardiac arrest. TRIAL REGISTRATION: Clinical...

  13. Pre-clinical grades predict clinical performance in the MBBS stage II examination at the University of the West Indies, Mona Campus.

    Science.gov (United States)

    Pepple, Dagogo J; Young, Lauriann E; Gordon-Strachan, Georgiana M; Carroll, Robert G

    2013-12-20

    In the preclinical sciences, statistically significant predictive values have been reported between the performances in one discipline and the others, supporting the hypothesis that students who perform well in one discipline were likely to perform well in the other disciplines. We therefore decided to conduct a retrospective study to investigate the predictive effects of preclinical subjects on clinical subjects from 87 students of The University of the West Indies (UWI), Mona Campus who took the MBBS Stage II examination at various times between May 2000 and May 2002. The grade in Pathology was significantly predicted by scores in Anatomy and Pharmacology; Medicine by Physiology and Pharmacology scores; Surgery by Anatomy and Social and Preventive Medicine scores; while, the Obstetrics and Gynecology grade was predicted by the Anatomy score. The results support the hypothesis that the scores in some preclinical subjects can predict the performance in specific clinical subjects, which could be interpreted to suggest that poor performance in specific preclinical disciplines could be a warning sign of future poor performance in the related clinical disciplines.

  14. High-performance PEGylated Mn-Zn ferrite nanocrystals as a passive-targeted agent for magnetically induced cancer theranostics.

    Science.gov (United States)

    Xie, Jun; Zhang, Yu; Yan, Caiyun; Song, Lina; Wen, Song; Zang, Fengchao; Chen, Gong; Ding, Qi; Yan, Changzhi; Gu, Ning

    2014-11-01

    An effective magnetic nanocrystals (MNCs)-mediated theranostics strategy as a combination of simultaneous diagnostics and heating treatment of tumors by using magnetic resonance imaging (MRI) and alternating current magnetic field (ACMF) is successfully developed. In this strategy, we had firstly synthesized a well-established Mn-Zn ferrite MNCs coated with PEG-phospholipids (1,2-distearoyl-sn-glycero-3-phosphoethanolamine-N-[methoxy(polyethylene glycol copolymers, DSPE-PEG2000). The monodisperse PEGylated MNCs with core-shell structure (15 nm) exhibited excellent performance, such as high magnetism of 98 emu g(-1) Fe, relaxivity coefficient (r2) of 338 mm(-1) s(-1), and specific absorption rate (SAR) value of 324 W g(-1) Fe. It was proved that the obtained MNCs with an average diameter of 48.6 nm can drastically minimize the recognition and phagocytosis of macrophages, simultaneously improve their biocompatibility in vitro. These advantages endowed them with efficient passive targeting ability in vivo for prominent tumor MRI and magnetically induced heating when exposed to ACMF, based on enhanced permeability and retention (EPR) effects. To ensure sufficient accumulation of MNCs within tumors for targeted hyperthermia, we described the use of MNCs with a well-tolerated intravenous single dose of 18 mg Fe/kg mouse body weight, achieving repeatedly injection and hyperthermia within a subcutaneous breast cell carcinoma mouse model. With an ACMF of 12 A at 390 kHz, the tumor surface sites could be heated to approximately 43 °C in 30 min based on MNCs-mediated intravenous injections. The long-lasting hyperthermia could effectively induce the apoptosis of tumor cells, inhibit the angiogenesis of tumor vessels, and finally suppress the tumor growth within a certain period of time.

  15. Analytical performance and clinical utility of a bioassay for thyroid-stimulating immunoglobulins.

    Science.gov (United States)

    Leschik, Johannes J; Diana, Tanja; Olivo, Paul D; König, Jochem; Krahn, Ulrike; Li, Yunsheng; Kanitz, Michael; Kahaly, George J

    2013-02-01

    The analytical performance and the clinical utility of a thyrotropin receptor (TSHR)-stimulating immunoglobulin (TSI) bioassay were compared with those of a TSHR-binding inhibitory immunoglobulin (TBII) assay. Limits of detection (LoD) and quantitation (LoQ), assay cutoff, and the half-maximal effective concentration (EC(50)) were measured. Dilution analysis was performed in sera of hyperthyroid patients with Graves disease (GD) during antithyroid treatment (ATD). Titer was defined as the first dilution step at which measurement of TSI or TBII fell below the assay cutoff. The LoD, LoQ, cutoff, and EC(50) of the bioassay were 251-, 298-, 814-, and 827-fold lower than for the TBII assay. There were 22%, 42%, 23%, and 14% more positive samples in the TSI bioassay at dilutions of 1:3, 1:9, 1:27, and 1:81 (P bioassay detected lower levels of TSHR autoantibodies, and the dilution analysis provided similar predictive values of both assays in GD.

  16. Artificial gait in complete spinal cord injured subjects: how to assess clinical performance

    Directory of Open Access Journals (Sweden)

    Karla Rocha Pithon

    2015-02-01

    Full Text Available Objective Adapt the 6 minutes walking test (6MWT to artificial gait in complete spinal cord injured (SCI patients aided by neuromuscular electrical stimulation. Method Nine male individuals with paraplegia (AIS A participated in this study. Lesion levels varied between T4 and T12 and time post injured from 4 to 13 years. Patients performed 6MWT 1 and 6MWT 2. They used neuromuscular electrical stimulation, and were aided by a walker. The differences between two 6MWT were assessed by using a paired t test. Multiple r-squared was also calculated. Results The 6MWT 1 and 6MWT 2 were not statistically different for heart rate, distance, mean speed and blood pressure. Multiple r-squared (r2 = 0.96 explained 96% of the variation in the distance walked. Conclusion The use of 6MWT in artificial gait towards assessing exercise walking capacity is reproducible and easy to apply. It can be used to assess SCI artificial gait clinical performance.

  17. The Effect of Student Self-Video of Performance on Clinical Skill Competency: A Randomised Controlled Trial

    Science.gov (United States)

    Maloney, Stephen; Storr, Michael; Morgan, Prue; Ilic, Dragan

    2013-01-01

    Emerging technologies and student information technology literacy are enabling new methods of teaching and learning for clinical skill performance. Facilitating experiential practice and reflection on performance through student self-video, and exposure to peer benchmarks, may promote greater levels of skill competency. This study examines the…

  18. Case Specificity of Standardized-Patient Examinations: Consistency of Performance on Components of Clinical Competence within and between Cases.

    Science.gov (United States)

    Colliver, Jerry A.; And Others

    1990-01-01

    Standardized patient case problems were administered to approximately 280 final year medical students. Results indicate that performance on a given component of clinical competence shows less consistency when measured on different cases than does performance on different components measured on the same case. (TJH)

  19. Comparison of clinical characteristics and survival on patients with idiopathic pulmonary arterial hypertension and familial pulmonary arterial hypertension during conventional therapy era and targeted therapy era

    Institute of Scientific and Technical Information of China (English)

    徐希奇

    2014-01-01

    Objective To compare the clinical characteristics and survival on Chinese patients with idiopathic pulmonary arterial hypertension(IPAH)and familiar pulmonary arterial hypertension(FPAH)during conventional therapy era and targeted therapy era.Methods IPAH and FPAH patients who were referred between Jan 1999and Oct 2004 in Fuwai Hospital were defined as conventional therapy era group(before 2005 no PAH-specific drug was available in China).All patients in this group

  20. Predictive performance of the Domino, Hijazi, and Clements models during low-dose target-controlled ketamine infusions in healthy volunteers

    NARCIS (Netherlands)

    Absalom, A. R.; Lee, M.; Menon, D. K.; Sharar, S. R.; De Smet, T.; Halliday, J.; Ogden, M.; Corlett, P.; Honey, G. D.; Fletcher, P. C.

    2007-01-01

    Background. Healthy volunteers received low-dose target-controlled infusions (TCI) of ketamine controlled by the Domino model while cognitive function tests and functional neuroimaging were performed. The aim of the current study was to assess the predictive performance of the Domino model during th

  1. Academic Performance on First-Year Medical School Exams: How Well Does It Predict Later Performance on Knowledge-Based and Clinical Assessments?

    Science.gov (United States)

    Krupat, Edward; Pelletier, Stephen R; Dienstag, Jules L

    2017-01-01

    Number of appearances in the bottom quartile of 1st-year medical school exams were used to represent the extent to which students were having academic difficulties. Medical educators have long expressed a desire to have indicators of medical student performance that have strong predictive validity. Predictors traditionally used fell into 4 general categories: demographic (e.g., gender), other background factors (e.g., college major), performance/aptitude (e.g., medical college admission test scores), and noncognitive factors (e.g., curiosity). These factors, however, have an inconsistent record of predicting student performance. In comparison to traditional predictive factors, we sought to determine the extent to which academic performance in the 1st-year of medical school, as measured by examination performance in the bottom quartile of the class in 7 required courses, predicted later performance on a variety of assessments, both knowledge based (e.g., United States Medical Licensing Examination Step 1 and Step IICK) and clinical skills based (e.g., clerkship grades and objective structured clinical exam performance). Of all predictors measured, number of appearances in the bottom quartile in Year 1 was the most strongly related to performance in knowledge-based assessments, as well as clinically related outcomes, and, for each outcome, bottom-quartile performance accounted for additional variance beyond that of the traditional predictors. Low academic performance in the 1st year of medical school is a meaningful risk factor with both predictive validity and predictive utility for low performance later in medical school. The question remains as to how we can incorporate this indicator into a system of formative assessment that effectively addresses the challenges of medical students once they have been identified.

