WorldWideScience

Sample records for clinical variables response

  1. A Virtual Clinical Trial of FDG-PET Imaging of Breast Cancer: Effect of Variability on Response Assessment1

    OpenAIRE

    Harrison, Robert L; Elston, Brian F; Doot, Robert K; Lewellen, Thomas K; Mankoff, David A; Kinahan, Paul E

    2014-01-01

    INTRODUCTION: There is growing interest in using positron emission tomography (PET) standardized uptake values (SUVs) to assess tumor response to therapy. However, many error sources compromise the ability to detect SUV changes. We explore relationships between these errors and overall SUV variability. METHODS: We used simulations in a virtual clinical trial framework to study impacts of error sources from scanning and analysis effects on assessment of SUV changes. We varied tumor diameter, s...

  2. Cerebral venous thrombosis in Saudi Arabia. Clinical variables, response to treatment, and outcome

    International Nuclear Information System (INIS)

    Kajtazi, Naim I; Arulneyam, Jayanthi C; AlSenani, Fahmi M; Zimmerman, Valerie A; AlShami, Sadiq Y

    2009-01-01

    To investigate cerebral venous thrombosis (CVTR) clinical presentations, risk factors, and response to treatment in Saudi Arabia. Retrospective analysis of the King Farad Medical City, Riyadh, acute stroke database from April 2005 through February 2008 revealed 22 patients with CVTR. Hyper coagulable work-up and neuroimaging were performed. Sixteen patients were female (72.7%), and the median age was 35 years. Clinical presentations included: headache (77.3%), seizures (54.5%), focal neurological signs (54.5%), and decreased level of consciousness (50%). Over two-thirds (n=11; 69%) of female patients had a history of oral contraceptive use, which was the most common risk factor. Protein S deficiency (n=3), anti phospholipid antibody syndrome secondary to systemic lupus erythematosus (SLE) (n=1), rhinocerebral mucormycosis (n=1), leukemia (n=1), non-Hodgkin's lymphoma (n=1), sepsis (n=1), and unknown (n=6) were causes. Affected areas included superior sagittal (n=13), transverse (n=16), sigmoid (n=14), straight (n=6), and cavernous sinus (n=1); internal cerebral vein (n=2); vein of Galen (n=3); cortical veins (n=10); and internal jugular vein (n=12). Two patients had quadriparesis, and 2 patients died. The remainder (n=18, 81.8%) improved. Bilateral hemorrhagic presentation or venous infarction, deep venous system thrombosis, and underlying malignancy had less favorable results. Presentations in our series were similar to those in other reports, although altered consciousness and seizures were more common. Cortical vein involvement was also higher than commonly reported. Oral contraceptive use was a primary risk factor in female patients. Outcomes were favorable in 81.8% of patients. (author)

  3. [Final clinical indications and etiology in 1,023 enucleations. Descriptive databank evaluation with SPSS software in variable response mode with dummy variables].

    Science.gov (United States)

    Becker, H; Bialasiewicz, A A; Schaudig, U; Schäfer, H; von Domarus, D

    2002-05-01

    A new data bank developed for ophthalmopathology using a computer-generated, multidigital data code is expected to be able to accomplish complex clinicopathologic correlations of diagnoses and signs, as provided by (multiple) clinical events and histopathologically proven etiologies, and to facilitate the documentation of new data. In the ophthalmopathology laboratory 2890 eyes were examined between January 20, 1975 and December 12, 1996. The main diagnoses and patient data from this 22-year period were recorded. To facilitate the presentation of data, a 10-year period with eyes of 976 patients enucleated from December, 1986 to December, 1996 was chosen. Principal and secondary diagnoses served for establishing the data bank. The frequencies of successive histologic and clinical diagnoses were evaluated by a descriptive computing program using an SPSS-multi-response mode with dummy variables and a categorical variable listing of the software (SPSS version 10.0) classified as (a) non-filtered random, (b) filtered by multiple etiologies, and (c) filtered by multiple events. The principal groups (e.g., histologic diagnoses concerning etiology) and subgroups (e.g., trauma, neoplasia, surgery, systemic diseases, and inflammations) were defined and correlated with 798 separate diagnoses. From 11 diagnoses/events ascribed to the clinical cases, 11,198 namings resulted. Thus, a comparative study of complex etiologies and events leading to enucleation in different hospitals of a specific area may be performed using this electronic ophthalmopathologic data bank system. The complexity of rare disease and integration into a superimposed structure can be managed with this custom-made data bank. A chronologically and demographically oriented consideration of reasons for enucleation is thus feasible.

  4. The role of clinical variables, neuropsychological performance and SLC6A4 and COMT gene polymorphisms on the prediction of early response to fluoxetine in major depressive disorder.

    Science.gov (United States)

    Gudayol-Ferré, Esteve; Herrera-Guzmán, Ixchel; Camarena, Beatriz; Cortés-Penagos, Carlos; Herrera-Abarca, Jorge E; Martínez-Medina, Patricia; Cruz, David; Hernández, Sandra; Genis, Alma; Carrillo-Guerrero, Mariana Y; Avilés Reyes, Rubén; Guàrdia-Olmos, Joan

    2010-12-01

    Major depressive disorder (MDD) is treated with antidepressants, but only between 50% and 70% of the patients respond to the initial treatment. Several authors suggested different factors that could predict antidepressant response, including clinical, psychophysiological, neuropsychological, neuroimaging, and genetic variables. However, these different predictors present poor prognostic sensitivity and specificity by themselves. The aim of our work is to study the possible role of clinical variables, neuropsychological performance, and the 5HTTLPR, rs25531, and val108/58Met COMT polymorphisms in the prediction of the response to fluoxetine after 4weeks of treatment in a sample of patient with MDD. 64 patients with MDD were genotyped according to the above-mentioned polymorphisms, and were clinically and neuropsychologically assessed before a 4-week fluoxetine treatment. Fluoxetine response was assessed by using the Hamilton Depression Rating Scale. We carried out a binary logistic regression model for the potential predictive variables. Out of the clinical variables studied, only the number of anxiety disorders comorbid with MDD have predicted a poor response to the treatment. A combination of a good performance in variables of attention and low performance in planning could predict a good response to fluoxetine in patients with MDD. None of the genetic variables studied had predictive value in our model. The possible placebo effect has not been controlled. Our study is focused on response prediction but not in remission prediction. Our work suggests that the combination of the number of comorbid anxiety disorders, an attentional variable, and two planning variables makes it possible to correctly classify 82% of the depressed patients who responded to the treatment with fluoxetine, and 74% of the patients who did not respond to that treatment. Copyright © 2010 Elsevier B.V. All rights reserved.

  5. A multi-dataset time-reversal approach to clinical trial placebo response and the relationship to natural variability in epilepsy.

    Science.gov (United States)

    Goldenholz, Daniel M; Strashny, Alex; Cook, Mark; Moss, Robert; Theodore, William H

    2017-12-01

    Clinical epilepsy drug trials have been measuring increasingly high placebo response rates, up to 40%. This study was designed to examine the relationship between the natural variability in epilepsy, and the placebo response seen in trials. We tested the hypothesis that 'reversing' trial direction, with the baseline period as the treatment observation phase, would reveal effects of natural variability. Clinical trial simulations were run with time running forward and in reverse. Data sources were: SeizureTracker.com (patient reported diaries), a randomized sham-controlled TMS trial, and chronically implanted intracranial EEG electrodes. Outcomes were 50%-responder rates (RR50) and median percentage change (MPC). The RR50 results showed evidence that temporal reversal does not prevent large responder rates across datasets. The MPC results negative in the TMS dataset, and positive in the other two. Typical RR50s of clinical trials can be reproduced using the natural variability of epilepsy as a substrate across multiple datasets. Therefore, the placebo response in epilepsy clinical trials may be attributable almost entirely to this variability, rather than the "placebo effect". Published by Elsevier Ltd.

  6. Improvement in latent variable indirect response modeling of multiple categorical clinical endpoints: application to modeling of guselkumab treatment effects in psoriatic patients.

    Science.gov (United States)

    Hu, Chuanpu; Randazzo, Bruce; Sharma, Amarnath; Zhou, Honghui

    2017-10-01

    Exposure-response modeling plays an important role in optimizing dose and dosing regimens during clinical drug development. The modeling of multiple endpoints is made possible in part by recent progress in latent variable indirect response (IDR) modeling for ordered categorical endpoints. This manuscript aims to investigate the level of improvement achievable by jointly modeling two such endpoints in the latent variable IDR modeling framework through the sharing of model parameters. This is illustrated with an application to the exposure-response of guselkumab, a human IgG1 monoclonal antibody in clinical development that blocks IL-23. A Phase 2b study was conducted in 238 patients with psoriasis for which disease severity was assessed using Psoriasis Area and Severity Index (PASI) and Physician's Global Assessment (PGA) scores. A latent variable Type I IDR model was developed to evaluate the therapeutic effect of guselkumab dosing on 75, 90 and 100% improvement of PASI scores from baseline and PGA scores, with placebo effect empirically modeled. The results showed that the joint model is able to describe the observed data better with fewer parameters compared with the common approach of separately modeling the endpoints.

  7. Clinical variables in radiotracer biodistributions

    International Nuclear Information System (INIS)

    Lentle, B.C.; Scott, J.R.; Schmidt, R.P.; Noujaim, A.A.

    1981-01-01

    Radionuclide dosimetry must, by its nature, define tissue irradiation in terms of mean exposure in a population of a statistically acceptable size. In the daily practice of clinical nuclear medicine there are, however, quite large variations in the biodistribution of tracers and thus in resulting radiation doses. Age is a variable, particularly in respect of bone-seeking tracers. Sex imposes variations in radiation dose on account of the differing anatomical configurations of the gonads. Breast uptake and excretion of certain tracers in women are additional variables. Activity and occupation are occasional variables. Numerous iatrogenic causes of altered radiotracer biodistributions have been described. Cancer chemotherapy is a particularly potent cause of changed biodistributions while even a trivial matter such as preparing the skin with an iodine containing antiseptic may cause displacement of technetium from its compounds. In the blocking of thyroid uptake of radioiodines, there is good precedent for the manipulation of regional tissue dosimetry. It is possible to go beyond the mere cataloguing of these effects to look creatively at the subject of comparative tissue biodistributions and hence comparative dosimetry. Effects such as the clinical observation of the interference by cis-platinum with the usual biodistribution of radio-gallium suggest that such compounds can be used as probes each to lead to a better understanding of the mechanism of action of the other

  8. Variability of plasma homovanillic acid over 13 months in patients with schizophrenia; relationship with the clinical response and the Wisconsin card sort test.

    Science.gov (United States)

    Zumárraga, Mercedes; González-Torres, Miguel A; Arrue, Aurora; Dávila, Ricardo; Dávila, Wendy; Inchausti, Lucía; Pérez-Cabeza, Lucía; Fernández-Rivas, Aránzazu; Bustamante, Sonia; Basterreche, Nieves; Guimón, José

    2011-08-01

    In the present study we have measured, on a monthly basis, the concentration of plasma homovanillic acid (pHVA) in schizophrenic patients during 13 months of their pharmacological treatment. The average pHVA values of each patient were within the range of 7.30-17.70 ng/ml and the coefficients of variation for each patient (CV %) were within the range of 13-33%. Half of the patients that showed higher pHVA CV% values also showed higher scores on the Brief Psychiatric Rating Scale at the beginning of the study, and improved more after 6 months, when compared to the remaining 50% with lower CV% values. There was no significant relationship between the scores of the Wisconsin Card Sort Test and the concentration or the CV% of the pHVA of each patient. A greater variability in the pHVA may be associated with a greater plasticity of the dopaminergic system and a better clinical response.

  9. Bedform response to flow variability

    Science.gov (United States)

    Nelson, J.M.; Logan, B.L.; Kinzel, P.J.; Shimizu, Y.; Giri, S.; Shreve, R.L.; McLean, S.R.

    2011-01-01

    Laboratory observations and computational results for the response of bedform fields to rapid variations in discharge are compared and discussed. The simple case considered here begins with a relatively low discharge over a flat bed on which bedforms are initiated, followed by a short high-flow period with double the original discharge, during which the morphology of the bedforms adjusts, followed in turn by a relatively long period of the original low discharge. For the grain size and hydraulic conditions selected, the Froude number remains subcritical during the experiment, and sediment moves predominantly as bedload. Observations show rapid development of quasi-two-dimensional bedforms during the initial period of low flow with increasing wavelength and height over the initial low-flow period. When the flow increases, the bedforms rapidly increase in wavelength and height, as expected from other empirical results. When the flow decreases back to the original discharge, the height of the bedforms quickly decreases in response, but the wavelength decreases much more slowly. Computational results using an unsteady two-dimensional flow model coupled to a disequilibrium bedload transport model for the same conditions simulate the formation and initial growth of the bedforms fairly accurately and also predict an increase in dimensions during the high-flow period. However, the computational model predicts a much slower rate of wavelength increase, and also performs less accurately during the final low-flow period, where the wavelength remains essentially constant, rather than decreasing. In addition, the numerical results show less variability in bedform wavelength and height than the measured values; the bedform shape is also somewhat different. Based on observations, these discrepancies may result from the simplified model for sediment particle step lengths used in the computational approach. Experiments show that the particle step length varies spatially and

  10. Clinical variables in radiotracer biodistributions

    International Nuclear Information System (INIS)

    Lentle, B.C.; Scott, J.R.; Schmidt, R.P.; Noujaim, A.A.

    1981-01-01

    Numerous iatrogenic causes of altered radiotracer biodistributions have been described. Cancer chemotherapy is a particularly potent cause of changed biodistributions while even a trivial matter such as preparing the skin with an iodine containing antiseptic may cause displacement of technetium from its compounds. In the blocking of thyroid uptake of radioiodines, there is good precedent for the manipulation of regional tissue dosimetry. It is possible to go beyond the mere cataloguing of these effects to look creatively at the subject of comparative tissue biodistributions and hence comparative dosimetry. Effects such as the clinical observation of the interference by cis-platinum with the usual biodistribution of radio-gallium suggests that such compounds can be used as probes each to lead to a better understanding of the mechanism of action of the other

  11. Variability in response to albuminuria-lowering drugs

    DEFF Research Database (Denmark)

    Petrykiv, Sergei I; de Zeeuw, Dick; Persson, Frederik

    2017-01-01

    AIMS: Albuminuria-lowering drugs have shown different effect size in different individuals. Since urine albumin levels are known to vary considerably from day-to-day, we questioned whether the between-individual variability in albuminuria response after therapy initiation reflects a random...... variability or a true response variation to treatment. In addition, we questioned whether the response variability is drug dependent. METHODS: To determine whether the response to treatment is random or a true drug response, we correlated in six clinical trials the change in albuminuria during placebo...... or active treatment (on-treatment) with the change in albuminuria during wash-out (off-treatment). If these responses correlate during active treatment, it suggests that at least part of the response variability can be attributed to drug response variability. We tested this for enalapril, losartan...

  12. What variables can influence clinical reasoning?

    Directory of Open Access Journals (Sweden)

    Vahid Ashoorion

    2012-01-01

    Full Text Available Background: Clinical reasoning is one of the most important competencies that a physician should achieve. Many medical schools and licensing bodies try to predict it based on some general measures such as critical thinking, personality, and emotional intelligence. This study aimed at providing a model to design the relationship between the constructs. Materials and Methods: Sixty-nine medical students participated in this study. A battery test devised that consist four parts: Clinical reasoning measures, personality NEO inventory, Bar-On EQ inventory, and California critical thinking questionnaire. All participants completed the tests. Correlation and multiple regression analysis consumed for data analysis. Results: There is low to moderate correlations between clinical reasoning and other variables. Emotional intelligence is the only variable that contributes clinical reasoning construct (r=0.17-0.34 (R 2 chnage = 0.46, P Value = 0.000. Conclusion: Although, clinical reasoning can be considered as a kind of thinking, no significant correlation detected between it and other constructs. Emotional intelligence (and its subscales is the only variable that can be used for clinical reasoning prediction.

  13. What variables can influence clinical reasoning?

    Science.gov (United States)

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

    2012-12-01

    Clinical reasoning is one of the most important competencies that a physician should achieve. Many medical schools and licensing bodies try to predict it based on some general measures such as critical thinking, personality, and emotional intelligence. This study aimed at providing a model to design the relationship between the constructs. Sixty-nine medical students participated in this study. A battery test devised that consist four parts: Clinical reasoning measures, personality NEO inventory, Bar-On EQ inventory, and California critical thinking questionnaire. All participants completed the tests. Correlation and multiple regression analysis consumed for data analysis. There is low to moderate correlations between clinical reasoning and other variables. Emotional intelligence is the only variable that contributes clinical reasoning construct (r=0.17-0.34) (R(2) chnage = 0.46, P Value = 0.000). Although, clinical reasoning can be considered as a kind of thinking, no significant correlation detected between it and other constructs. Emotional intelligence (and its subscales) is the only variable that can be used for clinical reasoning prediction.

  14. Clinical and acoustical variability in hypokinetic dysarthria

    International Nuclear Information System (INIS)

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

    1986-01-01

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

  15. Clinical variables, lifestyle and coping in hemodialysis.

    Science.gov (United States)

    Comelis Bertolin, Daniela

    2016-10-01

    To verify the relationship between coping strategies of people with chronic kidney disease undergoing hemodialysis and their clinical variables and lifestyle habits. It was developed a cross-sectional study that used the Coping Strategies Inventory of Folkman and Lazarus and a semi-structured questionnaire for collecting clinical variables and lifestyles of patients undergoing hemodialysis in the Urology and Nephrology Institute of São Jose do Rio Preto-SP (Brazil). Participants were 107 adults undergoing hemodialysis, with an average age of 51 years; 62.4% were men. The main causes of chronic kidney disease were chronic glomerulonephritis, diabetes mellitus, undetermined cause and hypertension. The most reported coping strategies were focused on emotion. There were greater coping scores among people who had diabetes, those who had leisure and those who referred religion. People who exercised and those who had undergone renal transplantation had more positive coping. Clinical variables of people undergoing hemodialysis can be sources of stress, and lifestyle habits are associated with coping strategies to mitigate the effects of stress. Copyright© by the Universidad de Antioquia.

  16. Centile estimation for a proportion response variable.

    Science.gov (United States)

    Hossain, Abu; Rigby, Robert; Stasinopoulos, Mikis; Enea, Marco

    2016-03-15

    This paper introduces two general models for computing centiles when the response variable Y can take values between 0 and 1, inclusive of 0 or 1. The models developed are more flexible alternatives to the beta inflated distribution. The first proposed model employs a flexible four parameter logit skew Student t (logitSST) distribution to model the response variable Y on the unit interval (0, 1), excluding 0 and 1. This model is then extended to the inflated logitSST distribution for Y on the unit interval, including 1. The second model developed in this paper is a generalised Tobit model for Y on the unit interval, including 1. Applying these two models to (1-Y) rather than Y enables modelling of Y on the unit interval including 0 rather than 1. An application of the new models to real data shows that they can provide superior fits. Copyright © 2015 John Wiley & Sons, Ltd.

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

    Science.gov (United States)

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

    2016-07-01

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

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

    Directory of Open Access Journals (Sweden)

    Maite Garaigordobil

    2017-05-01

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

  19. Response Variability in Commercial MOSFET SEE Qualification

    International Nuclear Information System (INIS)

    George, J. S.; Clymer, D. A.; Turflinger, T. L.; Mason, L. W.; Stone, S.

    2016-01-01

    Single-event effects (SEE) evaluation of five different part types of next generation, commercial trench MOSFETs indicates large part-to-part variation in determining a safe operating area (SOA) for drain-source voltage (V_D_S) following a test campaign that exposed >50 samples per part type to heavy ions. These results suggest a determination of a SOA using small sample sizes may fail to capture the full extent of the part-to-part variability. An example method is discussed for establishing a Safe Operating Area using a one-sided statistical tolerance limit based on the number of test samples. Finally, burn-in is shown to be a critical factor in reducing part-to-part variation in part response. Implications for radiation qualification requirements are also explored.

  20. Acoustic response variability in automotive vehicles

    Science.gov (United States)

    Hills, E.; Mace, B. R.; Ferguson, N. S.

    2009-03-01

    A statistical analysis of a series of measurements of the audio-frequency response of a large set of automotive vehicles is presented: a small hatchback model with both a three-door (411 vehicles) and five-door (403 vehicles) derivative and a mid-sized family five-door car (316 vehicles). The sets included vehicles of various specifications, engines, gearboxes, interior trim, wheels and tyres. The tests were performed in a hemianechoic chamber with the temperature and humidity recorded. Two tests were performed on each vehicle and the interior cabin noise measured. In the first, the excitation was acoustically induced by sets of external loudspeakers. In the second test, predominantly structure-borne noise was induced by running the vehicle at a steady speed on a rough roller. For both types of excitation, it is seen that the effects of temperature are small, indicating that manufacturing variability is larger than that due to temperature for the tests conducted. It is also observed that there are no significant outlying vehicles, i.e. there are at most only a few vehicles that consistently have the lowest or highest noise levels over the whole spectrum. For the acoustically excited tests, measured 1/3-octave noise reduction levels typically have a spread of 5 dB or so and the normalised standard deviation of the linear data is typically 0.1 or higher. Regarding the statistical distribution of the linear data, a lognormal distribution is a somewhat better fit than a Gaussian distribution for lower 1/3-octave bands, while the reverse is true at higher frequencies. For the distribution of the overall linear levels, a Gaussian distribution is generally the most representative. As a simple description of the response variability, it is sufficient for this series of measurements to assume that the acoustically induced airborne cabin noise is best described by a Gaussian distribution with a normalised standard deviation between 0.09 and 0.145. There is generally

  1. The interrelationship between clinical and immunity variables in epilepsy

    Directory of Open Access Journals (Sweden)

    Kalinin Vladimir V.

    2016-12-01

    Full Text Available Introduction. The role of cellular immunity in the pathogenesis of epilepsy, as an interaction between immunity and clinical and neurobiological variables is not properly understood.

  2. Clinical characteristics and premorbid variables in childhoodonset ...

    African Journals Online (AJOL)

    Objective: To analyze clinical and demographic data of childhood-onset (12 years and younger) schizophrenia patients collected for a genetic study in schizophrenia, undertaken nationally in South Africa, using multiple parameters. Method: Patients with an onset of schizophrenia at 12 years or younger, were included.

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

    DEFF Research Database (Denmark)

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

    2016-01-01

    . CONCLUSION: These findings are consistent with variable involvement of different brain regions during a migraine attack. The variable occurrence of nausea, and phonophobia in conjunction with photophobia, both defining features of migraine, may be an important consideration in designing clinical studies......BACKGROUND: There is significant variability in the clinical presentation of migraine, both among patients, and between attacks in an individual patient. We examined clinical features of migraine with aura in a large group of patients enrolled in a clinical trial, and compared retrospective...... a detailed retrospective description of the clinical features of their attacks of migraine. During the trial, clinical symptoms in migraine attacks starting with aura were recorded prospectively in 861 attacks. RESULTS: Retrospectively reported visual aura symptoms were variable and often overlapping...

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

    OpenAIRE

    Garaigordobil, Maite; Bernar?s, Elena; Jaureguizar, Joana; Machimbarrena, Juan M.

    2017-01-01

    The study had two goals: (1) to explore the relations between self-assessed childhood depression and other adaptive and clinical variables (2) to identify predictor variables of childhood depression. Participants were 420 students aged 7–10 years old (53.3% boys, 46.7% girls). Results revealed: (1) positive correlations between depression and clinical maladjustment, school maladjustment, emotional symptoms, internalizing and externalizing problems, problem behaviors, emotional reactivity, and...

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

    Directory of Open Access Journals (Sweden)

    Hye Seung Jung

    2015-06-01

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

  6. Error response test system and method using test mask variable

    Science.gov (United States)

    Gender, Thomas K. (Inventor)

    2006-01-01

    An error response test system and method with increased functionality and improved performance is provided. The error response test system provides the ability to inject errors into the application under test to test the error response of the application under test in an automated and efficient manner. The error response system injects errors into the application through a test mask variable. The test mask variable is added to the application under test. During normal operation, the test mask variable is set to allow the application under test to operate normally. During testing, the error response test system can change the test mask variable to introduce an error into the application under test. The error response system can then monitor the application under test to determine whether the application has the correct response to the error.

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

    Science.gov (United States)

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

    2011-10-10

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

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

    Science.gov (United States)

    2011-01-01

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

  9. Dose-response relationship in clinical oncology

    International Nuclear Information System (INIS)

    Gehan, E.A.

    1984-01-01

    The relationship of dose (and dose rate) to response and toxicity in clinical oncology is reviewed. The concepts expressed by some authors in dose-response studies in animal and human systems are reviewed briefly. Dose rate and tactics of conducting clinical studies are reviewed for both radiotherapy and various types of chemotherapeutic treatment. Examples are given from clinical studies in Hodgkin's disease, acute leukemia, and breast cancer that may prove useful in planning future clinical studies

  10. Clinical polymorphism and variability in education of autistic children

    Directory of Open Access Journals (Sweden)

    Morozov S.A.Morozova T.I.

    2016-12-01

    Full Text Available Children with autism spectrum disorders are considered a highly heterogeneous group by clinical signs, which makes it impossible to develop a common method of correctional and educational development for them. In this article, results of an analysis of clinical, psychological and pedagogic polymorphism in autism spectrum disorders are shown, emphasized are its main components and basic consequences necessary for organizing education. Results are viewed in the context of the principle of variability in education. A dual structure of variability in education of autistic children has been discovered. Shortly reviewed are some topical problems of correctional education process for autism spectrum disorders

  11. Building prognostic models for breast cancer patients using clinical variables and hundreds of gene expression signatures

    Directory of Open Access Journals (Sweden)

    Liu Yufeng

    2011-01-01

    Full Text Available Abstract Background Multiple breast cancer gene expression profiles have been developed that appear to provide similar abilities to predict outcome and may outperform clinical-pathologic criteria; however, the extent to which seemingly disparate profiles provide additive prognostic information is not known, nor do we know whether prognostic profiles perform equally across clinically defined breast cancer subtypes. We evaluated whether combining the prognostic powers of standard breast cancer clinical variables with a large set of gene expression signatures could improve on our ability to predict patient outcomes. Methods Using clinical-pathological variables and a collection of 323 gene expression "modules", including 115 previously published signatures, we build multivariate Cox proportional hazards models using a dataset of 550 node-negative systemically untreated breast cancer patients. Models predictive of pathological complete response (pCR to neoadjuvant chemotherapy were also built using this approach. Results We identified statistically significant prognostic models for relapse-free survival (RFS at 7 years for the entire population, and for the subgroups of patients with ER-positive, or Luminal tumors. Furthermore, we found that combined models that included both clinical and genomic parameters improved prognostication compared with models with either clinical or genomic variables alone. Finally, we were able to build statistically significant combined models for pathological complete response (pCR predictions for the entire population. Conclusions Integration of gene expression signatures and clinical-pathological factors is an improved method over either variable type alone. Highly prognostic models could be created when using all patients, and for the subset of patients with lymph node-negative and ER-positive breast cancers. Other variables beyond gene expression and clinical-pathological variables, like gene mutation status or DNA

  12. Multi-Wheat-Model Ensemble Responses to Interannual Climate Variability

    Science.gov (United States)

    Ruane, Alex C.; Hudson, Nicholas I.; Asseng, Senthold; Camarrano, Davide; Ewert, Frank; Martre, Pierre; Boote, Kenneth J.; Thorburn, Peter J.; Aggarwal, Pramod K.; Angulo, Carlos

    2016-01-01

    We compare 27 wheat models' yield responses to interannual climate variability, analyzed at locations in Argentina, Australia, India, and The Netherlands as part of the Agricultural Model Intercomparison and Improvement Project (AgMIP) Wheat Pilot. Each model simulated 1981e2010 grain yield, and we evaluate results against the interannual variability of growing season temperature, precipitation, and solar radiation. The amount of information used for calibration has only a minor effect on most models' climate response, and even small multi-model ensembles prove beneficial. Wheat model clusters reveal common characteristics of yield response to climate; however models rarely share the same cluster at all four sites indicating substantial independence. Only a weak relationship (R2 0.24) was found between the models' sensitivities to interannual temperature variability and their response to long-termwarming, suggesting that additional processes differentiate climate change impacts from observed climate variability analogs and motivating continuing analysis and model development efforts.

  13. Responsiveness of Clinical Outcome Measures

    DEFF Research Database (Denmark)

    Lauridsen, Henrik Hein

    Background The Oswestry Disability Index (ODI) is one of two standardised functional health measurement scales (HMS) recommended. Despite extensive psychometric testing, little is known about HMS behaviour and the minimal clinically important difference (MCID) in subgroups of LBP patients. Moreover...... obtainable by a certain treatment. Chronic LBP patients seem to have a reasonable idea of an acceptable change in pain but overestimate change in functional and psychological /affective domains....

  14. Multi-wheat-model ensemble responses to interannual climatic variability

    DEFF Research Database (Denmark)

    Ruane, A C; Hudson, N I; Asseng, S

    2016-01-01

    We compare 27 wheat models' yield responses to interannual climate variability, analyzed at locations in Argentina, Australia, India, and The Netherlands as part of the Agricultural Model Intercomparison and Improvement Project (AgMIP) Wheat Pilot. Each model simulated 1981–2010 grain yield, and ......-term warming, suggesting that additional processes differentiate climate change impacts from observed climate variability analogs and motivating continuing analysis and model development efforts.......We compare 27 wheat models' yield responses to interannual climate variability, analyzed at locations in Argentina, Australia, India, and The Netherlands as part of the Agricultural Model Intercomparison and Improvement Project (AgMIP) Wheat Pilot. Each model simulated 1981–2010 grain yield, and we...... evaluate results against the interannual variability of growing season temperature, precipitation, and solar radiation. The amount of information used for calibration has only a minor effect on most models' climate response, and even small multi-model ensembles prove beneficial. Wheat model clusters reveal...

  15. Promoting Response Variability and Stimulus Generalization in Martial Arts Training

    Science.gov (United States)

    Harding, Jay W.; Wacker, David P.; Berg, Wendy K.; Rick, Gary; Lee, John F.

    2004-01-01

    The effects of reinforcement and extinction on response variability and stimulus generalization in the punching and kicking techniques of 2 martial arts students were evaluated across drill and sparring conditions. During both conditions, the students were asked to demonstrate different techniques in response to an instructor's punching attack.…

  16. Barn Owl Productivity Response to Variability of Vole Populations.

    Directory of Open Access Journals (Sweden)

    Petr Pavluvčík

    Full Text Available We studied the response of the barn owl annual productivity to the common vole population numbers and variability to test the effects of environmental stochasticity on their life histories. Current theory predicts that temporal environmental variability can affect long-term nonlinear responses (e.g., production of young both positively and negatively, depending on the shape of the relationship between the response and environmental variables. At the level of the Czech Republic, we examined the shape of the relationship between the annual sum of fledglings (annual productivity and vole numbers in both non-detrended and detrended data. At the districts' level, we explored whether the degree of synchrony (measured by the correlation coefficient and the strength of the productivity response increase (measured by the regression coefficient in areas with higher vole population variability measured by the s-index. We found that the owls' annual productivity increased linearly with vole numbers in the Czech Republic. Furthermore, based on district data, we also found that synchrony between dynamics in owls' reproductive output and vole numbers increased with vole population variability. However, the strength of the response was not affected by the vole population variability. Additionally, we have shown that detrending remarkably increases the Taylor's exponent b relating variance to mean in vole time series, thereby reversing the relationship between the coefficient of variation and the mean. This shift was not responsible for the increased synchrony with vole population variability. Instead, we suggest that higher synchrony could result from high food specialization of owls on the common vole in areas with highly fluctuating vole populations.

  17. Groundwater level responses to precipitation variability in Mediterranean insular aquifers

    Science.gov (United States)

    Lorenzo-Lacruz, Jorge; Garcia, Celso; Morán-Tejeda, Enrique

    2017-09-01

    Groundwater is one of the largest and most important sources of fresh water on many regions under Mediterranean climate conditions, which are exposed to large precipitation variability that includes frequent meteorological drought episodes, and present high evapotranspiration rates and water demand during the dry season. The dependence on groundwater increases in those areas with predominant permeable lithologies, contributing to aquifer recharge and the abundance of ephemeral streams. The increasing pressure of tourism on water resources in many Mediterranean coastal areas, and uncertainty related to future precipitation and water availability, make it urgent to understand the spatio-temporal response of groundwater bodies to precipitation variability, if sustainable use of the resource is to be achieved. We present an assessment of the response of aquifers to precipitation variability based on correlations between the Standardized Precipitation Index (SPI) at various time scales and the Standardized Groundwater Index (SGI) across a Mediterranean island. We detected three main responses of aquifers to accumulated precipitation anomalies: (i) at short time scales of the SPI (24 months). The differing responses were mainly explained by differences in lithology and the percentage of highly permeable rock strata in the aquifer recharge areas. We also identified differences in the months and seasons when aquifer storages are more dependent on precipitation; these were related to climate seasonality and the degree of aquifer exploitation or underground water extraction. The recharge of some aquifers, especially in mountainous areas, is related to precipitation variability within a limited spatial extent, whereas for aquifers located in the plains, precipitation variability influence much larger areas; the topography and geological structure of the island explain these differences. Results indicate large spatial variability in the response of aquifers to precipitation in

  18. Variability in ACL tunnel placement: observational clinical study of surgeon ACL tunnel variability.

    Science.gov (United States)

    Wolf, Brian R; Ramme, Austin J; Wright, Rick W; Brophy, Robert H; McCarty, Eric C; Vidal, Armando R; Parker, Richard D; Andrish, Jack T; Amendola, Annunziato

    2013-06-01

    Multicenter and multisurgeon cohort studies on anterior cruciate ligament (ACL) reconstruction are becoming more common. Minimal information exists on intersurgeon and intrasurgeon variability in ACL tunnel placement. Purpose/ The purpose of this study was to analyze intersurgeon and intrasurgeon variability in ACL tunnel placement in a series of The Multicenter Orthopaedic Outcomes Network (MOON) ACL reconstruction patients and in a clinical cohort of ACL reconstruction patients. The hypothesis was that there would be minimal variability between surgeons in ACL tunnel placement. Cross-sectional study; Level of evidence, 3. Seventy-eight patients who underwent ACL reconstruction by 8 surgeons had postoperative imaging with computed tomography, and ACL tunnel location and angulation were analyzed using 3-dimensional surface processing and measurement. Intersurgeon and intrasurgeon variability in ACL tunnel placement was analyzed. For intersurgeon variability, the range in mean ACL femoral tunnel depth between surgeons was 22%. For femoral tunnel height, there was a 19% range. Tibial tunnel location from anterior to posterior on the plateau had a 16% range in mean results. There was only a small range of 4% for mean tibial tunnel location from the medial to lateral dimension. For intrasurgeon variability, femoral tunnel depth demonstrated the largest ranges, and tibial tunnel location from medial to lateral on the plateau demonstrated the least variability. Overall, surgeons were relatively consistent within their own cases. Using applied measurement criteria, 85% of femoral tunnels and 90% of tibial tunnels fell within applied literature-based guidelines. Ninety-one percent of the axes of the femoral tunnels fell within the boundaries of the femoral footprint. The data demonstrate that surgeons performing ACL reconstructions are relatively consistent between each other. There is, however, variability of average tunnel placement up to 22% of mean condylar depth

  19. Individual canine Airway Response Variability to a Deep Inspiration

    Directory of Open Access Journals (Sweden)

    Robert H. Brown

    2011-01-01

    Full Text Available In healthy individuals, a DI can reverse (bronchodilation or prevent (bronchoprotection induced airway constriction. For individuals with asthma or COPD, these effects may be attenuated or absent. Previous work showed that the size and duration of a DI affected the subsequent response of the airways. Also, increased airway tone lead to increased airway size variability. The present study examined how a DI affected the temporal variability in individual airway baseline size and after methacholine challenge in dogs using High-Resolution Computed Tomography. Dogs were anesthetized and ventilated, and on 4 separate days, HRCT scans were acquired before and after a DI at baseline and during a continuous intravenous infusion of methacholine (Mch at 3 dose rates (17, 67, and 200 μg/mm. The Coefficient of Variation was used as an index of temporal variability in airway size. We found that at baseline and the lowest dose of Mch, variability decreased immediately and 5 minutes after the DI ( P < 0.0001. In contrast, with higher doses of Mch, the DI caused a variable response. At a rate of 67 μg/min of Mch, the temporal variability increased after 5 minutes, while at a rate of 200 μg/min of Mch, the temporal variability increased immediately after the DI. Increased airway temporal variability has been shown to be associated with asthma. Although the mechanisms underlying this temporal variability are poorly understood, the beneficial effects of a DI to decrease airway temporal variability was eliminated when airway tone was increased. If this effect is absent in asthmatics, this may suggest a possible mechanism for the loss of bronchoprotective and bronchodilatory effects after a DI in asthma.

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

    Science.gov (United States)

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

    2016-12-01

    Several studies have shown that acute psychosocial stress and chronic psychosocial stress reduce heart rate variability (HRV). It is likely that individuals suffering from burnout have reduced HRV, as a consequence of the long-term stress exposure. This study investigated HRV in 54 patients with clinical burnout (40 women and 14 men) and in 55 individuals reporting low burnout scores (healthy; 24 women and 31 men) and 52 individuals reporting high burnout scores (non-clinical burnout; 33 women and 19 men). The participants underwent a 300s ECG recording in the supine position. Standard deviation of normal R-R intervals (SDNN) and the root mean square of successive normal interval differences (RMSSD) were derived from time domain HRV analysis. Frequency domain HRV measures; total power (TP), low frequency power (LF), high frequency power (HF), and LF/HF ratio were calculated. All HRV measures, except LF/HF ratio, were lower in the clinical burnout patients compared to both the non-clinical burnout group and the healthy group. The difference was larger between the patients and the healthy group than between the patients and the non-clinical burnout group. HRV did not differ significantly between the non-clinical burnout group and the healthy group. Low HRV in burnout patients may constitute one of the links to associated adverse health, since low HRV reflects low parasympathetic activity - and accordingly low anabolic/regenerative activity. Copyright © 2016 Elsevier B.V. All rights reserved.

  1. Variability of CSF Alzheimer's disease biomarkers: implications for clinical practice.

    Directory of Open Access Journals (Sweden)

    Stephanie J B Vos

    Full Text Available BACKGROUND: Cerebrospinal fluid (CSF biomarkers are increasingly being used for diagnosis of Alzheimer's disease (AD. OBJECTIVE: We investigated the influence of CSF intralaboratory and interlaboratory variability on diagnostic CSF-based AD classification of subjects and identified causes of this variation. METHODS: We measured CSF amyloid-β (Aβ 1-42, total tau (t-tau, and phosphorylated tau (p-tau by INNOTEST enzyme-linked-immunosorbent assays (ELISA in a memory clinic population (n = 126. Samples were measured twice in a single or two laboratories that served as reference labs for CSF analyses in the Netherlands. Predefined cut-offs were used to classify CSF biomarkers as normal or abnormal/AD pattern. RESULTS: CSF intralaboratory variability was higher for Aβ1-42 than for t-tau and p-tau. Reanalysis led to a change in biomarker classification (normal vs. abnormal of 26% of the subjects based on Aβ1-42, 10% based on t-tau, and 29% based on p-tau. The changes in absolute biomarker concentrations were paralleled by a similar change in levels of internal control samples between different assay lots. CSF interlaboratory variability was higher for p-tau than for Aβ1-42 and t-tau, and reanalysis led to a change in biomarker classification of 12% of the subjects based on Aβ1-42, 1% based on t-tau, and 22% based on p-tau. CONCLUSIONS: Intralaboratory and interlaboratory CSF variability frequently led to change in diagnostic CSF-based AD classification for Aβ1-42 and p-tau. Lot-to-lot variation was a major cause of intralaboratory variability. This will have implications for the use of these biomarkers in clinical practice.

  2. Mahalanobis distance and variable selection to optimize dose response

    International Nuclear Information System (INIS)

    Moore, D.H. II; Bennett, D.E.; Wyrobek, A.J.; Kranzler, D.

    1979-01-01

    A battery of statistical techniques are combined to improve detection of low-level dose response. First, Mahalanobis distances are used to classify objects as normal or abnormal. Then the proportion classified abnormal is regressed on dose. Finally, a subset of regressor variables is selected which maximizes the slope of the dose response line. Use of the techniques is illustrated by application to mouse sperm damaged by low doses of x-rays

  3. Genetic variability of genital mycoplasmas and its clinical value

    Directory of Open Access Journals (Sweden)

    K. I. Plakhova

    2015-01-01

    Full Text Available The article presents data on genetic variability of genital mycoplasmas. The author presents the results of genetic variability studies for M. hominis, gene vaa, U. parvum, gene mba, and M. genitalium, gene mg192, sampled from women with different clinical manifestations of inflammatory diseases of the urogenital system. Based on the molecular typing results for 138 samples of genital mycoplasmas, the author revealed a relationship between clinical manifestations of inflammatory diseases of the urogenital system caused by U. parvum and different U. parvum serovars as well as different genetic variations of M. hominis.Infection with 6 U. parvum serovar results in the development of inflammatory diseases of the urogenital tract accompanied by subjective manifestations (р < 0.05. Genetic variant II of М. hominis was revealed more often in patients with clinical manifestations of inflammatory diseases while variant I was revealed more often in patients infected with М. hominis without any signs of inflammation (р < 0.05. Genetic variants of M. genitalium were determined; no significant differences in terms of their prevalence in the examined patients were revealed.

  4. Heart Rate Variability: Effect of Exercise Intensity on Postexercise Response

    Science.gov (United States)

    James, David V. B.; Munson, Steven C.; Maldonado-Martin, Sara; De Ste Croix, Mark B. A.

    2012-01-01

    The purpose of the present study was to investigate the influence of two exercise intensities (moderate and severe) on heart rate variability (HRV) response in 16 runners 1 hr prior to (-1 hr) and at +1 hr, +24 hr, +48 hr, and +72 hr following each exercise session. Time domain indexes and a high frequency component showed a significant decrease…

  5. Understanding Farmers' Response to Climate Variability in Nigeria ...

    African Journals Online (AJOL)

    In this study, farmers 'response to climate variability was examined. Primary and secondary data were used. A multi-stage sampling procedure was adopted in the collection of the primary data using structured questionnaires. Four vegetation zones out of seven where farming is mainly carried out were selected for the study.

  6. Response-rate differences in variable-interval and variable-ratio schedules: An old problem revisited

    OpenAIRE

    Cole, Mark R.

    1994-01-01

    In Experiment 1, a variable-ratio 10 schedule became, successively, a variable-interval schedule with only the minimum interreinforcement intervals yoked to the variable ratio, or a variable-interval schedule with both interreinforcement intervals and reinforced interresponse times yoked to the variable ratio. Response rates in the variable-interval schedule with both interreinforcement interval and reinforced interresponse time yoking fell between the higher rates maintained by the variable-...

  7. Variable reflectivity signal mirrors and signal response measurements

    International Nuclear Information System (INIS)

    Vine, Glenn de; Shaddock, Daniel A; McClelland, David E

    2002-01-01

    Future gravitational wave detectors will include some form of signal mirror in order to alter the signal response of the device. We introduce interferometer configurations which utilize a variable reflectivity signal mirror allowing a tunable peak frequency and variable signal bandwidth. A detector configured with a Fabry-Perot cavity as the signal mirror is compared theoretically with one using a Michelson interferometer for a signal mirror. A system for the measurement of the interferometer signal responses is introduced. This technique is applied to a power-recycled Michelson interferometer with resonant sideband extraction. We present broadband measurements of the benchtop prototype's signal response for a range of signal cavity detunings. This technique is also applicable to most other gravitational wave detector configurations

  8. Variable reflectivity signal mirrors and signal response measurements

    CERN Document Server

    Vine, G D; McClelland, D E

    2002-01-01

    Future gravitational wave detectors will include some form of signal mirror in order to alter the signal response of the device. We introduce interferometer configurations which utilize a variable reflectivity signal mirror allowing a tunable peak frequency and variable signal bandwidth. A detector configured with a Fabry-Perot cavity as the signal mirror is compared theoretically with one using a Michelson interferometer for a signal mirror. A system for the measurement of the interferometer signal responses is introduced. This technique is applied to a power-recycled Michelson interferometer with resonant sideband extraction. We present broadband measurements of the benchtop prototype's signal response for a range of signal cavity detunings. This technique is also applicable to most other gravitational wave detector configurations.

  9. Responsiveness and minimal clinically important change

    DEFF Research Database (Denmark)

    Christiansen, David Høyrup; Frost, Poul; Falla, Deborah

    2015-01-01

    Study Design A prospective cohort study nested in a randomized controlled trial. Objectives To determine and compare responsiveness and minimal clinically important change of the modified Constant score (CS) and the Oxford Shoulder Score (OSS). Background The OSS and the CS are commonly used...... to assess shoulder outcomes. However, few studies have evaluated the measurement properties of the OSS and CS in terms of responsiveness and minimal clinically important change. Methods The study included 126 patients who reported having difficulty returning to usual activities 8 to 12 weeks after...... were observed for the CS and the OSS. Minimal clinically important change ROC values were 6 points for the OSS and 11 points for the CS, with upper 95% cutoff limits of 12 and 22 points, respectively. Conclusion The CS and the OSS were both suitable for assessing improvement after decompression surgery....

  10. Bet-hedging response to environmental variability, an intraspecific comparison.

    Science.gov (United States)

    Nevoux, Marie; Forcada, Jaume; Barbraud, Christophe; Croxall, John; Weimerskirchi, Henri

    2010-08-01

    A major challenge in ecology is to understand the impact of increased environmental variability on populations and ecosystems. To maximize their fitness in a variable environment, life history theory states that individuals should favor a bet-hedging strategy, involving a reduction of annual breeding performance and an increase in adult survival so that reproduction can be attempted over more years. As a result, evolution toward longer life span is expected to reduce the deleterious effects of extra variability on population growth, and consequently on the trait contributing the most to it (e.g., adult survival in long-lived species). To investigate this, we compared the life histories of two Black-browed Albatross (Thalassarche melanophrys) populations breeding at South Georgia (Atlantic Ocean) and Kerguelen (Indian Ocean), the former in an environment nearly three times more variable climatically (e.g., in sea surface temperature) than the latter. As predicted, individuals from South Georgia (in the more variable environment) showed significantly higher annual adult survival (0.959, SE = 0.003) but lower annual reproductive success (0.285 chick per pair, SE = 0.039) than birds from Kerguelen (survival = 0.925, SE = 0.004; breeding success = 0.694, SE = 0.027). In both populations, climatic conditions affected the breeding success and the survival of inexperienced breeders, whereas the survival of experienced breeders was unaffected. The strength of the climatic impact on survival of inexperienced breeders was very similar between the two populations, but the effect on breeding success was positively related to environmental variability. These results provide rare and compelling evidence to support bet-hedging underlying changes in life history traits as an adaptive response to environmental variability.

  11. Human Responses to Climate Variability: The Case of South Africa

    Science.gov (United States)

    Oppenheimer, M.; Licker, R.; Mastrorillo, M.; Bohra-Mishra, P.; Estes, L. D.; Cai, R.

    2014-12-01

    Climate variability has been associated with a range of societal and individual outcomes including migration, violent conflict, changes in labor productivity, and health impacts. Some of these may be direct responses to changes in mean temperature or precipitation or extreme events, such as displacement of human populations by tropical cyclones. Others may be mediated by a variety of biological, social, or ecological factors such as migration in response to long-term changes in crops yields. Research is beginning to elucidate and distinguish the many channels through which climate variability may influence human behavior (ranging from the individual to the collective, societal level) in order to better understand how to improve resilience in the face of current variability as well as future climate change. Using a variety of data sets from South Africa, we show how climate variability has influenced internal (within country) migration in recent history. We focus on South Africa as it is a country with high levels of internal migration and dramatic temperature and precipitation changes projected for the 21st century. High poverty rates and significant levels of rain-fed, smallholder agriculture leave large portions of South Africa's population base vulnerable to future climate change. In this study, we utilize two complementary statistical models - one micro-level model, driven by individual and household level survey data, and one macro-level model, driven by national census statistics. In both models, we consider the effect of climate on migration both directly (with gridded climate reanalysis data) and indirectly (with agricultural production statistics). With our historical analyses of climate variability, we gain insights into how the migration decisions of South Africans may be influenced by future climate change. We also offer perspective on the utility of micro and macro level approaches in the study of climate change and human migration.

  12. Idiopathic granulomatous mastitis: a heterogeneous disease with variable clinical presentation.

    Science.gov (United States)

    Baslaim, Muna M; Khayat, Hind A; Al-Amoudi, Shefaa A

    2007-08-01

    Idiopathic granulomatous mastitis (IGM) is a rare benign inflammatory breast disease that presents with variable local manifestations. We describe here the different management protocols based on the clinical presentation of these patients. A retrospective review of 20 histopathologic confirmed cases of IGM seen over a period of 10 years was performed. The median age was 34 years (age range: 21-45 years). All were married, parous with history of breast feeding. Ill-defined mass mimicking carcinoma was the commonest presentation (70%); however, with the presence of signs of inflammation like pain (55%), redness (40%), and peau d'orange (40%), an inflammatory process appeared more likely. Axillary lymph node enlargement was infrequently seen (40%). Radiologic findings (mammography and ultrasound) were nonspecific. Histopathology showed the characteristic lobular distribution of granulomatous inflammation in all cases. Surgically, 7 patients had abscess drainage with open biopsy, and 7 patients had lumpectomy. Six patients with diffuse breast involvement were diagnosed by core needle biopsy only. Microbial cultures showed no growth. Antibiotics were given empirically when signs of inflammation where present. Two patients needed further abscess drainage followed by persistent sinus excision 3-6 weeks later. The median follow-up was 24 months (range: 15-42 months). Seventeen patients (85%) were recurrence-free, and 3 patients (15%) were lost to follow-up. Management of IGM cases needs to be tailored according to the clinical presentation. Precise radiologic and pathologic data interpretation by a multidisciplinary breast team will facilitate diagnosis and minimize unnecessary intervention.

  13. The Response of Ice Sheets to Climate Variability

    Science.gov (United States)

    Snow, K.; Goldberg, D. N.; Holland, P. R.; Jordan, J. R.; Arthern, R. J.; Jenkins, A.

    2017-12-01

    West Antarctic Ice Sheet loss is a significant contributor to sea level rise. While the ice loss is thought to be triggered by fluctuations in oceanic heat at the ice shelf bases, ice sheet response to ocean variability remains poorly understood. Using a synchronously coupled ice-ocean model permitting grounding line migration, this study evaluates the response of an ice sheet to periodic variations in ocean forcing. Resulting oscillations in grounded ice volume amplitude is shown to grow as a nonlinear function of ocean forcing period. This implies that slower oscillations in climatic forcing are disproportionately important to ice sheets. The ice shelf residence time offers a critical time scale, above which the ice response amplitude is a linear function of ocean forcing period and below which it is quadratic. These results highlight the sensitivity of West Antarctic ice streams to perturbations in heat fluxes occurring at decadal time scales.

  14. HiSCR (Hidradenitis Suppurativa Clinical Response)

    DEFF Research Database (Denmark)

    Kimball, B. A.; Sobell, J. M.; Zouboulis, C C

    2016-01-01

    Background: Determining treatment response for patients with hidradenitis suppurativa (HS) can be challenging due to limitations of current disease activity evaluations. Objective: Evaluate the novel, validated endpoint, Hidradenitis Suppurativa Clinical Response (HiSCR) and its utility as an out......Background: Determining treatment response for patients with hidradenitis suppurativa (HS) can be challenging due to limitations of current disease activity evaluations. Objective: Evaluate the novel, validated endpoint, Hidradenitis Suppurativa Clinical Response (HiSCR) and its utility...... as an outcome measure. Methods: Patients with baseline total abscess and inflammatory nodule count (AN count) of at least three and draining fistula count of 20 or fewer comprised the post hoc subpopulation analysed. HiSCR (at least a 50% reduction in total AN count, with no increase in abscess count...... week, or placebo (1 : 1 : 1). Results: The subpopulation included 132 (85.7%) patients; 70.5% women and 73.5% white. At week 16, HiSCR was achieved by 54.5% receiving weekly adalimumab, 33.3% every other week, and 25.6% placebo and HS-PGA Response was achieved by 20.5% receiving weekly adalimumab, 6...

  15. Estimation of road profile variability from measured vehicle responses

    Science.gov (United States)

    Fauriat, W.; Mattrand, C.; Gayton, N.; Beakou, A.; Cembrzynski, T.

    2016-05-01

    When assessing the statistical variability of fatigue loads acting throughout the life of a vehicle, the question of the variability of road roughness naturally arises, as both quantities are strongly related. For car manufacturers, gathering information on the environment in which vehicles evolve is a long and costly but necessary process to adapt their products to durability requirements. In the present paper, a data processing algorithm is proposed in order to estimate the road profiles covered by a given vehicle, from the dynamic responses measured on this vehicle. The algorithm based on Kalman filtering theory aims at solving a so-called inverse problem, in a stochastic framework. It is validated using experimental data obtained from simulations and real measurements. The proposed method is subsequently applied to extract valuable statistical information on road roughness from an existing load characterisation campaign carried out by Renault within one of its markets.

  16. Divergent phenological response to hydroclimate variability in forested mountain watersheds.

    Science.gov (United States)

    Hwang, Taehee; Band, Lawrence E; Miniat, Chelcy F; Song, Conghe; Bolstad, Paul V; Vose, James M; Love, Jason P

    2014-08-01

    Mountain watersheds are primary sources of freshwater, carbon sequestration, and other ecosystem services. There is significant interest in the effects of climate change and variability on these processes over short to long time scales. Much of the impact of hydroclimate variability in forest ecosystems is manifested in vegetation dynamics in space and time. In steep terrain, leaf phenology responds to topoclimate in complex ways, and can produce specific and measurable shifts in landscape forest patterns. The onset of spring is usually delayed at a specific rate with increasing elevation (often called Hopkins' Law; Hopkins, 1918), reflecting the dominant controls of temperature on greenup timing. Contrary with greenup, leaf senescence shows inconsistent trends along elevation gradients. Here, we present mechanisms and an explanation for this variability and its significance for ecosystem patterns and services in response to climate. We use moderate-resolution imaging spectro-radiometer (MODIS) Normalized Difference Vegetation Index (NDVI) data to derive landscape-induced phenological patterns over topoclimate gradients in a humid temperate broadleaf forest in southern Appalachians. These phenological patterns are validated with different sets of field observations. Our data demonstrate that divergent behavior of leaf senescence with elevation is closely related to late growing season hydroclimate variability in temperature and water balance patterns. Specifically, a drier late growing season is associated with earlier leaf senescence at low elevation than at middle elevation. The effect of drought stress on vegetation senescence timing also leads to tighter coupling between growing season length and ecosystem water use estimated from observed precipitation and runoff generation. This study indicates increased late growing season drought may be leading to divergent ecosystem response between high and low elevation forests. Landscape-induced phenological patterns

  17. Taking the pulse of mountains: Ecosystem responses to climatic variability

    Science.gov (United States)

    Fagre, Daniel B.; Peterson, David L.; Hessl, Amy E.

    2003-01-01

    An integrated program of ecosystem modeling and field studies in the mountains of the Pacific Northwest (U.S.A.) has quantified many of the ecological processes affected by climatic variability. Paleoecological and contemporary ecological data in forest ecosystems provided model parameterization and validation at broad spatial and temporal scales for tree growth, tree regeneration and treeline movement. For subalpine tree species, winter precipitation has a strong negative correlation with growth; this relationship is stronger at higher elevations and west-side sites (which have more precipitation). Temperature affects tree growth at some locations with respect to length of growing season (spring) and severity of drought at drier sites (summer). Furthermore, variable but predictable climate-growth relationships across elevation gradients suggest that tree species respond differently to climate at different locations, making a uniform response of these species to future climatic change unlikely. Multi-decadal variability in climate also affects ecosystem processes. Mountain hemlock growth at high-elevation sites is negatively correlated with winter snow depth and positively correlated with the winter Pacific Decadal Oscillation (PDO) index. At low elevations, the reverse is true. Glacier mass balance and fire severity are also linked to PDO. Rapid establishment of trees in subalpine ecosystems during this century is increasing forest cover and reducing meadow cover at many subalpine locations in the western U.S.A. and precipitation (snow depth) is a critical variable regulating conifer expansion. Lastly, modeling potential future ecosystem conditions suggests that increased climatic variability will result in increasing forest fire size and frequency, and reduced net primary productivity in drier, east-side forest ecosystems. As additional empirical data and modeling output become available, we will improve our ability to predict the effects of climatic change

  18. Hyperthyroidism in adults: variable clinical presentations and approaches to diagnosis.

    Science.gov (United States)

    Knudson, P B

    1995-01-01

    Hyperthyroidism is a disease that has various symptoms and can present in many ways. In the elderly patient hyperthyroidism often is not expressed in the classical manner. A case report of a middle-aged man who had hyperthyroidism with only one symptom is detailed. A literature review utilizing MEDLINE files from 1988 to the present, as well as current textbooks of medicine and endocrinology, was used to prepare this report. Keywords for the search were "hyperthyroidism," "symptoms," "unintentional weight loss," and "differential diagnosis." The clinical presentation of hyperthyroidism can vary from almost asymptomatic to apathetic in appearance to a marked hyperdynamic physiologic response. Family physicians must be well informed of this variation in disease expression. Overlooking the diagnosis of this relatively easily treated condition can be detrimental to patient care and expensive.

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

    Science.gov (United States)

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

    2015-01-01

    Common variable immunodeficiency is the primary immunodeficiency (CVID) frequently found in adults. Its prevalence is estimated from 1:25,000 to 75,000 alive newborns; there are variations by ethnic groups, it is estimated about 50-70% in Caucasian patients. Oral cavity lesions are rarely found in adult patients with CVID, there are reports about lesions on pediatric patients mostly caused by infections. To describe the orofacial lesions (oral, maxillofacial and neck area) affecting adults with CVID. A transversal, prospective study was done in patients with CVID attended at Specialties Hospital, CMN SXXI, Mexico City. Patients where examined by the oral and maxillofacial surgeon and clinical findings were reported, then the descriptive analysis of the lesions was done. We evaluated 26 patients, 16 female and 10 males, average age of 38.6 years. In 18/26 patients we found oral lesions on 7 different types. The most frequent was minor salivary glands hiperplasia (19/26),petechiae (12/26) and herpetic ulcers (7/26). In head and neck, we found 4 different lesions, the most common was lymphadenopathy <2cm (4/26). The immunologic alterations associated to CVID favors the development of lesions mainly of infectious and probably autoinmune origin that affects the oral cavity and head and neck area.

  20. Platelet Function Tests: Preanalytical Variables, Clinical Utility, Advantages, and Disadvantages.

    Science.gov (United States)

    Hvas, Anne-Mette; Grove, Erik Lerkevang

    2017-01-01

    Platelet function tests are mainly used in the diagnostic work-up of platelet disorders. During the last decade, the additional use of platelet function tests to evaluate the effect of antiplatelet therapy has also emerged in an attempt to identify patients with an increased risk of arterial thrombosis. Furthermore, platelet function tests are increasingly used to measure residual effect of antiplatelet therapy prior to surgery with the aim of reducing the risk of bleeding. To a limited extend, platelet function tests are also used to evaluate hyperaggregability as a potential marker of a prothrombotic state outside the setting of antiplatelet therapy. This multifaceted use of platelet function tests and the development of simpler point-of-care tests with narrower application have increased the use of platelet function testing and also facilitated the use of platelet function tests outside the highly specialized laboratories. The present chapter describes the preanalytical variables, which should be taken into account when planning platelet function testing. Also, the most widely used platelet function tests are introduced, and their clinical utility and their relative advantages and disadvantages are discussed.

  1. Clinical Characteristics and Genetic Variability of Human Rhinovirus in Mexico

    Directory of Open Access Journals (Sweden)

    Hilda Montero

    2012-01-01

    Full Text Available Human rhinovirus (HRV is a leading cause of acute respiratory infection (ARI in young children and infants worldwide and has a high impact on morbidity and mortality in this population. Initially, HRV was classified into two species: HRV-A and HRV-B. Recently, a species called HRV-C and possibly another species, HRV-D, were identified. In Mexico, there is little information about the role of HRV as a cause of ARI, and the presence and importance of species such as HRV-C are not known. The aim of this study was to determine the clinical characteristics and genetic variability of HRV in Mexican children. Genetic characterization was carried out by phylogenetic analysis of the 5′-nontranslated region (5′-NTR of the HRV genome. The results show that the newly identified HRV-C is circulating in Mexican children more frequently than HRV-B but not as frequently as HRV-A, which was the most frequent species. Most of the cases of the three species of HRV were in children under 2 years of age, and all species were associated with very mild and moderate ARI.

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

    Directory of Open Access Journals (Sweden)

    Lian-Jun Lin

    2015-01-01

    Full Text Available Background: Common variable immunodeficiency (CVID is one of the most common symptomatic primary immunodeficiency syndromes. The purpose of this article was to broaden our knowledge about CVID for better diagnosis and treatment. Methods: Clinical and immunological features of 40 Chinese patients with CVID were analyzed retrospectively. Results: The median age at onset was 11-year-old (range 4-51 years. The median age at diagnosis was 14.5-year-old (range 5-66 years. The average time of delay in diagnosis was 5.3 years (range 1-41 years. The most common main complaint was fever due to infections (35 cases, 87.5%. Pneumonia (28 cases, 70% was the most common type of infections. Bronchiectasis was present in 6 patients (15%. Autoimmune disease was detected in 6 cases of CVID, and malignancy in 2 cases. The median total serum levels of IgG, IgA, and IgM at diagnosis were 1.07 g/L, 0.07 g/L, and 0.28 g/L, respectively. The percentages of CD3− /CD19 + B-cells were 1%-3.14%. Conclusions: Infection is the most frequent presentation of CVID. Patients with unexplainable infections should receive further examination including serum immunoglobulin (Ig and lymphocyte subset analysis. Regular and sufficient substitution with Ig is recommended.

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

    Science.gov (United States)

    Ciaroni, Stefano

    2007-03-14

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

  4. Dynamic Variables Fail to Predict Fluid Responsiveness in an Animal Model With Pericardial Effusion.

    Science.gov (United States)

    Broch, Ole; Renner, Jochen; Meybohm, Patrick; Albrecht, Martin; Höcker, Jan; Haneya, Assad; Steinfath, Markus; Bein, Berthold; Gruenewald, Matthias

    2016-10-01

    The reliability of dynamic and volumetric variables of fluid responsiveness in the presence of pericardial effusion is still elusive. The aim of the present study was to investigate their predictive power in a porcine model with hemodynamic relevant pericardial effusion. A single-center animal investigation. Twelve German domestic pigs. Pigs were studied before and during pericardial effusion. Instrumentation included a pulmonary artery catheter and a transpulmonary thermodilution catheter in the femoral artery. Hemodynamic variables like cardiac output (COPAC) and stroke volume (SVPAC) derived from pulmonary artery catheter, global end-diastolic volume (GEDV), stroke volume variation (SVV), and pulse-pressure variation (PPV) were obtained. At baseline, SVV, PPV, GEDV, COPAC, and SVPAC reliably predicted fluid responsiveness (area under the curve 0.81 [p = 0.02], 0.82 [p = 0.02], 0.74 [p = 0.07], 0.74 [p = 0.07], 0.82 [p = 0.02]). After establishment of pericardial effusion the predictive power of dynamic variables was impaired and only COPAC and SVPAC and GEDV allowed significant prediction of fluid responsiveness (area under the curve 0.77 [p = 0.04], 0.76 [p = 0.05], 0.83 [p = 0.01]) with clinically relevant changes in threshold values. In this porcine model, hemodynamic relevant pericardial effusion abolished the ability of dynamic variables to predict fluid responsiveness. COPAC, SVPAC, and GEDV enabled prediction, but their threshold values were significantly changed. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Patterns of intraspecific variability in the response to caloric restriction

    Science.gov (United States)

    Gribble, Kristin E.; Kaido, Oksana; Jarvis, George; Mark Welch, David B.

    2014-01-01

    Caloric restriction (CR) is cited as the most robust means of increasing lifespan across a range of taxa, yet there is a high degree of variability in the response to CR, both within and between species. To examine the intraspecific evolutionary conservation of lifespan extension by CR, we tested the effects of chronic caloric restriction (CCR) at multiple food levels and of intermittent fasting (IF) in twelve isolates from the Brachionus plicatilis species complex of monogonont rotifers. While CCR generally increased or did not change lifespan and total fecundity, IF caused increased, unchanged, or decreased lifespan, depending upon the isolate, and decreased total fecundity in all but one isolate. Lifespan under ad libitum (AL) feeding varied among isolates and predicted the lifespan response to CR: longer-lived isolates under AL were less likely to have a significant increase in lifespan under CCR and were more likely to have a significantly shortened lifespan under IF. Lifespan under AL conditions and the response to CR were not correlated with hydroperiodicity of native habitat or with time in culture. Lack of trade-off between lifespan and fecundity under CCR, and differences in lifespan and fecundity under CCR and IF, even when average food intake was similar, suggest that longevity changes are not always directly determined by energy intake and that CCR and IF regimens extend lifespan through diverse genetic mechanisms. PMID:24384399

  6. Contact parameter identification for vibrational response variability prediction

    DEFF Research Database (Denmark)

    Creixell Mediante, Ester; Brunskog, Jonas; Jensen, Jakob Søndergaard

    2018-01-01

    industry, where the vibrational behavior of the structures within the hearing frequency range is critical for the performance of the devices. A procedure to localize the most probable contact areas and determine the most sensitive contact points with respect to variations in the modes of vibration......Variability in the dynamic response of assembled structures can arise due to variations in the contact conditions between the parts that conform them. Contact conditions are difficult to model accurately due to randomness in physical properties such as contact surface, load distribution...... or geometric details. Those properties can vary for a given structure due to the assembly and disassembly process, and also across nominally equal items that are produced in series. This work focuses on modeling the contact between small light-weight plastic pieces such as those used in the hearing aid...

  7. The relationships between clinical variables and renal parenchymal disease in pediatric clinically suspected urinary tract infection

    Directory of Open Access Journals (Sweden)

    Jung Lim Byun

    2010-02-01

    Full Text Available Purpose : To evaluate the significance of clinical signs and laboratory findings as predictors of renal parenchymal lesions and vesicoureteral reflux (VUR in childhood urinary tract infection (UTI. Methods : From July 2005 to July 2008, 180 patients admitted with a first febrile UTI at the Pediatric Department of Konkuk University Hospital were included in this study. The following were the clinical variables: leukocytosis, elevated C-reactive protein (CRP, positive urine nitrite, positive urine culture, and fever duration both before and after treatment. We evaluated the relationships between clinical variables and dimercaptosuccinic acid (DMSA scan and voiding cystourethrography (VCUG results. Results : VCUG was performed in 148 patients; of them, 37 (25.0% had VUR: 18 (12.2% had low-grade (I-II VUR, and 19 (10.5% had high-grade (III-V VUR. Of the 95 patients who underwent DMSA scanning, 29 (30.5% had cortical defects, of which 21 (63.6% had VUR: 10 (30.3%, low-grade (I-II VUR; and 11 (33.3%, high-grade VUR. Of the 57 patients who were normal on DMSA scan, 8 (14.0% had low-grade VUR and 6 (10.5% had high-grade VUR. The sensitivity, specificity, and positive and negative predictive values of the DMSA scan in predicting high-grade VUR were 64.7%, 69.9%, 33.3%, and 89.5%, respectively. Leukocytosis, elevated CRP, and prolonged fever (?#243;6 hours after treatment were significantly correlated with the cortical defects on DMSA scans and high-grade VUR. Conclusion : Clinical signs, including prolonged fever after treatment, elevated CRP, and leukocytosis, are positive predictors of acute pyelonephritis and high-grade VUR.

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

    NARCIS (Netherlands)

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

    2014-01-01

    Common variable immunodeficiency (CVID) is an antibody deficiency with an equal sex distribution and a high variability in clinical presentation. The main features include respiratory tract infections and their associated complications, enteropathy, autoimmunity, and lymphoproliferative disorders.

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

    NARCIS (Netherlands)

    Gathmann, B.; Mahlaoui, N.; Gerard, L.; Oksenhendler, E.; Warnatz, K.; Schulze, I.; Kindle, G.; Kuijpers, T.W.; Dutch, W.I.D.; Beem, R.T. van; Guzman, D.; Workman, S.; Soler-Palacin, P.; Gracia, J.; Witte, T. de; Schmidt, R.E.; Litzman, J.; Hlavackova, E.; Thon, V.; Borte, M.; Borte, S.; Kumararatne, D.; Feighery, C.; Longhurst, H.; Helbert, M.; Szaflarska, A.; Sediva, A.; Belohradsky, B.H.; Jones, A.; Baumann, U.; Meyts, I.; Kutukculer, N.; Wagstrom, P.; Galal, N.M.; Roesler, J.; Farmaki, E.; Zinovieva, N.; Ciznar, P.; Papadopoulou-Alataki, E.; Bienemann, K.; Velbri, S.; Panahloo, Z.; Grimbacher, B.; Meer, L.T. van der; Deuren, M. van; Netea, M.G.; Meer, J.W.M. van der; et al.,

    2014-01-01

    BACKGROUND: Common variable immunodeficiency (CVID) is an antibody deficiency with an equal sex distribution and a high variability in clinical presentation. The main features include respiratory tract infections and their associated complications, enteropathy, autoimmunity, and lymphoproliferative

  10. Response variability to glucose facilitation of cognitive enhancement.

    Science.gov (United States)

    Owen, Lauren; Scholey, Andrew; Finnegan, Yvonne; Sünram-Lea, Sandra I

    2013-11-01

    Glucose facilitation of cognitive function has been widely reported in previous studies (including our own). However, several studies have also failed to detect glucose facilitation. There is sparsity of research examining the factors that modify the effect of glucose on cognition. The aims of the present study were to (1) demonstrate the previously observed enhancement of cognition through glucose administration and (2) investigate some of the factors that may exert moderating roles on the behavioural response to glucose, including glucose regulation, body composition (BC) and hypothalamic–pituitary–adrenal axis response. A total of twenty-four participants took part in a double-blind, placebo-controlled, randomised, repeated-measures study, which examined the effect of 25 and 60 g glucose compared with placebo on cognitive function. At 1 week before the study commencement, all participants underwent an oral glucose tolerance test. Glucose facilitated performance on tasks of numeric and spatial working memory, verbal declarative memory and speed of recognition. Moderating variables were examined using several indices of glucoregulation and BC. Poorer glucoregulation predicted improved immediate word recall accuracy following the administration of 25 g glucose compared with placebo. Those with better glucoregulation showed performance decrements on word recall accuracy following the administration of 25 g glucose compared with placebo. These findings are in line with accumulating evidence that glucose load may preferentially enhance cognition in those with poorer glucoregulation. Furthermore, the finding that individuals with better glucoregulation may suffer impaired performance following a glucose load is novel and requires further substantiation.

  11. When is affect variability bad for health? The association between affect variability and immune response to the influenza vaccination.

    Science.gov (United States)

    Jenkins, Brooke N; Hunter, John F; Cross, Marie P; Acevedo, Amanda M; Pressman, Sarah D

    2018-01-01

    This study addresses methodological and theoretical questions about the association between affect and physical health. Specifically, we examine the role of affect variability and its interaction with mean levels of affect to predict antibody (Ab) levels in response to an influenza vaccination. Participants (N=83) received the vaccination and completed daily diary measures of affect four times a day for 13days. At one and four months post-vaccination, blood was collected from the participants to assess Ab levels. Findings indicate that affect variability and its interaction with mean levels of affect predict an individual's immune response. Those high in mean positive affect (PA) who had more PA variability were more likely to have a lower Ab response in comparison to those who had high mean PA and less PA variability. Although it did not interact with mean negative affect (NA), NA variability on its own was associated with Ab response, whereby those with less NA variability mounted a more robust immune response. Affect variability is related to immune response to an influenza vaccination and, in some cases, interacts with mean levels of affect. These oscillations in affective experiences are critical to consider in order to unpack the intricacies of how affect influences health. These findings suggest that future researchers should consider the important role of affect variability on physical health-relevant outcomes as well as examine the moderating effect of mean affect levels. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Avian community responses to variability in river hydrology.

    Science.gov (United States)

    Royan, Alexander; Hannah, David M; Reynolds, S James; Noble, David G; Sadler, Jonathan P

    2013-01-01

    River flow is a major driver of morphological structure and community dynamics in riverine-floodplain ecosystems. Flow influences in-stream communities through changes in water velocity, depth, temperature, turbidity and nutrient fluxes, and perturbations in the organisation of lower trophic levels are cascaded through the food web, resulting in shifts in food availability for consumer species. River birds are sensitive to spatial and phenological mismatches with aquatic prey following flow disturbances; however, the role of flow as a determinant of riparian ecological structure remains poorly known. This knowledge is crucial to help to predict if, and how, riparian communities will be influenced by climate-induced changes in river flow characterised by more extreme high (i.e. flood) and/or low (i.e. drought) flow events. Here, we combine national-scale datasets of river bird surveys and river flow archives to understand how hydrological disturbance has affected the distribution of riparian species at higher trophic levels. Data were analysed for 71 river locations using a Generalized Additive Model framework and a model averaging procedure. Species had complex but biologically interpretable associations with hydrological indices, with species' responses consistent with their ecology, indicating that hydrological-disturbance has implications for higher trophic levels in riparian food webs. Our quantitative analysis of river flow-bird relationships demonstrates the potential vulnerability of riparian species to the impacts of changing flow variability and represents an important contribution in helping to understand how bird communities might respond to a climate change-induced increase in the intensity of floods and droughts. Moreover, the success in relating parameters of river flow variability to species' distributions highlights the need to include river flow data in climate change impact models of species' distributions.

  13. Clinical Operations Variables are Associated With Blood Pressure Outcomes.

    Science.gov (United States)

    Kressin, Nancy R; Lasser, Karen E; Paasche-Orlow, Michael; Allison, Jeroan; Ash, Arlene S; Adams, William G; Shanahan, Christopher W; Legler, Aaron; Pizer, Steven D

    2015-06-01

    Uncontrolled blood pressure (BP), among patients diagnosed and treated for the condition, remains an important clinical challenge; aspects of clinical operations could potentially be adjusted if they were associated with better outcomes. To assess clinical operations factors' effects on normalization of uncontrolled BP. Observational cohort study. Patients diagnosed with hypertension from a large urban clinical practice (2005-2009). We obtained clinical data on BP, organized by person-month, and administrative data on primary care provider (PCP) staffing. We assessed the resolution of an episode of uncontrolled BP as a function of time-varying covariates including practice-level appointment volume, individual clinicians' appointment volume, overall practice-level PCP staffing, and number of unique PCPs. Among the 7409 unique patients representing 50,403 person-months, normalization was less likely for the patients in whom the episode starts during months when the number of unique PCPs were high [the top quintile of unique PCPs was associated with a 9 percentage point lower probability of normalization (Ppercentage point reduction in the probability of normalization (P=0.01)]. Neither clinician appointment volume nor practice clinician staffing levels were significantly associated with the probability of normalization. Findings suggest that clinical operations factors can affect clinical outcomes like BP normalization, and point to the importance of considering outcome effects when organizing clinical care.

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

    Science.gov (United States)

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

    2017-12-01

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

  15. EEC syndrome sans clefting: Variable clinical presentations in a family

    Directory of Open Access Journals (Sweden)

    Thakkar Sejal

    2007-01-01

    Full Text Available Ectrodactyly, ectodermal dysplasia and cleft palate/lip syndrome (EEC is a rare autosomal dominant syndrome with varied presentation and is actually a multiple congenital anomaly syndrome leading to intra- and interfamilial differences in severity because of its variable expression and reduced penetrance. The cardinal features include ectrodactyly, sparse, wiry, hypopigmented hair, peg-shaped teeth with defective enamel and cleft palate/lip. A family comprising father, daughter and son presented to us with split hand-split foot deformity (ectrodactyly, epiphora, hair changes and deafness with variable involvement in each family member.

  16. Pavement Response to Variable Tyre Pressure of Heavy Vehicles

    Directory of Open Access Journals (Sweden)

    Arshad Ahmad Kamil

    2016-01-01

    Full Text Available In recent years, the effect of overinflated tyre pressure and increased heavy vehicles’ axle load on flexible pavements has become a subject of great concern because of the higher stress levels induced and damage caused to road pavements. This paper aims to evaluate the effect of variable tyre inflation pressures (using actual tyre contact/footprint area to determine the responses of flexible pavement. A full scale experiment was conducted on a heavy vehicle with 1:1:2 axle configuration, 10 R 20 tyre size and attached trailer with constant axle load. Measurements were made for actual tyre-pavement contact area. KENPAVE linear elastic program was then used to analyse the effects of the measured actual tyre-pavement contact area and the results was compared using conventional circular tyre contact area. A comparative analysis was then made between the actual contact area and the conventional circular tyre contact area. It was found that high tyre inflation pressure produce smaller contact area, giving more detrimental effect on the flexible pavement. It was also found that the temperature of tyres when the heavy vehicles are operational give less significant impact on tyre inflation pressure for the Malaysian climate.

  17. Persistent fatigue in young athletes: measuring the clinical course and identifying variables affecting clinical recovery.

    Science.gov (United States)

    Locke, S; Osborne, M; O'Rourke, P

    2011-02-01

    The objective of this paper is to measure the clinical course (months) in young athletes with persistent fatigue and to identify any covariates affecting the duration of recovery. This was a prospective longitudinal study of 68 athletes; 87% were elite (42 males, 26 females), aged 20.5±3.74 years (SD), who presented with the symptom of persistent fatigue. The collective duration to full clinical recovery was estimated using Kaplan-Meier product-limit curves, and covariates associated with prolonging recovery were identified from Cox proportional hazard models. The median recovery was 5 months (range 1-60 months). The range of presenting symptom duration was 0.5-36 months. The covariates identified were an increased duration of presenting symptoms [hazard ratio (HR), 1.06; 95% confidence interval (CI), 1.02-1.12; P=0.005] and the response of serum cortisol concentration to a standard exercise challenge (HR, 1.92; 95% CI, 1.09-3.38; P=0.03). Delay in recovery was not associated with categories of fatigue that included medical, training-related diagnoses, or other causes. In conclusion, the fatigued athlete represents a significant clinical problem with a median recovery of 5 months, whose collective clinical course to recovery can be estimated by Kaplan-Meier curves and appears to be a continuum. © 2009 John Wiley & Sons A/S.

  18. Soil gas radon response to environmental and soil physics variables

    International Nuclear Information System (INIS)

    Thomas, D.M.; Chen, C.; Holford, D.

    1991-01-01

    During the last three years a field study of soil gas radon activities conducted at Poamoho, Oahu, has shown that the primary environmental variables that control radon transport in shallow tropical soils are synoptic and diurnal barometric pressure changes and soil moisture levels. Barometric pressure changes drive advective transport and mixing of soil gas with atmospheric air; soil moisture appears to control soil porosity and permeability to enhance or inhibit advective and diffusive radon transport. An advective barrier test/control experiment has shown that advective exchange of soil gas and air may account for a substantial proportion of the radon loss from shallow soils but does not significantly affect radon activities at depths greater than 2.3 m. An irrigation test/control experiment also suggests that, at soil moisture levels approaching field capacity, saturation of soil macroporosity can halt all advective transport of radon and limit diffusive mobility to that occurring in the liquid phase. The results of the authors field study have been used to further refine and extend a numerical model, RN3D, that has been developed by Pacific Northwest Laboratories to simulate subsurface transport of radon. The field data have allowed them to accurately simulate the steady state soil gas radon profile at their field site and to track transient radon activities under the influence of barometric pressure changes and in response to changes in soil permeability that result from variations in soil moisture levels. Further work is continuing on the model to enable it to properly account for the relative effects of advective transport of soil gas through cracks and diffusive mobility in the bulk soils

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

    NARCIS (Netherlands)

    Wolters, E.C.

    2008-01-01

    Parkinsonism is a clinical syndrome characterized by bradykinesia, hypo-/akinesia, muscular rigidity, and resting tremor, mainly caused by Parkinson's disease (PD). Symptoms of PD are due to a progressive loss of nigral neurons causing striatal dopaminergic denervation. However, nigral degeneration

  20. Joubert syndrome: large clinical variability and a unique neuroimaging aspect

    International Nuclear Information System (INIS)

    Leao, Emilia Katiane Embirucu; Lima, Marcilia Martyn; Kok, Fernando; Parizotto, Juliana; Maia Junior, Otacilio de Oliveira

    2010-01-01

    Joubert syndrome (JS) is an autosomal recessive inherited disorder characterized by hypotonia, cerebellar vermis hypoplasia, ocular abnormalities (e.g. pigmentary retinopathy, oculomotor apraxia and nystagmus), renal cysts and hepatic fibrosis. Respiratory abnormalities, as apnoea and hyperpnoea, may be present, as well as mental retardation. At least seven JS loci have been determined and five genes identified. Herein, we report five children, belonging to independent families, with JS: they shared the same typical MRI abnormality, known as molar tooth sign, but had an otherwise quite variable phenotype, regarding mostly their cognitive performance, visual abilities and extra-neurological compromise. (author)

  1. Joubert syndrome: large clinical variability and a unique neuroimaging aspect

    Energy Technology Data Exchange (ETDEWEB)

    Leao, Emilia Katiane Embirucu; Lima, Marcilia Martyn; Kok, Fernando; Parizotto, Juliana [University of Sao Paulo (USP), Sao Paulo, SP (Brazil). Clinical Hospital. Dept. of Child Neurology; Maia Junior, Otacilio de Oliveira [University of Sao Paulo (USP), Sao Paulo, SP (Brazil). Clinical Hospital. Dept. of Child Ophthalmology

    2010-04-15

    Joubert syndrome (JS) is an autosomal recessive inherited disorder characterized by hypotonia, cerebellar vermis hypoplasia, ocular abnormalities (e.g. pigmentary retinopathy, oculomotor apraxia and nystagmus), renal cysts and hepatic fibrosis. Respiratory abnormalities, as apnoea and hyperpnoea, may be present, as well as mental retardation. At least seven JS loci have been determined and five genes identified. Herein, we report five children, belonging to independent families, with JS: they shared the same typical MRI abnormality, known as molar tooth sign, but had an otherwise quite variable phenotype, regarding mostly their cognitive performance, visual abilities and extra-neurological compromise. (author)

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

    Directory of Open Access Journals (Sweden)

    Gianluca Mirizzi

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

  3. Impact of genetic polymorphisms on clinical response to antithrombotics

    Directory of Open Access Journals (Sweden)

    Kena J Lanham

    2010-06-01

    Full Text Available Kena J Lanham1,2, Julie H Oestreich3, Steven P Dunn1,2, Steven R Steinhubl41Pharmacy Services, UK HealthCare, University of Kentucky, Lexington, Kentucky, USA; 2Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA; 3Department of Pharmacy Practice, College of Pharmacy, University of Nebraska, Omaha, Nebraska, USA; 4The Medicines Company, Zurich, Switzerland and The Geisinger Clinic, Danville, Pennsylvania, USAAbstract: Antithrombotic therapy, including anticoagulants as well as antiplatelet drugs, is an important component in the treatment of cardiovascular disease. Variability in response to such medications, of which pharmacogenetic response is a major source, can decrease or enhance the benefits expected. This review is a comprehensive assessment of the literature published to date on the effects of genetic polymorphisms on the actions of a variety of antithrombotic medications, including warfarin, clopidogrel, prasugrel, and aspirin. Literature evaluating surrogate markers in addition to the impact of pharmacogenetics on clinical outcomes has been reviewed. The results of the studies are conflicting as to what degree pharmacogenetics will affect medication management in cardiovascular disease. Additional research is necessary to discover, characterize, and prospectively evaluate genetic and non-genetic factors that impact antithrombotic treatment in order to maximize the effectiveness and limit the harmful effects of these valuable agents.Keywords: aspirin, warfarin, clopidogrel, prasugrel, pharmacogenetic, antithrombotic, antiplatelet

  4. Quantification of clinical scores through physiological recordings in low-responsive patients: a feasibility study

    Directory of Open Access Journals (Sweden)

    Wieser Martin

    2012-05-01

    Full Text Available Abstract Clinical scores represent the gold standard in characterizing the clinical condition of patients in vegetative or minimally conscious state. However, they suffer from problems of sensitivity, specificity, subjectivity and inter-rater reliability. In this feasibility study, objective measures including physiological and neurophysiological signals are used to quantify the clinical state of 13 low-responsive patients. A linear regression method was applied in nine patients to obtain fixed regression coefficients for the description of the clinical state. The statistical model was extended and evaluated with four patients of another hospital. A linear mixed models approach was introduced to handle the challenges of data sets obtained from different locations. Using linear backward regression 12 variables were sufficient to explain 74.4% of the variability in the change of the clinical scores. Variables based on event-related potentials and electrocardiogram account for most of the variability. These preliminary results are promising considering that this is the first attempt to describe the clinical state of low-responsive patients in such a global and quantitative way. This new model could complement the clinical scores based on objective measurements in order to increase diagnostic reliability. Nevertheless, more patients are necessary to prove the conclusions of a statistical model with 12 variables.

  5. Platelet aggregation responses in clinically healthy adult llamas.

    Science.gov (United States)

    Gilbert, Rosanne M; Bird, Karyn E; Kutzler, Michelle A

    2009-03-01

    Limited information exists regarding hemostasis in camelids despite the importance of platelet function testing in the accurate identification of platelet disorders. As further importation of llamas to North America is restricted, variability in breeding stock will continue to decrease, potentially leading to an increase in heritable bleeding disorders. The objective of this study was to measure platelet aggregation responses in clinically healthy llamas and provide baseline data to which abnormal platelet function may be compared in the future. Blood samples were collected from 39 healthy adult llamas, citrated, and centrifuged to produce platelet-rich plasma (PRP). Within 4 hours of the blood draw, 20 microL of each agonist reagent were added to 180 microL of PRP. Final concentrations of agonists were 2 x 10(-5) M ADP, 0.19 mg collagen/mL PRP, 1 x 10(-4) M epinephrine, and 500 microg arachidonic acid/mL PRP. Llama platelets were most responsive to ADP and collagen, with a maximum percent aggregation (mean+/-SD) of 71.3+/-18.6% and 55.8+/-19% and aggregation rates of 9.5+/-3.9 and 6.7+/-3.7 cm/min, respectively. Llama platelet aggregation in response to epinephrine and arachidonic acid was minimal to absent. This study is the first of its kind to establish baseline values for platelet aggregation in healthy adult llamas.

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

    Science.gov (United States)

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

    2017-09-18

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

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

    Science.gov (United States)

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

    2015-01-01

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

  8. Effects of autogenic training on stress response and heart rate variability in nursing students.

    Science.gov (United States)

    Lim, Seung-Joo; Kim, Chunmi

    2014-12-01

    This study was undertaken to confirm the effects of autogenic training (AT) on stress response and heart rate variability in nursing school students experiencing stress related to clinical training. The study was carried out from September 2012 to April 2013 in a quasi-experimental nonequivalent control group using a pretest-posttest design. The participants were 40 nursing students in their third year at either of two nursing colleges. All consented to participate. Nineteen nursing students at one college were assigned to the experimental group and underwent the 8-week AT program, and the other 21 were assigned to the control group and did not undergo any training. Stress response was assessed by questionnaire and HRV was measured three times, that is, before the program, at the end of the program, and 6 months after the end of the AT program. A significant time/group interaction was found for stress response (F = 4.68, p = .012), a subjective indicator. However, no significant interaction was found for the objective indicators of heart rate variability, normalized low frequency (F = 2.59, p = .090), normalized high frequency (F = 2.59, p = .090), or low frequency to high frequency ratio (F = 1.38, p = .257). The results suggest that AT provides an acceptable approach to stress reduction in nursing students. Copyright © 2014. Published by Elsevier B.V.

  9. Latent variables underlying the memory beliefs of Chartered Clinical Psychologists, Hypnotherapists and undergraduate students.

    Science.gov (United States)

    Ost, James; Easton, Simon; Hope, Lorraine; French, Christopher C; Wright, Daniel B

    2017-01-01

    In courts in the United Kingdom, understanding of memory phenomena is often assumed to be a matter of common sense. To test this assumption 337 UK respondents, consisting of 125 Chartered Clinical Psychologists, 88 individuals who advertised their services as Hypnotherapists (HTs) in a classified directory, the Yellow Pages TM , and 124 first year undergraduate psychology students, completed a questionnaire that assessed their knowledge of 10 memory phenomena about which there is a broad scientific consensus. HTs' responses were the most inconsistent with the scientific consensus, scoring lowest on six of these ten items. Principal Components Analysis indicated two latent variables - reflecting beliefs about memory quality and malleability - underlying respondents' responses. In addition, respondents were asked to rate their own knowledge of the academic memory literature in general. There was no significant relationship between participants' self reported knowledge and their actual knowledge (as measured by their responses to the 10-item questionnaire). There was evidence of beliefs among the HTs that could give rise to some concern (e.g., that early memories from the first year of life are accurately stored and are retrievable).

  10. Northern goshawk broadcast surveys: Hawk response variables and survey cost

    Science.gov (United States)

    Suzanne M. Joy; Richard T. Reynolds; Douglas G. Leslie

    1994-01-01

    We examined responses of Northern Goshawks (Accipter gentilis) to taped broadcast calls of conspecifics in tree-harvest areas and around alternate goshawk nests on Kaibab National Forest, Arizona, in 1991 and 1992. Forest areas totaling 476 km2 were systematically surveyed for goshawks. Ninety responses by adult and juvenile goshawks were elicited...

  11. The effect of respiratory disorders on clinical pharmacokinetic variables.

    Science.gov (United States)

    Taburet, A M; Tollier, C; Richard, C

    1990-12-01

    Respiratory disorders induce several pathophysiological changes involving gas exchange and acid-base balance, regional haemodynamics, and alterations of the alveolocapillary membrane. The consequences for the absorption, distribution and elimination of drugs are evaluated. Drug absorption after inhalation is not significantly impaired in patients. With drugs administered by this route, an average of 10% of the dose reaches the lungs. It is not completely clear whether changes in pulmonary endothelium in respiratory failure enhance lung absorption. The effects of changes in blood pH on plasma protein binding and volume of distribution are discussed, but relevant data are not available to explain the distribution changes observed in acutely ill patients. Lung diffusion of some antimicrobial agents is enhanced in patients with pulmonary infections. Decreased cardiac output and hepatic blood flow in patients under mechanical ventilation cause an increase in the plasma concentration of drugs with a high hepatic extraction ratio, such as lidocaine (lignocaine). On a theoretical basis, hypoxia should lead to decreased biotransformation of drugs with a low hepatic extraction ratio, but in vivo data with phenazone (antipyrine) or theophylline are conflicting. The effects of disease on the lung clearance of drugs are discussed but clinically relevant data are lacking. The pharmacokinetics of drugs in patients with asthma or chronic obstructive pulmonary disease are reviewed. Stable asthma and chronic obstructive pulmonary disease do not appear to affect the disposition of theophylline or beta 2-agonists such as salbutamol (albuterol) or terbutaline. Important variations in theophylline pharmacokinetics have been reported in critically ill patients, the causes of which are more likely to be linked to the poor condition of the patients than to a direct effect of hypoxia or hypercapnia. Little is known regarding the pharmacokinetics of cromoglycate, ipratropium, corticoids or

  12. When to trust our learners? Clinical teachers' perceptions of decision variables in the entrustment process.

    Science.gov (United States)

    Duijn, Chantal C M A; Welink, Lisanne S; Bok, Harold G J; Ten Cate, Olle T J

    2018-06-01

    Clinical training programs increasingly use entrustable professional activities (EPAs) as focus of assessment. However, questions remain about which information should ground decisions to trust learners. This qualitative study aimed to identify decision variables in the workplace that clinical teachers find relevant in the elaboration of the entrustment decision processes. The findings can substantiate entrustment decision-making in the clinical workplace. Focus groups were conducted with medical and veterinary clinical teachers, using the structured consensus method of the Nominal Group Technique to generate decision variables. A ranking was made based on a relevance score assigned by the clinical teachers to the different decision variables. Field notes, audio recordings and flip chart lists were analyzed and subsequently translated and, as a form of axial coding, merged into one list, combining the decision variables that were similar in their meaning. A list of 11 and 17 decision variables were acknowledged as relevant by the medical and veterinary teacher groups, respectively. The focus groups yielded 21 unique decision variables that were considered relevant to inform readiness to perform a clinical task on a designated level of supervision. The decision variables consisted of skills, generic qualities, characteristics, previous performance or other information. We were able to group the decision variables into five categories: ability, humility, integrity, reliability and adequate exposure. To entrust a learner to perform a task at a specific level of supervision, a supervisor needs information to support such a judgement. This trust cannot be credited on a single case at a single moment of assessment, but requires different variables and multiple sources of information. This study provides an overview of decision variables giving evidence to justify the multifactorial process of making an entrustment decision.

  13. [Pain and workplace. Sociodemographic variables influence in therapeutic response and labor productivity].

    Science.gov (United States)

    Vicente-Herrero, M T; López-González, Á A; Ramírez Iñiguez de la Torre, M V; Capdevila García, L M; Terradillos García, M J; Aguilar Jiménez, E

    2016-09-01

    Pain is a major cause of medical consultation. The complexity of managing it is due to its long duration and intensity, and it sometimes requires a combination of multiple drugs. The objective of this study is to assess the use of drugs for pain in workers, the clinical response obtained, its influence on estimating work productivity, its relationship to sociodemographic variables, and the type of drug used. A cross-sectional study on 1,080 workers, aged 18-65 years, during periodic surveys to monitor their health in companies in the service sector in Spain. Treatments used, clinical efficacy, influence on work productivity and sociodemographic variables (age, gender) are evaluated. The Brief Pain Inventory questionnaire, validated for Spain, was used to assess pain, and the SPSS(®) 20.0 package for the statistical analysis. NSAIDs and simple analgesics have higher percentages of improvement in pain (P=.032 and P<.0001, respectively). Men respond better to NSAIDs, and women to simple analgesics. Improved productivity is higher in men than in women (P=.042). No significant differences were observed for age, pain improvement or productivity, except in those over 55 years. The analgesic prescription pain conditions must consider the age and gender of the patient, as well as the type of drug. The choice of drug should be based on the aetiology and aspects unrelated to the clinical variables, such as sociodemographic, work or psychosocial. Copyright © 2015 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Variable prognostic value of blood pressure response to exercise.

    Science.gov (United States)

    Kato, Yuko; Suzuki, Shinya; Uejima, Tokuhisa; Semba, Hiroaki; Yamashita, Takeshi

    2018-01-01

    The aim of this study was to evaluate the impact of patient background including exercise capacity on the relationship between the blood pressure (BP) response to exercise and prognosis in patients visiting a cardiovascular hospital. A total of 2134 patients who were referred to our hospital underwent symptom-limited maximal cardiopulmonary exercise testing, and were followed through medical records and mail. The BP response to exercise was defined as the difference between peak and rest systolic BP. The end point was set as cardiovascular events including cardiovascular death, acute coronary syndrome, hospitalization for heart failure, and cerebral infarction. During a median follow-up period of 3 years, 179 (8%) patients reached the end point (2.5%/year). Multivariate analysis showed that BP response was independently and negatively associated with the occurrence of the end point. This prognostic significance of BP response was consistent regardless of left ventricular ejection fraction, renal function, presence of heart failure symptoms, the presence of organic heart disease, and hypertension. However, peak VO 2 showed a significant interaction with the effects of BP response on the end point, suggesting that the prognostic value of BP response was limited in patients with preserved exercise capacity. The role of BP response to exercise as the predictor depends on exercise capacity of each patient. Copyright © 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  15. Evaluation of Clinical and Pathological Response after Two Cycles ...

    African Journals Online (AJOL)

    Results: The clinical response rate was 83%; 11 patients (11.2%) had a complete clinical remission (cCR); 71 had a partial remission (72.4%); 13 had stable disease (13.3%), and 3 had progressive disease (3.1%). Seven patients had complete pathological response. Conclusion: Neoadjuvant chemotherapy can achieve a ...

  16. The Effect of Heart Rate on the Heart Rate Variability Response to Autonomic Interventions

    Directory of Open Access Journals (Sweden)

    George E Billman

    2013-08-01

    Full Text Available Heart rate variability (HRV, the beat-to-beat variation in either heart rate (HR or heart period (R-R interval, has become a popular clinical and investigational tool to quantify cardiac autonomic regulation. However, it is not widely appreciated that, due to the inverse curvilinear relationship between HR and R-R interval, HR per se can profoundly influence HRV. It is, therefore, critical to correct HRV for the prevailing HR particularly, as HR changes in response to autonomic neural activation or inhibition. The present study evaluated the effects of HR on the HRV response to autonomic interventions that either increased (submaximal exercise, n = 25 or baroreceptor reflex activation, n = 20 or reduced (pharmacological blockade: β-adrenergic receptor, muscarinic receptor antagonists alone and in combination, n = 25, or bilateral cervical vagotomy, n = 9 autonomic neural activity in a canine model. Both total (RR interval standard deviation, RRSD and the high frequency variability (HF, 0.2 to 1.04 Hz were determined before and in response to an autonomic intervention. All interventions that reduced or abolished cardiac parasympathetic regulation provoked large reductions in HRV even after HR correction [division by mean RRsec or (mean RRsec2 for RRSD and HF, respectively] while interventions that reduced HR yielded mixed results. β-adrenergic receptor blockade reduced HRV (RRSD but not HF while both RRSD and HF increased in response to increases in arterial blood (baroreceptor reflex activation even after HR correction. These data suggest that the physiological basis for HRV is revealed after correction for prevailing HR and, further, that cardiac parasympathetic activity is responsible for a major portion of the HRV in the dog.

  17. 42 CFR 493.1419 - Standard; Clinical consultant responsibilities.

    Science.gov (United States)

    2010-10-01

    ... Testing Laboratories Performing Moderate Complexity Testing § 493.1419 Standard; Clinical consultant... clinical consultation to the laboratory's clients; (b) Be available to assist the laboratory's clients in... 42 Public Health 5 2010-10-01 2010-10-01 false Standard; Clinical consultant responsibilities. 493...

  18. A Decline in Response Variability Improves Neural Signal Detection during Auditory Task Performance.

    Science.gov (United States)

    von Trapp, Gardiner; Buran, Bradley N; Sen, Kamal; Semple, Malcolm N; Sanes, Dan H

    2016-10-26

    The detection of a sensory stimulus arises from a significant change in neural activity, but a sensory neuron's response is rarely identical to successive presentations of the same stimulus. Large trial-to-trial variability would limit the central nervous system's ability to reliably detect a stimulus, presumably affecting perceptual performance. However, if response variability were to decrease while firing rate remained constant, then neural sensitivity could improve. Here, we asked whether engagement in an auditory detection task can modulate response variability, thereby increasing neural sensitivity. We recorded telemetrically from the core auditory cortex of gerbils, both while they engaged in an amplitude-modulation detection task and while they sat quietly listening to the identical stimuli. Using a signal detection theory framework, we found that neural sensitivity was improved during task performance, and this improvement was closely associated with a decrease in response variability. Moreover, units with the greatest change in response variability had absolute neural thresholds most closely aligned with simultaneously measured perceptual thresholds. Our findings suggest that the limitations imposed by response variability diminish during task performance, thereby improving the sensitivity of neural encoding and potentially leading to better perceptual sensitivity. The detection of a sensory stimulus arises from a significant change in neural activity. However, trial-to-trial variability of the neural response may limit perceptual performance. If the neural response to a stimulus is quite variable, then the response on a given trial could be confused with the pattern of neural activity generated when the stimulus is absent. Therefore, a neural mechanism that served to reduce response variability would allow for better stimulus detection. By recording from the cortex of freely moving animals engaged in an auditory detection task, we found that variability

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

    Science.gov (United States)

    Cleophas, Ton J

    2016-01-01

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

  20. Variability salt stress response analysis of Tunisian natural ...

    African Journals Online (AJOL)

    We evaluated the responses to salt stress of 106 Medicago truncatula lines from 11 Tunisian natural populations collected from areas that varied in soil composition, salinity and water availability. Five references lines were also included in this study. Plants were cultivated in two treatments (0 and 50 mM of NaCl) during a ...

  1. Use of Portable Digital Devices to Analyze Autonomic Stress Response in Psychology Objective Structured Clinical Examination.