  2. The role of a clinical director in developing an innovative assertive community treatment team targeting ethno-racial minority patients.

    Science.gov (United States)

    Law, Samuel

    2007-09-01

    Assertive Community Treatment (ACT) is a well established, evidence-based approach for delivering psychiatric care to clients with severe and persistent mental illness (SPMI). Research shows that special populations such as refugees, recent immigrants, and persons from ethnic minorities with cultural and language barriers are among the hardest to serve and one of the most underserved groups of mental health patients. Focusing on examples of the Clinical Directors' three main task domains, this paper discusses the unique role of the Clinical Director in developing an ACT team that specifically serves ethno-racial minority patients. A program evaluation process to validate the effectiveness of the team illustrates the administrative role; a strategy to incorporate the culturally sensitive and competent "illness narrative" model in all clinical encounters of the team illustrates the direct service role; and clinical programming and research addressing the unique family psychoeducation and other needs of this special client population illustrates the clinical collaboration role. The role of the Clinical Director on this special ACT team fits well with that of a program level Clinical Director as described in literature. The role demands specialized clinical, administrative, advocacy, and evaluative skills emphasized in programs such as the Columbia University Public Psychiatry Fellowship.

  3. Comparison and Consensus Guidelines for Delineation of Clinical Target Volume for CT- and MR-Based Brachytherapy in Locally Advanced Cervical Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Viswanathan, Akila N., E-mail: aviswanathan@lroc.harvard.edu [Brigham and Women' s Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Erickson, Beth [Medical College of Wisconsin, Milwaukee, Wisconsin (United States); Gaffney, David K. [University of Utah Huntsman Cancer Hospital, Salt Lake City, Utah (United States); Beriwal, Sushil [University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania (United States); Bhatia, Sudershan K. [University of Iowa, Iowa City, Iowa (United States); Lee Burnett, Omer [University of Alabama, Birmingham, Alabama (United States); D' Souza, David P.; Patil, Nikhilesh [London Health Sciences Centre and Western University, London, Ontario (Canada); Haddock, Michael G. [Mayo Medical Center, Rochester, Minnesota (United States); Jhingran, Anuja [University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Jones, Ellen L. [University of North Carolina, Chapel Hill, North Carolina (United States); Kunos, Charles A. [Case Western Reserve University, Cleveland, Ohio (United States); Lee, Larissa J. [Brigham and Women' s Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Lin, Lilie L. [University of Pennsylvania, Philadelphia, Pennsylvania (United States); Mayr, Nina A. [University of Washington, Seattle, Washington (United States); Petersen, Ivy [Mayo Medical Center, Rochester, Minnesota (United States); Petric, Primoz [Division of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana (Slovenia); Department of Radiation Oncology, National Center for Cancer Care and Research, Doha (Qatar); Portelance, Lorraine [University of Miami Miller School of Medicine, Miami, Florida (United States); Small, William [Loyola University Strich School of Medicine, Chicago, Illinois (United States); Strauss, Jonathan B. [The Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois (United States); and others

    2014-10-01

    Objective: To create and compare consensus clinical target volume (CTV) contours for computed tomography (CT) and 3-Tesla (3-T) magnetic resonance (MR) image-based cervical-cancer brachytherapy. Methods and Materials: Twenty-three experts in gynecologic radiation oncology contoured the same 3 cervical cancer brachytherapy cases: 1 stage IIB near-complete response (CR) case with a tandem and ovoid, 1 stage IIB partial response (PR) case with tandem and ovoid with needles, and 1 stage IB2 CR case with a tandem and ring applicator. The CT contours were completed before the MRI contours. These were analyzed for consistency and clarity of target delineation using an expectation maximization algorithm for simultaneous truth and performance level estimation (STAPLE), with κ statistics as a measure of agreement between participants. The conformity index was calculated for each of the 6 data sets. Dice coefficients were generated to compare the CT and MR contours of the same case. Results: For all 3 cases, the mean tumor volume was smaller on MR than on CT (P<.001). The κ and conformity index estimates were slightly higher for CT, indicating a higher level of agreement on CT. The Dice coefficients were 89% for the stage IB2 case with a CR, 74% for the stage IIB case with a PR, and 57% for the stage IIB case with a CR. Conclusion: In a comparison of MR-contoured with CT-contoured CTV volumes, the higher level of agreement on CT may be due to the more distinct contrast medium visible on the images at the time of brachytherapy. MR at the time of brachytherapy may be of greatest benefit in patients with large tumors with parametrial extension that have a partial or complete response to external beam. On the basis of these results, a 95% consensus volume was generated for CT and for MR. Online contouring atlases are available for instruction at (http://www.nrgoncology.org/Resources/ContouringAtlases/GYNCervicalBrachytherapy.aspx)

  4. Building a medical multimedia database system to integrate clinical information: an application of high-performance computing and communications technology.

    Science.gov (United States)

    Lowe, H J; Buchanan, B G; Cooper, G F; Vries, J K

    1995-01-01

    The rapid growth of diagnostic-imaging technologies over the past two decades has dramatically increased the amount of nontextual data generated in clinical medicine. The architecture of traditional, text-oriented, clinical information systems has made the integration of digitized clinical images with the patient record problematic. Systems for the classification, retrieval, and integration of clinical images are in their infancy. Recent advances in high-performance computing, imaging, and networking technology now make it technologically and economically feasible to develop an integrated, multimedia, electronic patient record. As part of The National Library of Medicine's Biomedical Applications of High-Performance Computing and Communications program, we plan to develop Image Engine, a prototype microcomputer-based system for the storage, retrieval, integration, and sharing of a wide range of clinically important digital images. Images stored in the Image Engine database will be indexed and organized using the Unified Medical Language System Metathesaurus and will be dynamically linked to data in a text-based, clinical information system. We will evaluate Image Engine by initially implementing it in three clinical domains (oncology, gastroenterology, and clinical pathology) at the University of Pittsburgh Medical Center.

  5. Targeted Mutagenesis of the Hypophysiotropic Gnrh3 in Zebrafish (Danio rerio Reveals No Effects on Reproductive Performance.

    Directory of Open Access Journals (Sweden)

    Olivia Smith Spicer

    Full Text Available Gnrh is the major neuropeptide regulator of vertebrate reproduction, triggering a cascade of events in the pituitary-gonadal axis that result in reproductive competence. Previous research in mice and humans has demonstrated that Gnrh/GNRH null mutations result in hypogonadotropic hypogonadism and infertility. The goal of this study was to eliminate gnrh3 (the hypophysiotropic Gnrh form function in zebrafish (Danio rerio to determine how ontogeny and reproductive performance are affected, as well as factors downstream of Gnrh3 along the reproductive axis. Using the TALEN technology, we developed a gnrh3-/- zebrafish line that harbors a 62 bp deletion in the gnrh3 gene. Our gnrh3-/- zebrafish line represents the first targeted and heritable mutation of a Gnrh isoform in any organism. Using immunohistochemistry, we verified that gnrh3-/- fish do not possess Gnrh3 peptide in any regions of the brain. However, other than changes in mRNA levels of pituitary gonadotropin genes (fshb, lhb, and cga during early development, which are corrected by adulthood, there were no changes in ontogeny and reproduction in gnrh3-/- fish. The gnrh3-/- zebrafish are fertile, displaying normal gametogenesis and reproductive performance in males and females. Together with our previous results that Gnrh3 cell ablation causes infertility, these results indicate that a compensatory mechanism is being activated, which is probably primed early on upon Gnrh3 neuron differentiation and possibly confined to Gnrh3 neurons. Potential compensation factors and sensitive windows of time for compensation during development and puberty should be explored.

  6. Clinical spectrum of food allergy in children in Australia and South-East Asia: identification and targets for treatment.

    Science.gov (United States)

    Hill, D J; Hosking, C S; Heine, R G

    1999-08-01

    The prevalence of atopic diseases is increasing worldwide for reasons that are not clear. Food allergies are the earliest manifestations of atopy. This review defines the foods most commonly involved in allergic reactions and identifies an emerging group of syndromes in which food allergy is involved. A study of the frequency of food allergies in Australia and South-East Asia has recently shown that egg, cow's milk and peanut are the most common food allergens in Australia, but there were divergent results from different regions of South-East Asia. It is not clear whether the differences in reactivity to foods are due to genetic or cultural factors, but the findings raise the possibility that genetic susceptibility to food allergy may operate at the T-cell level modulated by the major histocompatibility complex. The Melbourne Milk Allergy Study defined a wide range of clinical symptoms and syndromes that could be reproduced by dietary challenge. A subsequent analysis of the infants with hypersensitivity to cow's milk and other multiple food proteins identified a new syndrome, multiple food protein intolerance of infancy. Food challenges demonstrated reactions developing slowly days after commencement of low-allergen soy formula or extensively hydrolysed formula. Follow-up at the age of 3 years showed that most children with this disorder tolerated most foods apart from cow's milk, egg and peanut. Atopic dermatitis affects about 18% of infants in the first 2 years of life. In a community-based study we have shown a very strong association (RR 3.5) between atopic dermatitis and infants with immunoglobulin E allergy to cow's milk, egg or peanut. Family studies on these infants have shown a link between atopic dermatitis and the genomic region 5q31 adjacent to the interleukin-4 gene cluster. Infantile colic (distress) affects 15-40% of infants in the first 4 months of life. Many theories of causation have been proposed, but a study from our centre showed that dietary