    Science.gov (United States)

    Beltrán-Velasco, Ana Isabel; Bellido-Esteban, Alberto; Ruisoto-Palomera, Pablo; Clemente-Suárez, Vicente Javier

    2018-01-12

    The aim of the present study was to explore changes in the autonomic stress response of Psychology students in a Psychology Objective Structured Clinical Examination (OSCE) and their relationship with OSCE performance. Variables of autonomic modulation by the analysis of heart rate variability in temporal, frequency and non-linear domains, subjective perception of distress strait and academic performance were measured before and after the two different evaluations that composed the OSCE. A psychology objective structured clinical examination composed by two different evaluation scenarios produced a large anxiety anticipatory response, a habituation response in the first of the evaluation scenarios and a in the entire evaluation, and a no habituation response in the second evaluation scenario. Autonomic modulation parameters do not correlate with academic performance of students.

  2. Blocking Avoidance and Escape Responses: Relations With Clinically Relevant Behaviors

    Directory of Open Access Journals (Sweden)

    Juliana Maria Bubna Popovitz

    Full Text Available Abstract: The current study aims to evaluate the possible effects of interrupting problematic clinically relevant behaviors on the percentage of these responses and of clinical improvement-related responses. Two clients were treated with Functional Analytic Psychotherapy (FAP, alternating two conditions (ABAB. On condition A, procedures to the therapist consisted of responding to the clinical improvement responses, and to description of outside of therapeutic setting behaviors, but therapists were advised to ignore problem behaviors emitted in session. During condition B, therapists followed the same procedures, but they were oriented to block (interrupt problematic responses emitted in session. Results suggest increase in the percentage of problem behaviors during condition B. Results are discussed, highlighting the viability of planning the contingent response the therapist emits to clinically relevant behaviors.

  3. Decreased heart rate variability responses during early postoperative mobilization

    DEFF Research Database (Denmark)

    Jans, Øivind; Brinth, Louise; Kehlet, Henrik

    2015-01-01

    in relation to postural change. METHODS: A standardized mobilization protocol before, 6 and 24 h after surgery was performed in 23 patients scheduled for elective THA. Beat-to-beat arterial blood pressure was measured by photoplethysmography and HRV was derived from pulse wave interbeat intervals and analysed......BACKGROUND: Intact orthostatic blood pressure regulation is essential for early mobilization after surgery. However, postoperative orthostatic hypotension and intolerance (OI) may delay early ambulation. The mechanisms of postoperative OI include impaired vasopressor responses relating...... and postural responses in arterial pressures decreased compared to preoperative conditions. During standing HF variation increased by 16.7 (95 % CI 8.0-25.0) normalized units (nu) at 6 h and 10.7 (2.0-19.4) nu at 24 h compared to the preoperative evaluation. At 24 h the LF/HF ratio decreased from 1.8 (1...

  4. [An Investigation of the Role Responsibilities of Clinical Research Nurses in Conducting Clinical Trials].

    Science.gov (United States)

    Kao, Chi-Yin; Huang, Guey-Shiun; Dai, Yu-Tzu; Pai, Ya-Ying; Hu, Wen-Yu

    2015-06-01

    Clinical research nurses (CRNs) play an important role in improving the quality of clinical trials. In Taiwan, the increasing number of clinical trials has increased the number of practicing CRNs. Understanding the role responsibilities of CRNs is necessary to promote professionalism in this nursing category. This study investigates the role responsibilities of CRNs in conducting clinical trials / research. A questionnaire survey was conducted in a medical center in Taipei City, Taiwan. Eighty CRNs that were registered to facilitate and conduct clinical trials at this research site completed the survey. "Subject protection" was the CRN role responsibility most recognized by participants, followed by "research coordination and management", "subject clinical care", and "advanced professional nursing". Higher recognition scores were associated with higher importance scores and lower difficulty scores. Participants with trial training had significantly higher difficulty scores for "subject clinical care" and "research coordination and management" than their peers without this training (p research coordination and management" (p clinical practice.

  5. Contribution of positron emission tomography for the study of response variability to opioid drugs

    International Nuclear Information System (INIS)

    Auvity, Sylvain

    2017-01-01

    investigate the neuro-pharmacokinetic component of opioid pharmacology. "1"1C-diphenhydramine was developed in rats as a specific probe to estimate the H"+/antiporter function at the blood-brain barrier. This newly identified carrier transport System was shown to control the brain exposure of many CNS drugs, including oxycodone. Then, we used "1"1C-buprenorphine PET imaging and validated a co-injection strategy to quantify the parameters that describe the brain kinetics of buprenorphine in nonhuman primates. Throughout this project, several methods have been evaluated or developed in order to address original hypothesis regarding the pharmacology of opioid drugs. The choice for noninvasive and quantitative methods such as PET imaging allows for clinical translation. These tools may thus be useful to investigate the neuro-immune and neuro-pharmacokinetic component of the variability of response to opioid drugs in humans. (author) [fr

  6. The therapeutic effect of clinical trials: understanding placebo response rates in clinical trials – A secondary analysis

    Directory of Open Access Journals (Sweden)

    Walach Harald

    2005-08-01

    Full Text Available Abstract Background and purpose Placebo response rates in clinical trials vary considerably and are observed frequently. For new drugs it can be difficult to prove effectiveness superior to placebo. It is unclear what contributes to improvement in the placebo groups. We wanted to clarify, what elements of clinical trials determine placebo variability. Methods We analysed a representative sample of 141 published long-term trials (randomized, double-blind, placebo-controlled; duration > 12 weeks to find out what study characteristics predict placebo response rates in various diseases. Correlational and regression analyses with study characteristics and placebo response rates were carried out. Results We found a high and significant correlation between placebo and treatment response rate across diseases (r = .78; p Conclusion Medication response rates and placebo response rates in clinical trials are highly correlated. Trial characteristics can explain some portion of the variance in placebo healing rates in RCTs. Placebo response in trials is only partially due to methodological artefacts and only partially dependent on the diagnoses treated.

  7. Inter- and Intra-individual Variability in Response to Transcranial Direct Current Stimulation (tDCS) at Varying Current Intensities.

    Science.gov (United States)

    Chew, Taariq; Ho, Kerrie-Anne; Loo, Colleen K

    2015-01-01

    Translation of transcranial direct current stimulation (tDCS) from research to clinical practice is hindered by a lack of consensus on optimal stimulation parameters, significant inter-individual variability in response, and in sufficient intra-individual reliability data. Inter-individual differences in response to anodal tDCS at a range of current intensities were explored. Intra-individual reliability in response to anodal tDCS across two identical sessions was also investigated. Twenty-nine subjects participated in a crossover study. Anodal-tDCS using four different current intensities (0.2, 0.5, 1 and 2 mA), with an anode size of 16 cm2, was tested. The 0.5 mA condition was repeated to assess intra-individual variability. TMS was used to elicit 40 motor-evoked potentials (MEPs) before 10 min of tDCS, and 20 MEPs at four time-points over 30 min following tDCS. ANOVA revealed no main effect of TIME for all conditions except the first 0.5 mA condition, and no differences in response between the four current intensities. Cluster analysis identified two clusters for the 0.2 and 2 mA conditions only. Frequency distributions based on individual subject responses (excitatory, inhibitory or no response) to each condition indicate possible differential responses between individuals to different current intensities. Test-retest reliability was negligible (ICC(2,1) = -0.50). Significant inter-individual variability in response to tDCS across a range of current intensities was found. 2 mA and 0.2 mA tDCS were most effective at inducing a distinct response. Significant intra-individual variability in response to tDCS was also found. This has implications for interpreting results of single-session tDCS experiments. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.

  8. The IL--6 dependent effect of oral warfarin in heart valve replacement patients by measuring interacting clinical and demographic variables

    International Nuclear Information System (INIS)

    Shafiq, H.; Rashid, A.; Majeed, A.; Razah, S.; Asghar, I.

    2016-01-01

    Objective: To examine an inflammatory effect of warfarin and comparing with IL-6 levels along with different demographic and clinical variables. Study Design: Quasi experimental study. Place and Duration of Study: Center of Research in Experimental and Applied Medicine (CREAM), Army Medical College/National University of Sciences and Technology, Islamabad from Oct 2013 to Oct 2015. Material and Methods: The study design was Quasi Experimental study. Samples were collected by Non probability convenience sampling. Total 76 patients were included according to warfarin dose response in warfarin therapy patients, i.e. 32(42 percent) were taking 10mg/day of warfarin dose. Patient's demographic and clinical variables were noted i.e. age, gender, BMI, duration of therapy, INR history, hepatic, gastrointestinal and diabetic complications. Human IL-6 ELISA assay was performed. Results: The statistically significant difference was found between age groups (in years) and different levels of warfarin dose (p=0.046) along with IL-6 production. There is a negative correlation between warfarin dose and age group i.e. as age increases, the dose of warfarin decreases. Among the inter and intra-patient variability age and serum IL-6 levels were found to be statistically significant with warfarin dose response. BMI and warfarin dose were found to be weak positively correlated. Conclusion: A marked immunomodulatory response of warfarin was noted by measuring IL-6 levels. IL-6 levels retained a significant association with warfarin dose. (author)

  9. RELATION BETWEEN BACKGROUND VARIABLES, VALUES AND CORPORATE SOCIAL RESPONSIBILITY

    Directory of Open Access Journals (Sweden)

    Maria del Rosario González-Rodriguez

    2016-02-01

    Full Text Available Consumer perception of corporate social responsibility (CSR can be directly influenced by individual value structures. This research aims to provide new knowledge regarding the relationship between basic human values and the public’s perception of CSR. It focuses on the values of higher education students and their views regarding a particular corporate social initiative. The study reveals that social, educational, and economic circumstances influence human values. Those values in turn influence why different students perceive CSR differently. These findings are relevant to companies as they provide a more detailed understanding of why certain consumer groups perceive certain CSR initiatives the way that they do. They also suggest that universities should increase their awareness of the importance of integrating human values and CSR in the curricula of future business managers and social leaders.

  10. Synthesis of Room Impulse Responses for Variable Source Characteristics

    Directory of Open Access Journals (Sweden)

    M. Kunkemoeller

    2011-01-01

    Full Text Available Every acoustic source, e.g. a speaker, a musical instrument or a loudspeaker, generally has a frequency dependent characteristic radiation pattern, which is preeminent at higher frequencies. Room acoustic measurements nowadays only account for omnidirectional source characteristics. This motivates a measurement method that is capable of obtaining room impulse responses for these specific radiation patterns by using a superposition approach of several measurements with technically well-defined sound sources. We propose a method based on measurements with a 12-channel independentlydriven dodecahedron loudspeaker array rotated by an automatically controlled turntable.Radiation patterns can be efficiently described with the use of spherical harmonics representation. We propose a method that uses this representation for the spherical loudspeaker array used for the measurements and the target radiation pattern to be used for the synthesis.We show validating results for a deterministic test sound source inside in a small lecture hall.

  11. Response of South American Ecosystems to Precipitation Variability

    Science.gov (United States)

    Knox, R. G.; Kim, Y.; Longo, M.; Medvigy, D.; Wang, J.; Moorcroft, P. R.; Bras, R. L.

    2009-12-01

    The Ecosystem Demography Model 2 is a dynamic ecosystem model and land surface energy balance model. ED2 discretizes landscapes of particular terrain and meteorology into fractional areas of unique disturbance history. Each fraction, defined by a shared vertical soil column and canopy air space, contains a stratum of plant groups unique in functional type, size and number density. The result is a vertically distributed representation of energy transfer and plant dynamics (mortality, productivity, recruitment, disturbance, resource competition, etc) that successfully approximates the behaviour of individual-based vegetation models. In previous exercises simulating Amazonian land surface dynamics with ED 2, it was observed that when using grid averaged precipitation as an external forcing the resulting water balance typically over-estimated leaf interception and leaf evaporation while under estimating through-fall and transpiration. To investigate this result, two scenario were conducted in which land surface biophysics and ecosystem demography over the Northern portion of South America are simulated over ~200 years: (1) ED2 is forced with grid averaged values taken from the ERA40 reanalysis meteorological dataset; (2) ED2 is forced with ERA40 reanalysis, but with its precipitation re-sampled to reflect statistical qualities of point precipitation found at rain gauge stations in the region. The findings in this study suggest that the equilibrium moisture states and vegetation demography are co-dependent and show sensitivity to temporal variability in precipitation. These sensitivities will need to be accounted for in future projections of coupled climate-ecosystem changes in South America.

  12. Response of the Amazon rainforest to late Pleistocene climate variability

    Science.gov (United States)

    Häggi, Christoph; Chiessi, Cristiano M.; Merkel, Ute; Mulitza, Stefan; Prange, Matthias; Schulz, Michael; Schefuß, Enno

    2017-12-01

    Variations in Amazonian hydrology and forest cover have major consequences for the global carbon and hydrological cycles as well as for biodiversity. Yet, the climate and vegetation history of the lowland Amazon basin and its effect on biogeography remain debated due to the scarcity of suitable high-resolution paleoclimate records. Here, we use the isotopic composition (δD and δ13C) of plant-waxes from a high-resolution marine sediment core collected offshore the Amazon River to reconstruct the climate and vegetation history of the integrated lowland Amazon basin for the period from 50,000 to 12,800 yr before present. Our results show that δD values from the Last Glacial Maximum were more enriched than those from Marine Isotope Stage (MIS) 3 and the present-day. We interpret this trend to reflect long-term changes in precipitation and atmospheric circulation, with overall drier conditions during the Last Glacial Maximum. Our results thus suggest a dominant glacial forcing of the climate in lowland Amazonia. In addition to previously suggested thermodynamic mechanisms of precipitation change, which are directly related to temperature, we conclude that changes in atmospheric circulation are crucial to explain the temporal evolution of Amazonian rainfall variations, as demonstrated in climate model experiments. Our vegetation reconstruction based on δ13C values shows that the Amazon rainforest was affected by intrusions of savannah or more open vegetation types in its northern sector during Heinrich Stadials, while it was resilient to glacial drying. This suggests that biogeographic patterns in tropical South America were affected by Heinrich Stadials in addition to glacial-interglacial climate variability.

  13. Responsiveness of clinical tests for people with neck pain

    DEFF Research Database (Denmark)

    Jørgensen, René; Ris, Inge; Juhl, Carsten

    2017-01-01

    of four clinical tests which are low cost and easy to perform in a clinical setting, including the craniocervical flexion test, cervical active range of movement, test for the cervical extensors and pressure pain threshold testing. METHODS: This study is a secondary analysis of data collected......BACKGROUND: Responsiveness of a clinical test is highly relevant in order to evaluate the effect of a given intervention. However, the responsiveness of clinical tests for people with neck pain has not been adequately evaluated. The objective of the present study was to examine the responsiveness...... in a previously published randomised controlled trial. Participants were randomized to either physical training, exercises and pain education combined or pain education only. Participants were tested on the clinical tests at baseline and at 4-month follow-up. An anchor-based approach using Receiver Operator...

  14. Plant response to nutrient availability across variable bedrock geologies

    Science.gov (United States)

    Castle, S.C.; Neff, J.C.

    2009-01-01

    We investigated the role of rock-derived mineral nutrient availability on the nutrient dynamics of overlying forest communities (Populus tremuloides and Picea engelmanni-Abies lasiocarpa v. arizonica) across three parent materials (andesite, limestone, and sandstone) in the southern Rocky Mountains of Colorado. Broad geochemical differences were observed between bedrock materials; however, bulk soil chemistries were remarkably similar between the three different sites. In contrast, soil nutrient pools were considerably different, particularly for P, Ca, and Mg concentrations. Despite variations in nutrient stocks and nutrient availability in soils, we observed relatively inflexible foliar concentrations and foliar stoichiometries for both deciduous and coniferous species. Foliar nutrient resorption (P and K) in the deciduous species followed patterns of nutrient content across substrate types, with higher resorption corresponding to lower bedrock concentrations. Work presented here indicates a complex plant response to available soil nutrients, wherein plant nutrient use compensates for variations in supply gradients and results in the maintenance of a narrow range in foliar stoichiometry. ?? 2008 Springer Science+Business Media, LLC.

  15. 42 CFR 493.1457 - Standard; Clinical consultant responsibilities.

    Science.gov (United States)

    2010-10-01

    ... HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION LABORATORY REQUIREMENTS Personnel for Nonwaived Testing Laboratories Performing High Complexity Testing § 493.1457 Standard; Clinical consultant... 42 Public Health 5 2010-10-01 2010-10-01 false Standard; Clinical consultant responsibilities. 493...

  16. Variability in fluvial geomorphic response to anthropogenic disturbance

    Science.gov (United States)

    Verstraeten, Gert; Broothaerts, Nils; Van Loo, Maarten; Notebaert, Bastiaan; D'Haen, Koen; Dusar, Bert; De Brue, Hanne

    2017-10-01

    Humans have greatly impacted the processes and intensities of erosion, sediment transport and storage since the introduction of agriculture. In many regions around the world, accelerated floodplain sedimentation can be related to increases in human pressure on the environment. However, the relation between the intensity of anthropogenic disturbance and the magnitude of change in fluvial sediment dynamics is not straightforward and often non-linear. Here, we review a number of case studies from contrasting environmental settings in the European loess belt, the Eastern Mediterranean mountain ranges and the eastern USA. Detailed field-based sediment archive studies and sediment budgets covering time periods ranging from 200 to over 5000 year, as well as the use of pollen and sediment provenance techniques, show that no overarching concept of changes in floodplain sedimentation following anthropogenic disturbance can be established. Slope-channel (dis)connectivity controls the existence of thresholds or tipping points that need to be crossed before significant changes in downstream sediment dynamics are recorded following human impact. This coupling can be related to characteristics of human pressure such as its duration, intensity and spatial patterns, but also to the geomorphic and tectonic setting. Furthermore, internal feedback mechanisms, such as those between erosion and soil thickness, further complicate the story. All these factors controlling the propagation of sediment from eroding hillslopes to river channels vary between regions. Hence, only unique patterns of fluvial geomorphic response can be identified. As a result, unravelling the human impact from current-day sediment archives and predicting the impact of future human disturbances on fluvial sediment dynamics remain a major challenge. This has important implications for interpreting contemporary sediment yields as well as downstream sediment records in large floodplains, deltas and the marine

  17. Investigation of clinical pharmacokinetic variability of an opioid antagonist through physiologically based absorption modeling.

    Science.gov (United States)

    Ding, Xuan; He, Minxia; Kulkarni, Rajesh; Patel, Nita; Zhang, Xiaoyu

    2013-08-01

    Identifying the source of inter- and/or intrasubject variability in pharmacokinetics (PK) provides fundamental information in understanding the pharmacokinetics-pharmacodynamics relationship of a drug and project its efficacy and safety in clinical populations. This identification process can be challenging given that a large number of potential causes could lead to PK variability. Here we present an integrated approach of physiologically based absorption modeling to investigate the root cause of unexpectedly high PK variability of a Phase I clinical trial drug. LY2196044 exhibited high intersubject variability in the absorption phase of plasma concentration-time profiles in humans. This could not be explained by in vitro measurements of drug properties and excellent bioavailability with low variability observed in preclinical species. GastroPlus™ modeling suggested that the compound's optimal solubility and permeability characteristics would enable rapid and complete absorption in preclinical species and in humans. However, simulations of human plasma concentration-time profiles indicated that despite sufficient solubility and rapid dissolution of LY2196044 in humans, permeability and/or transit in the gastrointestinal (GI) tract may have been negatively affected. It was concluded that clinical PK variability was potentially due to the drug's antagonism on opioid receptors that affected its transit and absorption in the GI tract. Copyright © 2013 Wiley Periodicals, Inc.

  18. Correlation between measured energy expenditure and clinically obtained variables in trauma and sepsis patients.

    Science.gov (United States)

    Frankenfield, D C; Omert, L A; Badellino, M M; Wiles, C E; Bagley, S M; Goodarzi, S; Siegel, J H

    1994-01-01

    Indirect calorimetry is the preferred method for determining caloric requirements of patients, but availability of the device is limited by high cost. A study was therefore conducted to determine whether clinically obtainable variables could be used to predict metabolic rate. Patients with severe trauma or sepsis who required mechanical ventilation were measured by an open-circuit indirect calorimeter. Several clinical variables were obtained simultaneously. Measurements were repeated every 12 hours for up to 10 days. Twenty-six trauma and 30 sepsis patients were measured 423 times. Mean resting energy expenditure was 36 +/- 7 kcal/kg (trauma) vs 45 +/- 8 kcal/kg (sepsis) (p types.

  19. Amplitude variability over trials in hemodynamic responses in adolescents with ADHD

    DEFF Research Database (Denmark)

    Sørensen, L; Eichele, T; van Wageningen, H

    2016-01-01

    variable response times. In this study, we asked whether ADHD IIV in reaction time on a commonly-used test of attention might be related to variation in hemodynamic responses (HRs) observed trial-to-trial. Based on previous studies linking IIV to regions within the "default mode" network (DMN), we...... predicted that adolescents with ADHD would have higher HR variability in the DMN compared with controls, and this in turn would be related to behavioral IIV. We also explored the influence of social anxiety on HR variability in ADHD as means to test whether higher arousal associated with high trait anxiety...... would affect the neural abnormalities. We assessed single-trial variability of HRs, estimated from fMRI event-related responses elicited during an auditory oddball paradigm in adolescents with ADHD and healthy controls (11-18 years old; N = 46). Adolescents with ADHD had higher HR variability compared...

  20. Using dual response surfaces to reduce variability in launch vehicle design: A case study

    International Nuclear Information System (INIS)

    Yeniay, Ozgur; Unal, Resit; Lepsch, Roger A.

    2006-01-01

    Space transportation system conceptual design is a multidisciplinary process containing considerable element of risk. Uncertainties from one engineering discipline may propagate to another through linking parameters and the final system output may have an accumulation of risk. This may lead to significant deviations from expected performance. An estimate of variability or design risk therefore becomes essential for a robust design. This study utilizes the dual response surface approach to quantify variability in critical performance characteristics during conceptual design phase of a launch vehicle. Using design of experiments methods and disciplinary design analysis codes, dual response surfaces are constructed for the mean and standard deviation to quantify variability in vehicle weight and sizing analysis. Next, an optimum solution is sought to minimize variability subject to a constraint on mean weight. In this application, the dual response surface approach lead to quantifying and minimizing variability without much increase in design effort

  1. Epidemiological and clinical variables related with the predominant polarity on bipolar disorder: A systematic review.

    Science.gov (United States)

    García-Jiménez, Jesús; Álvarez-Fernández, Marisol; Aguado-Bailón, Lidia; Gutiérrez-Rojas, Luis

    2017-08-14

    Current classification of bipolar disorder (BD) in type i or type ii, however useful, may be insufficient to provide relevant clinical information in some patients. As a result, complementary classifications are being proposed, like the predominant polarity (PP) based, which is defined as a clear tendency in the patient to present relapses in the manic or depressive poles. We carried out a search in PubMed and Web of Science databases, following the Preferred Items for Reporting of Systematic Reviews and Meta-Analyses -PRISMA- guidelines, to identify studies about BD reporting PP. The search is updated to June 2016. Initial search revealed 907 articles, of which 16 met inclusion criteria. Manic PP was found to be associated with manic onset, drug consumption prior to onset and a better response to atypical antipsychotics and mood stabilisers. Depressive PP showed an association with depressive onset, more relapses, prolonged acute episodes, a greater suicide risk and a later diagnosis of BD. Depressive PP was also associated with anxiety disorders, mixed symptoms, melancholic symptoms and a wider use of quetiapine and lamotrigine. Few prospective studies. Variability in some results. PP may be useful as a supplement to current BD classifications. We have found consistent data on a great number of studies, but there is also contradictory information regarding PP. Further studies are needed, ideally of a prospective design and with a unified methodology. Copyright © 2017 SEP y SEPB. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Capturing the dynamics of response variability in the brain in ADHD

    Directory of Open Access Journals (Sweden)

    Janna van Belle

    2015-01-01

    Full Text Available ADHD is characterized by increased intra-individual variability in response times during the performance of cognitive tasks. However, little is known about developmental changes in intra-individual variability, and how these changes relate to cognitive performance. Twenty subjects with ADHD aged 7–24 years and 20 age-matched, typically developing controls participated in an fMRI-scan while they performed a go-no-go task. We fit an ex-Gaussian distribution on the response distribution to objectively separate extremely slow responses, related to lapses of attention, from variability on fast responses. We assessed developmental changes in these intra-individual variability measures, and investigated their relation to no-go performance. Results show that the ex-Gaussian measures were better predictors of no-go performance than traditional measures of reaction time. Furthermore, we found between-group differences in the change in ex-Gaussian parameters with age, and their relation to task performance: subjects with ADHD showed age-related decreases in their variability on fast responses (sigma, but not in lapses of attention (tau, whereas control subjects showed a decrease in both measures of variability. For control subjects, but not subjects with ADHD, this age-related reduction in variability was predictive of task performance. This group difference was reflected in neural activation: for typically developing subjects, the age-related decrease in intra-individual variability on fast responses (sigma predicted activity in the dorsal anterior cingulate gyrus (dACG, whereas for subjects with ADHD, activity in this region was related to improved no-go performance with age, but not to intra-individual variability. These data show that using more sophisticated measures of intra-individual variability allows the capturing of the dynamics of task performance and associated neural changes not permitted by more traditional measures.

  3. A plant's perspective of extremes: terrestrial plant responses to changing climatic variability.

    Science.gov (United States)

    Reyer, Christopher P O; Leuzinger, Sebastian; Rammig, Anja; Wolf, Annett; Bartholomeus, Ruud P; Bonfante, Antonello; de Lorenzi, Francesca; Dury, Marie; Gloning, Philipp; Abou Jaoudé, Renée; Klein, Tamir; Kuster, Thomas M; Martins, Monica; Niedrist, Georg; Riccardi, Maria; Wohlfahrt, Georg; de Angelis, Paolo; de Dato, Giovanbattista; François, Louis; Menzel, Annette; Pereira, Marízia

    2013-01-01

    We review observational, experimental, and model results on how plants respond to extreme climatic conditions induced by changing climatic variability. Distinguishing between impacts of changing mean climatic conditions and changing climatic variability on terrestrial ecosystems is generally underrated in current studies. The goals of our review are thus (1) to identify plant processes that are vulnerable to changes in the variability of climatic variables rather than to changes in their mean, and (2) to depict/evaluate available study designs to quantify responses of plants to changing climatic variability. We find that phenology is largely affected by changing mean climate but also that impacts of climatic variability are much less studied, although potentially damaging. We note that plant water relations seem to be very vulnerable to extremes driven by changes in temperature and precipitation and that heat-waves and flooding have stronger impacts on physiological processes than changing mean climate. Moreover, interacting phenological and physiological processes are likely to further complicate plant responses to changing climatic variability. Phenological and physiological processes and their interactions culminate in even more sophisticated responses to changing mean climate and climatic variability at the species and community level. Generally, observational studies are well suited to study plant responses to changing mean climate, but less suitable to gain a mechanistic understanding of plant responses to climatic variability. Experiments seem best suited to simulate extreme events. In models, temporal resolution and model structure are crucial to capture plant responses to changing climatic variability. We highlight that a combination of experimental, observational, and/or modeling studies have the potential to overcome important caveats of the respective individual approaches. © 2012 Blackwell Publishing Ltd.

  4. A plant’s perspective of extremes: Terrestrial plant responses to changing climatic variability

    Science.gov (United States)

    Reyer, C.; Leuzinger, S.; Rammig, A.; Wolf, A.; Bartholomeus, R. P.; Bonfante, A.; de Lorenzi, F.; Dury, M.; Gloning, P.; Abou Jaoudé, R.; Klein, T.; Kuster, T. M.; Martins, M.; Niedrist, G.; Riccardi, M.; Wohlfahrt, G.; de Angelis, P.; de Dato, G.; François, L.; Menzel, A.; Pereira, M.

    2013-01-01

    We review observational, experimental and model results on how plants respond to extreme climatic conditions induced by changing climatic variability. Distinguishing between impacts of changing mean climatic conditions and changing climatic variability on terrestrial ecosystems is generally underrated in current studies. The goals of our review are thus (1) to identify plant processes that are vulnerable to changes in the variability of climatic variables rather than to changes in their mean, and (2) to depict/evaluate available study designs to quantify responses of plants to changing climatic variability. We find that phenology is largely affected by changing mean climate but also that impacts of climatic variability are much less studied but potentially damaging. We note that plant water relations seem to be very vulnerable to extremes driven by changes in temperature and precipitation and that heatwaves and flooding have stronger impacts on physiological processes than changing mean climate. Moreover, interacting phenological and physiological processes are likely to further complicate plant responses to changing climatic variability. Phenological and physiological processes and their interactions culminate in even more sophisticated responses to changing mean climate and climatic variability at the species and community level. Generally, observational studies are well suited to study plant responses to changing mean climate, but less suitable to gain a mechanistic understanding of plant responses to climatic variability. Experiments seem best suited to simulate extreme events. In models, temporal resolution and model structure are crucial to capture plant responses to changing climatic variability. We highlight that a combination of experimental, observational and /or modeling studies have the potential to overcome important caveats of the respective individual approaches. PMID:23504722

  5. The Variability of Neural Responses to Naturalistic Videos Change with Age and Sex.

    Science.gov (United States)

    Petroni, Agustin; Cohen, Samantha S; Ai, Lei; Langer, Nicolas; Henin, Simon; Vanderwal, Tamara; Milham, Michael P; Parra, Lucas C

    2018-01-01

    Neural development is generally marked by an increase in the efficiency and diversity of neural processes. In a large sample ( n = 114) of human children and adults with ages ranging from 5 to 44 yr, we investigated the neural responses to naturalistic video stimuli. Videos from both real-life classroom settings and Hollywood feature films were used to probe different aspects of attention and engagement. For all stimuli, older ages were marked by more variable neural responses. Variability was assessed by the intersubject correlation of evoked electroencephalographic responses. Young males also had less-variable responses than young females. These results were replicated in an independent cohort ( n = 303). When interpreted in the context of neural maturation, we conclude that neural function becomes more variable with maturity, at least during the passive viewing of real-world stimuli.

  6. A Composite Likelihood Inference in Latent Variable Models for Ordinal Longitudinal Responses

    Science.gov (United States)

    Vasdekis, Vassilis G. S.; Cagnone, Silvia; Moustaki, Irini

    2012-01-01

    The paper proposes a composite likelihood estimation approach that uses bivariate instead of multivariate marginal probabilities for ordinal longitudinal responses using a latent variable model. The model considers time-dependent latent variables and item-specific random effects to be accountable for the interdependencies of the multivariate…

  7. RBE and clinical response in radiotherapy with neutron beams

    International Nuclear Information System (INIS)

    Ellis, F.

    1984-01-01

    Consideration of the clinical results reported, when a cyclotron produced neutron beam was used for treatments in the pelvis region, suggested that a constant RBE of 3 should not have been used for all neutron doses. Instead a variable RBE, which increased from approximately 3 to 8 (with decreasing dose), should have been used. Although some of these RBE values are much higher than 3, they have been observed in clinical practice. An ''equivalent photon'' isodose plan was produced by employing a variable RBE and, by taking a TDF limit of 86 for bowel, an isoeffect plan was produced. This shows that in the clinical situation under consideration much of the pelvis was overdosed. Doses to tumour cells and late effects are also briefly considered. It is suggested that, in neutron therapy, both an ''equivalent photon'' isodose plan and an isoeffect plan should be produced prior to treatment. (author)

  8. Tracer responses and control of vessels with variable flow and volume

    International Nuclear Information System (INIS)

    Niemi, A.J.

    1990-01-01

    Continuous flow vessels which are subject to variation of flow and volume are characterized by time-variable parameters. It is shown that their residence time distributions and weighting functions obtained by tracer testing are made invariant with regard to the integrated flow variables which are introduced. Under variable flow but constant volume, one such integrated variable is sufficient. Under variable volume, two different variables are suggested for the residence time distribution and weighting function, while the appropriate variable of the perfect mixer differs distinctly from that of vessels with a distinct velocity profile. It is shown through a number of example cases, that an agreement with their mathematical models is reached. The approach is extended to include also arbitrary, non-analytic response functions obtained by tracer measurements. Applications of the derived models and their incorporation in automatic control algorithms is discussed. (orig.) [de

  9. Undergraduate Nurse Variables that Predict Academic Achievement and Clinical Competence in Nursing

    Science.gov (United States)

    Blackman, Ian; Hall, Margaret; Darmawan, I Gusti Ngurah.

    2007-01-01

    A hypothetical model was formulated to explore factors that influenced academic and clinical achievement for undergraduate nursing students. Sixteen latent variables were considered including the students' background, gender, type of first language, age, their previous successes with their undergraduate nursing studies and status given for…

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

    Science.gov (United States)

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

    2010-08-01

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

  11. Changes in sleep polygraphic variables and clinical state in depressed patients during treatment with citalopram

    NARCIS (Netherlands)

    Bemmel, Alex L. van; Hoofdakker, Rutger H. van den; Beersma, Domien G.M.; Bouhuys, Antoinette L.

    1993-01-01

    Drug-induced improvement of depression may be mediated by changes in sleep physiology. The aim of this study was to relate changes in sleep polygraphic variables to clinical state during treatment with citalopram, a highly specific serotonin uptake inhibitor. Sixteen patients took part. The study

  12. Clinical implications of heterogeneity of tumor response to radiation therapy

    International Nuclear Information System (INIS)

    Suit, H.; Skates, S.; Taghian, A.; Okunieff, P.; Efird, J.T.

    1992-01-01

    Heterogeneity of response of tumor tissue to radiation clearly exists. Major parameters include histopathologic type, size (number of tumor rescue units (TRUs)), hemoglobin concentration, cell proliferation kinetics and immune rejection reaction by host. Further, normal and presumably tumor tissue response is altered in certain genetic diseases, e.g. ataxia telangiectasia. Any assessment of response of tumor tissue to a new treatment method or the testing of a new clinical response predictor is optimally based upon a narrow strata, viz., uniform with respect to known parameters of response, e.g. size, histological type. Even among tumors of such a clinical defined narrow strata, there will be residual heterogeneity with respect to inherent cellular radiation sensitivity, distributions of pO 2 , (SH), cell proliferation, etc. (author). 39 refs., 7 figs., 3 tabs

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

    Science.gov (United States)

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

    2016-06-01

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

  14. Within-person variability in response speed as an indicator of cognitive impairment in older adults.

    Science.gov (United States)

    Strauss, Esther; Bielak, Allison A M; Bunce, David; Hunter, Michael A; Hultsch, David F

    2007-11-01

    Within-person variability may be an important indicator of central nervous system compromise. In this study, within-person variability in response speed was examined in community-dwelling older adults, ages 64-92 years, using a new framework that takes into account both the extent (single versus multiple domains affected) and nature (amnestic versus non-amnestic) of the cognitive impairment. Those with multiple domains of impairment were more variable than those who showed an isolated area of impairment, regardless of whether memory was one of the domains affected. Further, for those with difficulties in two or more non-memory domains, increased variability was most evident in more cognitively demanding situations, when individuals had to manipulate information held briefly in mind, switch cognitive set or inhibit an automatic response. Finally, group differentiation was better achieved when within-person variability as opposed to mean speed of performance was considered.

  15. Study on Short-term Variability of Ship Responses in Waves

    DEFF Research Database (Denmark)

    Nielsen, Ulrik Dam; Iseki, Toshio

    2015-01-01

    Short-term variability of ship responses is investigated by cross-spectrum analysis. In a steady state condition, it is well known that a certain length of sampled data is required for stable results of the spectral analysis. However, the phase lag between responses, in terms of the phase angle o...

  16. The Paradox of Pelvic Exenteration: The Interaction of Clinical and Psychological Variables.

    Science.gov (United States)

    Arnaboldi, Paola; Santoro, Luigi; Mazzocco, Ketti; Oliveri, Serena; Maggioni, Angelo; Pravettoni, Gabriella

    2015-10-01

    To text the feasibility of a psychological intervention package administered to 49 pelvic exenteration candidates, aimed at evaluating the preoperative prevalence of psychological distress and assessing the presence of any correlation between preoperative psychological distress and clinical variables such as pain and hospitalization length. Patients were referred to the psychology unit from the very beginning of their clinical pathway and were administered the Psychological Distress Inventory (PDI) and the Mini-Mental Adjustment to Cancer (Mini-MAC) questionnaire at prehospital admission. Patients presenting with a significant level of distress received nonstandardized psychological support. Statistical analyses were performed to detect the presence of any correlation between psychological variables at prehospital admission and clinical outcomes. The 40% of patients had significant levels of distress at prehospital admission (PDI ≥ 30). As regards Mini-MAC, the mean value of fighting spirit attitude and fatalism was higher in our sample than in the normative sample of the Mini-MAC validation study in the Italian cancer population. Their anxious preoccupation attitude was lower. There were no correlations between clinical and psychological variables: level of postsurgery pain was higher (3.7) in the subgroup of patients with presurgery PDI < 30 compared with those with PDI ≥ 30 (3.5). However, this difference was not statistically significant (P = 1.00). Considering hospitalization length, the above described trend was similar. Although highly distressed, pelvic exenteration candidates show an adaptive range of coping mechanisms. This calls for a greater effort in studying the complexity of their psychoemotional status to provide them with the best multidisciplinary care. Extensive study of the real effectiveness of psychological intervention is warranted: randomized clinical trials could help in detecting the presence of any correlation between clinical and

  17. Variability in clinical data is often more useful than the mean: illustration of concept and simple methods of assessment

    NARCIS (Netherlands)

    Zwinderman, A. H.; Cleophas, T. J.

    2005-01-01

    BACKGROUND: Clinical investigators, although they are generally familiar with testing differences between averages, have difficulty testing differences between variabilities. OBJECTIVE: To give examples of situations where variability is more relevant than averages and to describe simple methods for

  18. Partial clinical response to anakinra in severe palmoplantar pustular psoriasis.

    Science.gov (United States)

    Tauber, M; Viguier, M; Alimova, E; Petit, A; Lioté, F; Smahi, A; Bachelez, H

    2014-09-01

    Palmoplantar pustular psoriasis is a clinical psoriasis variant characterised by a high impact on quality of life and poor response to biologics approved for plaque type psoriasis.The recombinant interleukin-1 (IL-1) receptor antagonist anakinra has been recently used for the treatment of isolated refractory cases of generalised pustular psoriasis with contrasted results. To report the clinical response in two patients treated with anakinra as salvage therapy in two patients with severe palmoplantar pustular psoriasis refractory to currently available antipsoriatic systemic therapies. Anakinra was given subcutaneously at the daily dose of 100 mg, and clinical response was evaluated using the palmoplantar psoriasis area and severity index (PPPASI). Only partial and transient responses were observed in both patients, who had to stop anakinra due to lack of efficacy and to side effects. Anakinra appears to provide only partial clinical improvement in refractory palmoplantar pustular psoriasis. Prospective clinical studies on larger populations are warranted to investigate more accurately both efficacy and safety of IL-1-inhibiting strategies in pustular psoriasis. © 2014 British Association of Dermatologists.

  19. Physicians’ Professionally Responsible Power: A Core Concept of Clinical Ethics

    Science.gov (United States)

    McCullough, Laurence B.

    2016-01-01

    The gathering of power unto themselves by physicians, a process supported by evidence-based practice, clinical guidelines, licensure, organizational culture, and other social factors, makes the ethics of power—the legitimation of physicians’ power—a core concept of clinical ethics. In the absence of legitimation, the physician’s power over patients becomes problematic, even predatory. As has occurred in previous issues of the Journal, the papers in the 2016 clinical ethics issue bear on the professionally responsible deployment of power by physicians. This introduction explores themes of physicians’ power in papers from an international group of authors who address autonomy and trust, the virtues of perinatal hospice, conjoined twins in ethics and law, addiction and autonomy in clinical research on addicting substances, euthanasia of patients with dementia in Belgium, and a pragmatic approach to clinical futility. PMID:26671961

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

    Science.gov (United States)

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

    2014-12-30

    For determining a manageable set of covariates potentially influential with respect to a time-to-event endpoint, Cox proportional hazards models can be combined with variable selection techniques, such as stepwise forward selection or backward elimination based on p-values, or regularized regression techniques such as component-wise boosting. Cox regression models have also been adapted for dealing with more complex event patterns, for example, for competing risks settings with separate, cause-specific hazard models for each event type, or for determining the prognostic effect pattern of a variable over different landmark times, with one conditional survival model for each landmark. Motivated by a clinical cancer registry application, where complex event patterns have to be dealt with and variable selection is needed at the same time, we propose a general approach for linking variable selection between several Cox models. Specifically, we combine score statistics for each covariate across models by Fisher's method as a basis for variable selection. This principle is implemented for a stepwise forward selection approach as well as for a regularized regression technique. In an application to data from hepatocellular carcinoma patients, the coupled stepwise approach is seen to facilitate joint interpretation of the different cause-specific Cox models. In conditional survival models at landmark times, which address updates of prediction as time progresses and both treatment and other potential explanatory variables may change, the coupled regularized regression approach identifies potentially important, stably selected covariates together with their effect time pattern, despite having only a small number of events. These results highlight the promise of the proposed approach for coupling variable selection between Cox models, which is particularly relevant for modeling for clinical cancer registries with their complex event patterns. Copyright © 2014 John Wiley & Sons

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

    Science.gov (United States)

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

    2015-10-01

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

  2. A study of the variability in the febrile responses of rabbits to endogenous pyrogen.

    Science.gov (United States)

    Stitt, J T

    1985-10-01

    The range of body temperature increases elicited by a standard dose of endogenous pyrogen (0.5 ml/kg iv) was examined in a population of 26 male New Zealand White rabbits. Although the mean maximum increase in rectal temperature was 0.88 +/- 0.06 degree C (SE), individual responses varied from 0.4 degree to 1.5 degree C. Three representative animals that responded to the standard dose of pyrogen with small, intermediate, and large febrile responses were selected and challenged with the same dose of pyrogen on eight separate occasions, and the variability of these responses was examined. There was little variability within the characteristic responses of any particular animal to the repeated challenges. The variability of the febrile responses elicited by both intravenous and intracerebroventricular administration of the same pyrogen was examined and compared using another group of 11 rabbits. The variability in response to the intravenous route was similar to that found in the larger population, whereas the variation in response to the intracerebroventricular route was smaller, and all 11 animals had fevers that were greater than 1 degrees C. It is concluded that the variability of the febrile responses of rabbits to intravenous pyrogen was due to differences between individual sensitivities of animals to the intravenously administered pyrogen. This difference in sensitivity may be due to a difference in the amount of pyrogen that reaches the putative receptor sites, or to a difference in the density or effectiveness of receptor sites in translating the pyrogenic stimulus into a fever response.

  3. Effects of Amerindian Genetic Ancestry on Clinical Variables and Therapy in Patients with Rheumatoid Arthritis.

    Science.gov (United States)

    Sánchez, Elena; García de la Torre, Ignacio; Sacnún, Mónica; Goñi, Mario; Berbotto, Guillermo; Paira, Sergio; Musuruana, Jorge Luis; Graf, César; Alvarellos, Alejandro; Messina, Osvaldo D; Babini, Alejandra; Strusberg, Ingrid; Marcos, Juan Carlos; Scherbarth, Hugo; Spindler, Alberto; Quinteros, Ana; Toloza, Sergio; Moreno, José Luis C; Catoggio, Luis J; Tate, Guillermo; Eimon, Alicia; Citera, Gustavo; Pellet, Antonio Catalán; Nasswetter, Gustavo; Cardiel, Mario H; Miranda, Pedro; Ballesteros, Francisco; Esquivel-Valerio, Jorge A; Maradiaga-Ceceña, Marco A; Acevedo-Vásquez, Eduardo M; García, Conrado García; Tusié-Luna, Teresa; Pons-Estel, Bernardo A; Alarcón-Riquelme, Marta E

    2017-12-01

    To define whether Amerindian genetic ancestry correlates with clinical and therapeutic variables in admixed individuals with rheumatoid arthritis (RA) from Latin America. Patients with RA (n = 1347) and healthy controls (n = 1012) from Argentina, Mexico, Chile, and Peru were included. Samples were genotyped for the Immunochip v1 using the Illumina platform. Clinical data were obtained through interviews or the clinical history. Percentage of Amerindian ancestry was comparable between cases and controls. Morning stiffness (p ancestry after Bonferroni correction. Higher Amerindian ancestry correlated only with weight loss (p Bonferroni ancestry correlated with higher doses of azathioprine (p ancestry protects against most major clinical criteria of RA, but regarding the association of RF with increased European ancestry, age, sex, and smoking are modifiers. Ancestry also correlates with the therapeutic profiles.

  4. Childhood asthma clusters and response to therapy in clinical trials.

    Science.gov (United States)

    Chang, Timothy S; Lemanske, Robert F; Mauger, David T; Fitzpatrick, Anne M; Sorkness, Christine A; Szefler, Stanley J; Gangnon, Ronald E; Page, C David; Jackson, Daniel J

    2014-02-01

    Childhood asthma clusters, or subclasses, have been developed by computational methods without evaluation of clinical utility. To replicate and determine whether childhood asthma clusters previously identified computationally in the Severe Asthma Research Program (SARP) are associated with treatment responses in Childhood Asthma Research and Education (CARE) Network clinical trials. A cluster assignment model was determined by using SARP participant data. A total of 611 participants 6 to 18 years old from 3 CARE trials were assigned to SARP pediatric clusters. Primary and secondary outcomes were analyzed by cluster in each trial. CARE participants were assigned to SARP clusters with high accuracy. Baseline characteristics were similar between SARP and CARE children of the same cluster. Treatment response in CARE trials was generally similar across clusters. However, with the caveat of a smaller sample size, children in the early-onset/severe-lung function cluster had best response with fluticasone/salmeterol (64% vs 23% 2.5× fluticasone and 13% fluticasone/montelukast in the Best ADd-on Therapy Giving Effective Responses trial; P = .011) and children in the early-onset/comorbidity cluster had the least clinical efficacy to treatments (eg, -0.076% change in FEV1 in the Characterizing Response to Leukotriene Receptor Antagonist and Inhaled Corticosteroid trial). In this study, we replicated SARP pediatric asthma clusters by using a separate, large clinical trials network. Early-onset/severe-lung function and early-onset/comorbidity clusters were associated with differential and limited response to therapy, respectively. Further prospective study of therapeutic response by cluster could provide new insights into childhood asthma treatment. Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.

  5. Spectral Kernel Approach to Study Radiative Response of Climate Variables and Interannual Variability of Reflected Solar Spectrum

    Science.gov (United States)

    Jin, Zhonghai; Wielicki, Bruce A.; Loukachine, Constantin; Charlock, Thomas P.; Young, David; Noeel, Stefan

    2011-01-01

    The radiative kernel approach provides a simple way to separate the radiative response to different climate parameters and to decompose the feedback into radiative and climate response components. Using CERES/MODIS/Geostationary data, we calculated and analyzed the solar spectral reflectance kernels for various climate parameters on zonal, regional, and global spatial scales. The kernel linearity is tested. Errors in the kernel due to nonlinearity can vary strongly depending on climate parameter, wavelength, surface, and solar elevation; they are large in some absorption bands for some parameters but are negligible in most conditions. The spectral kernels are used to calculate the radiative responses to different climate parameter changes in different latitudes. The results show that the radiative response in high latitudes is sensitive to the coverage of snow and sea ice. The radiative response in low latitudes is contributed mainly by cloud property changes, especially cloud fraction and optical depth. The large cloud height effect is confined to absorption bands, while the cloud particle size effect is found mainly in the near infrared. The kernel approach, which is based on calculations using CERES retrievals, is then tested by direct comparison with spectral measurements from Scanning Imaging Absorption Spectrometer for Atmospheric Cartography (SCIAMACHY) (a different instrument on a different spacecraft). The monthly mean interannual variability of spectral reflectance based on the kernel technique is consistent with satellite observations over the ocean, but not over land, where both model and data have large uncertainty. RMS errors in kernel ]derived monthly global mean reflectance over the ocean compared to observations are about 0.001, and the sampling error is likely a major component.

  6. A latent class distance association model for cross-classified data with a categorical response variable.

    Science.gov (United States)

    Vera, José Fernando; de Rooij, Mark; Heiser, Willem J

    2014-11-01

    In this paper we propose a latent class distance association model for clustering in the predictor space of large contingency tables with a categorical response variable. The rows of such a table are characterized as profiles of a set of explanatory variables, while the columns represent a single outcome variable. In many cases such tables are sparse, with many zero entries, which makes traditional models problematic. By clustering the row profiles into a few specific classes and representing these together with the categories of the response variable in a low-dimensional Euclidean space using a distance association model, a parsimonious prediction model can be obtained. A generalized EM algorithm is proposed to estimate the model parameters and the adjusted Bayesian information criterion statistic is employed to test the number of mixture components and the dimensionality of the representation. An empirical example highlighting the advantages of the new approach and comparing it with traditional approaches is presented. © 2014 The British Psychological Society.

  7. Heart rate variability response to mental arithmetic stress in patients with schizophrenia Autonomic response to stress in schizophrenia

    NARCIS (Netherlands)

    Castro, Mariana N.; Vigo, Daniel E.; Weidema, Hylke; Fahrer, Rodolfo D.; Chu, Elvina M.; De Achaval, Delfina; Nogues, Martin; Leiguarda, Ramon C.; Cardinali, Daniel P.; Guinjoan, Salvador N.

    Background: The vulnerability-stress hypothesis is an established model of schizophrenia symptom formation. We sought to characterise the pattern of the cardiac autonomic response to mental arithmetic stress in patients with stable schizophrenia. Methods: We performed heart rate variability (HRV)

  8. Assessing data quality and the variability of source data verification auditing methods in clinical research settings.

    Science.gov (United States)

    Houston, Lauren; Probst, Yasmine; Martin, Allison

    2018-05-18

    Data audits within clinical settings are extensively used as a major strategy to identify errors, monitor study operations and ensure high-quality data. However, clinical trial guidelines are non-specific in regards to recommended frequency, timing and nature of data audits. The absence of a well-defined data quality definition and method to measure error undermines the reliability of data quality assessment. This review aimed to assess the variability of source data verification (SDV) auditing methods to monitor data quality in a clinical research setting. The scientific databases MEDLINE, Scopus and Science Direct were searched for English language publications, with no date limits applied. Studies were considered if they included data from a clinical trial or clinical research setting and measured and/or reported data quality using a SDV auditing method. In total 15 publications were included. The nature and extent of SDV audit methods in the articles varied widely, depending upon the complexity of the source document, type of study, variables measured (primary or secondary), data audit proportion (3-100%) and collection frequency (6-24 months). Methods for coding, classifying and calculating error were also inconsistent. Transcription errors and inexperienced personnel were the main source of reported error. Repeated SDV audits using the same dataset demonstrated ∼40% improvement in data accuracy and completeness over time. No description was given in regards to what determines poor data quality in clinical trials. A wide range of SDV auditing methods are reported in the published literature though no uniform SDV auditing method could be determined for "best practice" in clinical trials. Published audit methodology articles are warranted for the development of a standardised SDV auditing method to monitor data quality in clinical research settings. Copyright © 2018. Published by Elsevier Inc.

  9. Inter- and intrapatient variability of facial nerve response areas in the floor of the fourth ventricle.

    Science.gov (United States)

    Bertalanffy, Helmut; Tissira, Nadir; Krayenbühl, Niklaus; Bozinov, Oliver; Sarnthein, Johannes

    2011-03-01

    Surgical exposure of intrinsic brainstem lesions through the floor of the 4th ventricle requires precise identification of facial nerve (CN VII) fibers to avoid damage. To assess the shape, size, and variability of the area where the facial nerve can be stimulated electrophysiologically on the surface of the rhomboid fossa. Over a period of 18 months, 20 patients were operated on for various brainstem and/or cerebellar lesions. Facial nerve fibers were stimulated to yield compound muscle action potentials (CMAP) in the target muscles. Using the sites of CMAP yield, a detailed functional map of the rhomboid fossa was constructed for each patient. Lesions resected included 14 gliomas, 5 cavernomas, and 1 epidermoid cyst. Of 40 response areas mapped, 19 reached the median sulcus. The distance from the obex to the caudal border of the response area ranged from 8 to 27 mm (median, 17 mm). The rostrocaudal length of the response area ranged from 2 to 15 mm (median, 5 mm). Facial nerve response areas showed large variability in size and position, even in patients with significant distance between the facial colliculus and underlying pathological lesion. Lesions located close to the facial colliculus markedly distorted the response area. This is the first documentation of variability in the CN VII response area in the rhomboid fossa. Knowledge of this remarkable variability may facilitate the assessment of safe entry zones to the brainstem and may contribute to improved outcome following neurosurgical interventions within this sensitive area of the brain.

  10. Visit-to-visit cholesterol variability correlates with coronary atheroma progression and clinical outcomes.

    Science.gov (United States)

    Clark, Donald; Nicholls, Stephen J; St John, Julie; Elshazly, Mohamed B; Kapadia, Samir R; Tuzcu, E Murat; Nissen, Steven E; Puri, Rishi

    2018-04-21

    Utilizing serial intravascular ultrasonography (IVUS), we aimed to exam the association of intra-individual lipid variability, coronary atheroma progression, and clinical outcomes. We performed a post hoc patient-level analysis of nine clinical trials involving 4976 patients with coronary artery disease who underwent serial coronary IVUS in the setting of a range of medical therapies. We assessed the associations between progression in percent atheroma volume (ΔPAV), clinical outcomes, and visit-to-visit lipid variability including low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), non-HDL-C, total cholesterol (TC)/HDL-C, and apolipoprotein B (ApoB). Variability of lipid parameters was measured using intra-individual standard deviation over 3, 6, 12, 18, and 24 months. Atherogenic lipoprotein variability significantly associated with ΔPAV [odds ratio (95% confidence interval; P-value), LDL-C: 1.09 (1.02, 1.17, P = 0.01); non-HDL-C: 1.10 (1.02, 1.18, P = 0.01); TC/HDL-C: 1.14 (1.06, 1.24, P = 0.001); ApoB: 1.13 (1.03, 1.24, P = 0.01)]. Survival curves revealed significant stepwise relationships between cumulative major adverse cardiovascular events and increasing quartiles of atherogenic lipoprotein variability at 24-months follow-up (log-rank P C). Stronger associations were noted between achieved lipoprotein levels and ΔPAV [LDL-C: 1.27 (1.17, 1.39; P C: 1.32 (1.21, 1.45; P C: 1.31 (1.19, 1.45; P < 0.001); ApoB: 1.20 (1.07, 1.35; P = 0.003)]. Greater visit-to-visit variability in atherogenic lipoprotein levels significantly associates with coronary atheroma progression and clinical outcomes, although the association between achieved atherogenic lipoproteins and atheroma progression appears stronger. These data highlight the importance of achieving low and consistent atherogenic lipoprotein levels to promote plaque regression and improve clinical outcomes.

  11. Selection of response criteria for clinical trials of sarcoma treatment.

    Science.gov (United States)

    Schuetze, Scott M; Baker, Laurence H; Benjamin, Robert S; Canetta, Renzo

    2008-01-01

    Soft tissue sarcomas are a heterogeneous group of malignancies arising from mesenchymal tissues. A large number of new therapies are being evaluated in patients with sarcomas, and consensus criteria defining treatment responses are essential for comparison of results from studies completed by different research groups. The 1979 World Health Organization (WHO) handbook set forth operationally defined criteria for response evaluation in solid tumors that were updated in 2000 with the publication of the Response Evaluation Criteria in Solid Tumors (RECIST). There have been significant advances in tumor imaging, however, that are not reflected in the RECIST. For example, computed tomography (CT) slice thickness has been reduced from 10 mm to < or =2.5 mm, allowing for more reproducible and accurate measurement of smaller lesions. Combination of imaging techniques, such as positron emission tomography with fluorine-18-fluorodeoxyglucose (18FDG-PET) and CT can provide investigators and clinicians with both anatomical and functional information regarding tumors, and there is now a large body of evidence demonstrating the effectiveness of PET/CT and other newer imaging methods for the detection and staging of tumors as well as early determination of responses to therapy. The application of newer imaging methods has the potential to decrease both the sample sizes required for, and duration of, clinical trials by providing an early indication of therapeutic response that is well correlated with clinical outcomes, such as time to tumor progression or overall survival. The results summarized in this review support the conclusion that the RECIST and the WHO criteria for evaluation of response in solid tumors need to be modernized. In addition, there is a current need for prospective trials to compare new response criteria with established endpoints and to validate imaging-based response rates as surrogate endpoints for clinical trials of new agents for sarcoma and other solid

  12. Logic Learning Machine and standard supervised methods for Hodgkin's lymphoma prognosis using gene expression data and clinical variables.

    Science.gov (United States)

    Parodi, Stefano; Manneschi, Chiara; Verda, Damiano; Ferrari, Enrico; Muselli, Marco

    2018-03-01

    This study evaluates the performance of a set of machine learning techniques in predicting the prognosis of Hodgkin's lymphoma using clinical factors and gene expression data. Analysed samples from 130 Hodgkin's lymphoma patients included a small set of clinical variables and more than 54,000 gene features. Machine learning classifiers included three black-box algorithms ( k-nearest neighbour, Artificial Neural Network, and Support Vector Machine) and two methods based on intelligible rules (Decision Tree and the innovative Logic Learning Machine method). Support Vector Machine clearly outperformed any of the other methods. Among the two rule-based algorithms, Logic Learning Machine performed better and identified a set of simple intelligible rules based on a combination of clinical variables and gene expressions. Decision Tree identified a non-coding gene ( XIST) involved in the early phases of X chromosome inactivation that was overexpressed in females and in non-relapsed patients. XIST expression might be responsible for the better prognosis of female Hodgkin's lymphoma patients.

  13. Ecological response of Cedrus atlantica to climate variability in the Massif of Guetiane (Algeria

    Directory of Open Access Journals (Sweden)

    Said Slimani

    2014-12-01

    Full Text Available Aim of the study: The study analyzes the long-term response of Atlas cedar, Cedrus atlantica (Manneti, to climate variability. Area of study: Atlas cedar forest of Guetiane (Batna, Algeria.Material and methods: The dendrochronological approach was adopted. An Atlas cedar tree-ring chronology was established from twenty trees. The response of the species to climate variability was assessed through the pointer years (PYs, the common climate signal among the individual chronologies, expressed by the first component (PC1, the mean sensitivity (msx, and response function and correlations analysis involving the tree-ring index and climate data (monthly mean temperature and total precipitation.Results: The highest growth variability was registered from the second half of the 20th century. The lower than the mean PYs, the PC1, and the msx increased markedly during the studied period. Dramatic increases in the PC1 and msx were detected at the end of the 1970s, reflecting a shift towards drier conditions enhancing an increasing trend towards more synchronous response of trees to climate conditions. The response function and correlations analysis showed that tree growth was mainly influenced by precipitation variability.Research highlights: Our findings provide baseline knowledge concerning the ecological response of Atlas cedar to climate variability in in its southern distribution limit, where a high level of tree mortality has been observed during recent decades, coinciding with the driest period Algeria has ever experienced. This information is vital to support ongoing ecosystem management efforts in the region. Keywords: Atlas cedar; annual growth variability; dieback; dendrochronology. 

  14. Criteria for evaluating response and outcome in clinical trials for children with juvenile myelomonocytic leukemia.

    LENUS (Irish Health Repository)

    Niemeyer, Charlotte M

    2015-01-01

    Juvenile myelomonocytic leukemia is a rare myeloproliferative disease in young children. While hematopoietic stem cell transplantation remains the only curative therapeutic option for most patients, children with juvenile myelomonocytic leukemia increasingly receive novel agents in phase I-II clinical trials as pre-transplant therapy or therapy for relapse after transplantation. However, response criteria or definitions of outcome for standardized evaluation of treatment effect in patients with juvenile myelomonocytic leukemia are currently lacking. Here we propose criteria to evaluate the response to the non-transplant therapy and definitions of remission status after hematopoietic stem cell transplantation. For the evaluation of non-transplant therapy, we defined 6 clinical variables (white blood cell count, platelet count, hematopoietic precursors and blasts in peripheral blood, bone marrow blast percentage, spleen size and extramedullary disease) and 3 genetic variables (cytogenetic, molecular and chimerism response) which serve to describe the heterogeneous picture of response to therapy in each individual case. It is hoped that these criteria will facilitate the comparison of results between clinical trials in juvenile myelomonocytic leukemia.

  15. Admission Privileges and Clinical Responsibilities for Interventional Radiologists

    Energy Technology Data Exchange (ETDEWEB)

    Al-Kutoubi, Aghiad, E-mail: mk00@aub.edu.lb [The American University of Beirut Medical Center, IR Division, The Department of Diagnostic Radiology (Lebanon)

    2015-04-15

    Although clinical involvement by interventional radiologists in the care of their patients was advocated at the inception of the specialty, the change into the clinical paradigm has been slow and patchy for reasons related to pattern of practice, financial remuneration or absence of training. The case for the value of clinical responsibilities has been made in a number of publications and the consequences of not doing so have been manifest in the erosion of the role of the interventional radiologists particularly in the fields of peripheral vascular and neuro intervention. With the recent recognition of interventional radiology (IR) as a primary specialty in the USA and the formation of IR division in the Union of European Medical Specialists and subsequent recognition of the subspecialty in many European countries, it is appropriate to relook at the issue and emphasize the need for measures to promote the clinical role of the interventional radiologist.

  16. Admission Privileges and Clinical Responsibilities for Interventional Radiologists

    International Nuclear Information System (INIS)

    Al-Kutoubi, Aghiad

    2015-01-01

    Although clinical involvement by interventional radiologists in the care of their patients was advocated at the inception of the specialty, the change into the clinical paradigm has been slow and patchy for reasons related to pattern of practice, financial remuneration or absence of training. The case for the value of clinical responsibilities has been made in a number of publications and the consequences of not doing so have been manifest in the erosion of the role of the interventional radiologists particularly in the fields of peripheral vascular and neuro intervention. With the recent recognition of interventional radiology (IR) as a primary specialty in the USA and the formation of IR division in the Union of European Medical Specialists and subsequent recognition of the subspecialty in many European countries, it is appropriate to relook at the issue and emphasize the need for measures to promote the clinical role of the interventional radiologist

  17. Responses to clinical uncertainty in Australian general practice trainees: a cross-sectional analysis.

    Science.gov (United States)

    Cooke, Georga; Tapley, Amanda; Holliday, Elizabeth; Morgan, Simon; Henderson, Kim; Ball, Jean; van Driel, Mieke; Spike, Neil; Kerr, Rohan; Magin, Parker

    2017-12-01

    Tolerance for ambiguity is essential for optimal learning and professional competence. General practice trainees must be, or must learn to be, adept at managing clinical uncertainty. However, few studies have examined associations of intolerance of uncertainty in this group. The aim of this study was to establish levels of tolerance of uncertainty in Australian general practice trainees and associations of uncertainty with demographic, educational and training practice factors. A cross-sectional analysis was performed on the Registrar Clinical Encounters in Training (ReCEnT) project, an ongoing multi-site cohort study. Scores on three of the four independent subscales of the Physicians' Reaction to Uncertainty (PRU) instrument were analysed as outcome variables in linear regression models with trainee and practice factors as independent variables. A total of 594 trainees contributed data on a total of 1209 occasions. Trainees in earlier training terms had higher scores for 'Anxiety due to uncertainty', 'Concern about bad outcomes' and 'Reluctance to disclose diagnosis/treatment uncertainty to patients'. Beyond this, findings suggest two distinct sets of associations regarding reaction to uncertainty. Firstly, affective aspects of uncertainty (the 'Anxiety' and 'Concern' subscales) were associated with female gender, less experience in hospital prior to commencing general practice training, and graduation overseas. Secondly, a maladaptive response to uncertainty (the 'Reluctance to disclose' subscale) was associated with urban practice, health qualifications prior to studying medicine, practice in an area of higher socio-economic status, and being Australian-trained. This study has established levels of three measures of trainees' responses to uncertainty and associations with these responses. The current findings suggest differing 'phenotypes' of trainees with high 'affective' responses to uncertainty and those reluctant to disclose uncertainty to patients. More

  18. Pharmacogenomics of Methotrexate Membrane Transport Pathway: Can Clinical Response to Methotrexate in Rheumatoid Arthritis Be Predicted?

    Directory of Open Access Journals (Sweden)

    Aurea Lima

    2015-06-01

    Full Text Available Background: Methotrexate (MTX is widely used for rheumatoid arthritis (RA treatment. Single nucleotide polymorphisms (SNPs could be used as predictors of patients’ therapeutic outcome variability. Therefore, this study aims to evaluate the influence of SNPs in genes encoding for MTX membrane transport proteins in order to predict clinical response to MTX. Methods: Clinicopathological data from 233 RA patients treated with MTX were collected, clinical response defined, and patients genotyped for 23 SNPs. Genotype and haplotype analyses were performed using multivariate methods and a genetic risk index (GRI for non-response was created. Results: Increased risk for non-response was associated to SLC22A11 rs11231809 T carriers; ABCC1 rs246240 G carriers; ABCC1 rs3784864 G carriers; CGG haplotype for ABCC1 rs35592, rs2074087 and rs3784864; and CGG haplotype for ABCC1 rs35592, rs246240 and rs3784864. GRI demonstrated that patients with Index 3 were 16-fold more likely to be non-responders than those with Index 1. Conclusions: This study revealed that SLC22A11 and ABCC1 may be important to identify those patients who will not benefit from MTX treatment, highlighting the relevance in translating these results to clinical practice. However, further validation by independent studies is needed to develop the field of personalized medicine to predict clinical response to MTX treatment.

  19. Clinical significance of mobile health assessed sleep duration and variability in bipolar disorder.

    Science.gov (United States)

    Kaufmann, Christopher N; Gershon, Anda; Eyler, Lisa T; Depp, Colin A

    2016-10-01

    Sleep disturbances are prevalent, persistent, and impairing features of bipolar disorder. However, the near-term and cumulative impact of the severity and variability of sleep disturbances on symptoms and functioning remains unclear. We examined self-reported daily sleep duration and variability in relation to mood symptoms, medication adherence, cognitive functioning, and concurrent daily affect. Forty-one outpatients diagnosed with bipolar disorder were asked to provide daily reports of sleep duration and affect collected via ecological momentary assessment with smartphones over eleven weeks. Measures of depressive and manic symptoms, medication adherence, and cognitive function were collected at baseline and concurrent assessment of affect were collected daily. Analyses examined whether sleep duration or variability were associated with baseline measures and changes in same-day or next-day affect. Greater sleep duration variability (but not average sleep duration) was associated with greater depressive and manic symptom severity, and lower medication adherence at baseline, and with lower and more variable ratings of positive affect and higher ratings of negative affect. Sleep durations shorter than 7-8 h were associated with lower same-day ratings of positive and higher same-day ratings of negative affect, however this did not extend to next-day affect. Greater cumulative day-to-day sleep duration variability, but not average sleep duration, was related to more severe mood symptoms, lower self-reported medication adherence and higher levels of negative affect. Bouts of short- or long-duration sleep had transient impact on affect. Day-to-day sleep variability may be important to incorporate into clinical assessment of sleep disturbances in bipolar disorder. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Information needs for the rapid response team electronic clinical tool.

    Science.gov (United States)

    Barwise, Amelia; Caples, Sean; Jensen, Jeffrey; Pickering, Brian; Herasevich, Vitaly

    2017-10-02

    Information overload in healthcare is dangerous. It can lead to critical errors and delays. During Rapid Response Team (RRT) activations providers must make decisions quickly to rescue patients from physiological deterioration. In order to understand the clinical data required and how best to present that information in electronic systems we aimed to better assess the data needs of providers on the RRT when they respond to an event. A web based survey to evaluate clinical data requirements was created and distributed to all RRT providers at our institution. Participants were asked to rate the importance of each data item in guiding clinical decisions during a RRT event response. There were 96 surveys completed (24.5% response rate) with fairly even distribution throughout all clinical roles on the RRT. Physiological data including heart rate, respiratory rate, and blood pressure were ranked by more than 80% of responders as being critical information. Resuscitation status was also considered critically useful by more than 85% of providers. There is a limited dataset that is considered important during an RRT. The data is widely available in EMR. The findings from this study could be used to improve user-centered EMR interfaces.

  1. Cross-talk between Clinical and Host Response Parameters of Periodontitis in Smokers

    Science.gov (United States)

    Nagarajan, R.; Miller, C.S.; Dawson, D.; Al-Sabbagh, M.; Ebersole, J.L.

    2016-01-01

    Periodontal diseases are a major public health concern leading to tooth loss and also shown to be associated with several chronic systemic diseases. Smoking is a major risk factor for developing numerous systemic diseases, as well as periodontitis. While it is clear that smokers have a significantly enhanced risk for developing periodontitis leading to tooth loss, the population varies with regards to susceptibility to disease associated with smoking. This investigation focuses on identifying differences in four broad sets of variables consisting of: (a) host response molecules, (b) periodontal clinical parameters, (c) antibody measures for periodontal pathogens and oral commensal bacteria challenge, and (d) other variables of interest in a smoking population with (n = 171) and without periodontitis (n = 117). Subsequently, Bayesian network structured learning techniques (BNSL) techniques were used to investigate potential associations and cross-talk between the four broad sets of variables. BNSL revealed two broad communities with markedly different topology between the non-periodontitis and periodontitis smoking population. Confidence of the edges in the resulting network also showed marked variations within and between the periodontitis and non-periodontitis groups. The results presented validated known associations, as well as discovered new ones with minimal precedence that may warrant further investigation and novel hypothesis generation. Cross-talk between the clinical variables and antibody profiles of bacteria were especially pronounced in the case of periodontitis and mediated by the antibody response profile to P. gingivalis. PMID:27431617

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

    Directory of Open Access Journals (Sweden)

    Thomas E Bartlett

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

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

    Science.gov (United States)

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

    2015-01-01

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

  4. Meningococcal meningitis: clinical and laboratorial characteristics, fatality rate and variables associated with in-hospital mortality

    Directory of Open Access Journals (Sweden)

    Vanessa L. Strelow

    Full Text Available ABSTRACT Meningococcal meningitis is a public health problem. The aim of this study was to describe the clinical characteristics of patients with meningococcal meningitis, and to identify associated factors with mortality. This was a retrospective study, between 2006 and 2011, at a referral center in São Paulo, Brazil. Logistic regression analysis was used to identify factors associated with mortality. We included 316 patients. The median age was 16 years (IQR: 7–27 and 60% were male. The clinical triad: fever, headache and neck stiffness was observed in 89% of the patients. The cerebrospinal triad: pleocytosis, elevated protein levels and low glucose levels was present in 79% of patients. Factors associated with mortality in the multivariate model were age above 50 years, seizures, tachycardia, hypotension and neck stiffness. The classic clinical and laboratory triads of meningococcal meningitis were variable. The fatality rate was low. Age, seizures and shock signs were independently associated with mortality.

  5. Immunologic and clinical responses to "Monday morning miseries" antigens.

    Science.gov (United States)

    Cernelc, S; Stropnik, Z

    1987-01-01

    Authors analysed 96 workers exposed to air conditioning system (Group A), and 71 workers (Group B) breathing normal ambient air. 38 workers in group A had a positive clinical history of "Monday morning miseries". Eight cases with the diagnosis hypersensitivity pneumonitis, acute and chronic form was based on environmental history, clinical investigations, physical examination, Chest-X-ray examination, immunological test "in vivo" and "in vitro" with common allergens and antigen "Monday morning miseries", ELISA, spirometry and PEFR (Peak Expiratory Flow-Rate) measurements. Exposure to contaminated air may be responsible for morbidity and reduced performance of workers.

  6. The physiological basis for regeneration response to variable retention harvest treatments in three pine species

    Science.gov (United States)

    Matthew D. Powers; Kurt S. Pregitzer; Brian J. Palik; Christopher R. Webster

    2011-01-01

    Variable retention harvesting (VRH) is promoted for enhancing biodiversity and ecosystem processes in managed forests, but regeneration responses to the complex stand structures that result from VRH are poorly understood. We analyzed foliar stable carbon isotope ratios (δ13C), oxygen isotope ratios (δ18O...

  7. Resistance to Change and Preference for Variable versus Fixed Response Sequences

    Science.gov (United States)

    Arantes, Joana; Berg, Mark E.; Le, Dien; Grace, Randolph C.

    2012-01-01

    In Experiment 1, 4 pigeons were trained on a multiple chain schedule in which the initial link was a variable-interval (VI) 20-s schedule signalled by a red or green center key, and terminal links required four responses made to the left (L) and/or right (R) keys. In the REPEAT component, signalled by red keylights, only LRLR terminal-link…

  8. A longitudinal study in youth of heart rate variability at rest and in response to stress

    NARCIS (Netherlands)

    Li, Zhibin; Snieder, Harold; Su, Shaoyong; Ding, Xiuhua; Thayer, Julian F.; Treiber, Frank A.; Wang, Xiaoling

    Background: Few longitudinal studies have examined ethnic and sex differences, predictors and tracking stabilities of heart rate variability (HRV) at rest and in response to stress in youths and young adults. Methods: Two evaluations were performed approximately 1.5 years apart on 399 youths and

  9. Bayesian modeling of measurement error in predictor variables using item response theory

    NARCIS (Netherlands)

    Fox, Gerardus J.A.; Glas, Cornelis A.W.

    2000-01-01

    This paper focuses on handling measurement error in predictor variables using item response theory (IRT). Measurement error is of great important in assessment of theoretical constructs, such as intelligence or the school climate. Measurement error is modeled by treating the predictors as unobserved

  10. Does Response Variability Predict Distractibility among Adults with Attention-Deficit/Hyperactivity Disorder?

    Science.gov (United States)

    Adams, Zachary W.; Roberts, Walter M.; Milich, Richard; Fillmore, Mark T.

    2011-01-01

    Increased intraindividual variability in response time (RTSD) has been observed reliably in attention-deficit/hyperactivity disorder (ADHD) and has often been used as a measure of inattention. RTSD is assumed to reflect attentional lapses and distractibility, though evidence for the validity of this connection is lacking. We assessed whether RTSD…

  11. Study on Short-term Variability of Ship Responses in Waves

    DEFF Research Database (Denmark)

    Iseki, Toshio; Nielsen, Ulrik Dam

    2014-01-01

    Short-term variability of ship responses is investigated from the view point of cross-spectrum analysis. In a steady state condition, it is well known that a certain length of sampled data are required for stable spectral analysis. However, the phase angle of the cross-spectra has not been discus...

  12. Exploiting temporal variability to understand tree recruitment response to climate change

    Science.gov (United States)

    Ines Ibanez; James S. Clark; Shannon LaDeau; Janneke Hill Ris Lambers

    2007-01-01

    Predicting vegetation shifts under climate change is a challenging endeavor, given the complex interactions between biotic and abiotic variables that influence demographic rates. To determine how current trends and variation in climate change affect seedling establishment, we analyzed demographic responses to spatiotemporal variation to temperature and soil moisture in...

  13. 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

  14. Hypertensive response to exercise: mechanisms and clinical implication

    OpenAIRE

    Kim, Darae; Ha, Jong-Won

    2016-01-01

    A hypertensive response to exercise (HRE) is frequently observed in individuals without hypertension or other cardiovascular disease. However, mechanisms and clinical implication of HRE is not fully elucidated. Endothelial dysfunction and increased stiffness of large artery contribute to development of HRE. From neurohormonal aspects, excess stimulation of sympathetic nervous system and augmented rise of angiotensin II seems to be important mechanism in HRE. Increasing evidences indicates tha...

  15. Variability of Neuronal Responses: Types and Functional Significance in Neuroplasticity and Neural Darwinism.

    Science.gov (United States)

    Chervyakov, Alexander V; Sinitsyn, Dmitry O; Piradov, Michael A

    2016-01-01

    HIGHLIGHTS We suggest classifying variability of neuronal responses as follows: false (associated with a lack of knowledge about the influential factors), "genuine harmful" (noise), "genuine neutral" (synonyms, repeats), and "genuine useful" (the basis of neuroplasticity and learning).The genuine neutral variability is considered in terms of the phenomenon of degeneracy.Of particular importance is the genuine useful variability that is considered as a potential basis for neuroplasticity and learning. This type of variability is considered in terms of the neural Darwinism theory. In many cases, neural signals detected under the same external experimental conditions significantly change from trial to trial. The variability phenomenon, which complicates extraction of reproducible results and is ignored in many studies by averaging, has attracted attention of researchers in recent years. In this paper, we classify possible types of variability based on its functional significance and describe features of each type. We describe the key adaptive significance of variability at the neural network level and the degeneracy phenomenon that may be important for learning processes in connection with the principle of neuronal group selection.

  16. Population variability in biological adaptive responses to DNA damage and the shapes of carcinogen dose-response curves

    International Nuclear Information System (INIS)

    Conolly, Rory B.; Gaylor, David W.; Lutz, Werner K.

    2005-01-01

    Carcinogen dose-response curves for both ionizing radiation and chemicals are typically assumed to be linear at environmentally relevant doses. This assumption is used to ensure protection of the public health in the absence of relevant dose-response data. A theoretical justification for the assumption has been provided by the argument that low dose linearity is expected when an exogenous agent adds to an ongoing endogenous process. Here, we use computational modeling to evaluate (1) how two biological adaptive processes, induction of DNA repair and cell cycle checkpoint control, may affect the shapes of dose-response curves for DNA-damaging carcinogens and (2) how the resulting dose-response behaviors may vary within a population. Each model incorporating an adaptive process was capable of generating not only monotonic dose-responses but also nonmonotonic (J-shaped) and threshold responses. Monte Carlo analysis suggested that all these dose-response behaviors could coexist within a population, as the spectrum of qualitative differences arose from quantitative changes in parameter values. While this analysis is largely theoretical, it suggests that (a) accurate prediction of the qualitative form of the dose-response requires a quantitative understanding of the mechanism (b) significant uncertainty is associated with human health risk prediction in the absence of such quantitative understanding and (c) a stronger experimental and regulatory focus on biological mechanisms and interindividual variability would allow flexibility in regulatory treatment of environmental carcinogens without compromising human health

  17. Predictive value of clinical and laboratory variables for vesicoureteral reflux in children.

    Science.gov (United States)

    Soylu, Alper; Kasap, Belde; Demir, Korcan; Türkmen, Mehmet; Kavukçu, Salih

    2007-06-01

    We aimed to determine the predictability of clinical and laboratory variables for vesicoureteral reflux (VUR) in children with urinary tract infection (UTI). Data of children with febrile UTI who underwent voiding cystoureterography between 2002 and 2005 were evaluated retrospectively for clinical (age, gender, fever > or = 38.5 degrees C, recurrent UTI), laboratory [leukocytosis, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), pyuria, serum creatinine (S(Cr))] and imaging (renal ultrasonography) variables. Children with VUR (group 1) vs. no VUR (group 2) and children with high-grade (III-V) VUR (group 3) vs. no or low-grade (I-II) VUR (group 4) were compared. Among 88 patients (24 male), 38 had VUR and 21 high-grade VUR. Fever > or = 38.5 degrees C was associated with VUR [odds ratio (OR): 7.5]. CRP level of 50 mg/l was the best cut-off level for predicting high-grade VUR (OR 15.5; discriminative ability 0.89 +/- 0.05). Performing voiding cystourethrography based on this CRP level would result in failure to notice 9% of patients with high-grade VUR, whereas 69% of children with no/low-grade VUR would be spared from this invasive test. In conclusion, fever > or = 38 degrees C and CRP > 50 mg/l seem to be potentially useful clinical predictors of VUR and high-grade VUR, respectively, in pediatric patients with UTI. Further validation of these findings could limit unnecessary voiding cystourethrography.

  18. Sex as a Biological Variable in Emergency Medicine Research and Clinical Practice: A Brief Narrative Review

    Directory of Open Access Journals (Sweden)

    Alyson J. McGregor

    2017-10-01

    Full Text Available The National Institutes of Health recently highlighted the significant role of sex as a biological variable (SABV in research design, outcome and reproducibility, mandating that this variable be accounted for in all its funded research studies. This move has resulted in a rapidly increasing body of literature on SABV with important implications for changing the clinical practice of emergency medicine (EM. Translation of this new knowledge to the bedside requires an understanding of how sex-based research will ultimately impact patient care. We use three case-based scenarios in acute myocardial infarction, acute ischemic stroke and important considerations in pharmacologic therapy administration to highlight available data on SABV in evidence-based research to provide the EM community with an important foundation for future integration of patient sex in the delivery of emergency care as gaps in research are filled.

  19. Effects of CPAP on clinical variables and autonomic modulation in children during an asthma attack.

    Science.gov (United States)

    de Freitas Dantas Gomes, Evelim Leal; Costa, Dirceu; Germano, Sandra Maria; Borges, Pâmela Vieira; Sampaio, Luciana Maria Malosá

    2013-08-01

    Continuous positive airway pressure (CPAP) causes changes in alveolar and intrathoracic pressure and the activation of pulmonary stretch receptors affects the balance of the autonomic nervous system. The acute effects of CPAP on autonomic modulation have been demonstrated in different diseases, but no studies have been carried out addressing CPAP in patients with asthma. The hypothesis tested in the present study is that CPAP can produce an autonomic effect beyond a mechanical effect of bronchial dilatation in children with asthma. The results demonstrated improvements in clinical variables and an increase in vagal tone with the administration of CPAP during an asthma attack, as demonstrated by a diminished respiratory rate and a reduction in signs of respiratory distress. Regarding autonomic modulation, an increase in parasympathetic variables was found, indicating non-cholinergic activation stemming from the persistent increase in peak flow. Copyright © 2013 Elsevier B.V. All rights reserved.

  20. Variability in the Reporting of Serum Urate and Flares in Gout Clinical Trials

    DEFF Research Database (Denmark)

    Stamp, Lisa K; Morillon, Melanie B; Taylor, William J

    2018-01-01

    OBJECTIVE: To describe the ways in which serum urate (SU) and gout flares are reported in clinical trials, and to propose minimum reporting requirements. METHODS: This analysis was done as part of a systematic review aiming to validate SU as a biomarker for gout. The ways in which SU and flares.......3%) of these reporting at more than just the final study visit. Two ways of reporting gout flares were identified: mean flare rate and percentage of participants with flares. There was variability in time periods over which flares rates were reported. CONCLUSION: There is inconsistent reporting of SU and flares in gout...... studies. Reporting the percentage of participants who achieve a target SU reflects international treatment guidelines. SU should also be reported as a continuous variable with a relevant central and dispersion estimate. Gout flares should be reported as both percentage of participants and mean flare rates...

  1. Bladder cancer treatment response assessment with radiomic, clinical, and radiologist semantic features

    Science.gov (United States)

    Gordon, Marshall N.; Cha, Kenny H.; Hadjiiski, Lubomir M.; Chan, Heang-Ping; Cohan, Richard H.; Caoili, Elaine M.; Paramagul, Chintana; Alva, Ajjai; Weizer, Alon Z.

    2018-02-01

    We are developing a decision support system for assisting clinicians in assessment of response to neoadjuvant chemotherapy for bladder cancer. Accurate treatment response assessment is crucial for identifying responders and improving quality of life for non-responders. An objective machine learning decision support system may help reduce variability and inaccuracy in treatment response assessment. We developed a predictive model to assess the likelihood that a patient will respond based on image and clinical features. With IRB approval, we retrospectively collected a data set of pre- and post- treatment CT scans along with clinical information from surgical pathology from 98 patients. A linear discriminant analysis (LDA) classifier was used to predict the likelihood that a patient would respond to treatment based on radiomic features extracted from CT urography (CTU), a radiologist's semantic feature, and a clinical feature extracted from surgical and pathology reports. The classification accuracy was evaluated using the area under the ROC curve (AUC) with a leave-one-case-out cross validation. The classification accuracy was compared for the systems based on radiomic features, clinical feature, and radiologist's semantic feature. For the system based on only radiomic features the AUC was 0.75. With the addition of clinical information from examination under anesthesia (EUA) the AUC was improved to 0.78. Our study demonstrated the potential of designing a decision support system to assist in treatment response assessment. The combination of clinical features, radiologist semantic features and CTU radiomic features improved the performance of the classifier and the accuracy of treatment response assessment.

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

    Science.gov (United States)

    Kahraman, Nilgün; Hiçdurmaz, Duygu

    2016-04-01

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

  3. Inter-individual variability of stone marten behavioral responses to a highway.

    Directory of Open Access Journals (Sweden)

    Fernando Ascensão

    Full Text Available Efforts to reduce the negative impacts of roads on wildlife may be hindered if individuals within the population vary widely in their responses to roads and mitigation strategies ignore this variability. This knowledge is particularly important for medium-sized carnivores as they are vulnerable to road mortality, while also known to use available road passages (e.g., drainage culverts for safely crossing highways. Our goal in this study was to assess whether this apparently contradictory pattern of high road-kill numbers associated with a regular use of road passages is attributable to the variation in behavioral responses toward the highway between individuals. We investigated the responses of seven radio-tracked stone martens (Martes foina to a highway by measuring their utilization distribution, response turning angles and highway crossing patterns. We compared the observed responses to simulated movement parameterized by the observed space use and movement characteristics of each individual, but naïve to the presence of the highway. Our results suggested that martens demonstrate a diversity of responses to the highway, including attraction, indifference, or avoidance. Martens also varied in their highway crossing patterns, with some crossing repeatedly at the same location (often coincident with highway passages. We suspect that the response variability derives from the individual's familiarity of the landscape, including their awareness of highway passage locations. Because of these variable yet potentially attributable responses, we support the use of exclusionary fencing to guide transient (e.g., dispersers individuals to existing passages to reduce the road-kill risk.

  4. Eyewitness Accounts on Climate Variability and the Responses: Perspectives from Farmers

    Directory of Open Access Journals (Sweden)

    Jiban Mani Poudel

    2012-06-01

    Full Text Available People with different socio-cultural arrangements havedifferent experiences and responses to climatic variability. The place specific experiences and responses at community level still remain a little explored issue in the discourse of climate change research. This paper deals with local experiences of climatic variability which have been monitoring by locals in their lifetime, on the one hand, and, on the other, explore their responses or coping mechanisms which they have been practicing to mitigate with climatic risks. Moreover, farmers’ experiences were documented in term of observed climatic variability in their lifetime focusing on qualitative data. I have used eyewitness accounts and hearsays to document their experiences of climatic variability. Moreover, farmers have developed various coping mechanisms such as indigenous knowledge, utilize kinship based social network, environment friendly cropping practices, and use of alternative sources of water (water-tanker, well-water for irrigation, arrange rain-making ritual to cope with climatic uncertainty in their lifetime.DOI: http://dx.doi.org/10.3126/dsaj.v5i0.6362Dhaulagiri Journal of Sociology and Anthropology Vol. 5, 2011: 171-90

  5. Physicians' Professionally Responsible Power: A Core Concept of Clinical Ethics.

    Science.gov (United States)

    McCullough, Laurence B

    2016-02-01

    The gathering of power unto themselves by physicians, a process supported by evidence-based practice, clinical guidelines, licensure, organizational culture, and other social factors, makes the ethics of power--the legitimation of physicians' power--a core concept of clinical ethics. In the absence of legitimation, the physician's power over patients becomes problematic, even predatory. As has occurred in previous issues of the Journal, the papers in the 2016 clinical ethics issue bear on the professionally responsible deployment of power by physicians. This introduction explores themes of physicians' power in papers from an international group of authors who address autonomy and trust, the virtues of perinatal hospice, conjoined twins in ethics and law, addiction and autonomy in clinical research on addicting substances, euthanasia of patients with dementia in Belgium, and a pragmatic approach to clinical futility. © The Author 2015. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  6. Seasonal variability in clinical care of COPD outpatients: results from the Andalusian COPD audit

    Directory of Open Access Journals (Sweden)

    López-Campos JL

    2017-03-01

    Full Text Available Jose Luis López-Campos,1,2 Maria Abad Arranz,1 Carmen Calero-Acuña,1,2 Fernando Romero-Valero,3 Ruth Ayerbe-García,4 Antonio Hidalgo-Molina,3 Ricardo I Aguilar-Pérez-Grovas,4 Francisco García-Gil,5 Francisco Casas-Maldonado,6 Laura Caballero-Ballesteros,5 María Sánchez-Palop,6 Dolores Pérez-Tejero,7 Alejandro Segado Soriano,7 Jose Calvo-Bonachera,8 Bárbara Hernández-Sierra,8 Adolfo Doménech,9 Macarena Arroyo-Varela,9 Francisco González-Vargas,10 Juan J Cruz-Rueda10 1Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS, Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, 2CIBER de Enfermedades Respiratorias (CIBERES, Instituto de Salud Carlos III, Madrid, 3Sección de Neumología, Hospital Puerta del Mar, Cádiz, 4Servicio de Neumología, Hospital Juan Ramón Jiménez, Huelva, 5Servicio de Neumología, Hospital Universitario Reina Sofía, Córdoba, 6Servicio de Neumología, Hospital Universitario San Cecilio, Granada, 7Sección de Neumología, Hospital Infanta Margarita, Cabra, Córdoba, 8Servicio de Neumología, Hospital Torrecárdenas, Almería, 9Servicio de Neumología, Hospital Regional Universitario de Málaga, Málaga, 10Servicio de Neumología, Hospital Universitario Virgen de las Nieves, Granada, Spain Objectives: Clinical practice in chronic obstructive pulmonary disease (COPD can be influenced by weather variability throughout the year. To explore the hypothesis of seasonal variability in clinical practice, the present study analyzes the results of the 2013–2014 Andalusian COPD audit with regard to changes in clinical practice according to the different seasons.Methods: The Andalusian COPD audit was a pilot clinical project conducted from October 2013 to September 2014 in outpatient respiratory clinics of hospitals in Andalusia, Spain (8 provinces with more than 8 million inhabitants with retrospective data gathering. For the present analysis

  7. European Randomized Study of Screening for Prostate Cancer Risk Calculator: External Validation, Variability, and Clinical Significance.

    Science.gov (United States)

    Gómez-Gómez, Enrique; Carrasco-Valiente, Julia; Blanca-Pedregosa, Ana; Barco-Sánchez, Beatriz; Fernandez-Rueda, Jose Luis; Molina-Abril, Helena; Valero-Rosa, Jose; Font-Ugalde, Pilar; Requena-Tapia, Maria José

    2017-04-01

    To externally validate the European Randomized Study of Screening for Prostate Cancer (ERSPC) risk calculator (RC) and to evaluate its variability between 2 consecutive prostate-specific antigen (PSA) values. We prospectively catalogued 1021 consecutive patients before prostate biopsy for suspicion of prostate cancer (PCa). The risk of PCa and significant PCa (Gleason score ≥7) from 749 patients was calculated according to ERSPC-RC (digital rectal examination-based version 3 of 4) for 2 consecutive PSA tests per patient. The calculators' predictions were analyzed using calibration plots and the area under the receiver operating characteristic curve (area under the curve). Cohen kappa coefficient was used to compare the ability and variability. Of 749 patients, PCa was detected in 251 (33.5%) and significant PCa was detected in 133 (17.8%). Calibration plots showed an acceptable parallelism and similar discrimination ability for both PSA levels with an area under the curve of 0.69 for PCa and 0.74 for significant PCa. The ERSPC showed 226 (30.2%) unnecessary biopsies with the loss of 10 significant PCa. The variability of the RC was 16% for PCa and 20% for significant PCa, and a higher variability was associated with a reduced risk of significant PCa. We can conclude that the performance of the ERSPC-RC in the present cohort shows a high similitude between the 2 PSA levels; however, the RC variability value is associated with a decreased risk of significant PCa. The use of the ERSPC in our cohort detects a high number of unnecessary biopsies. Thus, the incorporation of ERSPC-RC could help the clinical decision to carry out a prostate biopsy. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Basophil responsiveness and clinical picture of acetylsalicylic acid intolerance.

    Science.gov (United States)

    Korosec, Peter; Mavsar, Nusa; Bajrovic, Nissera; Silar, Mira; Mrhar, Ales; Kosnik, Mitja

    2011-01-01

    Exposure to acetylsalicylic acid (ASA) may exacerbate respiratory or skin diseases or induce anaphylactoid reactions in apparently healthy individuals. We wanted to evaluate specific responsiveness of basophils to ASA in correlation with the clinical picture. We performed a prospective single-blind study of 59 subjects involved in clinical evaluation and/or ASA provocation testing. Whole blood basophils were stained with anti-CD63/CD123/HLA-DR mAbs after stimulation with 0.25 or 1 mg/ml ASA. We found that 40 subjects were ASA tolerant and 19 were ASA intolerant. Both groups had comparable manifestations of asthma and/or rhinitis (13 in the tolerant and 9 in the intolerant group). Intolerant subjects showed significantly higher basophil responsiveness to ASA in comparison to tolerant subjects, which was concentration-dependent in both groups. The ratio between responses at 1 mg/ml of ASA and at baseline (activation index) was analyzed according to the clinical picture. We demonstrate that the activation index was higher only in the intolerant subjects with anaphylactoid reactions, but not in a subgroup of subjects with asthma/rhinitis. The ROC calculations show that the optimal threshold activation index was more than 2.18. The sensitivity was 80% and the specificity was 83% in the subgroup with anaphylactoid reactions. In the asthma/rhinitis subgroup, the sensitivity was 78% and the specificity was 50%. Our study demonstrates that there is a significantly higher in vitro basophil response to ASA in intolerant as compared to tolerant subjects. ROC analyses suggest that this measurement might only have a diagnostic value in subjects without asthma and/or rhinitis. Copyright © 2011 S. Karger AG, Basel.

  9. Response of ENSO amplitude to global warming in CESM large ensemble: uncertainty due to internal variability

    Science.gov (United States)

    Zheng, Xiao-Tong; Hui, Chang; Yeh, Sang-Wook

    2018-06-01

    El Niño-Southern Oscillation (ENSO) is the dominant mode of variability in the coupled ocean-atmospheric system. Future projections of ENSO change under global warming are highly uncertain among models. In this study, the effect of internal variability on ENSO amplitude change in future climate projections is investigated based on a 40-member ensemble from the Community Earth System Model Large Ensemble (CESM-LE) project. A large uncertainty is identified among ensemble members due to internal variability. The inter-member diversity is associated with a zonal dipole pattern of sea surface temperature (SST) change in the mean along the equator, which is similar to the second empirical orthogonal function (EOF) mode of tropical Pacific decadal variability (TPDV) in the unforced control simulation. The uncertainty in CESM-LE is comparable in magnitude to that among models of the Coupled Model Intercomparison Project phase 5 (CMIP5), suggesting the contribution of internal variability to the intermodel uncertainty in ENSO amplitude change. However, the causations between changes in ENSO amplitude and the mean state are distinct between CESM-LE and CMIP5 ensemble. The CESM-LE results indicate that a large ensemble of 15 members is needed to separate the relative contributions to ENSO amplitude change over the twenty-first century between forced response and internal variability.

  10. Tannat grape composition responses to spatial variability of temperature in an Uruguay's coastal wine region

    Science.gov (United States)

    Fourment, Mercedes; Ferrer, Milka; González-Neves, Gustavo; Barbeau, Gérard; Bonnardot, Valérie; Quénol, Hervé

    2017-09-01

    Spatial variability of temperature was studied in relation to the berry basic composition and secondary compounds of the Tannat cultivar at harvest from vineyards located in Canelones and Montevideo, the most important wine region of Uruguay. Monitoring of berries and recording of temperature were performed in 10 commercial vineyards of Tannat situated in the southern coastal wine region of the country for three vintages (2012, 2013, and 2014). Results from a multivariate correlation analysis between berry composition and temperature over the three vintages showed that (1) Tannat responses to spatial variability of temperature were different over the vintages, (2) correlations between secondary metabolites and temperature were higher than those between primary metabolites, and (3) correlation values between berry composition and climate variables increased when ripening occurred under dry conditions (below average rainfall). For a particular studied vintage (2013), temperatures explained 82.5% of the spatial variability of the berry composition. Daily thermal amplitude was found to be the most important spatial mode of variability with lower values recorded at plots nearest to the sea and more exposed to La Plata River. The highest levels in secondary compounds were found in berries issued from plots situated as far as 18.3 km from La Plata River. The increasing knowledge of temperature spatial variability and its impact on grape berry composition contributes to providing possible issues to adapt grapevine to climate change.

  11. Identifying novel phenotypes of acute heart failure using cluster analysis of clinical variables.

    Science.gov (United States)

    Horiuchi, Yu; Tanimoto, Shuzou; Latif, A H M Mahbub; Urayama, Kevin Y; Aoki, Jiro; Yahagi, Kazuyuki; Okuno, Taishi; Sato, Yu; Tanaka, Tetsu; Koseki, Keita; Komiyama, Kota; Nakajima, Hiroyoshi; Hara, Kazuhiro; Tanabe, Kengo

    2018-07-01

    Acute heart failure (AHF) is a heterogeneous disease caused by various cardiovascular (CV) pathophysiology and multiple non-CV comorbidities. We aimed to identify clinically important subgroups to improve our understanding of the pathophysiology of AHF and inform clinical decision-making. We evaluated detailed clinical data of 345 consecutive AHF patients using non-hierarchical cluster analysis of 77 variables, including age, sex, HF etiology, comorbidities, physical findings, laboratory data, electrocardiogram, echocardiogram and treatment during hospitalization. Cox proportional hazards regression analysis was performed to estimate the association between the clusters and clinical outcomes. Three clusters were identified. Cluster 1 (n=108) represented "vascular failure". This cluster had the highest average systolic blood pressure at admission and lung congestion with type 2 respiratory failure. Cluster 2 (n=89) represented "cardiac and renal failure". They had the lowest ejection fraction (EF) and worst renal function. Cluster 3 (n=148) comprised mostly older patients and had the highest prevalence of atrial fibrillation and preserved EF. Death or HF hospitalization within 12-month occurred in 23% of Cluster 1, 36% of Cluster 2 and 36% of Cluster 3 (p=0.034). Compared with Cluster 1, risk of death or HF hospitalization was 1.74 (95% CI, 1.03-2.95, p=0.037) for Cluster 2 and 1.82 (95% CI, 1.13-2.93, p=0.014) for Cluster 3. Cluster analysis may be effective in producing clinically relevant categories of AHF, and may suggest underlying pathophysiology and potential utility in predicting clinical outcomes. Copyright © 2018 Elsevier B.V. All rights reserved.

  12. UL146 variability among clinical isolates of Human Cytomegalovirus from Japan

    Directory of Open Access Journals (Sweden)

    Francisco Aguayo

    2010-01-01

    Full Text Available Human Cytomegalovirus (HCMV is a herpesvirus associated with serious diseases in immunocompromised subjects. The region between ORF UL133 and UL151 from HCMV, named ULb' is frequently deleted in attenuated AD169 and in highly passaged laboratory strains. However, this region is conserved in low-passaged and more virulent HCMV, like the Toledo strain. The UL146 gene, which is located in the ULb' region, encodes a CXC-chemokine analogue. The diversity of UL146 gene was evaluated among fifty-six clinical isolates of HCMV from Japan. Results show that UL146 gene was successfully amplified by the polymerase chain reaction (PCR in only 17/56 strains (30%, while the success rate for UL145/UL147 gene was 18/56 strains (32%. After DNA sequencing, the 35 amplified strains were classified into 8 groups. When compared, variability of UL146 ranged from 25.1% to 52.9% at the DNA level and from 34.5% to 67% at the amino acid level. Seven groups had the interleukin-8 (IL-8 motif ERL (Glu-Leu-Arg CXC and one group had only the CXC motif, suggesting the absence of the IL-8 function of UL146. In conclusion, we found that UL146 gene of HCMV is hyper-variable in clinical strains from Japan suggesting the possibility of a different function in each sequence group.

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

    Science.gov (United States)

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

    2016-05-01

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

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

    Science.gov (United States)

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

    2017-10-01

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

  15. Spatial and temporal variability of rainfall and their effects on hydrological response in urban areas - a review

    Science.gov (United States)

    Cristiano, Elena; ten Veldhuis, Marie-claire; van de Giesen, Nick

    2017-07-01

    In urban areas, hydrological processes are characterized by high variability in space and time, making them sensitive to small-scale temporal and spatial rainfall variability. In the last decades new instruments, techniques, and methods have been developed to capture rainfall and hydrological processes at high resolution. Weather radars have been introduced to estimate high spatial and temporal rainfall variability. At the same time, new models have been proposed to reproduce hydrological response, based on small-scale representation of urban catchment spatial variability. Despite these efforts, interactions between rainfall variability, catchment heterogeneity, and hydrological response remain poorly understood. This paper presents a review of our current understanding of hydrological processes in urban environments as reported in the literature, focusing on their spatial and temporal variability aspects. We review recent findings on the effects of rainfall variability on hydrological response and identify gaps where knowledge needs to be further developed to improve our understanding of and capability to predict urban hydrological response.