  7. Intensity modulated radiation therapy (IMRT: differences in target volumes and improvement in clinically relevant doses to small bowel in rectal carcinoma

    Directory of Open Access Journals (Sweden)

    Delclos Marc E

    2011-06-01

    Full Text Available Abstract Background A strong dose-volume relationship exists between the amount of small bowel receiving low- to intermediate-doses of radiation and the rates of acute, severe gastrointestinal toxicity, principally diarrhea. There is considerable interest in the application of highly conformal treatment approaches, such as intensity-modulated radiation therapy (IMRT, to reduce dose to adjacent organs-at-risk in the treatment of carcinoma of the rectum. Therefore, we performed a comprehensive dosimetric evaluation of IMRT compared to 3-dimensional conformal radiation therapy (3DCRT in standard, preoperative treatment for rectal cancer. Methods Using RTOG consensus anorectal contouring guidelines, treatment volumes were generated for ten patients treated preoperatively at our institution for rectal carcinoma, with IMRT plans compared to plans derived from classic anatomic landmarks, as well as 3DCRT plans treating the RTOG consensus volume. The patients were all T3, were node-negative (N = 1 or node-positive (N = 9, and were planned to a total dose of 45-Gy. Pairwise comparisons were made between IMRT and 3DCRT plans with respect to dose-volume histogram parameters. Results IMRT plans had superior PTV coverage, dose homogeneity, and conformality in treatment of the gross disease and at-risk nodal volume, in comparison to 3DCRT. Additionally, in comparison to the 3DCRT plans, IMRT achieved a concomitant reduction in doses to the bowel (small bowel mean dose: 18.6-Gy IMRT versus 25.2-Gy 3DCRT; p = 0.005, bladder (V40Gy: 56.8% IMRT versus 75.4% 3DCRT; p = 0.005, pelvic bones (V40Gy: 47.0% IMRT versus 56.9% 3DCRT; p = 0.005, and femoral heads (V40Gy: 3.4% IMRT versus 9.1% 3DCRT; p = 0.005, with an improvement in absolute volumes of small bowel receiving dose levels known to induce clinically-relevant acute toxicity (small bowel V15Gy: 138-cc IMRT versus 157-cc 3DCRT; p = 0.005. We found that the IMRT treatment volumes were typically larger than that

  8. SU-E-J-35: Clinical Performance Evaluation of a Phase II Proton CT Scanner

    Energy Technology Data Exchange (ETDEWEB)

    Mandapaka, A; Ghebremedhin, A; Farley, D; Giacometti, V; Vence, N; Bashkirov, V; Patyal, B; Schulte, R [Loma Linda UniversityMedical Center, Loma Linda, CA (United States); Plautz, T; Zatserklyaniy, A; Johnson, R; Sadrozinski, H [University of California Santa Cruz, Santa Cruz, CA (United States)

    2014-06-01

    Purpose: To develop the methodology to evaluate the clinical performance of a Phase II Proton CT scanner Methods: Range errors on the order of 3%-5% constitute a major uncertainty in current charged particle treatment planning based on Hounsfield Unit (HU)-relative stopping power (RSP) calibration curves. Within our proton CT collaboration, we previously developed and built a Phase I proton CT scanner that provided a sensitive area of 9 cm (axial) × 18 cm (in-plane). This scanner served to get initial experience with this new treatment planning tool and to incorporate lessons learned into the next generation design. A Phase II scanner was recently completed and is now undergoing initial performance testing. It will increase the proton acquisition rate and provide a larger detection area of 9 cm x 36 cm. We are now designing a comprehensive evaluation program to test the image quality, imaging dose, and range uncertainty associated with this scanner. The testing will be performed along the lines of AAPM TG 66. Results: In our discussion of the evaluation protocol we identified the following priorities. The image quality of proton CT images, in particular spatial resolution and low-density contrast discrimination, will be evaluated with the Catphan600 phantom. Initial testing showed that the Catphan uniformity phantom did not provide sufficient uniformity; it was thus replaced by a cylindrical water phantom. The imaging dose will be tested with a Catphan dose module, and compared to a typical cone beam CT dose for comparable image quality. Lastly, we developed a dedicated dosimetry range phantom based on the CIRS pediatric head phantom HN715. Conclusion: A formal evaluation of proton CT as a new tool for proton treatment planning is an important task. The availability of the new Phase II proton CT scanner will allow us to perform this task. This research is supported by the National Institute of Biomedical Imaging and Bioengineering of the NIH under award number R01

  9. Development and clinical performance of high throughput loop-mediated isothermal amplification for detection of malaria

    Science.gov (United States)

    Perera, Rushini S.; Ding, Xavier C.; Tully, Frank; Oliver, James; Bright, Nigel; Bell, David; Chiodini, Peter L.; Gonzalez, Iveth J.; Polley, Spencer D.

    2017-01-01

    Background Accurate and efficient detection of sub-microscopic malaria infections is crucial for enabling rapid treatment and interruption of transmission. Commercially available malaria LAMP kits have excellent diagnostic performance, though throughput is limited by the need to prepare samples individually. Here, we evaluate the clinical performance of a newly developed high throughput (HTP) sample processing system for use in conjunction with the Eiken malaria LAMP kit. Methods The HTP system utilised dried blood spots (DBS) and liquid whole blood (WB), with parallel sample processing of 94 samples per run. The system was evaluated using 699 samples of known infection status pre-determined by gold standard nested PCR. Results The sensitivity and specificity of WB-HTP-LAMP was 98.6% (95% CI, 95.7–100), and 99.7% (95% CI, 99.2–100); sensitivity of DBS-HTP-LAMP was 97.1% (95% CI, 93.1–100), and specificity 100% against PCR. At parasite densities greater or equal to 2 parasites/μL, WB and DBS HTP-LAMP showed 100% sensitivity and specificity against PCR. At densities less than 2 p/μL, WB-HTP-LAMP sensitivity was 88.9% (95% CI, 77.1–100) and specificity was 99.7% (95% CI, 99.2–100); sensitivity and specificity of DBS-HTP-LAMP was 77.8% (95% CI, 54.3–99.5) and 100% respectively. Conclusions The HTP-LAMP system is a highly sensitive diagnostic test, with the potential to allow large scale population screening in malaria elimination campaigns. PMID:28166235

  10. Effects of Achieving Target Measures in Rheumatoid Arthritis on Functional Status, Quality of Life, and Resource Utilization: Analysis of Clinical Practice Data

    Science.gov (United States)

    Joo, Seongjung; Kawabata, Hugh; Al, Maiwenn J.; Allison, Paul D.; Rutten‐van Mölken, Maureen P. M. H.; Frits, Michelle L.; Iannaccone, Christine K.; Shadick, Nancy A.; Weinblatt, Michael E.

    2016-01-01

    Objective To evaluate associations between achieving guideline‐recommended targets of disease activity, defined by the Disease Activity Score in 28 joints using C‐reactive protein level (DAS28‐CRP) control for intraclass correlation and estimate effects of independent variables on outcomes of the modified Health Assessment Questionnaire (M‐HAQ), the EuroQol 5‐domain (EQ‐5D; a quality‐of‐life measure), hospitalization, and durable medical equipment (DME) use, we employed mixed models for continuous outcomes and generalized estimating equations for binary outcomes. Results Among 1,297 subjects, achievement (versus nonachievement) of recommended disease targets was associated with enhanced physical functioning and lower health resource utilization. After controlling for baseline covariates, achievement of disease targets (versus LDA) was associated with significantly enhanced physical functioning based on SDAI ≤3.3 (ΔM‐HAQ −0.047; P = 0.0100) and CDAI ≤2.8 (−0.073; P = 0.0003) but not DAS28‐CRP <2.6 (−0.022; P = 0.1735). Target attainment was associated with significantly improved EQ‐5D (0.022–0.096; P < 0.0030 versus LDA, MDA, or SDA). Patients achieving guideline‐recommended disease targets were 36–45% less likely to be hospitalized (P < 0.0500) and 23–45% less likely to utilize DME (P < 0.0100). Conclusion Attaining recommended target disease‐activity measures was associated with enhanced physical functioning and health‐related quality of life. Some health outcomes were similar in subjects attaining guideline targets versus LDA. Achieving LDA is a worthy clinical objective in some patients. PMID:26238974

  11. Clinical symptoms and performance on the continuous performance test in children with attention deficit hyperactivity disorder between subtypes: a natural follow-up study for 6 months

    Directory of Open Access Journals (Sweden)

    Chiang Yuan-Lin

    2011-04-01

    Full Text Available Abstract Background The aims of this study were to determine the time course of improvements in attention deficit hyperactivity disorder (ADHD clinical symptoms and neurocognitive function in a realistic clinical setting, and the differences in ADHD symptom improvement using different classifications of ADHD subtypes. Methods The Child Behavior Checklist (CBCL was completed by parents of ADHD children at the initial visit. The computerized Continuous Performance Test (CPT, Swanson, Nolan, and Pelham, and Version IV Scale for ADHD (SNAP-IV, and ADHD Rating Scale (ADHD-RS were performed at baseline, one month, three months, and six months later, respectively. Patient care including drug therapy was performed at the discretion of the psychiatrist. The ADHD patients were divided into DSM-IV subtypes (Inattentive, Hyperactive-impulsive and Combined type, and were additionally categorized into aggressive and non-aggressive subtypes by aggression scale in CBCL for comparisons. Results There were 50 ADHD patients with a mean age of 7.84 ± 1.64 years; 15 of them were inattentive type, 11 were hyperactive-impulsive type, and 24 were combined type. In addition, 28 of the ADHD patients were grouped into aggressive and 22 into non-aggressive subtypes. There were significant improvements in clinical symptoms of hyperactivity and inattention, and impulsivity performance in CPT during the 6-month treatment. The clinical hyperactive symptoms were significantly different between ADHD patients sub-grouping both by DSM-IV and aggression. Non-aggressive patients had significantly greater changes in distraction and impulsivity performances in CPT from baseline to month 6 than aggressive patients. Conclusions We found that ADHD symptoms, which included impulsive performances in CPT and clinical inattention and hyperactivity dimensions, had improved significantly over 6 months under pragmatic treatments. The non-aggressive ADHD patients might have a higher potential

  12. Clinical performance and survival of space maintainers: evaluation over a period of 5 years.

    Science.gov (United States)

    Rajab, Lamis D

    2002-01-01

    The study investigated the clinical performance of 387 space maintainers fitted in 358 patients aged from 3 to 9 years in the Department of Pediatric Dentistry at the Faculty of Dentistry-University of Jordan from 1996 to 2000. Failure occurred in 119 appliances (30.7%), of which 49.6% were due to solder breakage, 32.8% from cement loss, 11% from soft tissue lesions, 4.2% from eruption interference, and 2.5% were completely lost. By using the Kaplan-Meier method, the estimated median survival time for space maintainers was 18 months. Lingual arches had the lowest median survival time of 14 months. Bands and loops, Nance appliances, and removable partial dentures had similar probability of survival. Fixed bilateral mandibular appliances recorded lower survival time than fixed bilateral maxillary appliances. Gender, age, type of dentition, fixed vs. removable, year of placement of the appliance and number of space maintainers fitted simultaneously in the same patient had no significant effect on survival of the appliances.

  13. Clinical study: assessing the performance and skin environments of two reusable underpads.

    Science.gov (United States)

    Leiby, D M; Shanahan, N

    1994-10-01

    The authors wanted to compare the performance and skin environment provided by a recently introduced reusable underpad (Test Group underpad) to an underpad already well established in the absorbent products market (Reference Group underpad). A controlled, prospective, randomized multi-centered clinical trial was conducted in 18 facilities (6 hospitals, 7 home health agencies, and 5 skilled nursing facilities) and completed by 107 patients. The majority of the patients had a Braden score near 13, were 70 to 80 years of age, and weighed 130 to 138 lbs. The Test Group underpad ranked more favorably overall and in all eight categories of daily assessment. These differences were statistically significant (p Skin Dry, Keeping Clothing Dry, No Pooling of Fluid, and Patient Comfort. The Test Group underpad also ranked more favorably with statistical significance (p assessment categories at the conclusion of the study: Pad Absorbency, Pad's Ability to Wick Moisture, and Pad's Ability to Keep Skin Dry. Investigators also noted that 57 patients (53%) exhibited some measure of improvement by the end of the study. Of these, 45 (79%) had been assigned to the Test Group. The Test Group underpad demonstrated better absorbency, kept patients' skin, clothing and bed linens drier, exhibited less pooling of fluid and resulted in higher patient comfort. As a result, it may have contributed to a more beneficial skin environment, allowing for prevention of preexisting skin integrity problems and enhancement of healing.

  14. Survey and rapid detection of Klebsiella pneumoniae in clinical samples targeting the rcsA gene in Beijing, China

    OpenAIRE

    Derong eDong; Wei eLiu; Huan eLi; Yufei eWang; Xinran eLi; Dayang eZou; Zhan eYang; Simo eHuang; Dongsheng eZhou; Liuyu eHuang; Jing eYuan

    2015-01-01

    Klebsiella pneumoniae is a wide-spread nosocomial pathogen. A rapid and sensitive molecular method for the detection of K. pneumoniae in clinical samples is needed to guide therapeutic treatment. In this study, we first described a loop-mediated isothermal amplification (LAMP) method for the rapid detection of capsular polysaccharide synthesis regulating gene rcsA from K. pneumoniae in clinical samples by using two methods including real-time turbidity monitoring and fluorescence detection to...

  15. Survey and rapid detection of Klebsiella pneumoniae in clinical samples targeting the rcsA gene in Beijing, China

    OpenAIRE

    Dong, Derong; Liu, Wei; Li, Huan; Wang, Yufei; Li, Xinran; Zou, Dayang; Yang, Zhan; Huang, Simo; Zhou, Dongsheng; Huang, Liuyu; Yuan, Jing

    2015-01-01

    Klebsiella pneumoniae is a wide-spread nosocomial pathogen. A rapid and sensitive molecular method for the detection of K. pneumoniae in clinical samples is needed to guide therapeutic treatment. In this study, we first described a loop-mediated isothermal amplification (LAMP) method for the rapid detection of capsular polysaccharide synthesis regulating gene rcsA from K. pneumoniaein clinical samples by using two methods including real-time turbidity monitoring and fluorescence detection to ...

  16. Stereotactic body radiation therapy for abdominal targets using volumetric intensity modulated arc therapy with RapidArc: Feasibility and clinical preliminary results

    Energy Technology Data Exchange (ETDEWEB)

    Scorsetti, Marta; Bignardi, Mario; Alongi, Filippo; Mancosu, Pietro; Navarria, Piera; Castiglioni, Simona; Pentimalli, Sara; Tozzi, Angelo (IRCCS Istituto Clinico Humanitas, Rozzano (Italy)), e-mail: pietro.mancosu@humanitas.it; Fogliata, Antonella; Cozzi, Luca (Oncology Inst. of Southern Switzerland, Bellinzona (Switzerland))

    2011-05-15

    Purpose. To report early clinical experience in stereotactic body radiation therapy (SBRT) delivered using volumetric intensity modulated arc therapy with RapidArc (RA) in patients with primary or metastatic tumours at abdominal sites. Material and methods. Thirty-seven consecutive patients were treated using RA. Of these, 16 had primary or metastatic liver tumours, nine had pancreatic cancer and 12 a nodal metastasis in the retro-peritoneum. Dose prescription varied from 45 to 75 Gy to the Clinical Target Volume in 3 to 6 fractions. The median follow-up was 12 months (6-22). Early local control and toxicity were investigated and reported. Results. Planning objectives on target volumes and organs at risk were met in most cases. Delivery time ranged from 2.8 +- 0.3 to 9.2 +- 2.4 minutes and pre-treatment plan verification resulted in a Gamma Agreement Index from 95.3 +- 3.8 to 98.3 +- 1.7%. At the time of analysis, local control (freedom from progression) at six months, was assessable in 24 of 37 patients and was achieved in 19 patients with a crude rate of 79.2%. Seven patients experienced treatment-related toxicity. Three patients experienced a mild and transient G1 enteritis and two showed a transient G1 liver damage. Two had late toxicity: one developed chronic enteritis causing G1 diarrhoea and G1 abdominal pain and one suffered at three months a G3 gastric bleeding. No patients experienced G4 acute toxicity. Conclusions. SBRT for abdominal targets delivered by means of RA resulted to be feasible with good early clinical results in terms of local control rate and acute toxicity profile. RA allowed to achieve required target coverage as well as to keep within normal tissue dose/volume constraints

  17. Kinect One-based biomechanical assessment of upper-limb performance compared to clinical scales in post-stroke patients.

    Science.gov (United States)

    Scano, Alessandro; Caimmi, Marco; Chiavenna, Andrea; Malosio, Matteo; Tosatti, Lorenzo Molinari

    2015-08-01

    This paper presents a Kinect One sensor-based protocol for the evaluation of the motor-performances of the upper limb of neurological patients during rehabilitative sessions. The assessment provides evaluations of kinematic, dynamic, motor and postural control variables. A pilot study was conducted on three post-stroke neurological patients, comparing Kinect-One biomechanical assessment with the outcomes of some of the most common clinical scales for the evaluation of the upper-limb functionality. Preliminary results indicate coherency between the clinical and instrumental evaluation. Moreover, the Kinect-One assessment seems to provide some complementary quantitative information, consistently integrating the clinical assessment.