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

    Science.gov (United States)

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

    2016-02-01

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

  17. Changes of interannual NAO variability in response to greenhouse gases forcing

    Energy Technology Data Exchange (ETDEWEB)

    Dong, Buwen; Sutton, Rowan T.; Woollings, Tim [University of Reading, National Centre for Atmospheric Science, Department of Meteorology, Reading (United Kingdom)

    2011-10-15

    Observations show that there was change in interannual North Atlantic Oscillation (NAO) variability in the mid-1970s. This change was characterized by an eastward shift of the NAO action centres, a poleward shift of zonal wind anomalies and a downstream extension of climate anomalies associated with the NAO. The NAO interannual variability for the period after the mid-1970s has an annular mode structure that penetrates deeply into the stratosphere, indicating a strengthened relationship between the NAO and the Arctic Oscillation (AO) and strengthened stratosphere-troposphere coupling. In this study we have investigated possible causes of these changes in the NAO by carrying out experiments with an atmospheric GCM. The model is forced either by doubling CO{sub 2}, or increasing sea surface temperatures (SST), or both. In the case of SST forcing the SST anomaly is derived from a coupled model simulation forced by increasing CO{sub 2}. Results indicate that SST and CO{sub 2} change both force a poleward and eastward shift in the pattern of interannual NAO variability and the associated poleward shift of zonal wind anomalies, similar to the observations. The effect of SST change can be understood in terms of mean changes in the troposphere. The direct effect of CO{sub 2} change, in contrast, can not be understood in terms of mean changes in the troposphere. However, there is a significant response in the stratosphere, characterized by a strengthened climatological polar vortex with strongly enhanced interannual variability. In this case, the NAO interannual variability has a strong link with the variability over the North Pacific, as in the annular AO pattern, and is also strongly related to the stratospheric vortex, indicating strengthened stratosphere-troposphere coupling. The similarity of changes in many characteristics of NAO interannual variability between the model response to doubling CO{sub 2} and those in observations in the mid-1970s implies that the

  18. Decreased reaction time variability is associated with greater cardiovascular responses to acute stress.

    Science.gov (United States)

    Wawrzyniak, Andrew J; Hamer, Mark; Steptoe, Andrew; Endrighi, Romano

    2016-05-01

    Cardiovascular (CV) responses to mental stress are prospectively associated with poor CV outcomes. The association between CV responses to mental stress and reaction times (RTs) in aging individuals may be important but warrants further investigation. The present study assessed RTs to examine associations with CV responses to mental stress in healthy, older individuals using robust regression techniques. Participants were 262 men and women (mean age = 63.3 ± 5.5 years) from the Whitehall II cohort who completed a RT task (Stroop) and underwent acute mental stress (mirror tracing) to elicit CV responses. Blood pressure, heart rate, and heart rate variability were measured at baseline, during acute stress, and through a 75-min recovery. RT measures were generated from an ex-Gaussian distribution that yielded three predictors: mu-RT, sigma-RT, and tau-RT, the mean, standard deviation, and mean of the exponential component of the normal distribution, respectively. Decreased intraindividual RT variability was marginally associated with greater systolic (B = -.009, SE = .005, p = .09) and diastolic (B = -.004, SE = .002, p = .08) blood pressure reactivity. Decreased intraindividual RT variability was associated with impaired systolic blood pressure recovery (B = -.007, SE = .003, p = .03) and impaired vagal tone (B = -.0047, SE = .0024, p = .045). Study findings offer tentative support for an association between RTs and CV responses. Despite small effect sizes and associations not consistent across predictors, these data may point to a link between intrinsic neuronal plasticity and CV responses. © 2016 The Authors. Psychophysiology published by Wiley Periodicals, Inc. on behalf of Society for Psychophysiological Research.

  19. Responses of Montane Forest to Climate Variability in the Central Himalayas of Nepal

    Directory of Open Access Journals (Sweden)

    Janardan Mainali

    2015-02-01

    Full Text Available Climate changes are having dramatic ecological impacts in mid- to high-latitude mountain ranges where growth conditions are limited by climatic variables such as duration of growing season, moisture, and ambient temperature. We document patterns of forest vegetative response for 5 major alpine forest communities to current climate variability in the central Himalayas of Nepal to provide a baseline for assessment of future changes, as well as offer some insight into the trajectory of these changes over time. We used mean monthly surface air temperature and rainfall and the monthly averaged normalized difference vegetation index (NDVI to compare relative vegetation productivity among forest types and in relation to both climatic variables. Because changes in temperature and precipitation are directly manifested as changes in phenology, we examined current vegetative responses to climate variability in an effort to determine which climate variable is most critical for different alpine forest types. Our results show that correlations differ according to vegetation type and confirm that both precipitation and temperature affect monthly NDVI values, though more significant correlations were found with temperature data. The temperature response was more consistent because at the maximum increased temperatures, there was still an ongoing increase in vegetative vigor. This indicates that temperature is still the major limiting factor for plant growth at higher-elevation sites. This part of the Himalayas has abundant moisture, and some forest types are already saturated in terms of growth in relation to precipitation. Clear increases in productivity are documented on the upper treeline ecotones, and these systems are likely to continue to have increasing growth rates.

  20. Clinical Audit of the Radiotherapy Process in Rectal Cancer: Clinical Practice Guidelines and Quality Certification Do Not Avert Variability in Clinical Practice.

    Science.gov (United States)

    Torras, M G; Canals, E; Jurado-Bruggeman, D; Marín-Borras, S; Macià, M; Jové, J; Boladeras, A M; Muñoz-Montplet, C; Molero, J; Picón, C; Puigdemont, M; Aliste, L; Torrents, A; Guedea, F; Borras, J M

    2018-06-01

    The therapeutic approach to cancer is complex and multidisciplinary. Radiotherapy is among the essential treatments, whether used alone or in conjunction with other therapies. This study reports a clinical audit of the radiotherapy process to assess the process of care, evaluate adherence to agreed protocols and measure the variability to improve therapeutic quality for rectal cancer. Multicentre retrospective cohort study in a representative sample of patients diagnosed with rectal cancer in the Institut Català d'Oncologia, a comprehensive cancer centre with three different settings. We developed a set of indicators to assess the key areas of the radiotherapy process. The clinical audit consisted of a review of a random sample of 40 clinical histories for each centre. The demographic profile, histology and staging of patients were similar between centres. The MRI reports did not include the distance from tumour to mesorectal fascia (rCRM) in 38.3% of the cases. 96.7% of patients received the planned dose, and 57.4% received it at the planned time. Surgery followed neoadjuvant treatment in 96.7% of the patients. Among this group, postoperative CRM was recorded in 65.5% of the cases and was negative in 93.4% of these. With regard to the 34.5% (n = 40) of cases where no CRM value was stated, there were differences between the centres. Mean follow-up was 3.4 (SD 0.6) years, and overall survival at four years was 81.7%. The audit revealed a suboptimal degree of adherence to clinical practice guidelines. Significant variability between centres exists from a clinical perspective but especially with regard to organization and process. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

  1. Traumatic Reticuloperitonitis in Water Buffalo (Bubalus bubalis: Clinical Findings and the Associated Inflammatory Response

    Directory of Open Access Journals (Sweden)

    Maged El-Ashker

    2013-01-01

    Full Text Available The present study was carried out to describe the clinical picture of traumatic reticuloperitonitis (TRP in water buffalo (Bubalus bubalis and to evaluate the inflammatory and immunologic responses for this clinical condition. Twenty-two buffalo with acute local TRP were monitored in our study. Additionally, 10 clinically healthy buffalo were randomly selected and served as controls. Acute local TRP was initially diagnosed by clinical examination and confirmed by ultrasonographic (USG examination and/or necropsy findings. Blood samples were collected from all examined buffalo to measure the respective levels of tumor necrosis factor alpha (TNF-α, interleukin (IL-1β, IL-6, IL-10 and interferon gamma (INF-γ, serum amyloid A (SAA, C-reactive protein (CRP, haptoglobin (Hp, fibrinogen (Fb, and serum sialic acid (SSA. It was found that TNF-α, IL-1β, IL-6, IL-10, SAA, CRP, Hp, Fb, and SSA were significantly higher in buffalo with TRP than the controls. Our findings suggest that the examined immunologic variables were helpful in documenting the inflammatory response in buffalo with TRP. However, their diagnostic usefulness only becomes apparent when considered in tandem with the clinical findings for any given animal, its anamnesis, and a subsequent USG assessment. Due to the frequent complications of TRP, more accurate indicators of its occurrence and severity would be useful.

  2. ltm: An R Package for Latent Variable Modeling and Item Response Analysis

    Directory of Open Access Journals (Sweden)

    Dimitris Rizopoulos

    2006-11-01

    Full Text Available The R package ltm has been developed for the analysis of multivariate dichotomous and polytomous data using latent variable models, under the Item Response Theory approach. For dichotomous data the Rasch, the Two-Parameter Logistic, and Birnbaum's Three-Parameter models have been implemented, whereas for polytomous data Semejima's Graded Response model is available. Parameter estimates are obtained under marginal maximum likelihood using the Gauss-Hermite quadrature rule. The capabilities and features of the package are illustrated using two real data examples.

  3. Interactive Voice/Web Response System in clinical research.

    Science.gov (United States)

    Ruikar, Vrishabhsagar

    2016-01-01

    Emerging technologies in computer and telecommunication industry has eased the access to computer through telephone. An Interactive Voice/Web Response System (IxRS) is one of the user friendly systems for end users, with complex and tailored programs at its backend. The backend programs are specially tailored for easy understanding of users. Clinical research industry has experienced revolution in methodologies of data capture with time. Different systems have evolved toward emerging modern technologies and tools in couple of decades from past, for example, Electronic Data Capture, IxRS, electronic patient reported outcomes, etc.

  4. Response variability of different anodal transcranial direct current stimulation intensities across multiple sessions.

    Science.gov (United States)

    Ammann, Claudia; Lindquist, Martin A; Celnik, Pablo A

    It is well known that transcranial direct current stimulation (tDCS) is capable of modulating corticomotor excitability. However, a source of growing concern has been the observed inter- and intra-individual variability of tDCS-responses. Recent studies have assessed whether individuals respond in a predictable manner across repeated sessions of anodal tDCS (atDCS). The findings of these investigations have been inconsistent, and their methods have some limitations (i.e. lack of sham condition or testing only one tDCS intensity). To study inter- and intra-individual variability of atDCS effects at two different intensities on primary motor cortex (M1) excitability. Twelve subjects participated in a crossover study testing 7-min atDCS over M1 in three separate conditions (2 mA, 1 mA, sham) each repeated three times separated by 48 h. Motor evoked potentials were recorded before and after stimulation (up to 30min). Time of testing was maintained consistent within participants. To estimate the reliability of tDCS effects across sessions, we calculated the Intra-class Correlation Coefficient (ICC). AtDCS at 2 mA, but not 1 mA, significantly increased cortical excitability at the group level in all sessions. The overall ICC revealed fair to high reliability of tDCS effects for multiple sessions. Given that the distribution of responses showed important variability in the sham condition, we established a Sham Variability-Based Threshold to classify responses and to track individual changes across sessions. Using this threshold an intra-individual consistent response pattern was then observed only for the 2 mA condition. 2 mA anodal tDCS results in consistent intra- and inter-individual increases of M1 excitability. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Executive function impairments in fibromyalgia syndrome: Relevance of clinical variables and body mass index

    Science.gov (United States)

    2018-01-01

    Background Several investigations suggest the presence of deterioration of executive function in fibromyalgia syndrome (FMS). The study quantified executive functions in patients with FMS. A wide array of functions was assessed, including updating, shifting and inhibition, as well as decision making and mental planning. Moreover, clinical variables were investigated as possible mediators of executive dysfunction, including pain severity, psychiatric comorbidity, medication and body mass index (BMI). Methods Fifty-two FMS patients and 32 healthy controls completed a battery of 14 neuropsychological tests. Clinical interviews were conducted and the McGill Pain Questionnaire, Beck Depression Inventory, State-Trait Anxiety Inventory, Fatigue Severity Scale and Oviedo Quality of Sleep Questionnaire were presented. Results Patients performed poorer than controls on the Letter Number Sequencing, Arithmetic and Similarities subtests of the Wechsler Adult Intelligence Scale, the Spatial Span subtest of the Wechsler Memory Scale, an N-back task, a verbal fluency task, the Ruff Figural Fluency Test, the Inhibition score of the Stroop Test, the Inhibition and Shifting scores of the Five Digits Test, the Key Search Test and the Zoo Map Task. Moreover, patients exhibited less steep learning curves on the Iowa Gambling Task. Among clinical variables, BMI and pain severity explained the largest proportion of performance variance. Conclusions This study demonstrated impairments in executive functions of updating, shifting inhibition, decision making and planning in FMS. While the mediating role of pain in cognitive impairments in FMS had been previously established, the influence of BMI is a novel finding. Overweight and obesity should be considered by FMS researchers, and in the treatment of the condition. PMID:29694417

  6. Screening program for Waardenburg syndrome in Colombia: clinical definition and phenotypic variability.

    Science.gov (United States)

    Tamayo, Marta L; Gelvez, Nancy; Rodriguez, Marcela; Florez, Silvia; Varon, Clara; Medina, David; Bernal, Jaime E

    2008-04-15

    A screening program to detect Waardenburg syndrome (WS) conducted between 2002 and 2005, among 1,763 deaf individuals throughout Columbia identified 95 affected individuals belonging to 95 families, giving a frequency of 5.38% of WS among the institutionalized deaf population. We confirmed the clinical diagnosis of WS in the 95 propositi and, through the family evaluation, we also identified 45 non-institutionalized affected relatives. Audiologic, ophthalmologic, and genetic studies were performed to confirm the diagnosis. Following the classification of the WS consortium, based on the Waardenburg Index (WI), to define the type of WS. We classified 62.1% of the propositi as WS2 and 37.9% as WS1. We present here the results of the study of clinical manifestations, analyzing the presence, severity, and symmetry of clinical findings among this affected population. Overall, among the 95 propositi, in addition to sensorineural deafness in all, the most frequent features were broad nasal root (58.9%), a first degree relative affected (37.9%), heterochromia irides (36.8%), skin hypopigmentation (31.6%), white forelock (28.0%), intense blue iris (27.4%), synophrys (12.6%), premature graying (10.5%), ptosis of the eyelids (9.5%), and hypoplasia alae nasi (1.1%). The majority of individuals had normal psychomotor development (87%), while the remaining 13% had developmental delay. Among the latter, 9.4% corresponded to WS2 and 3.6% to WS1. Our data confirm an interesting inter- and intrafamilial variability in the phenotypic manifestations as well as extremely variable expression. Copyright 2008 Wiley-Liss, Inc.

  7. Executive function impairments in fibromyalgia syndrome: Relevance of clinical variables and body mass index.

    Science.gov (United States)

    Muñoz Ladrón de Guevara, Cristina; Fernández-Serrano, María José; Reyes Del Paso, Gustavo A; Duschek, Stefan

    2018-01-01

    Several investigations suggest the presence of deterioration of executive function in fibromyalgia syndrome (FMS). The study quantified executive functions in patients with FMS. A wide array of functions was assessed, including updating, shifting and inhibition, as well as decision making and mental planning. Moreover, clinical variables were investigated as possible mediators of executive dysfunction, including pain severity, psychiatric comorbidity, medication and body mass index (BMI). Fifty-two FMS patients and 32 healthy controls completed a battery of 14 neuropsychological tests. Clinical interviews were conducted and the McGill Pain Questionnaire, Beck Depression Inventory, State-Trait Anxiety Inventory, Fatigue Severity Scale and Oviedo Quality of Sleep Questionnaire were presented. Patients performed poorer than controls on the Letter Number Sequencing, Arithmetic and Similarities subtests of the Wechsler Adult Intelligence Scale, the Spatial Span subtest of the Wechsler Memory Scale, an N-back task, a verbal fluency task, the Ruff Figural Fluency Test, the Inhibition score of the Stroop Test, the Inhibition and Shifting scores of the Five Digits Test, the Key Search Test and the Zoo Map Task. Moreover, patients exhibited less steep learning curves on the Iowa Gambling Task. Among clinical variables, BMI and pain severity explained the largest proportion of performance variance. This study demonstrated impairments in executive functions of updating, shifting inhibition, decision making and planning in FMS. While the mediating role of pain in cognitive impairments in FMS had been previously established, the influence of BMI is a novel finding. Overweight and obesity should be considered by FMS researchers, and in the treatment of the condition.

  8. Mass Market Demand Response and Variable Generation Integration Issues: A Scoping Study

    Energy Technology Data Exchange (ETDEWEB)

    Cappers, Peter; Mills, Andrew; Goldman, Charles; Wiser, Ryan; Eto, Joseph H.

    2011-09-10

    This scoping study focuses on the policy issues inherent in the claims made by some Smart Grid proponents that the demand response potential of mass market customers which is enabled by widespread implementation of Advanced Metering Infrastructure (AMI) through the Smart Grid could be the “silver bullet” for mitigating variable generation integration issues. In terms of approach, we will: identify key issues associated with integrating large amounts of variable generation into the bulk power system; identify demand response opportunities made more readily available to mass market customers through widespread deployment of AMI systems and how they can affect the bulk power system; assess the extent to which these mass market Demand Response (DR) opportunities can mitigate Variable Generation (VG) integration issues in the near-term and what electricity market structures and regulatory practices could be changed to further expand the ability for DR to mitigate VG integration issues over the long term; and provide a qualitative comparison of DR and other approaches to mitigate VG integration issues.

  9. Uncertainty in Indian Ocean Dipole response to global warming: the role of internal variability

    Science.gov (United States)

    Hui, Chang; Zheng, Xiao-Tong

    2018-01-01

    The Indian Ocean Dipole (IOD) is one of the leading modes of interannual sea surface temperature (SST) variability in the tropical Indian Ocean (TIO). The response of IOD to global warming is quite uncertain in climate model projections. In this study, the uncertainty in IOD change under global warming, especially that resulting from internal variability, is investigated based on the community earth system model large ensemble (CESM-LE). For the IOD amplitude change, the inter-member uncertainty in CESM-LE is about 50% of the intermodel uncertainty in the phase 5 of the coupled model intercomparison project (CMIP5) multimodel ensemble, indicating the important role of internal variability in IOD future projection. In CESM-LE, both the ensemble mean and spread in mean SST warming show a zonal positive IOD-like (pIOD-like) pattern in the TIO. This pIOD-like mean warming regulates ocean-atmospheric feedbacks of the interannual IOD mode, and weakens the skewness of the interannual variability. However, as the changes in oceanic and atmospheric feedbacks counteract each other, the inter-member variability in IOD amplitude change is not correlated with that of the mean state change. Instead, the ensemble spread in IOD amplitude change is correlated with that in ENSO amplitude change in CESM-LE, reflecting the close inter-basin relationship between the tropical Pacific and Indian Ocean in this model.

  10. Drought is Coming: Monitoring Vegetation Response to Water Scarcity through Variable Chlorophyll a Fluorescence

    Science.gov (United States)

    Guadagno, C. R.; Beverly, D.; Pleban, J. R.; Speckman, H. N.; Ewers, B. E.; Weinig, C.

    2017-12-01

    Aridity is one of the most pronounced environmental limits to plant survival, and understanding how plants respond to drought and recovery is crucial for predicting impacts on managed and natural ecosystems. Changes in soil moisture conditions induce a suite of physiological responses from the cell to ecosystem scale, complicating the assessment of drought effects. Characterizing early indicators of water scarcity across species can inform biophysical models with improved understanding of plant hydraulics. While indexes exist for drought monitoring across scales, many are unable to identify imminent vegetative drought. We explore a method of early diagnosis using leaf-level and kinetic imaging measures of variable chlorophyll a fluorescence. This is a fast and reliable tool capturing leaf physiological changes in advance of changes in NDVI or passive solar induced fluorescence. Both image and leaf level Pulse Amplitude Method (PAM) measurements illustrate the utility of variable chlorophyll a fluorescence for monitoring vegetative drought. Variable fluorescence was monitored across populations of crops, desert shrubs, montane conifers and riparian deciduous trees under variable water regimes. We found a strong correlation (R = 0.85) between the maximum efficiency of photosystem II measured using variable fluorescence (Fv'Fm') and leaf level electrolyte leakage, a proximal cause of drought stress induced by cellular damage in leaves. This association was confirmed in two gymnosperm species (Picea engelmannii and Pinus contorta) and for diverse varieties of the crop species Brassica rapa. The use of chlorophyll a fluorescence per image also allowed for early detection of drought in aspen (Populus tremuloides). These results provide evidence that variable chlorophyll fluorescence decreases between 25% and 70% in mild and severely droughted twigs with respect to ones collected from trees in wet soil conditions. While current systems for monitoring variable fluorescence

  11. High Intrapatient Variability of Tacrolimus Levels and Outpatient Clinic Nonattendance Are Associated With Inferior Outcomes in Renal Transplant Patients

    Directory of Open Access Journals (Sweden)

    Dawn L. Goodall, MSc

    2017-08-01

    Conclusions. This study shows that high tacrolimus IPV and clinic nonattendance are associated with inferior allograft survival. Interventions to minimize the causes of high variability, particularly nonadherence are essential to improve long-term allograft outcomes.

  12. Variability amongst radiographers in the categorization of clinical acceptability for digital trauma radiography

    Science.gov (United States)

    Decoster, Robin; Toomey, Rachel; Smits, Dirk; Mol, Harrie; Verhelle, Filip; Butler, Marie-Louise

    2016-03-01

    Introduction: Radiographers evaluate anatomical structures to judge clinical acceptability of a radiograph. Whether a radiograph is deemed acceptable for diagnosis or not depends on the individual decision of the radiographer. Individual decisions cause variation in the accepted image quality. To minimise these variations definitions of acceptability, such as in RadLex, were developed. On which criteria radiographers attribute a RadLex categories to radiographs is unknown. Insight into these criteria helps to further optimise definitions and reduce variability in acceptance between radiographers. Therefore, this work aims the evaluation of the correlation between the RadLex classification and the evaluation of anatomical structures, using a Visual Grading Analysis (VGA) Methods: Four radiographers evaluated the visibility of five anatomical structures of 25 lateral cervical spine radiographs on a secondary class display with a VGA. They judged clinical acceptability of each radiograph using RadLex. Relations between VGAS and RadLex category were analysed with Kendall's Tau correlation and Nagelkerke pseudo-R². Results: The overall VGA score (VGAS) and the RadLex score correlate (rτ= 0.62, pscore. The reproduction of spinous processes (rτ=0.67, pscore. Conclusion: RadLex scores and VGAS correlate positively, strongly and significantly. The predictive value of bony structures may support the use of these in the judgement of clinical acceptability. Considerable inter-observer variations in the VGAS within a certain RadLex category, suggest that observers use of observer specific cut-off values.

  13. Clinical intrafamilial variability in lethal familial neonatal seizure disorder caused by TBC1D24 mutations.

    Science.gov (United States)

    Lozano, Reymundo; Herman, Kristin; Rothfuss, Melanie; Rieger, Hillary; Bayrak-Toydemir, Pinar; Aprile, Davide; Fruscione, Floriana; Zara, Federico; Fassio, Anna

    2016-12-01

    TBC1D24-related disorders include a wide phenotypic ranging from mild to lethal seizure disorders, non-syndromic deafness, and composite syndromes such as DOORS (deafness, onychodystrophy, osteodystrophy, mental retardation, and seizures). The TBC1D24 gene has a role in cerebral cortex development and in presynaptic neurotransmission. Here, we present a familial case of a lethal early-onset epileptic encephalopathy, associated with two novel compound heterozygous missense variants on the TBC1D24 gene, which were detected by exome sequencing. The detailed clinical data of the three siblings is summarized in order to support the variability of the phenotype, severity, and progression of this disorder among these family members. Functional studies demonstrated that the identified novel missense mutations result in a loss of expression of the protein, suggesting a correlation between residual expression, and the disease severity. This indicates that protein expression analysis is important for interpreting genetic results when novel variants are found, as well as for complementing clinical assessment by predicting the functional impact. Further analysis is necessary to delineate the clinical presentation of individuals with TBC1D24 pathogenic variants, as well as to develop markers for diagnosis, prognosis, and potential targeted treatments. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  14. Comparison of insight and clinical variables in homeless and non-homeless psychiatric inpatients in China.

    Science.gov (United States)

    Fu, Yan-Nan; Cao, Xiao-Lan; Hou, Cai-Lan; Ng, Chee H; Ungvari, Gabor S; Chiu, Helen F K; Lin, Yong-Qiang; Wang, Lihui; Zheng, Xiaocong; Jia, Fu-Jun; Xiang, Yu-Tao

    2017-09-01

    There are no published data on insight in homeless patients with psychiatric disorders in China. This study examined insight in homeless and non-homeless Chinese psychiatric inpatients in relation to demographic and clinical variables. A total of 278 homeless and 222 non-homeless inpatients matched in age and gender were included in the study. Demographic and clinical characteristics were collected based on a review of medical charts and a clinical interview with standardized instruments. Insight was evaluated with the Insight and Treatment Attitudes Questionnaire. Altogether 20.5% of homeless inpatients and 43.7% of the non-homeless controls had good insight. Compared with homeless inpatients with impaired insight, homeless inpatients with good insight had higher physical quality of life, longer duration of illness and less severe positive and negative symptoms. Impaired insight appeared more common in homeless psychiatric inpatients in China. Further studies should address the need for effective therapeutic interventions that promote homeless patients' insight. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  15. Relationships of Cerebrospinal Fluid Monoamine Metabolite Levels With Clinical Variables in Major Depressive Disorder.

    Science.gov (United States)

    Yoon, Hyung Shin; Hattori, Kotaro; Ogawa, Shintaro; Sasayama, Daimei; Ota, Miho; Teraishi, Toshiya; Kunugi, Hiroshi

    Many studies have investigated cerebrospinal fluid (CSF) monoamine metabolite levels in depressive disorders. However, their clinical significance is still unclear. We tried to determine whether CSF monoamine metabolite levels could be a state-dependent marker for major depressive disorder (MDD) based on analyses stratified by clinical variables in a relatively large sample. Subjects were 75 patients with MDD according to DSM-IV criteria and 87 healthy controls, matched for age, sex, and ethnicity (Japanese). They were recruited between May 2010 and November 2013. We measured homovanillic acid (HVA), 5-hydroxyindoleacetic acid (5-HIAA), and 3-methoxy-4-hydroxyphenylethyleneglycol (MHPG) in CSF samples by high-performance liquid chromatography. We analyzed the relationships of the metabolite levels with age, sex, diagnosis, psychotropic medication use, and depression severity. There was a weak positive correlation between age and 5-HIAA levels in controls (ρ = 0.26, P 12) were significantly lower than those in controls (P .1), were related to depression severity. CSF 5-HIAA and HVA levels could be state-dependent markers in MDD patients. Since 5-HIAA levels greatly decrease with the use of antidepressants, HVA levels might be more useful in the clinical setting. © Copyright 2017 Physicians Postgraduate Press, Inc.

  16. Sunitinib in urothelial cancer: clinical, pharmacokinetic, and immunohistochemical study of predictors of response.

    LENUS (Irish Health Repository)

    Gallagher, David J

    2012-02-01

    BACKGROUND: Sunitinib has activity in patients with metastatic urothelial cancer (UC), but most patients do not respond. OBJECTIVE: To identify predictors of response to sunitinib. DESIGN, SETTING, AND PARTICIPANTS: Seventy-seven patients with advanced UC received sunitinib on one of two schedules at a single institution. Blood pressure (BP), immunohistochemistry (IHC), and pharmacokinetic (PK) results were correlated with response to sunitinib. MEASUREMENTS: BP was assessed on day 1 and 28 of each cycle and on day 14 of cycle 1. IHC was performed on 55 samples from 38 cases using mammalian target of rapamycin and hypoxia-inducible factor (HIF) pathway marker antibodies. Blood samples for PK analysis were collected from 15 patients at three time points. Response was assessed using Response Evaluation Criteria in Solid Tumors criteria. RESULTS AND LIMITATIONS: Sunitinib-induced hypertension predicted improved response when hypertension was categorized as a discrete (p = 0.02) or continuous variable (p = 0.005 [systolic BP] and p = 0.007 [diastolic BP]). The odds ratio of response was 12.5 (95% confidence interval, 1.95-246.8) for grade 3\\/4 hypertension compared with grade 0. Response was associated with low HIF-1alpha expression in primary (p = 0.07) tissue. A nonstatistically significant trend was seen for an association between greater drug concentration and best response. A correlation between expression markers within the same pathways was identified, phosphorylated-4EBP1 and phosphorylated-S6 (p = 6.5 x 10(-9)), and vascular endothelial growth factor receptor 2 and HIF-1alpha (p = 0.008). Results are limited by small numbers. CONCLUSIONS: Clinical and molecular biomarkers of response to sunitinib may have clinical relevance and require prospective validation. There is an urgent need for predictive biomarkers to guide the management of UC.

  17. [Explore objective clinical variables for detecting delirium in ICU patients: a prospective case-control study].

    Science.gov (United States)

    Liu, Xiaojiang; Lyu, Jie; An, Youzhong

    2017-04-01

    The aim of this case-control study is to explore clinical objective variables for diagnosing delirium of intensive care unit (ICU) patients. According to the method of prospective case-control study, critical adult postoperative patients who were transferred to ICU of Peking University People's Hospital from October 2015 to May 2016 and needed mechanical ventilation were included. After evaluating the Richmond agitation sedation scale score (RASS), the patients whose score were -2 or greater were sorted into two groups, delirium and non-delirium, according to the confusion assessment method for the ICU (CAM-ICU). Then these patients were observed by domestic multifunctional detector for electroencephalographic (EEG) variables such as brain lateralization, brain introvert, brain activity, brain energy consumption, focus inward, focus outward, cerebral inhibition, fatigue, sleep severity, sedation index, pain index, anxiety index, fidgety index, stress index and the cerebral blood flow (CBF) index which was named of perfusion index. Other variables including indexes of ICU blood gas analysis, which was consisted of variables of blood gas analysis, routine blood test and biochemistry, previous history and prognostic outcome was recorded. Binary logistic regression was used for multivariate analysis. Forty-three postoperative patients, who needed intensive care, were included. Eighteen were in delirium group and twenty-five in control group. Excluding the trauma, variables like gender, age, temperature, heart rate, respiratory rate, mean arterial pressure, acute physiology and chronic health evaluationII(APACHEII) score, organ failure, dementia and emergency surgery didn't show any statistical significance between two groups. The trauma in delirious patients increased obviously compared with the control group (33.3% vs. 4.0%, P = 0.031). Except for the brain activity [122.47 (88.62, 154.21) vs. 89.40 (86.27, 115.97), P = 0.034], there were no statistical differences in

  18. Variability in anatomical features of human clavicle: Its forensic anthropological and clinical significance

    Directory of Open Access Journals (Sweden)

    Jagmahender Singh Sehrawat

    2016-06-01

    Full Text Available Bones can reflect the basic framework of human body and may provide valuable information about the biological identity of the deceased. They, often, survive the morphological alterations, taphonomic destructions, decay/mutilation and decomposition insults. In-depth knowledge of variations in clavicular shape, size and its dimensions is very important from both clinical (fixation of clavicular fractures using external or inter-medullary devices, designing orthopedic fixation devices as well as forensic anthropological perspectives. Human clavicle is the most frequently fractured bone of human skeleton, possessing high degree of variability in its anatomical, biomechanical and morphological features. Extended period of skeletal growth (up to third decade in clavicle imparts it an additional advantage for forensic identification purposes. In present study, five categories of clavicular features like lengths, diameters, angles, indices and robustness were examined to explore the suitability of collarbone for forensic and clinical purposes. For this purpose, 263 pairs of adult clavicles (195 Males and 68 Females were collected from autopsied cadavers and were studied for 13 anatomical features. Gender and occupational affiliations of cadavers were found to have significant influences on anatomical dimensions of their clavicles. Product index, weight and circumference of collarbone were found the best univariate variables, discriminating sex of more than 80% individuals. The best multivariate Function-I (DF: -17.315 + 0.054 CL-L+0.196 CC-R+0.184 DM-L could identify sex and occupation of 89.4% (89.2% Male and 89.7% Female and 65.4% individuals, respectively. All clavicular variables were found bilaterally asymmetric; left clavicles being significantly longer in length, lighter in weight, smooth in texture and less curved than the right side bones. Among non-metric traits, sub-clavian groove, nutrient foramina and ‘type’ of clavicle exhibited

  19. Behavioral variability, elimination of responses, and delay-of-reinforcement gradients in SHR and WKY rats

    Directory of Open Access Journals (Sweden)

    Killeen Peter R

    2007-11-01

    Full Text Available Abstract Background Attention-deficit/hyperactivity disorder (ADHD is characterized by a pattern of inattention, hyperactivity, and impulsivity that is cross-situational, persistent, and produces social and academic impairment. Research has shown that reinforcement processes are altered in ADHD. The dynamic developmental theory has suggested that a steepened delay-of-reinforcement gradient and deficient extinction of behavior produce behavioral symptoms of ADHD and increased behavioral variability. Method The present study investigated behavioral variability and elimination of non-target responses during acquisition in an animal model of ADHD, the spontaneously hypertensive rat (SHR, using Wistar Kyoto (WKY rats as controls. The study also aimed at providing a novel approach to measuring delay-of-reinforcement gradients in the SHR and the WKY strains. The animals were tested in a modified operant chamber presenting 20 response alternatives. Nose pokes in a target hole produced water according to fixed interval (FI schedules of reinforcement, while nose pokes in the remaining 19 holes either had no consequences or produced a sound or a short flickering of the houselight. The stimulus-producing holes were included to test whether light and sound act as sensory reinforcers in SHR. Data from the first six sessions testing FI 1 s were used for calculation of the initial distribution of responses. Additionally, Euclidean distance (measured from the center of each hole to the center of the target hole and entropy (a measure of variability were also calculated. Delay-of-reinforcement gradients were calculated across sessions by dividing the fixed interval into epochs and determining how much reinforcement of responses in one epoch contributed to responding in the next interval. Results Over the initial six sessions, behavior became clustered around the target hole. There was greater initial variability in SHR behavior, and slower elimination of

  20. Meta-Analysis of Clinical Studies Supports the Pharmacokinetic Variability Hypothesis for Acquired Drug Resistance and Failure of Antituberculosis Therapy

    OpenAIRE

    Pasipanodya, Jotam G.; Srivastava, Shashikant; Gumbo, Tawanda

    2012-01-01

    Laboratory studies have questioned nonadherence as a cause of antituberculosis drug failure and propose that between-patient pharmacokinetic variability may be the cause. This meta-analysis provides clinical evidence that pharmacokinetic variability of isoniazid alone leads to worse microbiological failure, relapse, and acquired drug resistance.

  1. Light induced intraspecific variability in response to thermal stress in the hard coral Stylophora pistillata

    Directory of Open Access Journals (Sweden)

    Arjen Tilstra

    2017-10-01

    Full Text Available Recent research suggests that prior exposure of several months to elevated irradiance induces enhanced thermal tolerance in scleractinian corals. While this tolerance has been reported at the species level, individual coral colonies may react differently due to individual variability in thermal tolerance. As thermal anomalies are predicted to become common in the upcoming future, intraspecific variation may be key to the survival of coral populations. In order to study light-history based thermal stress responses on individual colonies, we developed a preliminary microcosm experiment where three randomly chosen, aquacultured colonies of the model coral Stylophora pistillata were exposed to two irradiance treatments (200 and 400 μmol photons m−2 s−1 for 31 days, followed by artificially induced heat stress (∼33.4 °C. We found different responses to occur at both the intraspecific and the intracolonial levels, as indicated by either equal, less severe, delayed, and/or even non-necrotic responses of corals previously exposed to the irradiance of 400 compared to 200 μmol photons m−2 s−1. In addition, all individual colonies revealed light-enhanced calcification. Finally, elevated irradiance resulted in a lower chlorophyll a concentration in one colony compared to the control treatment, and the same colony displayed more rapid bleaching compared to the other ones. Taken together, this study highlights the potential importance of intra-individual variability in physiological responses of scleractinian corals and provides recommendations for improving methodological designs for future studies.

  2. Variable postpartum responsiveness among humans and other primates with "cooperative breeding": A comparative and evolutionary perspective.

    Science.gov (United States)

    Hrdy, Sarah B

    2016-01-01

    This article is part of a Special Issue "Parental Care".Until recently, evolutionists reconstructing mother-infant bonding among human ancestors relied on nonhuman primate models characterized by exclusively maternal care, overlooking the highly variable responsiveness exhibited by mothers in species with obligate reliance on allomaternal care and provisioning. It is now increasingly recognized that apes as large-brained, slow maturing, and nutritionally dependent for so long as early humans were, could not have evolved unless "alloparents" (group members other than genetic parents), in addition to parents, had helped mothers to care for and provision offspring, a rearing system known as "cooperative breeding." Here I review situation-dependent maternal responses ranging from highly possessive to permissive, temporarily distancing, rejecting, or infanticidal, documented for a small subset of cooperatively breeding primates. As in many mammals, primate maternal responsiveness is influenced by physical condition, endocrinological priming, prior experience and local environments (especially related to security). But mothers among primates who evolved as cooperative breeders also appear unusually sensitive to cues of social support. In addition to more "sapient" or rational decision-making, humankind's deep history of cooperative breeding must be considered when trying to understand the extremely variable responsiveness of human mothers. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Eosinophilic Esophagitis: Clinical Features, Endoscopic Findings and Response to Treatment

    Directory of Open Access Journals (Sweden)

    Robert Enns

    2010-01-01

    Full Text Available Eosinophilic esophagitis (EE is a motility disorder of the esophagus that typically presents with dysphagia. The objective of the present study was to explore patient characteristics, clinical and endoscopic features, and response to treatment of patients with EE. Patients were selected retrospectively based on a review of biopsy results from previous endoscopies performed between 2004 and 2008. A total of 54 patients (41 men and 13 women with biopsy-proven EE were included in the study. Further information regarding the patients’ clinical and endoscopic features, and response to treatment were obtained through chart reviews and patient telephone interviews. The mean age of the patients at symptom onset was 30 years. All patients complained of dysphagia, 81% had a history of bolus obstruction, 43% had a history of asthma and 70% had a history of environmental allergies. Thirty-three per cent had a family history of asthma, while 52% had a family history of food or seasonal allergies. The most common endoscopic findings were rings and/or corrugations, which were found in 63% of patients. Swallowed fluticasone therapy resulted in symptom resolution in 74% of patients; however, 79% of these patients relapsed after discontinuing fluticasone therapy and required repeat treatments. Esophageal dilation was complication free and resulted in improvement in 80% of patients. However, 83% of those reporting improvement relapsed within one year. The clinical and endoscopic findings were similar to those found in the literature, with most patients requiring ongoing, repeated therapies. Further studies are needed to assess the safety and efficacy of treatment modalities ideally suited to patients with EE.

  4. Variability of creatinine measurements in clinical laboratories: results from the CRIC study.

    Science.gov (United States)

    Joffe, Marshall; Hsu, Chi-yuan; Feldman, Harold I; Weir, Matthew; Landis, J R; Hamm, L Lee

    2010-01-01

    Estimating equations using serum creatinine (SCr) are often used to assess glomerular filtration rate (GFR). Such creatinine (Cr)-based formulae may produce biased estimates of GFR when using Cr measurements that have not been calibrated to reference laboratories. In this paper, we sought to examine the degree of this variation in Cr assays in several laboratories associated with academic medical centers affiliated with the Chronic Renal Insufficiency Cohort (CRIC) Study; to consider how best to correct for this variation, and to quantify the impact of such corrections on eligibility for participation in CRIC. Variability of Cr is of particular concern in the conduct of CRIC, a large multicenter study of subjects with chronic renal disease, because eligibility for the study depends on Cr-based assessment of GFR. A library of 5 large volume plasma specimens from apheresis patients was assembled, representing levels of plasma Cr from 0.8 to 2.4 mg/dl. Samples from this library were used for measurement of Cr at each of the 14 CRIC laboratories repetitively over time. We used graphical displays and linear regression methods to examine the variability in Cr, and used linear regression to develop calibration equations. We also examined the impact of the various calibration equations on the proportion of subjects screened as potential participants who were actually eligible for the study. There was substantial variability in Cr assays across laboratories and over time. We developed calibration equations for each laboratory; these equations varied substantially among laboratories and somewhat over time in some laboratories. The laboratory site contributed the most to variability (51% of the variance unexplained by the specimen) and variation with time accounted for another 15%. In some laboratories, calibration equations resulted in differences in eligibility for CRIC of as much as 20%. The substantial variability in SCr assays across laboratories necessitates calibration

  5. Long-term Prognosis in COPD Exacerbation: Role of Biomarkers, Clinical Variables and Exacerbation Type.

    Science.gov (United States)

    Grolimund, Eva; Kutz, Alexander; Marlowe, Robert J; Vögeli, Alaadin; Alan, Murat; Christ-Crain, Mirjam; Thomann, Robert; Falconnier, Claudine; Hoess, Claus; Henzen, Christoph; Zimmerli, Werner; Mueller, Beat; Schuetz, Philipp

    2015-06-01

    Long-term outcome prediction in COPD is challenging. We conducted a prospective 5-7-year follow-up study in patients with COPD to determine the association of exacerbation type, discharge levels of inflammatory biomarkers including procalctionin (PCT), C-reactive protein (CRP), white blood cell count (WBC) and plasma proadrenomedullin (ProADM), alone or combined with demographic/clinical characteristics, with long-term all-cause mortality in the COPD setting. The analyzed cohort comprised 469 patients with index hospitalization for pneumonic (n = 252) or non-pneumonic (n = 217) COPD exacerbation. Five-to-seven-year vital status was ascertained via structured phone interviews with patients or their household members/primary care physicians. We investigated predictive accuracy using univariate and multivariate Cox regression models and area under the receiver operating characteristic curve (AUC). After a median [25th-75th percentile] 6.1 [5.6-6.5] years, mortality was 55% (95%CI 50%-59%). Discharge ProADM concentration was strongly associated with 5-7-year non-survival: adjusted hazard ratio (HR)/10-fold increase (95%CI) 10.4 (6.2-17.7). Weaker associations were found for PCT and no significant associations were found for CRP or WBC. Combining ProADM with demographic/clinical variables including age, smoking status, BMI, New York Heart Association dyspnea class, exacerbation type, and comorbidities significantly improved long-term predictive accuracy over that of the demographic/clinical model alone: AUC (95%CI) 0.745 (0.701-0.789) versus 0.727 (0.681-0.772), (p) = .043. In patients hospitalized for COPD exacerbation, discharge ProADM levels appeared to accurately predict 5-7-year all-cause mortality and to improve long-term prognostic accuracy of multidimensional demographic/clinical mortality risk assessment.

  6. Quantifying temporal glucose variability in diabetes via continuous glucose monitoring: mathematical methods and clinical application.

    Science.gov (United States)

    Kovatchev, Boris P; Clarke, William L; Breton, Marc; Brayman, Kenneth; McCall, Anthony

    2005-12-01

    Continuous glucose monitors (CGMs) collect detailed blood glucose (BG) time series, which carry significant information about the dynamics of BG fluctuations. In contrast, the methods for analysis of CGM data remain those developed for infrequent BG self-monitoring. As a result, important information about the temporal structure of the data is lost during the translation of raw sensor readings into clinically interpretable statistics and images. The following mathematical methods are introduced into the field of CGM data interpretation: (1) analysis of BG rate of change; (2) risk analysis using previously reported Low/High BG Indices and Poincare (lag) plot of risk associated with temporal BG variability; and (3) spatial aggregation of the process of BG fluctuations and its Markov chain visualization. The clinical application of these methods is illustrated by analysis of data of a patient with Type 1 diabetes mellitus who underwent islet transplantation and with data from clinical trials. Normative data [12,025 reference (YSI device, Yellow Springs Instruments, Yellow Springs, OH) BG determinations] in patients with Type 1 diabetes mellitus who underwent insulin and glucose challenges suggest that the 90%, 95%, and 99% confidence intervals of BG rate of change that could be maximally sustained over 15-30 min are [-2,2], [-3,3], and [-4,4] mg/dL/min, respectively. BG dynamics and risk parameters clearly differentiated the stages of transplantation and the effects of medication. Aspects of treatment were clearly visualized by graphs of BG rate of change and Low/High BG Indices, by a Poincare plot of risk for rapid BG fluctuations, and by a plot of the aggregated Markov process. Advanced analysis and visualization of CGM data allow for evaluation of dynamical characteristics of diabetes and reveal clinical information that is inaccessible via standard statistics, which do not take into account the temporal structure of the data. The use of such methods improves the

  7. The importance of histopathological and clinical variables in predicting the evolution of colon cancer.

    Science.gov (United States)

    Diculescu, Mircea; Iacob, Răzvan; Iacob, Speranţa; Croitoru, Adina; Becheanu, Gabriel; Popeneciu, Valentin

    2002-09-01

    It has been a consensus that prognostic factors should always be taken into account before planning treatment in colorectal cancer. A 5 year prospective study was conducted, in order to assess the importance of several histopathological and clinical prognostic variables in the prediction of evolution in colon cancer. Some of the factors included in the analysis are still subject to dispute by different authors. 46 of 53 screened patients qualified to enter the study and underwent a potentially curative resection of the tumor, followed, when necessary, by adjuvant chemotherapy. Univariate and multivariate analyses were carried out in order to identify independent prognostic indicators. The endpoint of the study was considered the recurrence of the tumor or the detection of metastases. 65.2% of the patients had a good evolution during the follow up period. Multivariate survival analysis performed by Cox proportional hazard model identified 3 independent prognostic factors: Dukes stage (p = 0.00002), the grade of differentiation (p = 0.0009) and the weight loss index, representing the weight loss of the patient divided by the number of months when it was actually lost (p = 0.02). Age under 40 years, sex, microscopic aspect of the tumor, tumor location, anemia degree were not identified by our analysis as having prognostic importance. Histopathological factors continue to be the most valuable source of information regarding the possible evolution of patients with colorectal cancer. Individual clinical symptoms or biological parameters such as erytrocyte sedimentation rate or hemoglobin level are of little or no prognostic value. More research is required relating to the impact of a performance status index (which could include also weight loss index) as another reliable prognostic variable.

  8. Scrub typhus in South India: clinical and laboratory manifestations, genetic variability, and outcome.

    Science.gov (United States)

    Varghese, George M; Janardhanan, Jeshina; Trowbridge, Paul; Peter, John V; Prakash, John A J; Sathyendra, Sowmya; Thomas, Kurien; David, Thambu S; Kavitha, M L; Abraham, Ooriapadickal C; Mathai, Dilip

    2013-11-01

    This study sought to document the clinical and laboratory manifestations, genetic variability, and outcomes of scrub typhus, an often severe infection caused by Orientia tsutsugamushi, in South India. Patients admitted to a large teaching hospital with IgM ELISA-confirmed scrub typhus were evaluated. Clinical examination with a thorough search for an eschar, laboratory testing, chest X-ray, and outcome were documented and analyzed. Additionally, a 410-bp region of the 56-kDa type-specific antigen gene of O. tsutsugamushi was sequenced and compared with isolates from other regions of Asia. Most of the 154 patients evaluated presented with fever and non-specific symptoms. An eschar was found in 86 (55%) patients. Mild hepatic involvement was seen in most, with other organ involvement including respiratory, cardiovascular, and renal. Multi-organ dysfunction was noted in 59 (38.3%), and the fatality rate was 7.8%. Hypotension requiring vasoactive agents was found to be an independent predictor of mortality (p<0.001). The phylogeny of 26 samples showed 17 (65%) clustering with the Kato-like group and eight (31%) with the Karp-like group. The presentation of scrub typhus can be variable, often non-specific, but with potentially severe multi-organ dysfunction. Prompt recognition is key to specific treatment and good outcomes. Further study of the circulating strains is essential for the development of a successful vaccine and sensitive point-of-care testing. Copyright © 2013 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  9. Psychological variables potentially implicated in opioid-related mortality as observed in clinical practice.

    Science.gov (United States)

    Passik, Steven D; Lowery, Amy

    2011-06-01

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

  10. Clinical and Demographic Variables Associated Coping and the Burden of Caregivers of Schizophrenia Patients.

    Science.gov (United States)

    Mora-Castañeda, Belvy; Márquez-González, María; Fernández-Liria, Alberto; de la Espriella, Ricardo; Torres, Néstor; Arenas Borrero, Álvaro

    To analyse of the relationship between burden of illness and coping strategies and the demographic variables of caregivers, and the demographic and clinical variables of people diagnosed with schizophrenia. Multicentre correlational cross-sectional study including 70 people diagnosed with schizophrenia, or a schizoaffective disorder, and 70 primary informal caregivers. They were evaluated using Zarit Caregiver Burden Inventory, Family Coping Strategies Questionnaire, Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, and the brief Disability Assessment Scale. Burden of illness positively associated with patient impairment in occupational and social functioning, and negatively with education level. Avoidance, coercion and positive communication were positively associated with impairment in occupational and social functioning of patients. Social interest and friendships showed a positive association with the education level of caregivers. Spiritual assistance negatively correlated with impairment in social functioning and patient age, and resignation was negatively associated with length of the disorder and patient education level. Burden and dysfunctional coping strategies, such as avoidance and coercion, are associated with functional impairment of the patient. These findings suggest the need to provide support to caregivers, adjusted to the functional level of the patient, in order to prevent burden of care. Copyright © 2016 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  11. [Population Council responsible for RU486 clinical trials in USA].

    Science.gov (United States)

    Aguillaume, C J

    1993-04-01

    As a result of the sudden political change that came with the Clinton Administration, RU-486's manufacturer, Roussel-Uclaf, and the Population Council agreed on April 20, 1992, on the manufacture and distribution of RU-486 in the US. In the US, there are less than 1.6 million induced abortions annually. From now on, US women will be able to have a choice between medical and surgical abortion. The Population Council and Roussel-Uclaf have had a contract since 1982. The Council is solely responsible for the phase 2 clinical trial of RU-486 in the US and other countries. It must present to the US Food and Drug Administration (FDA) an amendment allowing it to begin phase 3 clinical trials. The Council will also lead the US medical facilities in this study. It will identify partners for future production of RU-486 and its distribution in the US. It will also submit to FDA a New Drug Application (NDA). FDA will review the scientific literature on RU-486 and evaluate all data submitted by the Population Council. There are still obstacles to be surmounted. The Population Council must demonstrate good judgment when selecting the criteria for choosing a pharmaceutical firm before a Technical Committee which will be part of a group of players promoting women's health, scientific experts, and other interested parties. It must find the necessary funds to conduct the clinical trials and prepare the NDA. Phase 3 clinical trials in the US must have at least 2000 women. They will test RU-486's efficacy, safety, and acceptability among women choosing medical abortion over surgical abortion. Since the Council operates in almost all countries in the world, has innovated contraceptive research and development activities, and has been endorsed by the UN, product approval of RU-486 in the US will affect policy in all countries concerned about abortion.