  18. Achievement of recommended glucose and blood pressure targets in patients with type 2 diabetes and hypertension in clinical practice – study rationale and protocol of DIALOGUE

    Directory of Open Access Journals (Sweden)

    Gitt Anselm K

    2012-12-01

    Full Text Available Abstract Background Patients with type 2 diabetes have 2–4 times greater risk for cardiovascular morbidity and mortality than those without, and this is even further aggravated if they also suffer from hypertension. Unfortunately, less than one third of hypertensive diabetic patients meet blood pressure targets, and more than half fail to achieve target HbA1c values. Thus, appropriate blood pressure and glucose control are of utmost importance. Since treatment sometimes fails in clinical practice while clinical trials generally suggest good efficacy, data from daily clinical practice, especially with regard to the use of newly developed anti-diabetic and anti-hypertensive compounds in unselected patient populations, are essential. The DIALOGUE registry aims to close this important gap by evaluating different treatment approaches in hypertensive type 2 diabetic patients with respect to their effectiveness and tolerability and their impact on outcomes. In addition, DIALOGUE is the first registry to determine treatment success based on the new individualized treatment targets recommended by the ADA and the EASD. Methods DIALOGUE is a prospective observational German multicentre registry and will enrol 10,000 patients with both diabetes and hypertension in up to 700 sites. After a baseline visit, further documentations are scheduled at 6, 12 and 24 months. There are two co-primary objectives referring to the most recent guidelines for the treatment of diabetes and hypertension: 1 individual HbA1c goal achievement with respect to anti-diabetic pharmacotherapy and 2 individual blood pressure goal achievement with different antihypertensive treatments. Among the secondary objectives the rate of major cardio-vascular and cerebro-vascular events (MACCE and the rate of hospitalizations are the most important. Conclusion The registry will be able to gain insights into the reasons for the obvious gap between the demonstrated efficacy and safety of anti

  19. Determining performance characteristics of an NGS-based HLA typing method for clinical applications.

    Science.gov (United States)

    Duke, J L; Lind, C; Mackiewicz, K; Ferriola, D; Papazoglou, A; Gasiewski, A; Heron, S; Huynh, A; McLaughlin, L; Rogers, M; Slavich, L; Walker, R; Monos, D S

    2016-03-01

    This study presents performance specifications of an in-house developed human leukocyte antigen (HLA) typing assay using next-generation sequencing (NGS) on the Illumina MiSeq platform. A total of 253 samples, previously characterized for HLA-A, -B, -C, -DRB1 and -DQB1 were included in this study, which were typed at high-resolution using a combination of Sanger sequencing, sequence-specific primer (SSP) and sequence-specific oligonucleotide probe (SSOP) technologies and recorded at the two-field level. Samples were selected with alleles that cover a high percentage of HLA specificities in each of five different race/ethnic groups: European, African-American, Asian Pacific Islander, Hispanic and Native American. Sequencing data were analyzed by two software programs, Omixon's target and GenDx's NGSengine. A number of metrics including allele balance, sensitivity, specificity, precision, accuracy and remaining ambiguity were assessed. Data analyzed by the two software systems are shown independently. The majority of alleles were identical in the exonic sequences (third field) with both programs for HLA-A, -B, -C and -DQB1 in 97.7% of allele determinations. Among the remaining discrepant genotype calls at least one of the analysis programs agreed with the reference typing. Upon additional manual analysis 100% of the 2530 alleles were concordant with the reference HLA genotypes; the remaining ambiguities did not exceed 0.8%. The results demonstrate the feasibility and significant benefit of HLA typing by NGS as this technology is highly accurate, eliminates virtually all ambiguities, provides complete sequencing information for the length of the HLA gene and forms the basis for utilizing a single methodology for HLA typing in the immunogenetics labs.

  20. Survey and rapid detection of Klebsiella pneumoniae in clinical samples targeting the rcsA gene in Beijing, China.

    Science.gov (United States)

    Dong, Derong; Liu, Wei; Li, Huan; Wang, Yufei; Li, Xinran; Zou, Dayang; Yang, Zhan; Huang, Simo; Zhou, Dongsheng; Huang, Liuyu; Yuan, Jing

    2015-01-01

    Klebsiella pneumoniae is a wide-spread nosocomial pathogen. A rapid and sensitive molecular method for the detection of K. pneumoniae in clinical samples is needed to guide therapeutic treatment. In this study, we first described a loop-mediated isothermal amplification (LAMP) method for the rapid detection of capsular polysaccharide synthesis regulating gene rcsA from K. pneumoniaein clinical samples by using two methods including real-time turbidity monitoring and fluorescence detection to assess the reaction. Then dissemination of K. pneumoniae strains was investigated from ICU patients in three top hospitals in Beijing, China. The results showed that the detection limit of the LAMP method was 0.115 pg/μl DNA within 60 min under isothermal conditions (61°C), a 100-fold increase in sensitivity compared with conventional PCR. All 30 non- K. pneumoniae strains tested were negative for LAMP detection, indicating the high specificity of the LAMP reaction. To evaluate the application of the LAMP assay to clinical diagnosis, of 110 clinical sputum samples collected from ICU patients with clinically suspected multi-resistant infections in China, a total of 32 K. pneumoniae isolates were identified for LAMP-based surveillance of rcsA. All isolates belonged to nine different K. pneumoniae multilocus sequence typing (MLST) groups. Strikingly, of the 32 K. pneumoniae strains, 18 contained the Klebsiella pneumoniae Carbapenemase (KPC)-encoding gene bla KPC-2 and had high resistance to β-lactam antibiotics. Moreover, K. pneumoniae WJ-64 was discovered to contain bla KPC-2 and bla NDM-1genes simultaneously in the isolate. Our data showed the high prevalence of bla KPC-2 among K. pneumoniae and co-occurrence of many resistant genes in the clinical strains signal a rapid and continuing evolution of K. pneumoniae. In conclusion, we have developed a rapid and sensitive visual K. pneumoniae detection LAMP assay, which could be a useful tool for clinical screening, on

  1. Clinical performance of KeraSoft® IC in irregular corneas

    Directory of Open Access Journals (Sweden)

    Su S

    2015-10-01

    Full Text Available Stephanie Su,1 Lynette Johns,2 Marjorie J Rah,3 Robert Ryan,1 Joseph Barr3 1Visionary Eye Associates of Rochester, Rochester, NY, USA; 2Custom Lab Channel Business, Bausch & Lomb Incorporated, Wilmington, MA, USA; 3Medical Affairs – Vision Care, Bausch & Lomb Incorporated, Rochester, NY, USA Purpose: This study evaluated the clinical performance of KeraSoft® IC (KIC soft contact lenses in subjects with irregular corneas.Patients and methods: This was a 12-month, prospective, open-label, observational study, which enrolled 43 subjects who were 18 years of age or older with irregular corneas. Subjects were fit according to the KIC Fitting Manual (kerasoftic.com. After achieving best fit according to the fitting manual, lenses were assessed for comfort, vision, centration, rotation, and movement. Subjects were instructed to wear their lenses between 8 and 16 hours each day. Assessments at the exit visit included logMAR visual acuity with high and low contrast, spherocylindrical overrefraction, slit-lamp findings, adverse events, and subjective outcomes.Results: The average base curve was 8.17±0.32 mm (n=70 eyes, and the average diameter dispensed was 14.53±0.12 mm (n=70 eyes. From the baseline to 12 months, there was statistically significant improvement in logMAR visual acuity with high contrast (P=0.038, but no significant difference in low-contrast visual acuity was observed (P>0.05. Slit-lamp findings were ≤ grade 1 for the majority of subjects (89%. Two nonserious adverse events were reported for two of the 84 enrolled eyes (two subjects. At 12 months, subjects reported improvements from habitual baseline for comfort and vision, both upon insertion and just before removal of lenses.Conclusion: Clinical outcomes at 12 months showed good visual, safety, and subjective outcomes for subjects with corneal irregularities who wore KeraSoft® IC soft contact lenses. Keywords: irregular corneas, keratoconus, soft contact lenses, KeraSoft® IC

  2. Tradable permits without legislative targets: a review of the potential for a permit scheme for sterilized clinical waste in the UK.

    Science.gov (United States)

    Bailey, Ian; Haug, Brigitte; O'Doherty, Richard

    2004-06-01

    Tradable-permit schemes are becoming an increasingly popular technique for encouraging materials recovery and the diversion of waste from landfill. Such schemes operate using various forms of market-based trading of waste permits between polluters but usually rely on mandatory recycling targets to provide an incentive for trading. Using the UK's Packaging Recovery Note (PRN) scheme as a template, this paper examines the potential for permit trading where mandatory targets are absent and schemes must be driven solely by the financial benefits of reduced landfill costs and permit/material sales. The case examined is sterilized clinical waste, which has considerable recycling potential but suffers from health concerns and a poor public image. Interviews with healthcare and waste-management representatives indicate that although elements of the PRN scheme might prove appropriate for encouraging materials recovery, the absence of government targets and uncertain end markets for sterilized clinical waste present major obstacles to trading. Alternative incentives would therefore be required to catalyse schemes and develop recycling infrastructure. In the final analysis, thermal processing may be a more practical alternative to landfill than materials recovery for this particular waste stream.

  3. The impact of clinical and demographic variables on cognitive performance in methamphetamine-dependent individuals in rural South Carolina.

    Science.gov (United States)

    Price, Kimber L; DeSantis, Stacia M; Simpson, Annie N; Tolliver, Bryan K; McRae-Clark, Aimee L; Saladin, Michael E; Baker, Nathaniel L; Wagner, Mark T; Brady, Kathleen T

    2011-01-01

    Inconsistencies in reports on methamphetamine (METH) associated cognitive dysfunction may be attributed, at least in part, to the diversity of study sample features (eg, clinical and demographic characteristics). The current study assessed cognitive function in a METH-dependent population from rural South Carolina, and the impact of demographic and clinical characteristics on performance. Seventy-one male (28.2%) and female (71.8%) METH-dependent subjects were administered a battery of neurocognitive tests including the Test of Memory Malingering (TOMM), Shipley Institute of Living Scale, Paced Auditory Serial Addition Test (PASAT), Symbol Digit Modalities Test (SDMT), Grooved Pegboard Test, California Verbal Learning Test (CVLT), and Wisconsin Card Sorting Test (WCST). Demographic and clinical characteristics (eg, gender, frequency of METH use) were examined as predictors of performance. Subjects scored significantly lower than expected on one test of attention and one of fine motor function, but performed adequately on all other tests. There were no predictors of performance on attention; however, more frequent METH use was associated with better performance for males and worse for females on fine motor skills. The METH-dependent individuals in this population exhibit very limited cognitive impairment. The marked differences in education, Intellectual Quotient (IQ), and gender in our sample when compared to the published literature may contribute to these findings. Characterization of the impact of clinical and/or demographic features on cognitive deficits could be important in guiding the development of treatment interventions.

  4. Muscular activity of different shooting distances, different release techniques, and different performance levels, with and without stabilizers, in target archery.

    Science.gov (United States)

    Clarys, J P; Cabri, J; Bollens, E; Sleeckx, R; Taeymans, J; Vermeiren, M; Van Reeth, G; Voss, G

    1990-01-01

    The quadruple approach in the title refers to four different studies over a period of 3 years. The common factor in these studies is the methodology of the (Brussels) Electromyographic Signal Processing and Analysis System (ESPAS), a hardware and software EMG data acquisition system that has constantly been improved. Therefore, the ESPAS methodology is described extensively (i.e. the electrodes, amplifier, tape-recorder and processing hardware). Experiment 1 investigated muscular behaviour in target shooting, both indoors (18 and 25 m) and outdoors (50, 70 and 90 m). It was found (via iEMG) that a significant increase in activity only exists between 25 and 50 m, and that there is no linear increase of activity with increased distance. No differences in muscular pattern (IDANCO system: Clarys and Cabri, 1988) or activity between the indoor distances and between the outdoor distances were found. Experiment 2 investigated the muscular economy of four string grips: the three-finger grip, two-finger grip, thumb grip and reversed grip. The largest variations in activity were found for the two most unfamiliar grips, i.e. the thumb and reversed grips; however, low iEMG and the rapid precision improvement (over a limited number of shots) suggest that the thumb grip, if practised long enough, might be the most economical technique. Experiment 3 attempted to differentiate muscular activity and a number of performance variables in three different populations of archers--Olympic athletes, National competitors and beginners--in order to obtain feedback regarding improved performance. Apparently, overall muscle pattern, intensities and arrow speed were not discriminatory. The differences found between the groups (or levels of skill) were affected by the ability to reproduce identical patterns and arrow velocities in consecutive shots and by the constancy of neuromuscular control of the M. trapezius, M. biceps brachii and M. extensor digitorum. Finally, Experiment 4 investigated

  5. Clinical and radiographic outcome of a treat-to-target strategy using methotrexate and intra-articular glucocorticoids with or without adalimumab induction

    DEFF Research Database (Denmark)

    Hørslev-Petersen, K; Hetland, M L; Ørnbjerg, L M;

    2016-01-01

    OBJECTIVES: To study clinical and radiographic outcomes after withdrawing 1 year's adalimumab induction therapy for early rheumatoid arthritis (eRA) added to a methotrexate and intra-articular triamcinolone hexacetonide treat-to-target strategy (NCT00660647). METHODS: Disease-modifying antirheuma......OBJECTIVES: To study clinical and radiographic outcomes after withdrawing 1 year's adalimumab induction therapy for early rheumatoid arthritis (eRA) added to a methotrexate and intra-articular triamcinolone hexacetonide treat-to-target strategy (NCT00660647). METHODS: Disease......-modifying antirheumatic drug (DMARD)-naive patients with eRA started methotrexate (20 mg/week) and intra-articular triamcinolone (20 mg/ml) for 2 years. In addition, they were randomised to receive placebo adalimumab (DMARD group, n=91) or adalimumab (40 mg/every other week) (DMARD+adalimumab group, n=89) during....... RESULTS: One year after adalimumab withdrawal, treatment profiles and clinical responses did not differ between groups. In the DMARD/DMARD+adalimumab groups, the median 2-year methotrexate dose was 20/20 mg/week (p=0.45), triple DMARD therapy had been initiated in 33/27 patients (p=0.49), adalimumab...

  6. Integration of imaging into clinical practice to assess the delivery and performance of macromolecular and nanotechnology-based oncology therapies.

    Science.gov (United States)

    Spence, Tara; De Souza, Raquel; Dou, Yannan; Stapleton, Shawn; Reilly, Raymond M; Allen, Christine

    2015-12-10

    Functional and molecular imaging has become increasingly used to evaluate interpatient and intrapatient tumor heterogeneity. Imaging allows for assessment of microenvironment parameters including tumor hypoxia, perfusion and proliferation, as well as tumor metabolism and the intratumoral distribution of specific molecular markers. Imaging information may be used to stratify patients for targeted therapies, and to define patient populations that may benefit from alternative therapeutic approaches. It also provides a method for non-invasive monitoring of treatment response at earlier time-points than traditional cues, such as tumor shrinkage. Further, companion diagnostic imaging techniques are becoming progressively more important for development and clinical implementation of targeted therapies. Imaging-based companion diagnostics are likely to be essential for the validation and FDA approval of targeted nanotherapies and macromolecular medicines. This review describes recent clinical advances in the use of functional and molecular imaging to evaluate the tumor microenvironment. Additionally, this article focuses on image-based assessment of distribution and anti-tumor effect of nano- and macromolecular systems.

  7. A COMPARISON OF CLINICAL PERFORMANCE OF I-GEL WITH PROSEAL LMA IN PATIENTS UNDERGOING MASTECTOMY

    Directory of Open Access Journals (Sweden)

    Basheer Padinhare Madathil

    2016-04-01

    Full Text Available AIM To assess the ease of insertion of I-gel and ProSeal LMA and incidence of post op complications. Study design-A prospective randomised controlled trial comparing the clinical performance of I-gel and ProSeal LMA. METHODS After induction and good muscle relaxation LMA/I-gel was introduced as per randomised computer allocation. After insertion, nasogastric tube was inserted through the gastric channel. Parameters monitored were heart rate, nubp, SpO2, ETCO2 at 1, 5 minutes after insertion of the device and thereafter every 5 minutes till the end of surgery. In case of failure, airway was secured with an endotracheal tube. Ease of gastric tube insertion was noted at the end of surgery; postop complications were noted. Blood staining of the device, injury to the lips, teeth, and tongue were noted. Incidence of sore throat 24 hrs. after surgery was also noted. Statistical analysis was done with SPSS software. RESULTS Age, height, weight and BMI were comparable in both groups. The airway characteristics was also comparable in both the groups. Ease of introduction was also the same for both the groups, but the time taken was much lesser for I-gel group. The ease of insertion of gastric tube was much easier for the I-gel group. Blood staining of the device was more with the ProSeal LMA group. There was no injury to any of the structures mentioned above. Postop sore throat was more in the ProSeal LMA group. CONCLUSION From our study, we conclude that the airway can be secured much faster with I-gel than ProSeal LMA. Postop sore throat was much less for I-gel than ProSeal LMA. Both were comparable in number of attempts of insertion, gastric tube introduction. Trauma to the airway structures was also minimum with both I-gel and ProSeal LMA.

  8. ITC SOLUTIONS TO ACHIEVE PERFORMANCE AND EFFICIENCY OF HEALTH SERVICES: ONLINE VIRTUAL CLINIC

    Directory of Open Access Journals (Sweden)

    Adina BĂLAN

    2010-01-01

    Full Text Available The digital era modified the way people work, how the information and the informational resources are defined and organized. The organization which holds, uses and correctly reproduces the piece of information, the knowledge, the intellectual capital, becomes a leader in the proper field of activity. Following the actual tendencies in the digital era connected to the exchange of professional information, I can say that the exchange and sharing of digital information in a global multitude of interconnected computers are essential instruments that can contribute to the development and consolidation of the intellectual potential of the organization. This is why, the access of the individuals to information is an actual requirement of the development of the Romanian society in the context of globalization and world implication o contemporary processes and phenomena. The Digital integration eliminates the barriers that traditionally suppress the circuit of the medical information, lets the goods and services circulate to and from Romania by promoting efficiency as final purpose. Performance is needed in the health system, the transformation of the system of medical services by bringing the benefits of the medical science and technology to all individuals from every community. In order to accomplish these expectations it is needed that all the components that form the health system look at it as a whole and subscribe to modern solutions for improvement so that the quality of health should raise to an unprecedented level. Even if health systems differ from country to country from the organizational and financial point of view, they face the same challenges and problems, respectively the supply of medical care of better quality and keeping under control the health expenses. The use of information and communication technology in the field of medical assistance in order to stock, share, transmit and analyze clinical data and knowledge is more necessary

  9. Clinical profiling of BCL-2 family members in the setting of BRAF inhibition offers a rationale for targeting de novo resistance using BH3 mimetics.