  12. Impacts of environmental variability on desiccation rate, plastic responses and population dynamics of Glossina pallidipes.

    Science.gov (United States)

    Kleynhans, E; Clusella-Trullas, S; Terblanche, J S

    2014-02-01

    Physiological responses to transient conditions may result in costly responses with little fitness benefits, and therefore, a trade-off must exist between the speed of response and the duration of exposure to new conditions. Here, using the puparia of an important insect disease vector, Glossina pallidipes, we examine this potential trade-off using a novel combination of an experimental approach and a population dynamics model. Specifically, we explore and dissect the interactions between plastic physiological responses, treatment-duration and -intensity using an experimental approach. We then integrate these experimental results from organismal water-balance data and their plastic responses into a population dynamics model to examine the potential relative fitness effects of simulated transient weather conditions on population growth rates. The results show evidence for the predicted trade-off for plasticity of water loss rate (WLR) and the duration of new environmental conditions. When altered environmental conditions lasted for longer durations, physiological responses could match the new environmental conditions, and this resulted in a lower WLR and lower rates of population decline. At shorter time-scales however, a mismatch between acclimation duration and physiological responses was reflected by reduced overall population growth rates. This may indicate a potential fitness cost due to insufficient time for physiological adjustments to take place. The outcomes of this work therefore suggest plastic water balance responses have both costs and benefits, and these depend on the time-scale and magnitude of variation in environmental conditions. These results are significant for understanding the evolution of plastic physiological responses and changes in population abundance in the context of environmental variability. © 2014 The Authors. Journal of Evolutionary Biology © 2014 European Society For Evolutionary Biology.

  13. Dose Response Association between Physical Activity and Biological, Demographic, and Perceptions of Health Variables

    Directory of Open Access Journals (Sweden)

    Paul D. Loprinzi

    2013-08-01

    Full Text Available Background: Few population-based studies have examined the association between physical activity (PA and cardiovascular disease risk factors, demographic variables, and perceptions of health status, and we do not have a clear understanding of the dose-response relationship among these variables. Methods: Data from the 2003-2006 National Health and Nutrition Examination Survey was used to examine the dose-response relationship between objectively measured PA and metabolic syndrome (and its individual cardiovascular disease risk factors, demographic variables, and perceptions of health. After exclusions, 5,538 participants 18 years or older were included in the present study, with 2,538 participants providing fasting glucose and 2,527 providing fasting triglyceride data. PA was categorized into deciles. Results: Overall, the health benefits showed a general pattern of increase with each increasing levels of PA. Of the ten PA classifications examined, participants in the highest moderate-to-vigorous physical activity (MVPA category (at least 71 min/day had the lowest odds of developing metabolic syndrome. Conclusion: At a minimum, sedentary adults should strive to meet current PA guidelines (i.e., 150 min/week of MVPA, with additional positive benefits associated with engaging in three times this level of PA.

  14. Children with language problems in a speech and hearing clinic : Background variables and extent of language problems

    NARCIS (Netherlands)

    Keegstra, A.L.; Knijff, W.A.; Post, W.J.; Goorhuis-Brouwer, S.M.

    Objective: Analysis of a clinical population referred for language analysis in terms of background variables and extent of language problems. Design: Descriptive study. Materials and methods: Children referred to a speech and hearing clinic because of assumed language problems were analyzed with

  15. Elucidation of salvage laryngectomy pathologic and clinical variables to guide further treatment intensification investigation.

    Science.gov (United States)

    Scharpf, Joseph; Ward, Matthew; Adelstein, David; Koyfman, Shlomo; Li, Mingsi

    2018-04-01

    There are limited treatment options beyond surgical salvage for patients who fail nonoperative treatment for laryngeal squamous cell carcinoma. In this study, we examine the failure patterns after surgical salvage and the potential pathologic and clinical prognostic variables that might guide further postoperative intensification investigation. Retrospective analysis at a tertiary academic referral center. From an institutional review board-approved institutional head and neck cancer registry, a consecutive series of 147 patients who underwent salvage laryngectomy for squamous cell cancer recurrence or persistence after radiotherapy with or without chemotherapy between May 1995 and May 2016 were identified. Variables potentially associated with oncologic outcome after surgical salvage were then collected and retrospectively evaluated. The projected 2-year locoregional failure rate was 21.8% (95% confidence interval [CI], 14.6%-29.0%]), and the overall survival 65% (95% CI, 57.5%-74.3%) for the entire cohort after salvage laryngectomy. On multivariable analysis, sarcomatoid/spindle cell pathology (hazard ratio [HR], 3.147; 95% CI, 1.181-8.386; P = 0.022), lymphovascular space invasion (LVSI) (positive vs. negative; HR, 2.31; 95% CI, 1.21-4.42; P = 0.011), and advanced initial American Joint Committee on Cancer 7th Edition grouped stage (stages III-IVB vs. stages I-II; HR, 1.64; 95% CI, 1.04-2.6; P = 0.035) were found to be independently associated with inferior disease-free survival. No other clinical or pathologic variables predicted failure. Salvage laryngectomy after nonoperative treatment failure results in successful locoregional control rates and survival in the majority of patients failing initial therapy. This should temper enthusiasm for routine treatment intensification with postoperative re-irradiation and/or other systemic treatments for the vast majority of patients. Sarcomatoid pathology, LVSI, and an advanced initial stage are associated with inferior

  16. The sequence of cortical activity inferred by response latency variability in the human ventral pathway of face processing.

    Science.gov (United States)

    Lin, Jo-Fu Lotus; Silva-Pereyra, Juan; Chou, Chih-Che; Lin, Fa-Hsuan

    2018-04-11

    Variability in neuronal response latency has been typically considered caused by random noise. Previous studies of single cells and large neuronal populations have shown that the temporal variability tends to increase along the visual pathway. Inspired by these previous studies, we hypothesized that functional areas at later stages in the visual pathway of face processing would have larger variability in the response latency. To test this hypothesis, we used magnetoencephalographic data collected when subjects were presented with images of human faces. Faces are known to elicit a sequence of activity from the primary visual cortex to the fusiform gyrus. Our results revealed that the fusiform gyrus showed larger variability in the response latency compared to the calcarine fissure. Dynamic and spectral analyses of the latency variability indicated that the response latency in the fusiform gyrus was more variable than in the calcarine fissure between 70 ms and 200 ms after the stimulus onset and between 4 Hz and 40 Hz, respectively. The sequential processing of face information from the calcarine sulcus to the fusiform sulcus was more reliably detected based on sizes of the response variability than instants of the maximal response peaks. With two areas in the ventral visual pathway, we show that the variability in response latency across brain areas can be used to infer the sequence of cortical activity.

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

    Science.gov (United States)

    Trigueros Genao, M; Torres, R J

    2014-11-01

    Lesch-Nyhan disease is a rare genetic disease characterized by a deficiency in the function of the enzyme hypoxanthine-guanine phosphoribosyltransferase (HGPRT). Patients affected by this disease experience hyperuricemia, motor disorders, mental retardation and, in the most severe cases, self-mutilation. Its clinical manifestations depend on the enzymatic activity of HGPRT, which is classically linked to the type of alteration in the HGPRT gene. More than 400 mutations of this gene have been found. At present, one of the controversial aspects of the disease is the relationship between the genotype and phenotype; cases have been described lacking a mutation, such as the patient presented in this article, as well as families who despite sharing the same genetic defect show disorders with differing severity. Epigenetic processes, which modify the genetic expression without changing the sequence of the deoxyribonucleic acid (DNA), could explain the clinical variability observed in this disease. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  18. Low voltage RF MEMS variable capacitor with linear C-V response

    KAUST Repository

    Elshurafa, Amro M.

    2012-07-23

    An RF MEMS variable capacitor, fabricated in the PolyMUMPS process and tuned electrostatically, possessing a linear capacitance-voltage response is reported. The measured quality factor of the device was 17 at 1GHz, while the tuning range was 1.2:1 and was achieved at an actuation DC voltage of 8V only. Further, the linear regression coefficient was 0.98. The variable capacitor was created such that it has both vertical and horizontal capacitances present. As the top suspended plate moves towards the bottom fixed plate, the vertical capacitance increases whereas the horizontal capacitance decreases simultaneously such that the sum of the two capacitances yields a linear capacitance-voltage relation. © 2012 The Institution of Engineering and Technology.

  19. Complex response of white pines to past environmental variability increases understanding of future vulnerability.

    Directory of Open Access Journals (Sweden)

    Virginia Iglesias

    Full Text Available Ecological niche models predict plant responses to climate change by circumscribing species distributions within a multivariate environmental framework. Most projections based on modern bioclimatic correlations imply that high-elevation species are likely to be extirpated from their current ranges as a result of rising growing-season temperatures in the coming decades. Paleoecological data spanning the last 15,000 years from the Greater Yellowstone region describe the response of vegetation to past climate variability and suggest that white pines, a taxon of special concern in the region, have been surprisingly resilient to high summer temperature and fire activity in the past. Moreover, the fossil record suggests that winter conditions and biotic interactions have been critical limiting variables for high-elevation conifers in the past and will likely be so in the future. This long-term perspective offers insights on species responses to a broader range of climate and associated ecosystem changes than can be observed at present and should be part of resource management and conservation planning for the future.

  20. A Hydrological Response Analysis Considering Climatic Variability: Case Study of Hunza Catchment

    Directory of Open Access Journals (Sweden)

    A. N. Laghari

    2018-06-01

    Full Text Available The hydrological response of mountainous catchments particularly dependent on melting runoff is very vulnerable to climatic variability. This study is an attempt to assess hydrological response towards climatic variability of the Hunza catchment located in the mountainous chain of greater Hindu Kush-Himalaya (HKH region. The hydrological response is analyzed through changes in snowmelt, ice melt and total runoff simulated through the application of the hydrological modeling system PREVAH under hypothetically developed climate change scenarios. The developed scenarios are based on changes in precipitation (Prp and temperature (Tmp and their combination. Under all the warmer scenarios, the increase in temperature systematically decreases the mean annual snow melt and increases significantly glacier melt volume. Temperature changes from 1°C to 4°C produce a large increase in spring and summer runoff, while no major variation was observed in the winter and autumn runoff. The maximum seasonal changes recorded under the Tmp+4°C, Prp+10% scenario.

  1. Clinical variables affecting survival in patients with decompensated diastolic versus systolic heart failure.

    Science.gov (United States)

    Gorelik, Oleg; Almoznino-Sarafian, Dorit; Shteinshnaider, Miriam; Alon, Irena; Tzur, Irma; Sokolsky, Ilya; Efrati, Shai; Babakin, Zoanna; Modai, David; Cohen, Natan

    2009-04-01

    The impact of various clinical variables on long-term survival of patients with acutely decompensated diastolic heart failure (DHF) compared to systolic heart failure (SHF) has not been sufficiently investigated. Clinical, laboratory, electrocardiographic and echocardiographic data were collected and analyzed for all-cause mortality in 473 furosemide-treated patients aged >or=60 years, hospitalized for acutely decompensated HF. Diastolic heart failure patients (n = 183) were more likely to be older, female, hypertensive, obese, with shorter preexisting HF duration, atrial fibrillation, lower New York Heart Association (NYHA) class, lower maintenance furosemide dosages, and to receive calcium antagonists. The SHF group (290 patients) demonstrated prevailing coronary artery disease, nitrate or digoxin treatment, and electrocardiographic conduction disturbances (P clinical variables. This observation might carry practical implications.

  2. Clinical variability in hereditary optic neuropathies: Two novel mutations in two patients with dominant optic atrophy and Wolfram syndrome.

    Science.gov (United States)

    Galvez-Ruiz, Alberto

    2015-01-01

    Dominant optic atrophy (DOA) and Wolfram syndrome share a great deal of clinical variability, including an association with hearing loss and the presence of optic atrophy at similar ages. The objective of this paper was to discuss the phenotypic variability of these syndromes with respect to the presentation of two clinical cases. We present two patients, each with either DOA or Wolfram syndrome, and contribute to the research literature through our findings of two novel mutations. The overlapping of several clinical characteristics in hereditary optic neuropathies can complicate the differential diagnosis. Future studies are needed to better determine the genotype-phenotype correlation for these diseases.

  3. Climate variability slows evolutionary responses of Colias butterflies to recent climate change.

    Science.gov (United States)

    Kingsolver, Joel G; Buckley, Lauren B

    2015-03-07

    How does recent climate warming and climate variability alter fitness, phenotypic selection and evolution in natural populations? We combine biophysical, demographic and evolutionary models with recent climate data to address this question for the subalpine and alpine butterfly, Colias meadii, in the southern Rocky Mountains. We focus on predicting patterns of selection and evolution for a key thermoregulatory trait, melanin (solar absorptivity) on the posterior ventral hindwings, which affects patterns of body temperature, flight activity, adult and egg survival, and reproductive success in Colias. Both mean annual summer temperatures and thermal variability within summers have increased during the past 60 years at subalpine and alpine sites. At the subalpine site, predicted directional selection on wing absorptivity has shifted from generally positive (favouring increased wing melanin) to generally negative during the past 60 years, but there is substantial variation among years in the predicted magnitude and direction of selection and the optimal absorptivity. The predicted magnitude of directional selection at the alpine site declined during the past 60 years and varies substantially among years, but selection has generally been positive at this site. Predicted evolutionary responses to mean climate warming at the subalpine site since 1980 is small, because of the variability in selection and asymmetry of the fitness function. At both sites, the predicted effects of adaptive evolution on mean population fitness are much smaller than the fluctuations in mean fitness due to climate variability among years. Our analyses suggest that variation in climate within and among years may strongly limit evolutionary responses of ectotherms to mean climate warming in these habitats. © 2015 The Author(s) Published by the Royal Society. All rights reserved.

  4. Growth hormone responsiveness: peak stimulated growth hormone levels and other variables in idiopathic short stature (ISS): data from the National Cooperative Growth Study.

    Science.gov (United States)

    Moore, Wayne V; Dana, Ken; Frane, James; Lippe, Barbara

    2008-09-01

    In children with idiopathic short stature (ISS), growth hormone (GH) response to a provocative test will be inversely related to the first year response to hGH and be a variable accounting for a degree of responsiveness. Because high levels of GH are a characteristic of GH insensitivity, such as in Laron syndrome, it is possible that a high stimulated GH is associated with a lower first year height velocity among children diagnosed as having ISS. We examined the relationship between the peak stimulated GH levels in 3 ISS groups; GH >10 -40 ng/mL and the first year growth response to rhGH therapy. We also looked at 8 other predictor variables (age, sex, height SDS, height age, body mass index (BMI), bone age, dose, and SDS deficit from target parental height. Multiple regression analysis with the first year height as the dependent variable and peak stimulated GH was the primary endpoint. The predictive value of adding each of the other variables was then assessed. Mean change in height velocity was similar among the three groups, with a maximum difference among the groups of 0.6 cm/yr. There was a small but statistically significant correlation (r=-0.12) between the stimulated GH and first year height velocity. The small correlation between first year growth response and peak GH is not clinically relevant in defining GH resistance. No cut off level by peak GH could be determined to enhance the usefulness of this measure to predict response. Baseline age was the only clinically significant predictor, R-squared, 6.4%. All other variables contributed less than an additional 2% to the R-squared.

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

    Science.gov (United States)

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

    2016-01-01

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

  6. Precipitation response to the current ENSO variability in a warming world

    Science.gov (United States)

    Bonfils, C.; Santer, B. D.; Phillips, T. J.; Marvel, K.; Leung, L.

    2013-12-01

    The major triggers of past and recent droughts include large modes of variability, such as ENSO, as well as specific and persistent patterns of sea surface temperature anomalies (SSTAs; Hoerling and Kumar, 2003, Shin et al. 2010, Schubert et al. 2009). However, alternative drought initiators are also anticipated in response to increasing greenhouse gases, potentially changing the relative contribution of ocean variability as drought initiator. They include the intensification of the current zonal wet-dry patterns (the thermodynamic mechanism, Held and Soden, 2006), a latitudinal redistribution of global precipitation (the dynamical mechanism, Seager et al. 2007, Seidel et al. 2008, Scheff and Frierson 2008) and a reduction of local soil moisture and precipitation recycling (the land-atmosphere argument). Our ultimate goal is to investigate whether the relative contribution of those mechanisms change over time in response to global warming. In this study, we first perform an EOF analysis of the 1900-1999 time series of observed global SST field and identify a simple ENSO-like (ENSOL) mode of SST variability. We show that this mode is well spatially and temporally correlated with observed worldwide regional precipitation and drought variability. We then develop concise metrics to examine the fidelity with which the CMIP5 coupled global climate models (CGCMs) capture this particular ENSO-like mode in the current climate, and their ability to replicate the observed teleconnections with precipitation. Based on the CMIP5 model projections of future climate change, we finally analyze the potential temporal variations in ENSOL to be anticipated under further global warming, as well as their associated teleconnections with precipitation (pattern, amplitude, and total response). Overall, our approach allows us to determine what will be the effect of the current ENSO-like variability (i.e., as measured with instrumental observations) on precipitation in a warming world. This

  7. The response of the southwest Western Australian wave climate to Indian Ocean climate variability

    Science.gov (United States)

    Wandres, Moritz; Pattiaratchi, Charitha; Hetzel, Yasha; Wijeratne, E. M. S.

    2018-03-01

    Knowledge of regional wave climates is critical for coastal planning, management, and protection. In order to develop a regional wave climate, it is important to understand the atmospheric systems responsible for wave generation. This study examines the variability of the southwest Western Australian (SWWA) shelf and nearshore wind wave climate and its relationship to southern hemisphere climate variability represented by various atmospheric indices: the southern oscillation index (SOI), the Southern Annular Mode (SAM), the Indian Ocean Dipole Mode Index (DMI), the Indian Ocean Subtropical Dipole (IOSD), the latitudinal position of the subtropical high-pressure ridge (STRP), and the corresponding intensity of the subtropical ridge (STRI). A 21-year wave hindcast (1994-2014) of the SWWA continental shelf was created using the third generation wave model Simulating WAves Nearshore (SWAN), to analyse the seasonal and inter-annual wave climate variability and its relationship to the atmospheric regime. Strong relationships between wave heights and the STRP and the STRI, a moderate correlation between the wave climate and the SAM, and no significant correlation between SOI, DMI, and IOSD and the wave climate were found. Strong spatial, seasonal, and inter-annual variability, as well as seasonal longer-term trends in the mean wave climate were studied and linked to the latitudinal changes in the subtropical high-pressure ridge and the Southern Ocean storm belt. As the Southern Ocean storm belt and the subtropical high-pressure ridge shifted southward (northward) wave heights on the SWWA shelf region decreased (increased). The wave height anomalies appear to be driven by the same atmospheric conditions that influence rainfall variability in SWWA.

  8. Variable dead time counters. 1 - theoretical responses and the effects of neutron multiplication

    International Nuclear Information System (INIS)

    Lees, E.W.; Hooton, B.W.

    1978-10-01

    A theoretical expression is derived for calculating the response of any variable dead time counter (VDC) used in the passive assay of plutonium by neutron counting of the natural spontaneous fission activity. The effects of neutron multiplication in the sample arising from interactions of the original spontaneous fission neutrons is shown to modify the linear relationship between VDC signal and Pu mass. Numerical examples are shown for the Euratom VDC and a systematic investigation of the various factors affecting neutron multiplication is reported. Limited comparisons between the calculations and experimental data indicate provisional validity of the calculations. (author)

  9. Inter-Individual Variability in Human Response to Low-Dose Ionizing Radiation, Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Rocke, David [Univ. of California, Davis, CA (United States)

    2016-08-01

    In order to investigate inter-individual variability in response to low-dose ionizing radiation, we are working with three models, 1) in-vivo irradiated human skin, for which we have a realistic model, but with few subjects, all from a previous project, 2) ex-vivo irradiated human skin, for which we also have a realistic model, though with the limitations involved in keeping skin pieces alive in media, and 3) MatTek EpiDermFT skin plugs, which provides a more realistic model than cell lines, which is more controllable than human samples.

  10. Inter-Individual Variability in Human Response to Low-Dose Ionizing Radiation, Final Report

    International Nuclear Information System (INIS)

    Rocke, David

    2016-01-01

    In order to investigate inter-individual variability in response to low-dose ionizing radiation, we are working with three models, 1) in-vivo irradiated human skin, for which we have a realistic model, but with few subjects, all from a previous project, 2) ex-vivo irradiated human skin, for which we also have a realistic model, though with the limitations involved in keeping skin pieces alive in media, and 3) MatTek EpiDermFT skin plugs, which provides a more realistic model than cell lines, which is more controllable than human samples.

  11. Pastoral mobility as a response to climate variability in African drylands

    DEFF Research Database (Denmark)

    Adriansen, Hanne Kirstine

    1999-01-01

    The article outlines aspects of ‘the new paradigm’ for dryland ecosystems and pastoral production systems. Rationality of pastoralism was claimed by parts of the research community for decades, but especially among policy and development planners pastoralism was perceived as an irrational and des...... in West Africa. In an example from Ferlo, Senegal, different types of pastoral mobility are discussed with special focus on the importance of scale. It is concluded that pastoral mobility is a rational response to climate variability and unpredictability in African drylands....

  12. Resolución del Response Time Variability Problem mediante tabu search

    OpenAIRE

    Corominas Subias, Albert; García Villoria, Alberto; Pastor Moreno, Rafael

    2009-01-01

    El Response Time Variability Problem (RTVP) es un problema combinatorio de scheduling publicado recientemente en la literatura. Dicho problema de optimización combinatoria es muy fácil de formular pero muy difícil de resolver de forma exacta (es NP-hard). El RTVP se presenta cuando productos, clientes o tareas se han de secuenciar minimizando la variabilidad entre los instantes de tiempo en los que reciben los recursos que ellos necesitan. Este problema tiene una gran cantidad de aplicaciones...

  13. Regulating task-monitoring systems in response to variable reward contingencies and outcomes in cocaine addicts.

    Science.gov (United States)

    Morie, Kristen P; De Sanctis, Pierfilippo; Garavan, Hugh; Foxe, John J

    2016-03-01

    We investigated anticipatory and consummatory reward processing in cocaine addiction. In addition, we set out to assess whether task-monitoring systems were appropriately recalibrated in light of variable reward schedules. We also examined neural measures of task-monitoring and reward processing as a function of hedonic tone, since anhedonia is a vulnerability marker for addiction that is obviously germane in the context of reward processing. High-density event-related potentials were recorded while participants performed a speeded response task that systematically varied anticipated probabilities of reward receipt. The paradigm dissociated feedback regarding task success (or failure) from feedback regarding the value of reward (or loss), so that task-monitoring and reward processing could be examined in partial isolation. Twenty-three active cocaine abusers and 23 age-matched healthy controls participated. Cocaine abusers showed amplified anticipatory responses to reward predictive cues, but crucially, these responses were not as strongly modulated by reward probability as in controls. Cocaine users also showed blunted responses to feedback about task success or failure and did not use this information to update predictions about reward. In turn, they showed clearly blunted responses to reward feedback. In controls and users, measures of anhedonia were associated with reward motivation. In cocaine users, anhedonia was also associated with diminished monitoring and reward feedback responses. Findings imply that reward anticipation and monitoring deficiencies in addiction are associated with increased responsiveness to reward cues but impaired ability to predict reward in light of task contingencies, compounded by deficits in responding to actual reward outcomes.

  14. Distribution of the Most Common Genetic Variants Associated with a Variable Drug Response in the Population of the Republic of Macedonia

    Directory of Open Access Journals (Sweden)

    Nestorovska Kapedanovska A.

    2014-12-01

    Full Text Available Genetic variation in the regulation, expression and activity of genes coding for Phase I, Phase II drug metabolizing enzymes (DMEs and drug targets, can be defining factors for the variability in both the effectiveness and occurrence of drug therapy side effects. Information regarding the geographic structure and multi-ethnic distribution of clinically relevant genetic variations is becoming increasingly useful for improving drug therapy and explaining inter-individual and inter-ethnic differences in drug response.

  15. Natural and Human-Induced Variability in Barrier-Island Response to Sea Level Rise

    Science.gov (United States)

    Miselis, Jennifer L.; Lorenzo-Trueba, Jorge

    2017-12-01

    Storm-driven sediment fluxes onto and behind barrier islands help coastal barrier systems keep pace with sea level rise (SLR). Understanding what controls cross-shore sediment flux magnitudes is critical for making accurate forecasts of barrier response to increased SLR rates. Here, using an existing morphodynamic model for barrier island evolution, observations are used to constrain model parameters and explore potential variability in future barrier behavior. Using modeled drowning outcomes as a proxy for vulnerability to SLR, 0%, 28%, and 100% of the barrier is vulnerable to SLR rates of 4, 7, and 10 mm/yr, respectively. When only overwash fluxes are increased in the model, drowning vulnerability increases for the same rates of SLR, suggesting that future increases in storminess may increase island vulnerability particularly where sediment resources are limited. Developed sites are more vulnerable to SLR, indicating that anthropogenic changes to overwash fluxes and estuary depths could profoundly affect future barrier response to SLR.

  16. Application of Peleg's equation to describe creep responses of potatoes under constant and variable storage conditions.

    Science.gov (United States)

    Solomon, W K; Jindal, V K

    2017-06-01

    The application of Peleg's equation to characterize creep behavior of potatoes during storage was investigated. Potatoes were stored at 25, 15, 5C, and variable (fluctuating) temperature for 16 or 26 weeks. The Peleg equation adequately described the creep response of potatoes during storage at all storage conditions (R 2  = .97to .99). Peleg constant k 1 exhibited a significant (p creep responses during storage or processing will be potentially helpful to better understand the phenomenon. The model parameters from such model could be used to relate rheological properties of raw and cooked potatoes. Moreover, the model parameters could be used to establish relationship between instrumental and sensory attributes which will help in the prediction of sensory attributes from instrumental data. © 2016 Wiley Periodicals, Inc.

  17. Ecosystem responses to recent oceanographic variability in high-latitude Northern Hemisphere ecosystems

    Science.gov (United States)

    Mueter, Franz J.; Broms, Cecilie; Drinkwater, Kenneth F.; Friedland, Kevin D.; Hare, Jonathan A.; Hunt, George L., Jr.; Melle, Webjørn; Taylor, Maureen

    2009-04-01

    As part of the international MENU collaboration, we compared and contrasted ecosystem responses to climate-forced oceanographic variability across several high latitude regions of the North Pacific (Eastern Bering Sea (EBS) and Gulf of Alaska (GOA)) and North Atlantic Oceans (Gulf of Maine/Georges Bank (GOM/GB) and the Norwegian/Barents Seas (NOR/BAR)). Differences in the nitrate content of deep source waters and incoming solar radiation largely explain differences in average primary productivity among these ecosystems. We compared trends in productivity and abundance at various trophic levels and their relationships with sea-surface temperature. Annual net primary production generally increases with annual mean sea-surface temperature between systems and within the EBS, BAR, and GOM/GB. Zooplankton biomass appears to be controlled by both top-down (predation by fish) and bottom-up forcing (advection, SST) in the BAR and NOR regions. In contrast, zooplankton in the GOM/GB region showed no evidence of top-down forcing but appeared to control production of major fish populations through bottom-up processes that are independent of temperature variability. Recruitment of several fish stocks is significantly and positively correlated with temperature in the EBS and BAR, but cod and pollock recruitment in the EBS has been negatively correlated with temperature since the 1977 shift to generally warmer conditions. In each of the ecosystems, fish species showed a general poleward movement in response to warming. In addition, the distribution of groundfish in the EBS has shown a more complex, non-linear response to warming resulting from internal community dynamics. Responses to recent warming differ across systems and appear to be more direct and more pronounced in the higher latitude systems where food webs and trophic interactions are simpler and where both zooplankton and fish species are often limited by cold temperatures.

  18. An audit of the nature and impact of clinical coding subjectivity variability and error in otolaryngology.

    Science.gov (United States)

    Nouraei, S A R; Hudovsky, A; Virk, J S; Chatrath, P; Sandhu, G S

    2013-12-01

    To audit the accuracy of clinical coding in otolaryngology, assess the effectiveness of previously implemented interventions, and determine ways in which it can be further improved. Prospective clinician-auditor multidisciplinary audit of clinical coding accuracy. Elective and emergency ENT admissions and day-case activity. Concordance between initial coding and the clinician-auditor multi-disciplinary teams (MDT) coding in respect of primary and secondary diagnoses and procedures, health resource groupings health resource groupings (HRGs) and tariffs. The audit of 3131 randomly selected otolaryngology patients between 2010 and 2012 resulted in 420 instances of change to the primary diagnosis (13%) and 417 changes to the primary procedure (13%). In 1420 cases (44%), there was at least one change to the initial coding and 514 (16%) health resource groupings changed. There was an income variance of £343,169 or £109.46 per patient. The highest rates of health resource groupings change were observed in head and neck surgery and in particular skull-based surgery, laryngology and within that tracheostomy, and emergency admissions, and specially, epistaxis management. A randomly selected sample of 235 patients from the audit were subjected to a second audit by a second clinician-auditor multi-disciplinary team. There were 12 further health resource groupings changes (5%) and at least one further coding change occurred in 57 patients (24%). These changes were significantly lower than those observed in the pre-audit sample, but were also significantly greater than zero. Asking surgeons to 'code in theatre' and applying these codes without further quality assurance to activity resulted in an health resource groupings error rate of 45%. The full audit sample was regrouped under health resource groupings 3.5 and was compared with a previous audit of 1250 patients performed between 2007 and 2008. This comparison showed a reduction in the baseline rate of health resource

  19. Mechanisms of the atmospheric response to North Atlantic multidecadal variability: a model study

    Energy Technology Data Exchange (ETDEWEB)

    Msadek, Rym [Universite Pierre et Marie Curie-Paris 6, LOCEAN/IPSL, Paris Cedex 05 (France); Princeton University, GFDL/NOAA, AOS Program, Princeton, NJ (United States); Frankignoul, Claude [Universite Pierre et Marie Curie-Paris 6, LOCEAN/IPSL, Paris Cedex 05 (France); Li, Laurent Z.X. [Universite Pierre et Marie Curie-Paris 6, LMD/IPSL, Paris Cedex 05 (France)

    2011-04-15

    , significant impacts are found globally, indicating that the Atlantic ocean can drive a large scale atmospheric variability at decadal timescales. The atmospheric response is highly non-linear in both seasons and is consistent with the strong interaction between transient eddies and the mean flow. This study emphasizes that decadal fluctuations of the MOC can affect the storm tracks in both seasons and lead to weak but significant dynamical changes in the atmosphere. (orig.)

  20. Response of wheat restricted-tillering and vigorous growth traits to variables of climate change.

    Science.gov (United States)

    Dias de Oliveira, Eduardo A; Siddique, Kadambot H M; Bramley, Helen; Stefanova, Katia; Palta, Jairo A

    2015-02-01

    The response of wheat to the variables of climate change includes elevated CO2, high temperature, and drought which vary according to the levels of each variable and genotype. Independently, elevated CO2, high temperature, and terminal drought affect wheat biomass and grain yield, but the interactive effects of these three variables are not well known. The aim of this study was to determine the effects of elevated CO2 when combined with high temperature and terminal drought on the high-yielding traits of restricted-tillering and vigorous growth. It was hypothesized that elevated CO2 alone, rather than combined with high temperature, ameliorates the effects of terminal drought on wheat biomass and grain yield. It was also hypothesized that wheat genotypes with more sink capacity (e.g. high-tillering capacity and leaf area) have more grain yield under combined elevated CO2, high temperature, and terminal drought. Two pairs of sister lines with contrasting tillering and vigorous growth were grown in poly-tunnels in a four-factor completely randomized split-plot design with elevated CO2 (700 µL L(-1)), high day time temperature (3 °C above ambient), and drought (induced from anthesis) in all combinations to test whether elevated CO2 ameliorates the effects of high temperature and terminal drought on biomass accumulation and grain yield. For biomass and grain yield, only main effects for climate change variables were significant. Elevated CO2 significantly increased grain yield by 24-35% in all four lines and terminal drought significantly reduced grain yield by 16-17% in all four lines, while high temperature (3 °C above the ambient) had no significant effect. A trade-off between yield components limited grain yield in lines with greater sink capacity (free-tillering lines). This response suggests that any positive response to predicted changes in climate will not overcome the limitations imposed by the trade-off in yield components. © 2014 Commonwealth of

  1. Development and Validation of Culture-Specific Variable Response Inconsistency and True Response Inconsistency Scales for Use with the Korean MMPI-2

    Science.gov (United States)

    Ketterer, Holly L.; Han, Kyunghee; Hur, Jaehong; Moon, Kyungjoo

    2010-01-01

    In response to the concern that Minnesota Multiphasic Personality Inventory-2 (MMPI-2; J. N. Butcher, W. Dahlstrom, J. R. Graham, A. Tellegen, & B. Kaemmer, 1989; J. N. Butcher et al., 2001) Variable Response Inconsistency (VRIN) and True Response Inconsistency (TRIN) score invalidity criteria recommended for use with American samples results…

  2. Effect of response format for clinical vignettes on reporting quality of physician practice

    Directory of Open Access Journals (Sweden)

    Durieux Pierre

    2009-07-01

    Full Text Available Abstract Background Clinical vignettes have been used widely to compare quality of clinical care and to assess variation in practice, but the effect of different response formats has not been extensively evaluated. Our objective was to compare three clinical vignette-based survey response formats – open-ended questionnaire (A, closed-ended (multiple-choice questionnaire with deceptive response items mixed with correct items (B, and closed-ended questionnaire with only correct items (C – in rheumatologists' pre-treatment assessment for tumor-necrosis-factor (TNF blocker therapy. Methods Study design: Prospective randomized study. Setting: Rheumatologists attending the 2004 French Society of Rheumatology meeting. Physicians were given a vignette describing the history of a fictitious woman with active rheumatoid arthritis, who was a candidate for therapy with TNF blocking agents, and then were randomized to receive questionnaire A, B, or C, each containing the same four questions but with different response formats, that asked about their pretreatment assessment. Measurements: Long (recommended items and short (mandatory items checklists were developed for pretreatment assessment for TNF-blocker therapy, and scores were expressed on the basis of responses to questionnaires A, B, and C as the percentage of respondents correctly choosing explicit items on these checklists. Statistical analysis: Comparison of the selected items using pairwise Chi-square tests with Bonferonni correction for variables with statistically significant differences. Results Data for all surveys distributed (114 As, 118 Bs, and 118 Cs were complete and available for analysis. The percentage of questionnaire A, B, and C respondents for whom data was correctly complete for the short checklist was 50.4%, 84.0% and 95.0%, respectively, and was 0%, 5.0% and 5.9%, respectively, for the long version. As an example, 65.8%, 85.7% and 95.8% of the respondents of A, B, and C

  3. Analysis of the response of a photovoltaic module subjected to pulsating light of variable duty cycle

    International Nuclear Information System (INIS)

    Zuñiga-Reyes, Marco A.; Sevilla-Camacho, P.Y.; Robles-Ocampo, J.B.; Lopez-Villarea, S. A.

    2017-01-01

    The present work analyzes the time domain response of polycrystalline and amorphous silicon modules subjected to a pulsed light signal, applied under conditions of darkness and controlled temperature. The applied light has a wavelength of 625 nm, a constant power of 5 Watts, a constant frequency of 10 kHz and a variable duty cycle. The response of the modules was analyzed in both direct current (DC) and alternating current (AC). The results of the research showed differences between the waveform and the amplitude of the output voltage of each of the manufacturing technologies of the modules. To validate the obtained results, the simulation of the response of a solar cell using its equivalent circuit in CA was performed. From the experimental and simulation tests it is observed that the relation between the duty cycle and the response of the modules of different technologies can be used for the monitoring and detection of faults or for the determination of the components of the AC equivalent circuit from the solar cells. (author)

  4. Cold-season atmospheric response to the natural variability of the Atlantic meridional overturning circulation

    Energy Technology Data Exchange (ETDEWEB)

    Gastineau, Guillaume; Frankignoul, Claude [LOCEAN/IPSL, Universite Pierre et Marie Curie, 4 place Jussieu, BP100, Paris Cedex 05 (France)

    2012-07-15

    The influence of the natural variability of the Atlantic meridional overturning circulation (AMOC) on the atmosphere is studied in multi-centennial simulations of six global climate models, using Maximum Covariance Analysis (MCA). In all models, a significant but weak influence of the AMOC changes is found during the Northern Hemisphere cold-season, when the ocean leads the atmosphere by a few years. Although the oceanic pattern slightly varies, an intensification of the AMOC is followed in all models by a weak sea level pressure response that resembles a negative phase of the North Atlantic Oscillation (NAO). The signal amplitude is typically 0.5 hPa and explains about 10% of the yearly variability of the NAO in all models. The atmospheric response seems to be due primarily due to an increase of the heat loss along the North Atlantic Current and the subpolar gyre, associated with an AMOC-driven warming. Sea-ice changes appear to be less important. The stronger heating is associated to a southward shift of the lower-tropospheric baroclinicity and a decrease of the eddy activity in the North Atlantic storm track, which is consistent with the equivalent barotropic perturbation resembling the negative phase of the NAO. This study thus provides some evidence of an atmospheric signature of the AMOC in the cold-season, which may have some implications for the decadal predictability of climate in the North Atlantic region. (orig.)

  5. Heterogeneity of osteosarcoma cell lines led to variable responses in reprogramming.

    Science.gov (United States)

    Choong, Pei Feng; Teh, Hui Xin; Teoh, Hoon Koon; Ong, Han Kiat; Choo, Kong Bung; Sugii, Shigeki; Cheong, Soon Keng; Kamarul, Tunku

    2014-01-01

    Four osteosarcoma cell lines, Saos-2, MG-63, G-292 and U-2 OS, were reprogrammed to pluripotent state using Yamanaka factors retroviral transduction method. Embryonic stem cell (ESC)-like clusters started to appear between 15 to 20 days post transduction. Morphology of the colonies resembled that of ESC colonies with defined border and tightly-packed cells. The reprogrammed sarcomas expressed alkaline phosphatase and pluripotency markers, OCT4, SSEA4, TRA-1-60 and TRA-1-81, as in ESC up to Passage 15. All reprogrammed sarcomas could form embryoid body-like spheres when cultured in suspension in a low attachment dish for up to 10 days. Further testing on the directed differentiation capacity of the reprogrammed sarcomas showed all four reprogrammed sarcoma lines could differentiate into adipocytes while reprogrammed Saos-2-REP, MG-63-REP and G-292-REP could differentiate into osteocytes. Among the 4 osteosarcoma cell lines, U-2 OS reported the highest transduction efficiency but recorded the lowest reprogramming stability under long term culture. Thus, there may be intrinsic differences governing the variable responses of osteosarcoma cell lines towards reprogramming and long term culture effect of the reprogrammed cells. This is a first report to associate intrinsic factors in different osteosarcoma cell lines with variable reprogramming responses and effects on the reprogrammed cells after prolonged culture.

  6. Heterogeneity of Osteosarcoma Cell Lines Led to Variable Responses in Reprogramming

    Science.gov (United States)

    Choong, Pei Feng; Teh, Hui Xin; Teoh, Hoon Koon; Ong, Han Kiat; Choo, Kong Bung; Sugii, Shigeki; Cheong, Soon Keng; Kamarul, Tunku

    2014-01-01

    Four osteosarcoma cell lines, Saos-2, MG-63, G-292 and U-2 OS, were reprogrammed to pluripotent state using Yamanaka factors retroviral transduction method. Embryonic stem cell (ESC)-like clusters started to appear between 15 to 20 days post transduction. Morphology of the colonies resembled that of ESC colonies with defined border and tightly-packed cells. The reprogrammed sarcomas expressed alkaline phosphatase and pluripotency markers, OCT4, SSEA4, TRA-1-60 and TRA-1-81, as in ESC up to Passage 15. All reprogrammed sarcomas could form embryoid body-like spheres when cultured in suspension in a low attachment dish for up to 10 days. Further testing on the directed differentiation capacity of the reprogrammed sarcomas showed all four reprogrammed sarcoma lines could differentiate into adipocytes while reprogrammed Saos-2-REP, MG-63-REP and G-292-REP could differentiate into osteocytes. Among the 4 osteosarcoma cell lines, U-2 OS reported the highest transduction efficiency but recorded the lowest reprogramming stability under long term culture. Thus, there may be intrinsic differences governing the variable responses of osteosarcoma cell lines towards reprogramming and long term culture effect of the reprogrammed cells. This is a first report to associate intrinsic factors in different osteosarcoma cell lines with variable reprogramming responses and effects on the reprogrammed cells after prolonged culture. PMID:25170299

  7. Dissociating neural variability related to stimulus quality and response times in perceptual decision-making.

    Science.gov (United States)

    Bode, Stefan; Bennett, Daniel; Sewell, David K; Paton, Bryan; Egan, Gary F; Smith, Philip L; Murawski, Carsten

    2018-03-01

    According to sequential sampling models, perceptual decision-making is based on accumulation of noisy evidence towards a decision threshold. The speed with which a decision is reached is determined by both the quality of incoming sensory information and random trial-by-trial variability in the encoded stimulus representations. To investigate those decision dynamics at the neural level, participants made perceptual decisions while functional magnetic resonance imaging (fMRI) was conducted. On each trial, participants judged whether an image presented under conditions of high, medium, or low visual noise showed a piano or a chair. Higher stimulus quality (lower visual noise) was associated with increased activation in bilateral medial occipito-temporal cortex and ventral striatum. Lower stimulus quality was related to stronger activation in posterior parietal cortex (PPC) and dorsolateral prefrontal cortex (DLPFC). When stimulus quality was fixed, faster response times were associated with a positive parametric modulation of activation in medial prefrontal and orbitofrontal cortex, while slower response times were again related to more activation in PPC, DLPFC and insula. Our results suggest that distinct neural networks were sensitive to the quality of stimulus information, and to trial-to-trial variability in the encoded stimulus representations, but that reaching a decision was a consequence of their joint activity. Copyright © 2018 Elsevier Ltd. All rights reserved.

  8. Effect of Corporate Social Responsibility Disclosure on Financial Performance with Audit Quality as a Moderating Variable

    Directory of Open Access Journals (Sweden)

    Kartika Dewi

    2016-09-01

    Full Text Available This article aimed to examine the influence of Corporate Social Responsibility (CSR disclosure to the financial performance proxy on Return on Assets (ROA, Return on Equity (ROE, and company value proxy on Price to Book Value (PBV empirically as well as knowing the existence of the audit quality as moderating variable whether it will affect the relationship between CSR disclosure on ROA, ROE, and PBV. The object of this study was mining companies listed on the Indonesia Stock Exchange period 2010-2012. The sample was selected using a purposive sampling method and obtained samples as many as 26 companies with a total data of 78 data. Hypothesis testing methods used were simple regression analysis and moderated regression analysis. The results of this study showed that Corporate Social Responsibility (CSR disclosure had an effect on ROA, but had no effect on ROE and PBV, and audit quality as a moderating variable could not affect the relationship of CSR disc losure on ROA, ROE, and PBV.

  9. Biochemical and Clinical Variables of Normal Parathyroid and Hyperparathyroid Diabetic Chronic Kidney Disease Patients

    Directory of Open Access Journals (Sweden)

    Syed Abdul Kader

    2016-09-01

    Full Text Available Background: In chronic kidney disease (CKD intact parathyroid hormone (iPTH level is often increased before clinical hyperphosphatemia occurs. Despite its importance very few studies evaluated parathyroid status in CKD. Objective: The study was undertaken to estimate level of parathormone in diabetic CKD patients at a tertiary level hospital and assessing its relationship with different parameters like hemoglobin, calcium etc. and comparing biochemical and clinical variables between normal parathyroid and hyperparathyroid groups. Materials and Methods: It was a hospital based cross-sectional study involving purposively selected chronic kidney disease patients attending nephrology and endocrinology outdoor and indoor services of BIRDEM hospital, Dhaka, Bangladesh. Study was conducted during the period of April to October 2010. All the subjects were divided into two groups based on serum parathormone level and different parameters were compared between groups. Results: The mean duration of chronic kidney disease was significantly higher in hyperparathyroid group than that in the normal group (<0.001. Retinopathy and hypertension were more common in hyperparathyroid group than that in patients with normal serum parathormone (p<0.001 and p=0.012. Neuropathy was solely present in hyperparathyroid group (p<0.001. Mean fasting blood glucose, serum creatinine and serum phosphate were significantly higher in the hyperparathyroid group compared to normal group (p<0.001 in all cases while the mean serum calcium and haemoglobin were lower in hyperparathyroid group than those in the normal group (p<0.001 in both cases. Serum creatinine and serum parathormone bears a significantly linear relationship (r=0.986, p<0.001, while serum parathormone and serum calcium bears a significantly negative relationship (r=−0.892 and p<0.001. Conclusion: Earlier intervention on the basis of iPTH in addition to other biochemical parameters of chronic kidney disease is

  10. Practices for Identifying and Rejecting Hemolyzed Specimens Are Highly Variable in Clinical Laboratories.

    Science.gov (United States)

    Howanitz, Peter J; Lehman, Christopher M; Jones, Bruce A; Meier, Frederick A; Horowitz, Gary L

    2015-08-01

    Hemolysis is an important clinical laboratory quality attribute that influences result reliability. To determine hemolysis identification and rejection practices occurring in clinical laboratories. We used the College of American Pathologists Survey program to distribute a Q-Probes-type questionnaire about hemolysis practices to Chemistry Survey participants. Of 3495 participants sent the questionnaire, 846 (24%) responded. In 71% of 772 laboratories, the hemolysis rate was less than 3.0%, whereas in 5%, it was 6.0% or greater. A visual scale, an instrument scale, and combination of visual and instrument scales were used to identify hemolysis in 48%, 11%, and 41% of laboratories, respectively. A picture of the hemolysis level was used as an aid to technologists' visual interpretation of hemolysis levels in 40% of laboratories. In 7.0% of laboratories, all hemolyzed specimens were rejected; in 4% of laboratories, no hemolyzed specimens were rejected; and in 88% of laboratories, some specimens were rejected depending on hemolysis levels. Participants used 69 different terms to describe hemolysis scales, with 21 terms used in more than 10 laboratories. Slight and moderate were the terms used most commonly. Of 16 different cutoffs used to reject hemolyzed specimens, moderate was the most common, occurring in 30% of laboratories. For whole blood electrolyte measurements performed in 86 laboratories, 57% did not evaluate the presence of hemolysis, but for those that did, the most common practice in 21 laboratories (24%) was centrifuging and visually determining the presence of hemolysis in all specimens. Hemolysis practices vary widely. Standard assessment and consistent reporting are the first steps in reducing interlaboratory variability among results.

  11. Using Remote Sensing Mapping and Growth Response to Environmental Variability to Aide Aquatic Invasive Plant Management

    Science.gov (United States)

    Bubenheim, David L.; Schlick, Greg; Genovese, Vanessa; Wilson, Kenneth D.

    2018-01-01

    Management of aquatic weeds in complex watersheds and river systems present many challenges to assessment, planning and implementation of management practices for floating and submerged aquatic invasive plants. The Delta Region Areawide Aquatic Weed Project (DRAAWP), a USDA sponsored area-wide project, is working to enhance planning, decision-making and operational efficiency in the California Sacramento-San Joaquin Delta. Satellite and airborne remote sensing are used map (area coverage and biomass density), direct operations, and assess management impacts on plant communities. Archived satellite records enable review of results following previous climate and management events and aide in developing long-term strategies. Examples of remote sensing aiding effectiveness of aquatic weed management will be discussed as well as areas for potential technological improvement. Modeling at local and watershed scales using the SWAT modeling tool provides insight into land-use effects on water quality (described by Zhang in same Symposium). Controlled environment growth studies have been conducted to quantify the growth response of invasive aquatic plants to water quality and other environmental factors. Environmental variability occurs across a range of time scales from long-term climate and seasonal trends to short-term water flow mediated variations. Response time for invasive species response are examined at time scales of weeks, day, and hours using a combination of study duration and growth assessment techniques to assess water quality, temperature (air and water), nitrogen, phosphorus, and light effects. These provide response parameters for plant growth models in response to the variation and interact with management and economic models associated with aquatic weed management. Plant growth models are to be informed by remote sensing and applied spatially across the Delta to balance location and type of aquatic plant, growth response to altered environments and

  12. Inherently variable responses to glucocorticoid stress among endogenous retroviruses isolated from 23 mouse strains.

    Science.gov (United States)

    Hsu, Karen; Lee, Young-Kwan; Chew, Alex; Chiu, Sophia; Lim, Debora; Greenhalgh, David G; Cho, Kiho

    2017-10-01

    Active participation of endogenous retroviruses (ERVs) in disease processes has been exemplified by the finding that the HERV (human ERV)-W envelope protein is involved in the pathogenesis of multiple sclerosis, an autoimmune disease. We also demonstrated that injury-elicited stressors alter the expression of murine ERVs (MuERVs), both murine leukemia virus-type and mouse mammary tumor virus (MMTV)-type (MMTV-MuERV). In this study, to evaluate MMTV-MuERVs' responses to stress (e.g., injury, infection)-elicited systemic glucocorticoid (GC) levels, we examined the GC-stress response of 64 MMTV-MuERV promoters isolated from the genomes of 23 mouse strains. All 64 promoters responded to treatment with a synthetic GC, dexamethasone (DEX), at a wide range from a 0.6- to 85.7-fold increase in reporter activity compared to no treatment. An analysis of the 10 lowest and 10 highest DEX responders revealed specific promoter elements exclusively present in either the three lowest or the two highest responders. Each promoter had a unique profile of transcription regulatory elements and the glucocorticoid response element (GRE) was identified in all promoters with the number of GREs ranging from 2 to 7. The three lowest DEX responders were the only promoters with two GREs. The findings from this study suggest that certain MMTV-MuERVs are more responsive to stress-elicited systemic GC elevation compared to the others. The mouse strain-specific genomic MMTV-MuERV profiles and individual MMTV-MuERVs' differential responses to GC-stress might explain, at least in part, the variable inflammatory responses to injury and/or infection, often observed among different mouse strains. This article is part of a Special Issue entitled: Immune and Metabolic Alterations in Trauma and Sepsis edited by Dr. Raghavan Raju. Copyright © 2016 Elsevier B.V. All rights reserved.