    Directory of Open Access Journals (Sweden)

    Dennie T Frederick

    Full Text Available While response rates to BRAF inhibitiors (BRAFi are high, disease progression emerges quickly. One strategy to delay the onset of resistance is to target anti-apoptotic proteins such as BCL-2, known to be associated with a poor prognosis. We analyzed BCL-2 family member expression levels of 34 samples from 17 patients collected before and 10 to 14 days after treatment initiation with either vemurafenib or dabrafenib/trametinib combination. The observed changes in mRNA and protein levels with BRAFi treatment led us to hypothesize that combining BRAFi with a BCL-2 inhibitor (the BH3-mimetic navitoclax would improve outcome. We tested this hypothesis in cell lines and in mice. Pretreatment mRNA levels of BCL-2 negatively correlated with maximal tumor regression. Early increases in mRNA levels were seen in BIM, BCL-XL, BID and BCL2-W, as were decreases in MCL-1 and BCL2A. No significant changes were observed with BCL-2. Using reverse phase protein array (RPPA, significant increases in protein levels were found in BIM and BID. No changes in mRNA or protein correlated with response. Concurrent BRAF (PLX4720 and BCL2 (navitoclax inhibition synergistically reduced viability in BRAF mutant cell lines and correlated with down-modulation of MCL-1 and BIM induction after PLX4720 treatment. In xenograft models, navitoclax enhanced the efficacy of PLX4720. The combination of a selective BRAF inhibitor with a BH3-mimetic promises to be an important therapeutic strategy capable of enhancing the clinical efficacy of BRAF inhibition in many patients that might otherwise succumb quickly to de novo resistance. Trial registrations: ClinicalTrials.gov NCT01006980; ClinicalTrials.gov NCT01107418; ClinicalTrials.gov NCT01264380; ClinicalTrials.gov NCT01248936; ClinicalTrials.gov NCT00949702; ClinicalTrials.gov NCT01072175.

  10. Clinical validation of cutoff target ranges in newborn screening of metabolic disorders by tandem mass spectrometry : A worldwide collaborative project

    NARCIS (Netherlands)

    McHugh, David M. S.; Cameron, Cynthia A.; Abdenur, Jose E.; Abdulrahman, Mahera; Adair, Ona; Al Nuaimi, Shahira Ahmed; Ahlman, Henrik; Allen, Jennifer J.; Antonozzi, Italo; Archer, Shaina; Au, Sylvia; Auray-Blais, Christiane; Baker, Mei; Bamforth, Fiona; Beckmann, Kinga; Pino, Gessi Bentz; Berberich, Stanton L.; Binard, Robert; Boemer, Francois; Bonham, Jim; Breen, Nancy N.; Bryant, Sandra C.; Caggana, Michele; Caldwell, S. Graham; Camilot, Marta; Campbell, Carlene; Carducci, Claudia; Cariappa, Rohit; Carlisle, Clover; Caruso, Ubaldo; Cassanello, Michela; Miren Castilla, Ane; Castineiras Ramos, Daisy E.; Chakraborty, Pranesh; Chandrasekar, Ram; Ramos, Alfredo Chardon; Cheillan, David; Chien, Yin-Hsiu; Childs, Thomas A.; Chrastina, Petr; Sica, Yuri Cleverthon; Cocho de Juan, Jose Angel; Elena Colandre, Maria; Cornejo Espinoza, Veronica; Corso, Gaetano; Currier, Robert; Cyr, Denis; Czuczy, Noemi; D'Apolito, Oceania; Davis, Tim; de Sain-Van der Velden, Monique G.; Delgado Pecellin, Carmen; Di Gangi, Iole Maria; Di Stefano, Cristina Maria; Dotsikas, Yannis; Downing, Melanie; Downs, Stephen M.; Dy, Bonifacio; Dymerski, Mark; Rueda, Inmaculada; Elvers, Bert; Eaton, Roger; Eckerd, Barbara M.; El Mougy, Fatma; Eroh, Sarah; Espada, Mercedes; Evans, Catherine; Fawbush, Sandy; Fijolek, Kristel F.; Fisher, Lawrence; Franzson, Leifur; Frazier, Dianne M.; Garcia, Luciana R. C.; Garcia-Valdecasas Bermejo, Maria Sierra; Gavrilov, Dimitar; Gerace, Rosemarie; Giordano, Giuseppe; Irazabal, Yolanda Gonzalez; Greed, Lawrence C.; Grier, Robert; Grycki, Elyse; Gu, Xuefan; Gulamali-Majid, Fizza; Hagar, Arthur F.; Han, Lianshu; Hannon, W. Harry; Haslip, Christa; Hassan, Fayza Abdelhamid; He, Miao; Hietala, Amy; Himstedt, Leslie; Hoffman, Gary L.; Hoffman, William; Hoggatt, Philis; Hopkins, Patrick V.; Hougaard, David M.; Hughes, Kerie; Hunt, Patricia R.; Hwu, Wuh-Liang; Hynes, June; Ibarra-Gonzalez, Isabel; Ingham, Cindy A.; Ivanova, Maria; Jacox, Ward B.; John, Catharine; Johnson, John P.; Jonsson, Jon J.; Karg, Eszter; Kasper, David; Klopper, Brenda; Katakouzinos, Dimitris; Khneisser, Issam; Knoll, Detlef; Kobayashi, Hirinori; Koneski, Ronald; Kozich, Viktor; Kouapei, Rasoul; Kohlmueller, Dirk; Kremensky, Ivo; la Marca, Giancarlo; Lavochkin, Marcia; Lee, Soo-Youn; Lehotay, Denis C.; Lemes, Aida; Lepage, Joyce; Lesko, Barbara; Lewis, Barry; Lim, Carol; Linard, Sharon; Lindner, Martin; Lloyd-Puryear, Michele A.; Lorey, Fred; Loukas, Yannis L.; Luedtke, Julie; Maffitt, Neil; Magee, J. Fergall; Manning, Adrienne; Manos, Shawn; Marie, Sandrine; Hadachi, Sonia Marchezi; Marquardt, Gregg; Martin, Stephen J.; Matern, Dietrich; Gibson, Stephanie K. Mayfield; Mayne, Philip; McCallister, Tonya D.; McCann, Mark; McClure, Julie; McGill, James J.; McKeever, Christine D.; McNeilly, Barbara; Morrissey, Mark A.; Moutsatsou, Paraskevi; Mulcahy, Eleanor A.; Nikoloudis, Dimitris; Norgaard-Pedersen, Bent; Oglesbee, Devin; Oltarzewski, Mariusz; Ombrone, Daniela; Ojodu, Jelili; Papakonstantinou, Vagelis; Reoyo, Sherly Pardo; Park, Hyung-Doo; Pasquali, Marzia; Pasquini, Elisabetta; Patel, Pallavi; Pass, Kenneth A.; Peterson, Colleen; Pettersen, Rolf D.; Pitt, James J.; Poh, Sherry; Pollak, Arnold; Porter, Cory; Poston, Philip A.; Price, Ricky W.; Queijo, Cecilia; Quesada, Jonessy; Randell, Edward; Ranieri, Enzo; Raymond, Kimiyo; Reddic, John E.; Reuben, Alejandra; Ricciardi, Charla; Rinaldo, Piero; Rivera, Jeff D.; Roberts, Alicia; Rocha, Hugo; Roche, Geraldine; Greenberg, Cheryl Rochman; Egea Mellado, Jose Maria; Jess Juan-Fita, Maria; Ruiz, Consuelo; Ruoppolo, Margherita; Rutledge, S. Lane; Ryu, Euijung; Saban, Christine; Sahai, Inderneel; Salazar Garcia-Blanco, Maria Isabel; Santiago-Borrero, Pedro; Schenone, Andrea; Schoos, Roland; Schweitzer, Barb; Scott, Patricia; Seashore, Margretta R.; Seeterlin, Mary A.; Sesser, David E.; Sevier, Darrin W.; Shone, Scott M.; Sinclair, Graham; Skrinska, Victor A.; Stanley, Eleanor L.; Strovel, Erin T.; Jones, April L. Studinski; Sunny, Sherlykutty; Takats, Zoltan; Tanyalcin, Tijen; Teofoli, Francesca; Thompson, J. Robert; Tomashitis, Kathy; Domingos, Mouseline Torquado; Torres, Jasmin; Torres, Rosario; Tortorelli, Silvia; Turi, Sandor; Turner, Kimberley; Tzanakos, Nick; Valiente, Alf G.; Vallance, Hillary; Vela-Amieva, Marcela; Vilarinho, Laura; von Doebeln, Ulrika; Vincent, Marie-Francoise; Vorster, B. Chris; Watson, Michael S.; Webster, Dianne; Weiss, Sheila; Wilcken, Bridget; Wiley, Veronica; Williams, Sharon K.; Willis, Sharon A.; Woontner, Michael; Wright, Katherine; Yahyaoui, Raquel; Yamaguchi, Seiji; Yssel, Melissa; Zakowicz, Wendy M.

    2011-01-01

    Purpose: To achieve clinical validation of cutoff values for newborn screening by tandem mass spectrometry through a worldwide collaborative effort. Methods: Cumulative percentiles of amino acids and acylcarnitines in dried blood spots of approximately 25-30 million normal newborns and 10,742 deiden

  11. Optimal targeting of HER2-PI3K signaling in breast cancer: mechanistic insights and clinical implications.

    Science.gov (United States)

    Rexer, Brent N; Arteaga, Carlos L

    2013-07-01

    The combination of a PI3K inhibitor with trastuzumab has been shown to be effective at overcoming trastuzumab resistance in models of HER2(+) breast cancer by inhibiting HER2-PI3K-FOXO-survivin signaling. In this review the potential clinical implications of these findings are discussed.

  12. Survey and rapid detection of Klebsiella pneumoniae in clinical samples targeting the rcsA gene in Beijing, China

    Directory of Open Access Journals (Sweden)

    Derong eDong

    2015-05-01

    Full Text Available Klebsiella pneumoniae is a wide-spread nosocomial pathogen. A rapid and sensitive molecular method for the detection of K. pneumoniae in clinical samples is needed to guide therapeutic treatment. In this study, we first described a loop-mediated isothermal amplification (LAMP method for the rapid detection of capsular polysaccharide synthesis regulating gene rcsA from K. pneumoniae in clinical samples by using two methods including real-time turbidity monitoring and fluorescence detection to assess the reaction. Then dissemination of K. pneumoniae strains was investigated from ICU patients in three top hospitals in Beijing, China. The results showed that the detection limit of the LAMP method was 0.115 pg/µl DNA within 60 min under isothermal conditions (61°C, a 100-fold increase in sensitivity compared with conventional PCR. All 30 non- K. pneumoniae strains tested were negative for LAMP detection, indicating the high specificity of the LAMP reaction. To evaluate the application of the LAMP assay to clinical diagnosis, of 110 clinical sputum samples collected from ICU patients with clinically suspected multi-resistant infections in China, a total of 32 K. pneumoniae isolates were identified for LAMP-based surveillance of rcsA. All isolates belonged to nine different K. pneumoniae multilocus sequence typing (MLST groups. Strikingly, of the 32 K. pneumoniae strains, 18 contained the Klebsiella pneumoniae Carbapenemase (KPC-encoding gene blaKPC-2 and had high resistance to β-lactam antibiotics. Moreover, K. pneumoniae WJ-64 was discovered to contain blaKPC-2 and blaNDM-1 genes simultaneously in the isolate. Our data showed the high prevalence of blaKPC-2 among K. pneumoniae and co-occurrence of many resistant genes in the clinical strains signal a rapid and continuing evolution of K. pneumoniae. In conclusion, we have developed a rapid and sensitive visual K. pneumoniae detection LAMP assay, which could be a useful tool for clinical screening

  13. Embedded Measures of Performance Validity in the Rey Complex Figure Test in a Clinical Sample of Veterans.

    Science.gov (United States)

    Sugarman, Michael A; Holcomb, Erin M; Axelrod, Bradley N; Meyers, John E; Liethen, Philip C

    2016-01-01

    The purpose of this study was to determine how well scores from the Rey Complex Figure Test (RCFT) could serve as embedded measures of performance validity in a large, heterogeneous clinical sample at an urban-based Veterans' Affairs hospital. Participants were divided into credible performance (n = 244) and noncredible performance (n = 87) groups based on common performance validity tests during their respective clinical evaluations. We evaluated how well preselected RCFT scores could discriminate between the 2 groups using cut scores from single indexes as well as multivariate logistic regression prediction models. Additionally, we evaluated how well memory error patterns (MEPs) could discriminate between the 2 groups. Optimal discrimination occurred when indexes from the Copy and Recognition trials were simultaneous predictors in logistic regression models, with 91% specificity and at least 53% sensitivity. Logistic regression yielded superior discrimination compared with individual indexes and compared with the use of MEPs. Specific scores on the RCFT, including the Copy and Recognition trials, can serve as adequate indexes of performance validity, when using both cut scores and logistic regression prediction models. We provide logistic regression equations that can be applied in similar clinical settings to assist in determining performance validity.

  14. Clinical Evaluation of ErbB-Targeted CAR T-Cells, Following Intracavity Delivery in Patients with ErbB-Expressing Solid Tumors.

    Science.gov (United States)

    Papa, Sophie; van Schalkwyk, May; Maher, John

    2015-01-01

    Adoptive cell therapy using gene-modified T-cells has achieved impressive results in the treatment of B-cell malignancies. However, the development of similar strategies to treat solid tumors raises challenges with respect to tumor antigen selection and the achievement of efficient T-cell homing, survival and sustained effector function within the tumor microenvironment. To address these challenges, we have developed a gene-modified cellular therapy called T4 immunotherapy. To generate T4 immunotherapy, autologous T-cells are engineered by retroviral transduction to co-express two transgenes: (1) a chimeric antigen receptor (CAR), T1E28z, targeted against a range of ErbB homodimers and heterodimers and (2) a chimeric cytokine receptor, 4αβ, that allows the selective ex vivo expansion of engineered cells using interleukin-4. Targeting of the extended ErbB network using CAR T-cells is supported by prevalence of ErbB dysregulation in diverse solid tumors and the clinical impact of monoclonal antibody therapy directed against members of this family. However, the key obstacle to effective clinical translation is risk of on-target toxicity owing to the lower level expression of ErbB family members in many healthy tissues. To de-risk T4 immunotherapy in man, we are undertaking a trial in patients with locally advanced or recurrent head and neck squamous cell carcinoma. In that setting, engineered T-cells are injected directly into the tumor without prior lymphodepletion, an approach that we believe will minimize risk of toxicity. This chapter outlines how we plan to advance the development of T4 immunotherapy thereafter in Phase II clinical testing. In that setting, regional (intracavitary) approaches will be used to administer this therapy to patients with epithelial ovarian cancer and malignant pleural mesothelioma.

  15. Do Expert Clinical Teachers Have a Shared Understanding of What Constitutes a Competent Reasoning Performance in Case-Based Teaching?

    Science.gov (United States)

    Gauthier, Geneviève; Lajoie, Susanne P.

    2014-01-01

    To explore the assessment challenge related to case based learning we study how experienced clinical teachers--i.e., those who regularly teach and assess case-based learning--conceptualize the notion of competent reasoning performance for specific teaching cases. Through an in-depth qualitative case study of five expert teachers, we investigate…

  16. Clinical performance of two visual scoring systems in detecting and assessing activity status of occlusal caries in primary teeth

    DEFF Research Database (Denmark)

    Braga, M M; Ekstrand, K R; Martignon, S

    2010-01-01

    This study aimed to compare the clinical performance of two sets of visual scoring criteria for detecting caries severity and assessing caries activity status in occlusal surfaces. Two visual scoring systems--the Nyvad criteria (NY) and the ICDAS-II including an adjunct system for lesion activity...

  17. Differential Gene Expression Profiles in Coronary Heart Disease Patients of Blood Stasis Syndrome in Traditional Chinese Medicine and Clinical Role of Target Gene

    Institute of Scientific and Technical Information of China (English)

    马晓娟; 殷惠军; 陈可冀

    2009-01-01

    Objective:To investigate the differential gene expression profiles in coronary heart disease(CHD) patients of blood-stasis syndrome(BSS) by oligonucleotide microarray technique,and the clinical significance of target gene.Methods:Subjects were assigned to CHD patients with BSS(n=8),CHD patients without BSS (n=8),and BSS patients without CHD(n=8) based on coronary angiography and the diagnostic criteria of BSS. The sex- and age-matched healthy volunteers(n=8) were enrolled as the control group.Venous bloo...

  18. Clinical and Pathological Complete Remission in a Patient With Metastatic Renal Cell Carcinoma (mRCC Treated With Sunitinib: Is mRCC Curable With Targeted Therapy?

    Directory of Open Access Journals (Sweden)

    Amishi Y. Shah

    2015-03-01

    Full Text Available We report a patient with metastatic clear-cell renal cell carcinoma (mRCC who presented with primary tumor in situ in the left kidney and metastases to bone, liver, lungs, and brain. After over 5 years of sunitinib therapy and subsequent cytoreductive left nephrectomy, the patient achieved radiographic complete response (CR and had pathologic CR in the nephrectomy specimen. Durable clinical and pathological CRs are possible with targeted agents, even with primary tumor in situ and widely disseminated metastases. Ongoing research will define the optimal duration of systemic therapy in exceptional responders and identify the molecular determinants of response and resistance.

  19. In silico target predictions: defining a benchmarking data set and comparison of performance of the multiclass Naïve Bayes and Parzen-Rosenblatt window.

    Science.gov (United States)

    Koutsoukas, Alexios; Lowe, Robert; Kalantarmotamedi, Yasaman; Mussa, Hamse Y; Klaffke, Werner; Mitchell, John B O; Glen, Robert C; Bender, Andreas

    2013-08-26

    In this study, two probabilistic machine-learning algorithms were compared for in silico target prediction of bioactive molecules, namely the well-established Laplacian-modified Naïve Bayes classifier (NB) and the more recently introduced (to Cheminformatics) Parzen-Rosenblatt Window. Both classifiers were trained in conjunction with circular fingerprints on a large data set of bioactive compounds extracted from ChEMBL, covering 894 human protein targets with more than 155,000 ligand-protein pairs. This data set is also provided as a benchmark data set for future target prediction methods due to its size as well as the number of bioactivity classes it contains. In addition to evaluating the methods, different performance measures were explored. This is not as straightforward as in binary classification settings, due to the number of classes, the possibility of multiple class memberships, and the need to translate model scores into "yes/no" predictions for assessing model performance. Both algorithms achieved a recall of correct targets that exceeds 80% in the top 1% of predictions. Performance depends significantly on the underlying diversity and size of a given class of bioactive compounds, with small classes and low structural similarity affecting both algorithms to different degrees. When tested on an external test set extracted from WOMBAT covering more than 500 targets by excluding all compounds with Tanimoto similarity above 0.8 to compounds from the ChEMBL data set, the current methodologies achieved a recall of 63.3% and 66.6% among the top 1% for Naïve Bayes and Parzen-Rosenblatt Window, respectively. While those numbers seem to indicate lower performance, they are also more realistic for settings where protein targets need to be established for novel chemical substances.