  13. Heart Rate Variability Responses of Individuals With and Without Saline-Induced Obstructive Sleep Apnea.

    Science.gov (United States)

    Vena, Daniel; Bradley, T Douglas; Millar, Philip J; Floras, John S; Rubianto, Jonathan; Gavrilovic, Bojan; Perger, Elisa; Yadollahi, Azadeh

    2018-03-30

    Postoperative development of obstructive sleep apnea (OSA) has been attributed to the fluid overloaded state of patients during the postoperative period. In this context, alterations in cardiac autonomic regulation caused by OSA may explain the increased postoperative risk for adverse cardiovascular events. This study tests the hypothesis that individuals with fluid overload-induced OSA will experience autonomic dysregulation, compared to those without fluid overload-induced OSA. Twenty-one normotensive, nonobese (mean body mass index 24.5 kg/m2) males (mean age 37 years) underwent a sleep study. Participants were randomly assigned to infusion with saline during sleep either at the minimum rate (control) or as a bolus of 22 mL/kg body weight (intervention). Participants were blinded to the intervention and crossed over to the other study arm after 1 week. Measures of heart rate variability were calculated from electrocardiography recordings presaline and postsaline infusion in the intervention arm. Heart rate variability measures computed were: standard deviation of the RR interval; root mean square of successive differences; low-frequency, high-frequency, and total power; and the ratio of low-frequency to high-frequency power. Although presaline infusion values were similar, postsaline infusion values of the standard deviation of the RR interval and high-frequency power were lower in the group whose apnea-hypopnea index increased in response to saline infusion, compared to the group whose apnea-hypopnea index did not increase in response to saline infusion ( P variability, consistent with vagal withdrawal. Future work should explore autonomic dysregulation in the postoperative period and its association with adverse events. Copyright © 2018 American Academy of Sleep Medicine. All rights reserved.

  14. Multi-scale responses of scattering layers to environmental variability in Monterey Bay, California

    Science.gov (United States)

    Urmy, Samuel S.; Horne, John K.

    2016-07-01

    A 38 kHz upward-facing echosounder was deployed on the seafloor at a depth of 875 m in Monterey Bay, CA, USA (36° 42.748‧N, 122° 11.214‧W) from 27 February 2009 to 18 August 2010. This 18-month record of acoustic backscatter was compared to oceanographic time series from a nearby data buoy to investigate the responses of animals in sound-scattering layers to oceanic variability at seasonal and sub-seasonal time scales. Pelagic animals, as measured by acoustic backscatter, moved higher in the water column and decreased in abundance during spring upwelling, attributed to avoidance of a shoaling oxycline and advection offshore. Seasonal changes were most evident in a non-migrating scattering layer near 500 m depth that disappeared in spring and reappeared in summer, building to a seasonal maximum in fall. At sub-seasonal time scales, similar responses were observed after individual upwelling events, though they were much weaker than the seasonal relationship. Correlations of acoustic backscatter with oceanographic variability also differed with depth. Backscatter in the upper water column decreased immediately following upwelling, then increased approximately 20 days later. Similar correlations existed deeper in the water column, but at increasing lags, suggesting that near-surface productivity propagated down the water column at 10-15 m d-1, consistent with sinking speeds of marine snow measured in Monterey Bay. Sub-seasonal variability in backscatter was best correlated with sea-surface height, suggesting that passive physical transport was most important at these time scales.

  15. Spatial representation and cognitive modulation of response variability in the lateral intraparietal area priority map.

    Science.gov (United States)

    Falkner, Annegret L; Goldberg, Michael E; Krishna, B Suresh

    2013-10-09

    The lateral intraparietal area (LIP) in the macaque contains a priority-based representation of the visual scene. We previously showed that the mean spike rate of LIP neurons is strongly influenced by spatially wide-ranging surround suppression in a manner that effectively sharpens the priority map. Reducing response variability can also improve the precision of LIP's priority map. We show that when a monkey plans a visually guided delayed saccade with an intervening distractor, variability (measured by the Fano factor) decreases both for neurons representing the saccade goal and for neurons representing the broad spatial surround. The reduction in Fano factor is maximal for neurons representing the saccade goal and steadily decreases for neurons representing more distant locations. LIP Fano factor changes are behaviorally significant: increasing expected reward leads to lower variability for the LIP representation of both the target and distractor locations, and trials with shorter latency saccades are associated with lower Fano factors in neurons representing the surround. Thus, the LIP Fano factor reflects both stimulus and behavioral engagement. Quantitative modeling shows that the interaction between mean spike count and target-receptive field (RF) distance in the surround during the predistractor epoch is multiplicative: the Fano factor increases more steeply with mean spike count further away from the RF. A negative-binomial model for LIP spike counts captures these findings quantitatively, suggests underlying mechanisms based on trial-by-trial variations in mean spike rate or burst-firing patterns, and potentially provides a principled framework to account simultaneously for the previously observed unsystematic relationships between spike rate and variability in different brain areas.

  16. Refractory myasthenia gravis - clinical profile, comorbidities and response to rituximab.

    Science.gov (United States)

    Sudulagunta, Sreenivasa Rao; Sepehrar, Mona; Sodalagunta, Mahesh Babu; Settikere Nataraju, Aravinda; Bangalore Raja, Shiva Kumar; Sathyanarayana, Deepak; Gummadi, Siddharth; Burra, Hemanth Kumar

    2016-01-01

    Introduction: Myasthenia gravis (MG) is an antibody mediated autoimmune neuromuscular disorder characterized by fatigable muscle weakness. A proportion of myasthenia gravis patients are classified as refractory due to non responsiveness to conventional treatment. This retrospective study was done to evaluate clinical profile, epidemiological, laboratory, and features of patients with MG and mode of management using rituximab and complications. Methods: Data of myasthenia gravis patients admitted or presented to outpatient department (previous medical records) with MG between January 2008 and January 2016 were included. A total of 512 patients fulfilled the clinical and diagnostic criteria of myasthenia gravis of which 76 patients met the diagnostic certainty for refractory myasthenia gravis and were evaluated. Results: Out of 76 refractory MG patients, 53 (69.73%) patients fulfilled all the three defined criteria. The median age of onset of the refractory MG group was 36 years with a range of 27-53 years. In our study 25 patients (32.89%) belonged to the age group of 21-30 years. Anti-MuSK antibodies were positive in 8 non-refractory MG patients (2.06%) and 36 refractory MG patients (47.36%). Mean HbA 1C was found to be 8.6±2.33. The dose of administered prednisone decreased by a mean of 59.7% ( p =3.3x10 -8 ) to 94.6% ( p =2.2x10 -14 ) after the third cycle of rituximab treatment. Conclusion: The refractory MG patients are most commonly female with an early age of onset, anti-MuSK antibodies, and thymomas. Refractory MG patients have higher prevalence and poor control (HbA 1C >8%) of diabetes mellitus and dyslipidemia probably due to increased steroid usage. Rituximab is very efficient in treatment of refractory MG with adverse effects being low.

  17. X-linked acrogigantism syndrome: clinical profile and therapeutic responses.

    Science.gov (United States)

    Beckers, Albert; Lodish, Maya Beth; Trivellin, Giampaolo; Rostomyan, Liliya; Lee, Misu; Faucz, Fabio R; Yuan, Bo; Choong, Catherine S; Caberg, Jean-Hubert; Verrua, Elisa; Naves, Luciana Ansaneli; Cheetham, Tim D; Young, Jacques; Lysy, Philippe A; Petrossians, Patrick; Cotterill, Andrew; Shah, Nalini Samir; Metzger, Daniel; Castermans, Emilie; Ambrosio, Maria Rosaria; Villa, Chiara; Strebkova, Natalia; Mazerkina, Nadia; Gaillard, Stéphan; Barra, Gustavo Barcelos; Casulari, Luis Augusto; Neggers, Sebastian J; Salvatori, Roberto; Jaffrain-Rea, Marie-Lise; Zacharin, Margaret; Santamaria, Beatriz Lecumberri; Zacharieva, Sabina; Lim, Ee Mun; Mantovani, Giovanna; Zatelli, Maria Chaira; Collins, Michael T; Bonneville, Jean-François; Quezado, Martha; Chittiboina, Prashant; Oldfield, Edward H; Bours, Vincent; Liu, Pengfei; W de Herder, Wouter; Pellegata, Natalia; Lupski, James R; Daly, Adrian F; Stratakis, Constantine A

    2015-06-01

    X-linked acrogigantism (X-LAG) is a new syndrome of pituitary gigantism, caused by microduplications on chromosome Xq26.3, encompassing the gene GPR101, which is highly upregulated in pituitary tumors. We conducted this study to explore the clinical, radiological, and hormonal phenotype and responses to therapy in patients with X-LAG syndrome. The study included 18 patients (13 sporadic) with X-LAG and microduplication of chromosome Xq26.3. All sporadic cases had unique duplications and the inheritance pattern in two families was dominant, with all Xq26.3 duplication carriers being affected. Patients began to grow rapidly as early as 2-3 months of age (median 12 months). At diagnosis (median delay 27 months), patients had a median height and weight standard deviation scores (SDS) of >+3.9 SDS. Apart from the increased overall body size, the children had acromegalic symptoms including acral enlargement and facial coarsening. More than a third of cases had increased appetite. Patients had marked hypersecretion of GH/IGF1 and usually prolactin, due to a pituitary macroadenoma or hyperplasia. Primary neurosurgical control was achieved with extensive anterior pituitary resection, but postoperative hypopituitarism was frequent. Control with somatostatin analogs was not readily achieved despite moderate to high levels of expression of somatostatin receptor subtype-2 in tumor tissue. Postoperative use of adjuvant pegvisomant resulted in control of IGF1 in all five cases where it was employed. X-LAG is a new infant-onset gigantism syndrome that has a severe clinical phenotype leading to challenging disease management. © 2015 Society for Endocrinology.

  18. Staphylococcus agnetis sp. nov., a coagulase-variable species from bovine subclinical and mild clinical mastitis.

    Science.gov (United States)

    Taponen, Suvi; Supré, Karlien; Piessens, Veerle; Van Coillie, Els; De Vliegher, Sarne; Koort, Joanna M K

    2012-01-01

    Thirteen Gram-positive-staining coagulase-variable staphylococci were isolated from subclinical and mild clinical mastitic bovine milk (n=12) and a teat apex (n=1). The results of sequence analysis of the 16S rRNA gene and two housekeeping genes, rpoB and tuf, and DNA fingerprinting with amplified fragment length polymorphism (AFLP) analysis showed that the isolates formed a separate branch within the genus Staphylococcus. The phylogenetically most closely related species were Staphylococcus hyicus and Staphylococcus chromogenes. DNA-DNA hybridization with S. hyicus DSM 20459(T) and S. chromogenes DSM 20674(T) confirmed that the isolates belonged to a separate species. The predominant fatty acids were i-C(15:0), ai-C(15:0), i-C(17:0) and C(20:0) and the peptidoglycan type was A3α L-Lys-Gly(5). Based on the results of genotypic and phenotypic analyses, it is proposed that the thirteen isolates represent a novel species, for which the name Staphylococcus agnetis sp. nov. is proposed. Strain 6-4(T) (=DSM 23656(T)=CCUG 59809(T)) is the type strain.

  19. Clinical variability of neuroacanthocytosis syndromes-a series of six patients with long follow-up.

    Science.gov (United States)

    Dulski, J; Sołtan, W; Schinwelski, M; Rudzińska, M; Wójcik-Pędziwiatr, M; Wictor, L; Schön, F; Puschmann, A; Klempíř, J; Tilley, L; Roth, J; Tacik, P; Fujioka, S; Drozdowski, W; Sitek, E J; Wszolek, Z; Sławek, J

    2016-08-01

    To provide clinical clues to differential diagnosis in patients with chorea and other movement disorders with blood acanthocytes. We present a long-term video accompanied follow-up of six Caucasian patients with neuroacanthocytosis from several centers, three diagnosed with chorea-acanthocytosis (ChAc): 34-y.o.(no.1), 36-y.o.(no.2), 43-y.o.(no.3), two diagnosed with McLeod Syndrome (MLS): 52-y.o.(no.4), 61-y.o.(no.5) and one 63-y.o.(no.6), a brother of no.5, with clinical suspicion of MLS. Additionally we report pathological findings of the mother of two brothers with MLS reported in our series with acanthocytes on peripheral blood smear The patients had an unremarkable family history and were asymptomatic until adulthood. Patients no. 1,2,4,5,6 developed generalized chorea and patient no. 3 had predominant bradykinesia. Patients no. 1,2,3 had phonic and motor tics, additionally patients no. 1 and 2 exhibited peculiar oromandibular dystonia with tongue thrusting. In patients no. 2 and 3 dystonic supination of feet was observed, patient no. 3 subsequently developed bilateral foot drop. Patients no. 2 and 4 had signs of muscle atrophy. Tendon reflexes were decreased or absent and electroneurography demonstrated sensorimotor neuropathy in patients no. 1,2,3,4,5, except no. 6. Generalized seizures were seen in patients no. 2,3,5,6 and myoclonic jerks in patient no. 1. Cognitive deterioration was reported in patients no. 1,2,3,5,6. Serum creatine kinase levels were elevated in all six patients. We highlight the variability of clinical presentation of neuroacanthocytosis syndromes and the long time from the onset to diagnosis with the need to screen the blood smears in uncertain cases, however, as in one of our cases acanthocytes may even be not found. Based on our observations and data from the literature we propose several red flags that should raise the suspicion of an NA syndrome in a patient with a movement disorder: severe orofacial dyskinesia with tongue and lip

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

    Directory of Open Access Journals (Sweden)

    Anastasia A

    2016-04-01

    Full Text Available Annalisa Anastasia,1 Chiara Colletti,1 Valentina Cuoco,1 Adele Quartini,1 Stefania Urso,2 Raffaella Rinaldi,2 Giuseppe Bersani1 1Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, 2Department of Anatomical, Istological, Forensic and Locomotor System Sciences, Sapienza University of Rome, Rome, Italy Introduction: Although adjustment disorder (AD is considered as residual diagnosis and receives little attention in research, it plays an important role in clinical practice and also assumes an increasingly important role in the field of legal medicine, where the majority of diagnostic frameworks (eg, mobbing often refer to AD. Our study aimed to look for specific stressor differences among demographic and clinical variables in a naturalistic setting of patients with AD.Methods: A restrospective statistical analysis of the data of patients diagnosed with AD from November 2009 to September 2012, identified via manual search from the archive of the outpatient setting at the University Unit of Psychiatry “A. Fiorini” Hospital, Terracina (Latina, Italy, was performed.Results: The sample consisted of 93 patients (46 males and 47 females, aged between 26 and 85, with medium–high educational level who were mainly employed. In most cases (54.80%, a diagnosis of AD with mixed anxiety and depressed mood was made. In all, 72% of the sample reported a negative family history for psychiatric disorders. In 22.60%, a previous history of psychopathology, especially mood disorders (76.19%, was reported. The main stressors linked to the development of AD were represented by working problems (32.30%, family problems (23.70%, and/or somatic disease (22.60% with significant differences with respect to age and sex. Half of the patients were subjected to a single first examination; 24.47% requested a copy of medical records.Conclusion: Confirming previous data from previous reports, our results

  1. Maternal-fetal acute responses to two moderate-intensity exercise types: a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Jousilene de Sales Tavares

    2018-03-01

    Full Text Available Objective:  This study aims to compare maternal and fetal responses during two physical exercise types. Design:  A randomized clinical trial compared 120 pregnant women, gestational age of 35-37 weeks, 56 exercising on a stationary bicycle (Group A and 64 on a treadmill (Group B. Methods: Participants were monitored for three 20-minute phases: resting, exercise and recovery.  Fetal heart rate (FHR and maternal heart rate (MHR were monitored.  Glucose and lactate levels were evaluated at rest and during exercise. Results:  After the beginning of exercise, maximum lactate (L levels were reached at 20 minutes and never exceeded 4 mmol/l.  FHR decreased by 22 bpm during exercise in relation to resting values, irrespective of the exercise type (p0.05, increasing at 20’ to 32% and 40.6%, respectively, (p>0.05.  The FHR decrease during exercise was accompanied by a simultaneous increase in its variability (p<0.001, nevertheless a rapid return to resting values was observed shortly after exercise end.  Glucose decreased in both groups irrespective of the exercise type (85 mg/dl at rest; 79 mg/dl during exercise and 81 mg/dl during recovery; p<0.001. There were no hypoglycemia cases. Conclusions: FHR variability increase and the rapid return to resting values after exercise suggests that the FHR fall and the presence of bradycardia during exercise is the fetal physiologic response to blood flow redistribution, with maintenance of fetal well-being. Key-words: Exercise; fetal heart rate; glucose; maternal heart rate; pregnancy Clinical Trial Registration: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01383889.

  2. Optimization of Process Variables for Insulation Coating of Conductive Particles by Response Surface Methodology

    International Nuclear Information System (INIS)

    Sim, Chol-Ho

    2016-01-01

    The powder core, conventionally fabricated from iron particles coated with insulator, showed large eddy current loss under high frequency, because of small specific resistance. To overcome the eddy current loss, the increase in the specific resistance of powder cores was needed. In this study, copper oxide coating onto electrically conductive iron particles was performed using a planetary ball mill to increase the specific resistance. Coating factors were optimized by the Response surface methodology. The independent variables were the CuO mass fraction, mill revolution number, coating time, ball size, ball mass and sample mass. The response variable was the specific resistance. The optimization of six factors by the fractional factorial design indicated that CuO mass fraction, mill revolution number, and coating time were the key factors. The levels of these three factors were selected by the three-factors full factorial design and steepest ascent method. The steepest ascent method was used to approach the optimum range for maximum specific resistance. The Box-Behnken design was finally used to analyze the response surfaces of the screened factors for further optimization. The results of the Box-Behnken design showed that the CuO mass fraction and mill revolution number were the main factors affecting the efficiency of coating process. As the CuO mass fraction increased, the specific resistance increased. In contrast, the specific resistance increased with decreasing mill revolution number. The process optimization results revealed a high agreement between the experimental and the predicted data (Adj-R2=0.944). The optimized CuO mass fraction, mill revolution number, and coating time were 0.4, 200 rpm, and 15 min, respectively. The measured value of the specific resistance of the coated pellet under the optimized conditions of the maximum specific resistance was 530 kΩ·cm

  3. Optimization of Process Variables for Insulation Coating of Conductive Particles by Response Surface Methodology

    Energy Technology Data Exchange (ETDEWEB)

    Sim, Chol-Ho [Sangji University, Wonju (Korea, Republic of)

    2016-02-15

    The powder core, conventionally fabricated from iron particles coated with insulator, showed large eddy current loss under high frequency, because of small specific resistance. To overcome the eddy current loss, the increase in the specific resistance of powder cores was needed. In this study, copper oxide coating onto electrically conductive iron particles was performed using a planetary ball mill to increase the specific resistance. Coating factors were optimized by the Response surface methodology. The independent variables were the CuO mass fraction, mill revolution number, coating time, ball size, ball mass and sample mass. The response variable was the specific resistance. The optimization of six factors by the fractional factorial design indicated that CuO mass fraction, mill revolution number, and coating time were the key factors. The levels of these three factors were selected by the three-factors full factorial design and steepest ascent method. The steepest ascent method was used to approach the optimum range for maximum specific resistance. The Box-Behnken design was finally used to analyze the response surfaces of the screened factors for further optimization. The results of the Box-Behnken design showed that the CuO mass fraction and mill revolution number were the main factors affecting the efficiency of coating process. As the CuO mass fraction increased, the specific resistance increased. In contrast, the specific resistance increased with decreasing mill revolution number. The process optimization results revealed a high agreement between the experimental and the predicted data (Adj-R2=0.944). The optimized CuO mass fraction, mill revolution number, and coating time were 0.4, 200 rpm, and 15 min, respectively. The measured value of the specific resistance of the coated pellet under the optimized conditions of the maximum specific resistance was 530 kΩ·cm.

  4. Influence of clinical and lipid variables on the magnitude of postprandial lipemia in subjects with and without hipertriglyceridemia

    Directory of Open Access Journals (Sweden)

    Clara Eugenia Pérez G.

    2007-01-01

    Full Text Available Introduction. The postprandial lipemia is characterized by some prolonged increase in circulation of triglycerides rich lipoproteins that can produce atherosclerosis, which is an important cause of death in our population. Objective. To evaluate the effect of lipidic and clinical variables on the values of postprandial lipemia in subjects with and without hipertriglyceridemia. Materials and methods. Forty-eight subjects of both sexes were studied, half of them, with basal triglycerides above 200mg/dl, who ingested a standardized lipidic load (breakfast with 30g of fat and then they were followed during seven hours gathering total blood every hour to determine the level of postprandial triglycerides and the postprandial lipemia values. The later data was correlated with clinical variables as age, body mass index, waist circumference, among other; and with lipidic variable as total cholesterol, HDL, LDL and basal triglycerides. Results. There was alteration in the clearence of postprandial triglycerides in those subjects with a basal concentration of triglycerides above 186 mg/dl. The clinical variables most related tothe magnitude of postprandial lipemia were age (p=0.009 and waist perimeter, while the lipidic variables that were strongly related with the postprandial lipemia were the basal triglycerides concentration (p=<0.001, the VLDL cholesterol (p=<0.001 and the HDL cholesterol(p=0.041. Conclusion. The variables that could predict the behavior of postprandial triglycerides in the individuals of this study are age, waist perimeter, VLDL cholesterol, HDL cholesterol and the basal triglycerides concentration.

  5. Hypertensive response to exercise: mechanisms and clinical implication.

    Science.gov (United States)

    Kim, Darae; Ha, Jong-Won

    2016-01-01

    A hypertensive response to exercise (HRE) is frequently observed in individuals without hypertension or other cardiovascular disease. However, mechanisms and clinical implication of HRE is not fully elucidated. Endothelial dysfunction and increased stiffness of large artery contribute to development of HRE. From neurohormonal aspects, excess stimulation of sympathetic nervous system and augmented rise of angiotensin II seems to be important mechanism in HRE. Increasing evidences indicates that a HRE is associated with functional and structural abnormalities of left ventricle, especially when accompanied by increased central blood pressure. A HRE harbors prognostic significance in future development of hypertension and increased cardiovascular events, particularly if a HRE is documented in moderate intensity of exercise. As supported by previous studies, a HRE is not a benign phenomenon, however, currently, whether to treat a HRE is controversial with uncertain treatment strategy. Considering underlying mechanisms, angiotensin receptor blockers and beta blockers can be suggested in individuals with HRE, however, evidences for efficacy and outcomes of treatment of HRE in individuals without hypertension is scarce and therefore warrants further studies.

  6. Autophagy in the immune response to tuberculosis: clinical perspectives.

    LENUS (Irish Health Repository)

    Ní Cheallaigh, C

    2011-06-01

    A growing body of evidence points to autophagy as an essential component in the immune response to tuberculosis. Autophagy is a direct mechanism of killing intracellular Mycobacterium tuberculosis and also acts as a modulator of proinflammatory cytokine secretion. In addition, autophagy plays a key role in antigen processing and presentation. Autophagy is modulated by cytokines; it is stimulated by T helper type 1 (Th1) cytokines such as tumour necrosis factor (TNF)-α and interferon (IFN)-γ, and is inhibited by the Th2 cytokines interleukin (IL)-4 and IL-13 and the anti-inflammatory cytokine IL-10. Vitamin D, via cathelicidin, can also induce autophagy, as can Toll-like receptor (TLR)-mediated signals. Autophagy-promoting agents, administered either locally to the lungs or systemically, could have a clinical application as adjunctive treatment of drug-resistant and drug-sensitive tuberculosis. Moreover, vaccines which effectively induce autophagy could be more successful in preventing acquisition or reactivation of latent tuberculosis.

  7. Modeling the Response of Primary Production and Sedimentation to Variable Nitrate Loading in the Mississippi River Plume

    National Research Council Canada - National Science Library

    Green, Rebecca E; Breed, Greg A; Dagg, Michael J; Lohrenz, Steven E

    2008-01-01

    ...% reduction in annual nitrogen discharge into the Gulf of Mexico. We developed an ecosystem model for the Mississippi River plume to investigate the response of organic matter production and sedimentation to variable nitrate loading...

  8. Impacts of variability in geomechanical properties on hydrate bearing sediment responses

    Science.gov (United States)

    Lin, J. S.; Uchida, S.; Choi, J. H.; Seol, Y.

    2017-12-01

    Hydrate bearing sediments (HBS) may become unstable during the gas production operation, or from natural processes such as change in the landform or temperature. The geomechanical modeling is a rational way to assess HBS stability regardless of the process involved. At the present time, such modeling is laced with uncertainties. The uncertainties come from many sources that include the adequacy of a modeling framework to accurately project the response of HBS, the gap in the available field information, and the variability in the laboratory test results from limited samples. For a reasonable stability assessment, the impact of the various uncertainties have to be addressed. This study looks into one particular aspect of the uncertainty, namely, the uncertainty caused by the scatter in the laboratory tests and the ability of a constitutive model to adequately represent them. Specifically this study focuses on the scatter in the results from laboratory tests on high quality pressured core samples from a marine site, and use a critical state constitutive model to represent them. The study investigates how the HBS responses shift when the parameters of the constitutive model are varied to reflect the different aspects of experimental results. Also investigated are impacts on the responses by altering certain formulations of the constitutive model to suit particular sets of results.

  9. Evoked response of heart rate variability using short-duration white noise.

    Science.gov (United States)

    Lee, Guo-She; Chen, Mei-Ling; Wang, Gin-You

    2010-06-24

    To investigate and to establish a model for evaluation of the instant cardiovascular responses to the noises of low-to-moderate intensity, sixteen healthy subjects were enrolled. The white noises were binaurally presented with a supra-aural earphone. The test intensities of noises were no noise, 50, 60, 70 and 80 dBA. Each noise was continued for 5 min and the electrocardiogram was simultaneously recorded. The cardiac autonomic responses were evaluated using power spectral analysis of the R-R contour obtained from digital signal processing of the ECG tracings. The result showed that the mean heart rate and mean blood pressure did not change significantly with the noises. However, the low-frequency power (LF) which represents cardiac autonomic modulations and the ratio (LHR) of LF to high-frequency power (HF) which reflects cardiac sympathetic modulations were significantly greater in the noise intensity of 50, 60, 70 and 80dBA (pnoise intensity (rho=0.90, pwhite noises can be detected using power spectral analysis of heart rate variability and the evoked responses may provide a sensitive way to evaluate the instant effect of noise to humans.

  10. Responses of mixed methanotrophic consortia to variable Cu2+/Fe2+ ratios.

    Science.gov (United States)

    Chidambarampadmavathy, Karthigeyan; Karthikeyan, Obulisamy Parthiba; Huerlimann, Roger; Maes, Gregory E; Heimann, Kirsten

    2017-07-15

    Methane mitigation in landfill top cover soils is mediated by methanotrophs whose optimal methane (CH 4 ) oxidation capacity is governed by environmental and complex microbial community interactions. Optimization of CH 4 remediating bio-filters need to take microbial responses into account. Divalent copper (Cu 2+ ) and iron (Fe 2+ ) are present in landfills at variable ratios and play a vital role in methane oxidation capacity and growth of methanotrophs. This study, as a first of its kind, therefore quantified effects of variable Cu 2+ and Fe 2+ (5:5, 5:25 and 5:50 μM) ratios on mixed methanotrophic communities enriched from landfill top cover (LB) and compost soils (CB). CH 4 oxidation capacity, CH 4 removal efficiencies, fatty acids content/profiles and polyhydroxybutyrate (PHB; a biopolymer) contents were also analysed to quantify performance and potential co-product development. Mixed methanotroph cultures were raised in 10 L continuous stirred tank reactors (CSTRs, Bioflo ® & Celligen ® 310 Fermentor/Bioreactor; John Morris Scientific, Chatswood, NSW, Australia). Community structure was determined by amplifying the V3-V4 region of 16s rRNA gene. Community structure and, consequently, fatty acid-profiles changed significantly with increasing Cu 2+ /Fe 2+ ratios, and responses were different for LB and CB. Effects on methane oxidation capacities and PHB content were similar in the LB- and CB-CSTR, decreasing with increasing Cu 2+ /Fe 2+ ratios, while biomass growth was unaffected. In general, high Fe 2+ concentration favored growth of the type -II methanotroph Methylosinus in the CB-CSTR, but methanotroph abundances decreased in the LB-CSTR. Increase in Cu 2+ /Fe 2+ ratio increased the growth of Sphingopyxis in both systems, while Azospirllum was co-dominant in the LB- but absent in the CB-CSTR. After 13 days, methane oxidation capacities and PHB content decreased by ∼50% and more in response to increasing Fe 2+ concentrations. Although methanotroph

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

    Science.gov (United States)

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

    2012-06-01

    It has been often demonstrated that clinicians exhibit both inter-expert and intra-expert variability when making difficult decisions. In contrast, the vast majority of computerized models that aim to provide automated support for such decisions do not explicitly recognize or replicate this variability. Furthermore, the perfect consistency of computerized models is often presented as a de facto benefit. In this paper, we describe a novel approach to incorporate variability within a fuzzy inference system using non-stationary fuzzy sets in order to replicate human variability. We apply our approach to a decision problem concerning the recommendation of post-operative breast cancer treatment; specifically, whether or not to administer chemotherapy based on assessment of five clinical variables: NPI (the Nottingham Prognostic Index), estrogen receptor status, vascular invasion, age and lymph node status. In doing so, we explore whether such explicit modeling of variability provides any performance advantage over a more conventional fuzzy approach, when tested on a set of 1310 unselected cases collected over a fourteen year period at the Nottingham University Hospitals NHS Trust, UK. The experimental results show that the standard fuzzy inference system (that does not model variability) achieves overall agreement to clinical practice around 84.6% (95% CI: 84.1-84.9%), while the non-stationary fuzzy model can significantly increase performance to around 88.1% (95% CI: 88.0-88.2%), psystems in any application domain. Copyright © 2012 Elsevier Inc. All rights reserved.

  12. Intraclass Correlation Coefficients in Hierarchical Design Studies with Discrete Response Variables: A Note on a Direct Interval Estimation Procedure

    Science.gov (United States)

    Raykov, Tenko; Marcoulides, George A.

    2015-01-01

    A latent variable modeling procedure that can be used to evaluate intraclass correlation coefficients in two-level settings with discrete response variables is discussed. The approach is readily applied when the purpose is to furnish confidence intervals at prespecified confidence levels for these coefficients in setups with binary or ordinal…

  13. A Method for Analyzing the Dynamic Response of a Structural System with Variable Mass, Damping and Stiffness

    Directory of Open Access Journals (Sweden)

    Mike D.R. Zhang

    2001-01-01

    Full Text Available In this paper, a method for analyzing the dynamic response of a structural system with variable mass, damping and stiffness is first presented. The dynamic equations of the structural system with variable mass and stiffness are derived according to the whole working process of a bridge bucket unloader. At the end of the paper, an engineering numerical example is given.

  14. Incidence of temonera, sulphuhydryl variables and cefotaximase genes associated with ?-lactamase producing escherichia coli in clinical isolates

    OpenAIRE

    Isaiah, Ibeh Nnana; Nche, Bikwe Thomas; Nwagu, Ibeh Georgina; Nwagu, Ibeh Isaiah

    2011-01-01

    Background: The occurrence of the different types of Extended spectrum beta Lactamase producing Escherichia coli with the, Sulphurhydryl variable, Temonera and the Cefotaximase have been on the rise Aim: The study was to determine the prevalence of extended spectrum beta lactamase gene resistance across the clinical isolates of hospitalized patients. Materials and Method: Three hundred and fifty isolates of Escherichia coli were received from different clinical specimens. The susceptibility p...

  15. How to include the variability of TMS responses in simulations: a speech mapping case study

    Science.gov (United States)

    De Geeter, N.; Lioumis, P.; Laakso, A.; Crevecoeur, G.; Dupré, L.

    2016-11-01

    When delivered over a specific cortical site, TMS can temporarily disrupt the ongoing process in that area. This allows mapping of speech-related areas for preoperative evaluation purposes. We numerically explore the observed variability of TMS responses during a speech mapping experiment performed with a neuronavigation system. We selected four cases with very small perturbations in coil position and orientation. In one case (E) a naming error occurred, while in the other cases (NEA, B, C) the subject appointed the images as smoothly as without TMS. A realistic anisotropic head model was constructed of the subject from T1-weighted and diffusion-weighted MRI. The induced electric field distributions were computed, associated to the coil parameters retrieved from the neuronavigation system. Finally, the membrane potentials along relevant white matter fibre tracts, extracted from DTI-based tractography, were computed using a compartmental cable equation. While only minor differences could be noticed between the induced electric field distributions of the four cases, computing the corresponding membrane potentials revealed different subsets of tracts were activated. A single tract was activated for all coil positions. Another tract was only triggered for case E. NEA induced action potentials in 13 tracts, while NEB stimulated 11 tracts and NEC one. The calculated results are certainly sensitive to the coil specifications, demonstrating the observed variability in this study. However, even though a tract connecting Broca’s with Wernicke’s area is only triggered for the error case, further research is needed on other study cases and on refining the neural model with synapses and network connections. Case- and subject-specific modelling that includes both electromagnetic fields and neuronal activity enables demonstration of the variability in TMS experiments and can capture the interaction with complex neural networks.

  16. Tree ring variability and climate response of Abies spectabilis along an elevation gradient in Mustang, Nepal

    DEFF Research Database (Denmark)

    Kharal, D.K.; Meilby, Henrik; Rayamajhi, S.

    2014-01-01

    In mountainous areas including the Himalayas, tree lines are expected to advance to higher altitudes due to global climate change affecting the distribution and growth of plant species. This study aimed at identifying the tree ring variability of Abies spectabilis (D. Don) and its response...... to the climate along an elevation gradient in the high Himalayas of central Nepal. Tree core samples were collected from four sites in Mustang district. All sites were located in the same valley and exposed to similar weather conditions. Out of 232 samples collected from the sites, Titi lower (2700 m), Titi......-elevation sites the correlation between pre-monsoon precipitation and tree growth was positive, and for the month of May this was statistically significant (ptree growth at all sites, and at the upper elevation...

  17. Trace metal pyritization variability in response to mangrove soil aerobic and anaerobic oxidation processes.

    Science.gov (United States)

    Machado, W; Borrelli, N L; Ferreira, T O; Marques, A G B; Osterrieth, M; Guizan, C

    2014-02-15

    The degree of iron pyritization (DOP) and degree of trace metal pyritization (DTMP) were evaluated in mangrove soil profiles from an estuarine area located in Rio de Janeiro (SE Brazil). The soil pH was negatively correlated with redox potential (Eh) and positively correlated with DOP and DTMP of some elements (Mn, Cu and Pb), suggesting that pyrite oxidation generated acidity and can affect the importance of pyrite as a trace metal-binding phase, mainly in response to spatial variability in tidal flooding. Besides these aerobic oxidation effects, results from a sequential extraction analyses of reactive phases evidenced that Mn oxidized phase consumption in reaction with pyrite can be also important to determine the pyritization of trace elements. Cumulative effects of these aerobic and anaerobic oxidation processes were evidenced as factors affecting the capacity of mangrove soils to act as a sink for trace metals through pyritization processes. Copyright © 2013 Elsevier Ltd. All rights reserved.

  18. LARF: Instrumental Variable Estimation of Causal Effects through Local Average Response Functions

    Directory of Open Access Journals (Sweden)

    Weihua An

    2016-07-01

    Full Text Available LARF is an R package that provides instrumental variable estimation of treatment effects when both the endogenous treatment and its instrument (i.e., the treatment inducement are binary. The method (Abadie 2003 involves two steps. First, pseudo-weights are constructed from the probability of receiving the treatment inducement. By default LARF estimates the probability by a probit regression. It also provides semiparametric power series estimation of the probability and allows users to employ other external methods to estimate the probability. Second, the pseudo-weights are used to estimate the local average response function conditional on treatment and covariates. LARF provides both least squares and maximum likelihood estimates of the conditional treatment effects.

  19. Origins of Total-Dose Response Variability in Linear Bipolar Microcircuits

    International Nuclear Information System (INIS)

    Barnaby, H.J.; Cirba, C.R.; Schrimpf, R.D.; Fleetwood, D.M.; Pease, R.L.; Shaneyfelt, Marty R.; Turflinger, T.; Krieg, J.F.; Maher, M.C.

    2000-01-01

    LM1ll voltage comparators exhibit a wide range of total-dose-induced degradation. Simulations show this variability may be a natural consequence of the low base doping of the substrate PNP (SPNP) input transistors. Low base doping increases the SPNP's collector to base breakdown voltage, current gain, and sensitivity to small fluctuations in the radiation-induced oxide defect densities. The build-up of oxide trapped charge (N ot ) and interface traps (N it ) is shown to be a function of pre-irradiation bakes. Experimental data indicate that, despite its structural similarities to the LM111, irradiated input transistors of the LM124 operational amplifier do not exhibit the same sensitivity to variations in pre-irradiation thermal cycles. Further disparities in LM111 and LM124 responses may result from a difference in the oxide defect build-up in the two part types. Variations in processing, packaging, and circuit effects are suggested as potential explanations

  20. Optimization and Modeling of Process Variables of Biodiesel Production from Marula Oil using Response Surface Methodology

    International Nuclear Information System (INIS)

    Enweremadu, C. C.; Rutto, H. L.

    2015-01-01

    This paper presents an optimization study in the production of biodiesel production from Marula oil. The study was carried out using a central composite design of experiments under response surface methodology. A mathematical model was developed to correlate the transesterification process variables to biodiesel yield. The transesterification reaction variables were methanol to oil ratio, x /sub 1/ (10-50 wt percentage), reaction time, x /sub 2/ (30-90 min), reaction temperature, x /sub 3/ (30-90 Degree C) stirring speed, x /sub 4/ (100-400 rpm) and amount of catalyst, x /sub 5/ (0.5-1.5 g). The optimum conditions for the production of the biodiesel were found to be methanol to oil ratio (29.43 wt percentage), reaction time (59.17 minutes), reaction temperature (58.80 Degree C), stirring speed (325 rpm) and amount of catalyst (1.02 g). The optimum yield of biodiesel that can be produced was 95 percentage. The results revealed that the crucial fuel properties of the biodiesel produced at the optimum conditions met the ASTM biodiesel specifications. (author)

  1. Clinical course and core variability in HBV infected patients without detectable anti-HBc antibodies.

    Science.gov (United States)

    Anastasiou, Olympia E; Widera, Marek; Verheyen, Jens; Korth, Johannes; Gerken, Guido; Helfritz, Fabian A; Canbay, Ali; Wedemeyer, Heiner; Ciesek, Sandra

    2017-08-01

    The presence of anti-HBc antibodies indicates direct encounter of the immune system with hepatitis B virus (HBV). Aim of our study was to seek for anti-HBc negative but HBV replicating patients and analyze their clinical course and preconditions. From 1568 HBV-DNA positive patients, 29 patients (1.85%) tested negative for anti-HBc. The absence of anti-HBc could be confirmed in 19 patients using an alternative assay. In 16 of 19 cases, a partial or full HBV genome analysis was performed with NGS sequencing to evaluate if specific mutations were associated with anti-HBc absence. As a control group samples from 32 matched HBV infected patients with detectable anti-HBc were sequenced. Patients with detectable HBV-DNA and sequenced HBV core region in the confirmed absence of anti-HBc were diagnosed with acute HBV infection (n=3), HBV reactivation (n=9) and chronic hepatitis B (n=4). Most patients (12/16) were immunosuppressed: 3/16 patients had an HIV coinfection, 7/16 patients suffered from a malignant disease and 4/16 patients underwent solid organ transplantation (from which 2/4 had a malignant disease). Compared to the control cohort, HBV variants from anti-HBc negative patients showed less variability in the core region. In the absence of anti-HBc, HBV-DNA was most often found in immunocompromised hosts. Distinct mutations or deletions in the core region did not explain anti-HBc negativity. It would be advisable not to rely only on a single result of anti-HBc negativity to exclude HBV infection in immunocompromised hosts, but to measure anti-HBc repeatedly or with different methods. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. Discrepancies between self and observer ratings of depression. The relationship to demographic, clinical and personality variables.

    Science.gov (United States)

    Enns, M W; Larsen, D K; Cox, B J

    2000-10-01

    The observer-rated Hamilton depression scale (HamD) and the self-report Beck Depression Inventory (BDI) are among the most commonly used rating scales for depression, and both have well demonstrated reliability and validity. However, many depressed subjects have discrepant scores on these two assessment methods. The present study evaluated the ability of demographic, clinical and personality factors to account for the discrepancies observed between BDI and HamD ratings. The study group consisted of 94 SCID-diagnosed outpatients with a current major depressive disorder. Subjects were rated with the 21-item HamD and completed the BDI and the NEO-Five Factor Inventory. Younger age, higher educational attainment, and depressive subtype (atypical, non-melancholic) were predictive of higher BDI scores relative to HamD observer ratings. In addition, high neuroticism, low extraversion and low agreeableness were associated with higher endorsement of depressive symptoms on the BDI relative to the HamD. In general, these predictive variables showed a greater ability to explain discrepancies between self and observer ratings of psychological symptoms of depression compared to somatic symptoms of depression. The study does not determine which aspects of neuroticism and extraversion contribute to the observed BDI/HamD discrepancies. Depression ratings obtained with the BDI and HamD are frequently discordant and a number of patient characteristics robustly predict the discrepancy between these two rating methods. The value of multi-modal assessment in the conduct of research on depressive disorders is re-affirmed.

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

    Science.gov (United States)

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

    2015-06-01

    To measure the variability (VB) of the arterial pressure (AP) with the use of serial measurements at the clinics (VBCLIN), with 24 h ambulatory monitoring (MAPA) (VBMAPA) and home automonitoring -AMPA- (VBAMPA) and to estimate a relationship among each method. This is an observational, descriptive and transversal study assessed with 91 hypertensive patients in treatment and stable with AP MAPA was assessed to all the patients included in the study in order to obtain the VBMAPA and an AMPA in two non-consecutive weeks to obtain the VBAMPA (total of 54 measurements). 91 patients with 66 ± 7.7 years old and 58.2% males were recruited. AP values were 134 ± 14/82 ± 10 mmHg for systolic and diastolic APCLIN, respectively. AP values were 122 ± 17 / 68 ± 12 mmHg for systolic and diastolic APMAPA, respectively. AP values were 125 ± 13/75 ± 7 mmHg for systolic and diastolic APAMPA, respectively. The systolic VB for the three above methods was significantly correlated being maximal between VBCLIN and VBAMPA (r = 0.45; 0 MAPA methods is weak. This observation suggests that these are not interchangeable methodologies. Future studies focused on the relationship between VB -with different methods- and vascular target organ damage would be of great help in order to define the best analytical method.

  4. Androgen responsiveness to competition in humans: the role of cognitive variables

    Directory of Open Access Journals (Sweden)

    Oliveira GA

    2014-02-01

    Full Text Available Gonçalo A Oliveira,1 Rui F Oliveira1,2 1Unidade de Investigação em Eco-Etologia, ISPA – Instituto Universitário, Lisbon, Portugal; 2Champalimaud Neuroscience Program, Instituto Gulbenkian de Ciência, Oeiras, Portugal Abstract: Although androgens are commonly seen as male sex hormones, it has been established over the years that in both sexes, androgens also respond to social challenges. To explain the socially driven changes in androgens, two theoretical models have been proposed: the biosocial model and the challenge hypothesis. These models are typically seen as partly overlapping; however, they generate different predictions that are clarified here. In humans, sports competition and nonmetabolic competitive tasks have been used in the laboratory setting, as a proxy for agonistic interactions in animals. The results reviewed here show that the testosterone (T response to competition in humans is highly variable – the studies present postcompetition T levels and changes in T that depend on the contest outcome and that cannot be predicted by the current theoretical models. These conflicting results bring to the foreground the importance of considering cognitive factors that could moderate the androgen response to competition. Among these variables, we elect cognitive appraisal and its components as a key candidate modulating factor. It is known that T also modulates the cognitive processes that are relevant to performance in competition. In this article, we reviewed the evidence arising from studies investigating the effect of administering exogenous T and compare those results with the findings from studies that measured endogenous T levels. Finally, we summarized the importance of also considering the interaction between androgens and other hormones, such as cortisol, when investigating the social modulation of T, as proposed by the dual-hormone hypothesis. Keywords: testosterone, challenge hypothesis, biosocial model, cognitive

  5. The response of the North Pacific Decadal Variability to strong tropical volcanic eruptions

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Tao [Chinese Academy of Sciences, Nansen-Zhu International Research Center, Institute of Atmospheric Physics, Beijing (China); Otteraa, Odd Helge [Uni Bjerknes Centre, Uni Research, Bergen (Norway); Bjerknes Center for Climate Research, Bergen (Norway); Gao, Yongqi [Chinese Academy of Sciences, Nansen-Zhu International Research Center, Institute of Atmospheric Physics, Beijing (China); Bjerknes Center for Climate Research, Bergen (Norway); Nansen Environmental and Remote Sensing Center, Bergen (Norway); Wang, Huijun [Chinese Academy of Sciences, Nansen-Zhu International Research Center, Institute of Atmospheric Physics, Beijing (China); Chinese Academy of Sciences, Climate Change Research Center, Institute of Atmospheric Physics, Beijing (China)

    2012-12-15

    In this study, the effects of volcanic forcing on North Pacific climate variability, on interannual to decadal time scales, are examined using climate model simulations covering the last 600 years. The model used is the Bergen Climate Model, a fully coupled atmosphere-ocean general circulation model. It is found that natural external forcings, such as tropical strong volcanic eruptions (SVEs) and variations in total solar irradiance, play an important role in regulating North Pacific Decadal Variability (NPDV). In response to tropical SVEs the lower stratospheric pole-to-equator temperature gradient is enhanced. The North polar vortex is strengthened, which forces a significant positive Arctic Oscillation. At the same time, dipole zonal wind anomalies associated with strong polar vortex propagate downward from the lower stratosphere. Through positive feedbacks in the troposphere, the surface westerly winds across the central North Pacific are significantly weakened, and positive sea level pressure anomalies are formed in the North Pacific. This anomalous surface circulation results in changes in the net heat fluxes and the oceanic advection across the North Pacific. As a result of this, warm water converges in the subtropical western North Pacific, where the surface waters in addition are heated by significantly reduced latent and sensible heat fluxes from the ocean. In the eastern and high-latitude North Pacific the ocean loses more heat, and large-scale decreases in sea surface temperatures are found. The overall response of this chain of events is that the North Pacific enters a negative phase of the Pacific decadal oscillation (PDO), and this negative phase of the PDO is maintained for several years. It is thus concluded that the volcanic forcing plays a key role in the phasing of the PDO. The model results furthermore highlight the important role of troposphere-stratosphere coupling, tropical-extratropical teleconnections and extratropical ocean

  6. Shared Responsibility for Type 1 Diabetes Care Is Associated With Glycemic Variability and Risk of Glycemic Excursions in Youth.

    Science.gov (United States)

    Marker, Arwen M; Noser, Amy E; Clements, Mark A; Patton, Susana R

    2018-01-01

    We examined how parent and youth responsibility for type 1 diabetes (T1D) care is related to adherence and glycemic outcomes, namely, glycemic variability and risk of glycemic excursions. One hundred thirty-five parent-youth dyads (10-16 years old; diagnosed with T1D for at least 6 months) participated in this study. Percent responsibility of T1D care attributed to the youth, parent, or shared was measured using the Diabetes Family Responsibility Questionnaire. We collected youth's hemoglobin A1c (HbA1c) and glucometer downloads to examine relationships between responsibility and HbA1c, frequency of blood glucose monitoring (self-monitoring blood glucose, SMBG), risk of glycemic excursions, and actual glycemic variability using bivariate correlations and path analysis. Participants reported shared responsibility for almost half of T1D self-care tasks. Bivariate correlations showed shared responsibility was associated with less variability, whereas parent responsibility was associated with greater glycemic variability and risk for glycemic excursions. Youth responsibility was associated with lower frequency of SMBG. The path analyses confirmed our correlational findings (pshypothesis that shared T1D responsibility is associated with better diabetes outcomes in youth. © The Author 2017. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  7. Response variability in Attention-Deficit/Hyperactivity Disorder: a neuronal and glial energetics hypothesis.

    Science.gov (United States)

    Russell, Vivienne A; Oades, Robert D; Tannock, Rosemary; Killeen, Peter R; Auerbach, Judith G; Johansen, Espen B; Sagvolden, Terje

    2006-08-23

    Current concepts of Attention-Deficit/Hyperactivity Disorder (ADHD) emphasize the role of higher-order cognitive functions and reinforcement processes attributed to structural and biochemical anomalies in cortical and limbic neural networks innervated by the monoamines, dopamine, noradrenaline and serotonin. However, these explanations do not account for the ubiquitous findings in ADHD of intra-individual performance variability, particularly on tasks that require continual responses to rapid, externally-paced stimuli. Nor do they consider attention as a temporal process dependent upon a continuous energy supply for efficient and consistent function. A consideration of this feature of intra-individual response variability, which is not unique to ADHD but is also found in other disorders, leads to a new perspective on the causes and potential remedies of specific aspects of ADHD. We propose that in ADHD, astrocyte function is insufficient, particularly in terms of its formation and supply of lactate. This insufficiency has implications both for performance and development: H1) In rapidly firing neurons there is deficient ATP production, slow restoration of ionic gradients across neuronal membranes and delayed neuronal firing; H2) In oligodendrocytes insufficient lactate supply impairs fatty acid synthesis and myelination of axons during development. These effects occur over vastly different time scales: those due to deficient ATP (H1) occur over milliseconds, whereas those due to deficient myelination (H2) occur over months and years. Collectively the neural outcomes of impaired astrocytic release of lactate manifest behaviourally as inefficient and inconsistent performance (variable response times across the lifespan, especially during activities that require sustained speeded responses and complex information processing). Multi-level and multi-method approaches are required. These include: 1) Use of dynamic strategies to evaluate cognitive performance under

  8. Dynamic sensorimotor planning during long-term sequence learning: the role of variability, response chunking and planning errors.

    Science.gov (United States)

    Verstynen, Timothy; Phillips, Jeff; Braun, Emily; Workman, Brett; Schunn, Christian; Schneider, Walter

    2012-01-01

    Many everyday skills are learned by binding otherwise independent actions into a unified sequence of responses across days or weeks of practice. Here we looked at how the dynamics of action planning and response binding change across such long timescales. Subjects (N = 23) were trained on a bimanual version of the serial reaction time task (32-item sequence) for two weeks (10 days total). Response times and accuracy both showed improvement with time, but appeared to be learned at different rates. Changes in response speed across training were associated with dynamic changes in response time variability, with faster learners expanding their variability during the early training days and then contracting response variability late in training. Using a novel measure of response chunking, we found that individual responses became temporally correlated across trials and asymptoted to set sizes of approximately 7 bound responses at the end of the first week of training. Finally, we used a state-space model of the response planning process to look at how predictive (i.e., response anticipation) and error-corrective (i.e., post-error slowing) processes correlated with learning rates for speed, accuracy and chunking. This analysis yielded non-monotonic association patterns between the state-space model parameters and learning rates, suggesting that different parts of the response planning process are relevant at different stages of long-term learning. These findings highlight the dynamic modulation of response speed, variability, accuracy and chunking as multiple movements become bound together into a larger set of responses during sequence learning.

  9. Spatial and temporal variability of rainfall and their effects on hydrological response in urban areas – a review

    Directory of Open Access Journals (Sweden)

    E. Cristiano

    2017-07-01

    Full Text Available In urban areas, hydrological processes are characterized by high variability in space and time, making them sensitive to small-scale temporal and spatial rainfall variability. In the last decades new instruments, techniques, and methods have been developed to capture rainfall and hydrological processes at high resolution. Weather radars have been introduced to estimate high spatial and temporal rainfall variability. At the same time, new models have been proposed to reproduce hydrological response, based on small-scale representation of urban catchment spatial variability. Despite these efforts, interactions between rainfall variability, catchment heterogeneity, and hydrological response remain poorly understood. This paper presents a review of our current understanding of hydrological processes in urban environments as reported in the literature, focusing on their spatial and temporal variability aspects. We review recent findings on the effects of rainfall variability on hydrological response and identify gaps where knowledge needs to be further developed to improve our understanding of and capability to predict urban hydrological response.

  10. Bread Affects Clinical Parameters and Induces Gut Microbiome-Associated Personal Glycemic Responses.

    Science.gov (United States)

    Korem, Tal; Zeevi, David; Zmora, Niv; Weissbrod, Omer; Bar, Noam; Lotan-Pompan, Maya; Avnit-Sagi, Tali; Kosower, Noa; Malka, Gal; Rein, Michal; Suez, Jotham; Goldberg, Ben Z; Weinberger, Adina; Levy, Avraham A; Elinav, Eran; Segal, Eran

    2017-06-06

    Bread is consumed daily by billions of people, yet evidence regarding its clinical effects is contradicting. Here, we performed a randomized crossover trial of two 1-week-long dietary interventions comprising consumption of either traditionally made sourdough-leavened whole-grain bread or industrially made white bread. We found no significant differential effects of bread type on multiple clinical parameters. The gut microbiota composition remained person specific throughout this trial and was generally resilient to the intervention. We demonstrate statistically significant interpersonal variability in the glycemic response to different bread types, suggesting that the lack of phenotypic difference between the bread types stems from a person-specific effect. We further show that the type of bread that induces the lower glycemic response in each person can be predicted based solely on microbiome data prior to the intervention. Together, we present marked personalization in both bread metabolism and the gut microbiome, suggesting that understanding dietary effects requires integration of person-specific factors. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Evaluating measurement models in clinical research: covariance structure analysis of latent variable models of self-conception.

    Science.gov (United States)

    Hoyle, R H

    1991-02-01

    Indirect measures of psychological constructs are vital to clinical research. On occasion, however, the meaning of indirect measures of psychological constructs is obfuscated by statistical procedures that do not account for the complex relations between items and latent variables and among latent variables. Covariance structure analysis (CSA) is a statistical procedure for testing hypotheses about the relations among items that indirectly measure a psychological construct and relations among psychological constructs. This article introduces clinical researchers to the strengths and limitations of CSA as a statistical procedure for conceiving and testing structural hypotheses that are not tested adequately with other statistical procedures. The article is organized around two empirical examples that illustrate the use of CSA for evaluating measurement models with correlated error terms, higher-order factors, and measured and latent variables.

  12. Araucaria growth response to solar and climate variability in South Brazil

    Science.gov (United States)

    Prestes, Alan; Klausner, Virginia; Rojahn da Silva, Iuri; Ojeda-González, Arian; Lorensi, Caren

    2018-05-01

    In this work, the Sun-Earth-climate relationship is studied using tree growth rings of Araucaria angustifolia (Bertol.) O. Kuntze collected in the city of Passo Fundo, located in the state of Rio Grande do Sul (RS), Brazil. These samples were previously studied by Rigozo et al. (2008); however, their main interest was to search for the solar periodicities in the tree-ring width mean time series without interpreting the rest of the periodicities found. The question arises as to what are the drivers related to those periodicities. For this reason, the classical method of spectral analysis by iterative regression and wavelet methods are applied to find periodicities and trends present in each tree-ring growth, in Southern Oscillation Index (SOI), and in annual mean temperature anomaly between the 24 and 44° S. In order to address the aforementioned question, this paper discusses the correlation between the growth rate of the tree rings with temperature and SOI. In each tree-ring growth series, periods between 2 and 7 years were found, possibly related to the El Niño/La Niña phenomena, and a ˜ 23-year period was found, which may be related to temperature variation. These novel results might represent the tree-ring growth response to local climate conditions during its lifetime, and to nonlinear coupling between the Sun and the local climate variability responsible to the regional climate variations.

  13. Empirically derived personality subtyping for predicting clinical symptoms and treatment response in bulimia nervosa.

    Science.gov (United States)

    Haynos, Ann F; Pearson, Carolyn M; Utzinger, Linsey M; Wonderlich, Stephen A; Crosby, Ross D; Mitchell, James E; Crow, Scott J; Peterson, Carol B

    2017-05-01

    Evidence suggests that eating disorder subtypes reflecting under-controlled, over-controlled, and low psychopathology personality traits constitute reliable phenotypes that differentiate treatment response. This study is the first to use statistical analyses to identify these subtypes within treatment-seeking individuals with bulimia nervosa (BN) and to use these statistically derived clusters to predict clinical outcomes. Using variables from the Dimensional Assessment of Personality Pathology-Basic Questionnaire, K-means cluster analyses identified under-controlled, over-controlled, and low psychopathology subtypes within BN patients (n = 80) enrolled in a treatment trial. Generalized linear models examined the impact of personality subtypes on Eating Disorder Examination global score, binge eating frequency, and purging frequency cross-sectionally at baseline and longitudinally at end of treatment (EOT) and follow-up. In the longitudinal models, secondary analyses were conducted to examine personality subtype as a potential moderator of response to Cognitive Behavioral Therapy-Enhanced (CBT-E) or Integrative Cognitive-Affective Therapy for BN (ICAT-BN). There were no baseline clinical differences between groups. In the longitudinal models, personality subtype predicted binge eating (p = 0.03) and purging (p = 0.01) frequency at EOT and binge eating frequency at follow-up (p = 0.045). The over-controlled group demonstrated the best outcomes on these variables. In secondary analyses, there was a treatment by subtype interaction for purging at follow-up (p = 0.04), which indicated a superiority of CBT-E over ICAT-BN for reducing purging among the over-controlled group. Empirically derived personality subtyping appears to be a valid classification system with potential to guide eating disorder treatment decisions. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:506-514). © 2016 Wiley Periodicals, Inc.

  14. Parental consanguineous marriages and clinical response to chemotherapy in locally advanced breast cancer patients.

    Science.gov (United States)

    Saadat, Mostafa; Khalili, Maryam; Omidvari, Shahpour; Ansari-Lari, Maryam

    2011-03-28

    The main aim of the present study was investigating the association between parental consanguinity and clinical response to chemotherapy in females affected with locally advanced breast cancer. A consecutive series of 92 patients were prospectively included in this study. Clinical assessment of treatment was accomplished by comparing initial tumor size with preoperative tumor size using revised RECIST guideline (version 1.1). Clinical response defined as complete response, partial response and no response. The Kaplan-Meier survival analysis were used to evaluate the association of parental marriages (first cousin vs unrelated marriages) and clinical response to chemotherapy (complete and partial response vs no response). Number of courses of chemotherapy was considered as time, in the analysis. Kaplan-Meier analysis revealed that offspring of unrelated marriages had poorer response to chemotherapy (log rank statistic=5.10, df=1, P=0.023). Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  15. The 20th anniversary of interleukin-2 therapy: bimodal role explaining longstanding random induction of complete clinical responses

    International Nuclear Information System (INIS)

    Coventry, Brendon J; Ashdown, Martin L

    2012-01-01

    This year marks the twentieth anniversary of the approval by the US Food and Drug Administration of interleukin-2 (IL2) for use in cancer therapy, initially for renal cell carcinoma and later for melanoma. IL2 therapy for cancer has stood the test of time, with continued widespread use in Europe, parts of Asia, and the US. Clinical complete responses are variably reported at 5%–20% for advanced malignant melanoma and renal cell carcinoma, with strong durable responses and sustained long-term 5–10-year survival being typical if complete responses are generated. The literature was reviewed for the actions and clinical effects of IL2 on subsets of T cells. The influence of IL2 on clinical efficacy was also sought. The review revealed that IL2 is capable of stimulating different populations of T cells in humans to induce either T effector or T regulatory responses. This apparent “functional paradox” has confounded a clear understanding of the mechanisms behind the clinical effects that are observed during and following administration of IL2 therapy. An average complete response rate of around 7% in small and large clinical trials using IL2 for advanced renal cell carcinoma and malignant melanoma has been shown from a recent review of the literature. This review considers the published literature concerning the actions and emerging clinical effects of IL2 therapy, spanning its 20-year period in clinical use. It further details some of the recently described “bimodal” effects of IL2 to explain the apparent functional paradox, and how IL2 might be harnessed to emerge rapidly as a much more effective and predictable clinical agent in the near future

  16. Manipulation of the metabolic response in clinical practice

    DEFF Research Database (Denmark)

    Kehlet, H

    2000-01-01

    morbidity. Effective afferent neural blockade with continuous epidural local anesthetic techniques inhibits a major part of the endocrine metabolic response, leading to improved protein economy but without important effects on inflammatory or immunologic responses. In contrast, pain treatment with other...... modalities such as nonsteroidal antiinflammatory drugs (NSAIDs) and opioids has only a small inhibitory effect on endocrine metabolic responses. Preoperative high-dose glucocorticoid therapy provides additional pain relief and improves pulmonary function, but it reduces the inflammatory response (acute......-phase proteins, cytokines, hyperthermia) and immune function. Minimally invasive surgery leaves the endocrine metabolic responses largely unaltered but reduces the inflammatory response and immune suppression. Thus several techniques are available to modify the stress responses in elective surgery patients...

  17. Educational climate seems unrelated to leadership skills of clinical consultants responsible of postgraduate medical education in clinical departments

    DEFF Research Database (Denmark)

    Malling, Bente Vigh; Mortensen, Lene S.; Scherpbier, Albert J J

    2010-01-01

    The educational climate is crucial in postgraduate medical education. Although leaders are in the position to influence the educational climate, the relationship between leadership skills and educational climate is unknown. This study investigates the relationship between the educational climate...... in clinical departments and the leadership skills of clinical consultants responsible for education....

  18. A clinical clerkship collaborative program in Taiwan: Acquiring core clinical competencies through patient care responsibility

    Directory of Open Access Journals (Sweden)

    Yong A. Wang

    2016-06-01

    Conclusion: This pilot collaborative program presented a successful model for clinical education in the teaching of core clinical competencies through direct patient care responsibilities at the clerkship stage. It is hoped that the project will become a catalyst for medical education reform in Taiwan and regions with similar traditions.

  19. Statistical Learning and Adaptive Decision-Making Underlie Human Response Time Variability in Inhibitory Control

    Directory of Open Access Journals (Sweden)

    Ning eMa

    2015-08-01

    Full Text Available Response time (RT is an oft-reported behavioral measure in psychological and neurocognitive experiments, but the high level of observed trial-to-trial variability in this measure has often limited its usefulness. Here, we combine computational modeling and psychophysics to examine the hypothesis that fluctuations in this noisy measure reflect dynamic computations in human statistical learning and corresponding cognitive adjustments. We present data from the stop-signal task, in which subjects respond to a go stimulus on each trial, unless instructed not to by a subsequent, infrequently presented stop signal. We model across-trial learning of stop signal frequency, P(stop, and stop-signal onset time, SSD (stop-signal delay, with a Bayesian hidden Markov model, and within-trial decision-making with an optimal stochastic control model. The combined model predicts that RT should increase with both expected P(stop and SSD. The human behavioral data (n=20 bear out this prediction, showing P(stop and SSD both to be significant, independent predictors of RT, with P(stop being a more prominent predictor in 75% of the subjects, and SSD being more prominent in the remaining 25%. The results demonstrate that humans indeed readily internalize environmental statistics and adjust their cognitive/behavioral strategy accordingly, and that subtle patterns in RT variability can serve as a valuable tool for validating models of statistical learning and decision-making. More broadly, the modeling tools presented in this work can be generalized to a large body of behavioral paradigms, in order to extract insights about cognitive and neural processing from apparently quite noisy behavioral measures. We also discuss how this behaviorally validated model can then be used to conduct model-based analysis of neural data, in order to help identify specific brain areas for representing and encoding key computational quantities in learning and decision-making.

  20. Statistical learning and adaptive decision-making underlie human response time variability in inhibitory control.

    Science.gov (United States)

    Ma, Ning; Yu, Angela J

    2015-01-01

    Response time (RT) is an oft-reported behavioral measure in psychological and neurocognitive experiments, but the high level of observed trial-to-trial variability in this measure has often limited its usefulness. Here, we combine computational modeling and psychophysics to examine the hypothesis that fluctuations in this noisy measure reflect dynamic computations in human statistical learning and corresponding cognitive adjustments. We present data from the stop-signal task (SST), in which subjects respond to a go stimulus on each trial, unless instructed not to by a subsequent, infrequently presented stop signal. We model across-trial learning of stop signal frequency, P(stop), and stop-signal onset time, SSD (stop-signal delay), with a Bayesian hidden Markov model, and within-trial decision-making with an optimal stochastic control model. The combined model predicts that RT should increase with both expected P(stop) and SSD. The human behavioral data (n = 20) bear out this prediction, showing P(stop) and SSD both to be significant, independent predictors of RT, with P(stop) being a more prominent predictor in 75% of the subjects, and SSD being more prominent in the remaining 25%. The results demonstrate that humans indeed readily internalize environmental statistics and adjust their cognitive/behavioral strategy accordingly, and that subtle patterns in RT variability can serve as a valuable tool for validating models of statistical learning and decision-making. More broadly, the modeling tools presented in this work can be generalized to a large body of behavioral paradigms, in order to extract insights about cognitive and neural processing from apparently quite noisy behavioral measures. We also discuss how this behaviorally validated model can then be used to conduct model-based analysis of neural data, in order to help identify specific brain areas for representing and encoding key computational quantities in learning and decision-making.

  1. The effect of genotype on methotrexate polyglutamate variability in juvenile idiopathic arthritis and association with drug response.

    Science.gov (United States)

    Becker, Mara L; Gaedigk, Roger; van Haandel, Leon; Thomas, Bradley; Lasky, Andrew; Hoeltzel, Mark; Dai, Hongying; Stobaugh, John; Leeder, J Steven

    2011-01-01

    The response to and toxicity of methotrexate (MTX) are unpredictable in patients with juvenile idiopathic arthritis (JIA). Intracellular polyglutamation of MTX, assessed by measuring concentrations of MTX polyglutamates (MTXGlu), has been demonstrated to be a promising predictor of drug response. Therefore, this study was aimed at investigating the genetic predictors of MTXGlu variability and associations between MTXGlu and drug response in JIA. The study was designed as a single-center cross-sectional analysis of patients with JIA who were receiving stable doses of MTX at a tertiary care children's hospital. After informed consent was obtained from the 104 patients with JIA, blood was withdrawn during routine MTX-screening laboratory testing. Clinical data were collected by chart review. Genotyping for 34 single-nucleotide polymorphisms (SNPs) in 18 genes within the MTX metabolic pathway was performed. An ion-pair chromatographic procedure with mass spectrometric detection was used to measure MTXGlu1-7. Analysis and genotyping of MTXGlu was completed in the 104 patients. K-means clustering resulted in 3 distinct patterns of MTX polyglutamation. Cluster 1 had low red blood cell (RBC) MTXGlu concentrations, cluster 2 had moderately high RBC MTXGlu1+2 concentrations, and cluster 3 had high concentrations of MTXGlu, specifically MTXGlu3-5. SNPs in the purine and pyrimidine synthesis pathways, as well as the adenosine pathway, were significantly associated with cluster subtype. The cluster with high concentrations of MTXGlu3-5 was associated with elevated liver enzyme levels on liver function tests (LFTs), and there were higher concentrations of MTXGlu3-5 in children who reported gastrointestinal side effects and had abnormal findings on LFTs. No association was noted between MTXGlu and active arthritis. MTXGlu remains a potentially useful tool for determining outcomes in patients with JIA being treated with MTX. The genetic predictors of MTXGlu variability may also

  2. Validation of the Oral Hygiene Habits Scale: Relationships with sociodemographic variables in the general and clinical population of Monterrey, Mexico.

    Directory of Open Access Journals (Sweden)

    Norma Rodríguez

    2016-12-01

    Full Text Available Several socioeconomic factors are associated with poor oral hygiene habits. A version of the Oral Hygiene Habits Scale (OHHS was developed in Mexico to measure these factors; however, its relationship with sociodemographic variables has not been studied. The verification of these relationships could contribute to the validation of the scale. Objective: To evaluate the relationship between oral hygiene habits and sociodemographic variables of sex, age, schooling, self-defined socioeconomic stratum, occupation and marital status in the general and clinical population of Monterrey, Mexico. Materials and Methods: A general population sample (GPS of 256 participants and a clinical sample (CPS of 240 participants were studied. The OHHS consisted of an eight-item Likert scale of 4 points ranging from 0 to 4. A descriptive correlational study was performed with a cross-sectional design. Data were analyzed using the Mann-Whitney U test, Kruskal-Wallis test, Spearman correlation coefficient, Cramer's V coefficient, and multivariate aligned rank test. Results: In GPS and CPS groups, OHHS was related to sex, schooling, socioeconomic stratum, occupation and marital status, but not to age. There were no significant interactions between the samples (GPS and CPS and sociodemographic variables. Conclusion: There is a statistically significant relationship between oral hygiene habits and some sociodemographic variables in the general and clinical population. This relationship supports the validity of the OHHS.

  3. Educational climate seems unrelated to leadership skills of clinical consultants responsible of postgraduate medical education in clinical departments.

    Science.gov (United States)

    Malling, Bente; Mortensen, Lene S; Scherpbier, Albert J J; Ringsted, Charlotte

    2010-09-21

    The educational climate is crucial in postgraduate medical education. Although leaders are in the position to influence the educational climate, the relationship between leadership skills and educational climate is unknown. This study investigates the relationship between the educational climate in clinical departments and the leadership skills of clinical consultants responsible for education. The study was a trans-sectional correlation study. The educational climate was investigated by a survey among all doctors (specialists and trainees) in the departments. Leadership skills of the consultants responsible for education were measured by multi-source feedback scores from heads of departments, peer consultants, and trainees. Doctors from 42 clinical departments representing 21 specialties participated. The response rate of the educational climate investigation was moderate 52% (420/811), Response rate was high in the multisource-feedback process 84.3% (420/498). The educational climate was scored quite high mean 3.9 (SD 0.3) on a five-point Likert scale. Likewise the leadership skills of the clinical consultants responsible for education were considered good, mean 5.4 (SD 0.6) on a seven-point Likert scale. There was no significant correlation between the scores concerning the educational climate and the scores on leadership skills, r = 0.17 (p = 0.29). This study found no relation between the educational climate and the leadership skills of the clinical consultants responsible for postgraduate medical education in clinical departments with the instruments used. Our results indicate that consultants responsible for education are in a weak position to influence the educational climate in the clinical department. Further studies are needed to explore, how heads of departments and other factors related to the clinical organisation could influence the educational climate.

  4. Bayesian Population Physiologically-Based Pharmacokinetic (PBPK Approach for a Physiologically Realistic Characterization of Interindividual Variability in Clinically Relevant Populations.

    Directory of Open Access Journals (Sweden)

    Markus Krauss

    Full Text Available Interindividual variability in anatomical and physiological properties results in significant differences in drug pharmacokinetics. The consideration of such pharmacokinetic variability supports optimal drug efficacy and safety for each single individual, e.g. by identification of individual-specific dosings. One clear objective in clinical drug development is therefore a thorough characterization of the physiological sources of interindividual variability. In this work, we present a Bayesian population physiologically-based pharmacokinetic (PBPK approach for the mechanistically and physiologically realistic identification of interindividual variability. The consideration of a generic and highly detailed mechanistic PBPK model structure enables the integration of large amounts of prior physiological knowledge, which is then updated with new experimental data in a Bayesian framework. A covariate model integrates known relationships of physiological parameters to age, gender and body height. We further provide a framework for estimation of the a posteriori parameter dependency structure at the population level. The approach is demonstrated considering a cohort of healthy individuals and theophylline as an application example. The variability and co-variability of physiological parameters are specified within the population; respectively. Significant correlations are identified between population parameters and are applied for individual- and population-specific visual predictive checks of the pharmacokinetic behavior, which leads to improved results compared to present population approaches. In the future, the integration of a generic PBPK model into an hierarchical approach allows for extrapolations to other populations or drugs, while the Bayesian paradigm allows for an iterative application of the approach and thereby a continuous updating of physiological knowledge with new data. This will facilitate decision making e.g. from preclinical to

  5. How Iranian Medical Trainees Approach their Responsibilities in Clinical Settings; A Grounded Theory Research

    Directory of Open Access Journals (Sweden)

    Omid Asemani

    2015-09-01

    Full Text Available Background: It seems we are now experiencing “responsibility problems” among medical trainees (MTs and some of those recently graduated from medical schools in Iran. Training responsible professionals have always been one of the main concerns of medical educators. Nevertheless, there is a dearth of research in the literature on “responsibility” especially from the medical education point of view. Therefore, the present study was carried out with the aim of presenting a theoretical based framework for understanding how MTs approach their responsibilities in educational settings. Method: This qualitative study was conducted at Shiraz University of Medical Sciences (SUMS using the grounded theory methodology. 15 MTs and 10 clinical experts and professional nurses were purposefully chosen as participants. Data was analyzed using the methodology suggested by Corbin and Strauss, 1998. Results: “Try to find acceptance toward expectations”, “try to be committed to meet the expectations” and “try to cope with unacceptable expectations” were three main categories extracted based on the research data. Abstractly, the main objective for using these processes was “to preserve the integrity of student identity” which was the core category of this research too. Moreover, it was also found that practically, “responsibility” is considerably influenced by lots of positive and negative contextual and intervening conditions. Conclusion: “Acceptance” was the most decisive variable highly effective in MTs’ responsibility. Therefore, investigating the “process of acceptance” regarding the involved contextual and intervening conditions might help medical educators correctly identify and effectively control negative factors and reinforce the constructive ones that affect the concept of responsibility in MTs.

  6. An exploratory clinical study to determine the utility of heart rate variability analysis in the assessment of dosha imbalance

    Directory of Open Access Journals (Sweden)

    P. Ram Manohar

    2018-04-01

    Full Text Available The present study is a comparison of the data of spectral analysis of heart rate variability with clinical evaluation of pathological state of doshas. The calculated cardiointervalography values are combined into three integral indexes, which according to the authors' opinion reflect the influence on heart rhythm of vata, pitta and kapha, the regulation systems of the body known as doshas in Ayurveda. Seven gross dosha imbalances were assessed to test the agreement between the two methods in this study. Heart Rate Variability (HRV spectral data was collected from 42 participants to make the comparison with the clinical assessment of dosha imbalance. Clinical method of dosha assessment and method of calculating integral indexes by cardiointervalography data showed substantial agreement by Kappa coefficient statistic (k = 0.78 in assessment of gross dosha imbalance. The results of the data generated from this pilot study warrant further studies to rigorously validate the algorithms of HRV analysis in understanding dosha imbalance in Ayurvedic clinical practice and research settings. Keywords: Heart rate variability, Ayurveda, Spectral analysis

  7. Year-to-year variability in haemoglobin mass response to two altitude training camps.

    Science.gov (United States)

    McLean, Blake D; Buttifant, David; Gore, Christopher J; White, Kevin; Kemp, Justin

    2013-12-01

    To quantify the year-to-year variability of altitude-induced changes in haemoglobin mass (Hb(mass)) in elite team-sport athletes. 12 Australian-Footballers completed a 19-day (ALT1) and 18-day (ALT2) moderate altitude (∼2100 m), training camp separated by 12 months. An additional 20 participants completed only one of the two training camps (ALT1 additional n=9, ALT2 additional n=11). Total Hb(mass) was assessed using carbon monoxide rebreathing before (PRE), after (POST₁) and 4 weeks after each camp. The typical error of Hb(mass) for the pooled data of all 32 participants was 2.6%. A contemporary statistics analysis was used with the smallest worthwhile change set to 2% for Hb(mass). POST₁ Hb(mass) was very likely increased in ALT1 (3.6 ± 1.6%, n=19; mean ± ∼90 CL) as well as ALT2 (4.4 ± 1.3%, n=23) with an individual responsiveness of 1.3% and 2.2%, respectively. There was a small correlation between ALT1 and ALT2 (R=0.21, p=0.59) for a change in Hb(mass), but a moderately inverse relationship between the change in Hb(mass) and initial relative Hb(mass) (g/kg (R=-0.51, p=0.04)). Two preseason moderate altitude camps 1 year apart yielded a similar (4%) mean increase in Hb(mass) of elite footballers, with an individual responsiveness of approximately half the group mean effect, indicating that most players gained benefit. Nevertheless, the same individuals generally did not change their Hb(mass) consistently from year to year. Thus, a 'responder' or 'non-responder' to altitude for Hb(mass) does not appear to be a fixed trait.

  8. Contrasting biogeochemical responses of ENSO induced upwelling variability in the Humboldt Current System

    Science.gov (United States)

    Franco, Ana C.; Gruber, Nicolas; Münnich, Matthias

    2017-04-01

    The Humboldt Current System (HCS) is one of the most productive ecosystems in the world. This high productivity is supported by a large input of nutrients from the subsurface layers to the surface due to year-round upwelling. However, upwelling also supplies waters with low pH and low aragonite saturation state potentially affecting many organisms, especially those that calcify. The influence, extent and source of upwelled water vary substantially on interannual timescales in association with the El Niño/Southern Oscillation (ENSO) phenomenon, generating natural contrasting responses on the biogeochemistry of this system. Here we analyze these responses using an eddy resolving, basin-scale ocean model that covers the whole Pacific Ocean with high resolution (4 km) on the west coast of South America. We performed a simulation of the last 30 years (hindcast simulation) that allows us to investigate the influence of at least eight El Niño episodes and eight La Niña episodes on productivity variations and changes in oxygen concentration and aragonite saturation state. An absolute change in surface omega aragonite of almost 2 units, as well as an absolute change of the aragonite saturation depth of 200 m result from the change of an El Niño phase to a La Niña phase. This variability is on the same order of magnitude as the projected change in the aragonite saturation state in a centennial timescale. During La Niña events, a lower aragonite saturation state values and reduced oxygen concentration in the surface layer are a direct consequence of enhanced upwelling and increased net primary productivity. The opposite is true during El Niño events, where high values of omega aragonite occur in concordance with extraordinarily low net primary productivity values.

  9. Exploring the Variability of Short-term Precipitation and Hydrological Response of Small Czech Watersheds

    Science.gov (United States)

    Kavka, Petr; Strouhal, Ludek; Weyskrabova, Lenka; Müller, Miloslav; Kozant, Petr

    2017-04-01

    The short-term rainfall temporal distribution is known to have a significant effect on the small watersheds' hydrological response. In Czech Republic there are limited publicly available data on rainfall patterns of short-term precipitation. On one side there are catalogues of very short-term synthetic rainfalls used in urban drainage planning and on the other side hourly distribution of daily totals of rainfalls with long return period for larger catchments analyses. This contribution introduces the preliminary outcomes of a running three years' project, which should bridge this gap and provide such data and methodology to the community of scientists, state administration as well as design planners. Six generalized 6-hours hyetographs with 1 minute resolution were derived from 10 years of radar and gauging stations data. These hyetographs are accompanied with information concerning the region of occurrence as well as their frequency related to the rainfall amount. In the next step these hyetographs are used in a complex sensitivity analysis focused on a rainfall-runoff response of small watersheds. This analysis takes into account the uncertainty related to type of the hydrological model, watershed characteristics and main model routines parameterization. Five models with different methods and structure are considered and each model is applied on 5 characteristic watersheds selected from a classification of 7700 small Czech watersheds. For each combination of model and watershed 30, rainfall scenarios were simulated and other scenarios will be used to address the parameters uncertainty. In the last step the variability of outputs will be assessed in the context of economic impacts on design of landscape water structures or mitigation measures. The research is supported by the grant QJ1520265 of the Czech Ministry of Agriculture, rainfall data were provided by the Czech Hydrometeorological Institute.

  10. Gender differences in the neural response to acupuncture: Clinical implications

    NARCIS (Netherlands)

    Yeo, S.; Rosen, B.; Bosch, M.P.C.; Noort, M.W.M.L. van den; Lim, S.

    2016-01-01

    Objective: To examine gender differences and similarities in the psychophysical and brain responses to acupuncture at GB34, a point that is frequently used to treat motor function issues in Traditional Chinese Medicine. Methods: Functional MRI (fMRI) was used to measure brain activation in response

  11. Haloperidol plasmatic levels and their clinical response to the treatment

    International Nuclear Information System (INIS)

    Cabranes, J.A.; Almoguera, I.; Santos, J.L.; Prieto, P.; Ramos, J.A.

    1988-01-01

    Schizophrenic patients were treated with haloperidol. Their haloperidol levels in plasma were determined with radioimmunoassay (RIA) and radioreceptor assay (RRA). The results obtained are compared with the clinical improvement. (M.C.B.)

  12. Temperature and pH Responsive Microfibers for Controllable and Variable Ibuprofen Delivery

    Directory of Open Access Journals (Sweden)

    Toan Tran

    2015-01-01

    Full Text Available Electrospun microfibers (MFs composed of pH and temperature responsive polymers can be used for controllable and variable delivery of ibuprofen. First, electrospinning technique was employed to prepare poly(ε-caprolactone (PCL and poly(N-isopropylacrylamide-co-methacrylic acid (pNIPAM-co-MAA MFs containing ibuprofen. It was found that drug release rates from PCL MFs cannot be significantly varied by either temperature (22–40°C or pH values (1.7–7.4. In contrast, the ibuprofen (IP diffusion rates from pNIPAM-co-MAA MFs were very sensitive to changes in both temperature and pH. The IP release from pNIPAM-co-MAA MFs was highly linear and controllable when the temperature was above the lower critical solution temperature (LCST of pNIPAM-co-MAA (33°C and the pH was lower than the pKa of carboxylic acids (pH 2. At room temperature, however, the release rate was dramatically increased by nearly ten times compared to that at higher temperature and lower pH. Such a unique and controllable drug delivery system could be naturally envisioned to find many practical applications in biomedical and pharmaceutical sciences such as programmable transdermal drug delivery.

  13. Larval fish variability in response to oceanographic features in a nearshore nursery area.

    Science.gov (United States)

    Pattrick, P; Strydom, N A

    2014-09-01

    The influence of oceanographic features on ichthyoplankton assemblages in the warm temperate nearshore region of Algoa Bay, South Africa, was assessed. The nearshore ichthyoplankton comprised 88 taxa from 34 families. Samples were collected at six stations between August 2010 and July 2012 using a plankton ring net of 750 mm diameter and 500 µm mesh aperture. The majority of larvae collected were in a preflexion stage, indicating the potential importance of the nearshore for newly hatched larvae. Engraulidae dominated the catch (38·4%), followed by Cynoglossidae (28·1%) and Sparidae (8·4%). Larval fish abundance was highest during austral spring and summer (September to February). Unique patterns in responses of each dominant fish species to oceanographic features in the nearshore indicate the sensitivity of the early developmental stage to environmental variables. Using generalized linear models, ichthyoplankton abundance responded positively to upwelling and when warm water plumes originating from an Agulhas Current meander entered Algoa Bay. Highest abundances of Engraulis encrasicolus and Sardinops sagax were observed during Agulhas Plume intrusions into Algoa Bay. When a mixed and stratified water column persisted in the nearshore region of Algoa Bay, larval fish abundance decreased. The nearshore region of Algoa Bay appears to serve as a favourable environment for the accumulation of ichthyoplankton. © 2014 The Fisheries Society of the British Isles.

  14. Norepinephrine genes predict response time variability and methylphenidate-induced changes in neuropsychological function in attention deficit hyperactivity disorder.

    Science.gov (United States)

    Kim, Bung-Nyun; Kim, Jae-Won; Cummins, Tarrant D R; Bellgrove, Mark A; Hawi, Ziarih; Hong, Soon-Beom; Yang, Young-Hui; Kim, Hyo-Jin; Shin, Min-Sup; Cho, Soo-Churl; Kim, Ji-Hoon; Son, Jung-Woo; Shin, Yun-Mi; Chung, Un-Sun; Han, Doug-Hyun

    2013-06-01

    Noradrenergic dysfunction may be associated with cognitive impairments in attention-deficit/hyperactivity disorder (ADHD), including increased response time variability, which has been proposed as a leading endophenotype for ADHD. The aim of this study was to examine the relationship between polymorphisms in the α-2A-adrenergic receptor (ADRA2A) and norepinephrine transporter (SLC6A2) genes and attentional performance in ADHD children before and after pharmacological treatment.One hundred one medication-naive ADHD children were included. All subjects were administered methylphenidate (MPH)-OROS for 12 weeks. The subjects underwent a computerized comprehensive attention test to measure the response time variability at baseline before MPH treatment and after 12 weeks. Additive regression analyses controlling for ADHD symptom severity, age, sex, IQ, and final dose of MPH examined the association between response time variability on the comprehensive attention test measures and allelic variations in single-nucleotide polymorphisms of the ADRA2A and SLC6A2 before and after MPH treatment.Increasing possession of an A allele at the G1287A polymorphism of SLC6A2 was significantly related to heightened response time variability at baseline in the sustained (P = 2.0 × 10) and auditory selective attention (P = 1.0 × 10) tasks. Response time variability at baseline increased additively with possession of the T allele at the DraI polymorphism of the ADRA2A gene in the auditory selective attention task (P = 2.0 × 10). After medication, increasing possession of a G allele at the MspI polymorphism of the ADRA2A gene was associated with increased MPH-related change in response time variability in the flanker task (P = 1.0 × 10).Our study suggested an association between norepinephrine gene variants and response time variability measured at baseline and after MPH treatment in children with ADHD. Our results add to a growing body of evidence, suggesting that response time

  15. Constant versus variable response signal delays in speed accuracy trade-offs : Effects of advance preparation for processing time

    OpenAIRE

    Miller, Jeff; Sproesser, Gudrun; Ulrich, Rolf

    2008-01-01

    In two experiments, we used response signals (RSs) to control processing time and trace out speed accuracy trade-off (SAT) functions in a difficult perceptual discrimination task. Each experiment compared performance in blocks of trials with constant and, hence, temporally predictable RS lags against performance in blocks with variable, unpredictable RS lags. In both experiments, essentially equivalent SAT functions were observed with constant and variable RS lags. We conclude that there is l...

  16. Clinical characteristics and therapeutic response in patients with Burning Mouth Syndrome: accompanying 2 years

    Directory of Open Access Journals (Sweden)

    Vanessa Juliana Gomes CARVALHO

    Full Text Available Abstract Introduction Burning Mouth Syndrome (BMS is a condition characterized by burning symptom of the oral mucosa in the absence of clinical signs. Its etiology is still unknown and, and to date there is no effective treatment. Purpose The aim of this study was to evaluate patients with BMS profile and the therapies results in a retrospective study. Material and method Clinical and therapeutic data were collected from records of patients with BMS diagnosed between January 2013 to April 2015 at the Clinic of Stomatology Clinic, Faculdade de Odontologia of Universidade de São Paulo, according to the criteria established by the International Headache Society in 2013. The therapies used for BMS control were also evaluated. Result Twelve patients were diagnosed with BMS at this period. All of them were women with a mean age of 61.18 years and the apex of the tongue was the most common affected site and the duration of the burning sensation ranged from 6 months to 25 years. Many therapies were prescribed for BMS control, such as topical capsaicin, topical clonazepan, low level laser therapy and homeopathy. Among the established therapies, capsaicin has immediate effect in reducing symptoms. Conclusion The present study showed that the challenges towards an effective treatment for BMS are varied and are mainly related to the lack knowing of the pathogenesis of this disease. The demographic profile of patients studied here was similar to that described in the available literature, however, the variables represented by secondary symptoms (medical history, anxiety and depression levels may be modifying factors of therapeutic response and the pathogenesis of the disease itself.

  17. Prediction of Methotrexate Clinical Response in Portuguese Rheumatoid Arthritis Patients: Implication of MTHFR rs1801133 and ATIC rs4673993 Polymorphisms

    Science.gov (United States)

    Lima, Aurea; Monteiro, Joaquim; Bernardes, Miguel; Sousa, Hugo; Azevedo, Rita; Seabra, Vitor; Medeiros, Rui

    2014-01-01

    Objective. Methotrexate (MTX), the most used drug in rheumatoid arthritis (RA) treatment, showing variability in clinical response, is often associated with genetic polymorphisms. This study aimed to elucidate the role of methylenetetrahydrofolate reductase (MTHFR) C677T and aminoimidazole carboxamide adenosine ribonucleotide transformylase (ATIC) T675C polymorphisms and clinicopathological variables in clinical response to MTX in Portuguese RA patients. Methods. Study included 233 RA patients treated with MTX for at least six months. MTHFR C677T and ATIC T675C polymorphisms were genotyped and clinicopathological variables were collected. Statistical analyses were performed and binary logistic regression method adjusted to possible confounding variables. Results. Multivariate analyses demonstrated that MTHFR 677TT (OR = 4.63; P = 0.013) and ATIC 675T carriers (OR = 5.16; P = 0.013) were associated with over 4-fold increased risk for nonresponse. For clinicopathological variables, noncurrent smokers (OR = 7.98; P = 0.001), patients positive to anti-cyclic citrullinated peptide (OR = 3.53; P = 0.004) and antinuclear antibodies (OR = 2.28; P = 0.045), with higher health assessment questionnaire score (OR = 2.42; P = 0.007), and nonsteroidal anti-inflammatory drug users (OR = 2.77; P = 0.018) were also associated with nonresponse. Contrarily, subcutaneous administration route (OR = 0.11; P < 0.001) was associated with response. Conclusion. Our study suggests that MTHFR C677T and ATIC T675C genotyping combined with clinicopathological data may help to identify patients whom will not benefit from MTX treatment and, therefore, assist clinicians in personalizing RA treatment. PMID:24967362

  18. A method to adjust radiation dose-response relationships for clinical risk factors

    DEFF Research Database (Denmark)

    Appelt, Ane Lindegaard; Vogelius, Ivan R

    2012-01-01

    Several clinical risk factors for radiation induced toxicity have been identified in the literature. Here, we present a method to quantify the effect of clinical risk factors on radiation dose-response curves and apply the method to adjust the dose-response for radiation pneumonitis for patients...

  19. Using climate response functions in analyzing electricity production variables. A case study from Norway.

    Science.gov (United States)

    Tøfte, Lena S.; Martino, Sara; Mo, Birger

    2016-04-01

    representation of hydropower is included and total hydro power production for each area is calculated, and the production is distributed among all available plants within each area. During simulation, the demand is affected by prices and temperatures. 6 different infrastructure scenarios of wind and power line development are analyzed. The analyses are done by running EMPS calibrated for today's situation for 11*11*8 different combinations of altered weather variables (temperature, precipitation and wind) describing different climate change scenarios, finding the climate response function for every EMPS-variable according the electricity production, such as prices and income, energy balances (supply, consumption and trade), overflow losses, probability of curtailment etc .

  20. Planning performance in schizophrenia patients: a meta-analysis of the influence of task difficulty and clinical and sociodemographic variables.

    Science.gov (United States)

    Knapp, F; Viechtbauer, W; Leonhart, R; Nitschke, K; Kaller, C P

    2017-08-01

    Despite a large body of research on planning performance in adult schizophrenia patients, results of individual studies are equivocal, suggesting either no, moderate or severe planning deficits. This meta-analysis therefore aimed to quantify planning deficits in schizophrenia and to examine potential sources of the heterogeneity seen in the literature. The meta-analysis comprised outcomes of planning accuracy of 1377 schizophrenia patients and 1477 healthy controls from 31 different studies which assessed planning performance using tower tasks such as the Tower of London, the Tower of Hanoi and the Stockings of Cambridge. A meta-regression analysis was applied to assess the influence of potential moderator variables (i.e. sociodemographic and clinical variables as well as task difficulty). The findings indeed demonstrated a planning deficit in schizophrenia patients (mean effect size: ; 95% confidence interval 0.56-0.78) that was moderated by task difficulty in terms of the minimum number of moves required for a solution. The results did not reveal any significant relationship between the extent of planning deficits and sociodemographic or clinical variables. The current results provide first meta-analytic evidence for the commonly assumed impairments of planning performance in schizophrenia. Deficits are more likely to become manifest in problem items with higher demands on planning ahead, which may at least partly explain the heterogeneity of previous findings. As only a small fraction of studies reported coherent information on sample characteristics, future meta-analyses would benefit from more systematic reports on those variables.

  1. Meta-analysis of clinical studies supports the pharmacokinetic variability hypothesis for acquired drug resistance and failure of antituberculosis therapy.

    Science.gov (United States)

    Pasipanodya, Jotam G; Srivastava, Shashikant; Gumbo, Tawanda

    2012-07-01

    Using hollow-fiber tuberculosis studies, we recently demonstrated that nonadherence is not a significant factor for ADR and that therapy failure only occurs after a large proportion of doses are missed. Computer-aided clinical trial simulations have suggested that isoniazid and rifampin pharmacokinetic variability best explained poor outcomes. We were interested in determining whether isoniazid pharmacokinetic variability was associated with either microbiological failure or ADR in the clinic. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Prospective, randomized, controlled clinical trials that reported isoniazid acetylation status and microbiological outcomes were selected. The main effects examined were microbiological sputum conversion, ADR, and relapse. Effect size was expressed as pooled risk ratios (RRs) comparing rapid with slow acetylators. Thirteen randomized studies with 1631 rapid acetylators and 1751 slow acetylators met inclusion and exclusion criteria. Rapid acetylators were more likely than slow acetylators to have microbiological failure (RR, 2.0; 95% confidence interval [CI], 1.5-2.7), ADR (RR, 2.0; CI, 1.1-3.4), and relapse (RR, 1.3; CI, .9-2.0). Higher failure rates were encountered even in drug regimens comprising >3 antibiotics. No publication bias or small-study effects were observed for the outcomes evaluated. Pharmacokinetic variability to a single drug in the regimen is significantly associated with failure of therapy and ADR in patients. This suggests that individualized dosing for tuberculosis may be more effective than standardized dosing, which is prescribed in directly observed therapy programs.

  2. Assessment of intrafamilial clinical variability of poikiloderma with neutropenia by a 10-year follow-up of three affected siblings.

    Science.gov (United States)

    Concolino, Daniela; Sestito, Simona; Falvo, Francesca; Romano, Giusy; Ceravolo, Miriam; Anastasio, Elisa; Pensabene, Licia; Colombo, Elisa A; Larizza, Lidia

    2018-05-23

    Clericuzio-type poikiloderma with neutropenia is a well-defined nosological entity, but despite a remarkable number of clinical reports, no long term follow-up data has been presented to date regarding patients with this rare condition. Here we describe the results of clinical follow-up of three siblings, one male (Patient 1) and two females (Patients 2 and 3), subsequent to their first clinical and then molecular diagnosis of Clericuzio-type poikiloderma with neutropenia syndrome due to mutation of USB1gene. Patient 1 always expressed the most severe phenotype, while patients 2 and 3 showed an intermediate and mild phenotype, respectively, as observed since their first clinical evaluation. None of the patients developed skin cancer and/or myelodysplastic disorders considering the peripheral haematological findings. Lens opacity, never reported before, was found in two of the three patients. The long term follow-up observations confirm the stability over time of the pronounced intra-familial heterogeneity of clinical manifestations observed prior to and upon molecular diagnosis. We conclude that prolonged follow-up is an adjunct tool to monitor intra-familial variability of PN clinical spectrum which may favour surveillance of more serious complications of the disease among siblings, when a patient-specific clinical expressivity is present. Copyright © 2018. Published by Elsevier Masson SAS.

  3. Clinical study on influences of enteric coated aspirin on blood pressure and blood pressure variability.

    Science.gov (United States)

    Ji, A-L; Chen, W-W; Huang, W-J

    2016-12-01

    We investigated the effects of oral administration of enteric coated aspirin (ASA) on blood pressure and blood pressure variability of hypertension patients before sleep. We observed 150 hypertension cases, classified as Grade 1-2, from September 2006 to March 2008. They are divided into a control group with 30 cases, ASA I group with 60 cases and ASA II group with 60 cases randomly. Subjects in the control group had proper diets, were losing weight, exercising and maintaining a healthy mentality and were taking 30 mg Adalat orally once a day. Based on the treatment of control group, patients in ASA I group were administered 0.1 g Bayaspirin (produced by Bayer Company) at drought in the morning. Also, based on the treatment of control group, patients in ASA II group were administered 0.1 g Bayaspirin at draught before sleep. The course of treatment is 3 months and then after the treatment, decreasing blood pressure and blood pressure variability conditions in three groups will be compared. Through the comparison of ASA II group with the control group, they have differences in terms of systolic blood pressure (SBP), diastolic blood pressure (DBP), decreasing range of blood pressure and blood pressure variability (p sleep has synergistic effects on decreasing blood pressure of hypertension patients and improving blood pressure variability.

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

    Science.gov (United States)

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

    2016-01-01

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

  5. Glenoid version by CT scan: an analysis of clinical measurement error and introduction of a protocol to reduce variability

    Energy Technology Data Exchange (ETDEWEB)

    Bunt, Fabian van de [VU University Medical Center, Amsterdam (Netherlands); Pearl, Michael L.; Lee, Eric K.; Peng, Lauren; Didomenico, Paul [Kaiser Permanente, Los Angeles, CA (United States)

    2015-11-15

    Recent studies have challenged the accuracy of conventional measurements of glenoid version. Variability in the orientation of the scapula from individual anatomical differences and patient positioning, combined with differences in observer measurement practices, have been identified as sources of variability. The purpose of this study was to explore the utility and reliability of clinically available software that allows manipulation of three-dimensional images in order to bridge the variance between clinical and anatomic version in a clinical setting. Twenty CT scans of normal glenoids of patients who had proximal humerus fractures were measured for version. Four reviewers first measured version in a conventional manner (clinical version), measurements were made again (anatomic version) after employing a protocol for reformatting the CT data to align the coronal and sagittal planes with the superior-inferior axis of the glenoid, and the scapular body, respectively. The average value of clinical retroversion for all reviewers and all subjects was -1.4 (range, -16 to 21 ), as compared to -3.2 (range, -21 to 6 ) when measured from reformatted images. The mean difference between anatomical and clinical version was 1.9 ± 5.6 but ranged on individual measurements from -13 to 26 . In no instance did all four observers choose the same image slice from the sequence of images. This study confirmed the variation in glenoid version dependent on scapular orientation previously identified in other studies using scapular models, and presents a clinically accessible protocol to correct for scapular orientation from the patient's CT data. (orig.)

  6. Glenoid version by CT scan: an analysis of clinical measurement error and introduction of a protocol to reduce variability

    International Nuclear Information System (INIS)

    Bunt, Fabian van de; Pearl, Michael L.; Lee, Eric K.; Peng, Lauren; Didomenico, Paul

    2015-01-01

    Recent studies have challenged the accuracy of conventional measurements of glenoid version. Variability in the orientation of the scapula from individual anatomical differences and patient positioning, combined with differences in observer measurement practices, have been identified as sources of variability. The purpose of this study was to explore the utility and reliability of clinically available software that allows manipulation of three-dimensional images in order to bridge the variance between clinical and anatomic version in a clinical setting. Twenty CT scans of normal glenoids of patients who had proximal humerus fractures were measured for version. Four reviewers first measured version in a conventional manner (clinical version), measurements were made again (anatomic version) after employing a protocol for reformatting the CT data to align the coronal and sagittal planes with the superior-inferior axis of the glenoid, and the scapular body, respectively. The average value of clinical retroversion for all reviewers and all subjects was -1.4 (range, -16 to 21 ), as compared to -3.2 (range, -21 to 6 ) when measured from reformatted images. The mean difference between anatomical and clinical version was 1.9 ± 5.6 but ranged on individual measurements from -13 to 26 . In no instance did all four observers choose the same image slice from the sequence of images. This study confirmed the variation in glenoid version dependent on scapular orientation previously identified in other studies using scapular models, and presents a clinically accessible protocol to correct for scapular orientation from the patient's CT data. (orig.)

  7. Carbon dioxide exchange in three tundra sites show a dissimilar response to environmental variables

    DEFF Research Database (Denmark)

    Mbufong, Herbert Njuabe; Lund, Magnus; Christensen, Torben Røjle

    2015-01-01

    variability. An improved understanding of the control of ancillary variables on net ecosystem exchange (NEE), gross primary production (GPP) and ecosystem respiration (Re) will improve the accuracy with which CO2 exchange seasonality in Arctic tundra ecosystems is modelled. Fluxes were measured with the eddy...... Lake. Growing season NEE correlated mainly to cumulative radiation and temperature-related variables at Zackenberg, while at Daring Lake the same variables showed significant correlations with the partitioned fluxes (GPP and Re). Stordalen was temperature dependent during the growing season. This study...

  8. Coccolithophore responses to environmental variability in the South China Sea: species composition and calcite content

    Science.gov (United States)

    Jin, Xiaobo; Liu, Chuanlian; Poulton, Alex J.; Dai, Minhan; Guo, Xianghui

    2016-08-01

    Coccolithophore contributions to the global marine carbon cycle are regulated by the calcite content of their scales (coccoliths) and the relative cellular levels of photosynthesis and calcification rates. All three of these factors vary between coccolithophore species and with response to the growth environment. Here, water samples were collected in the northern basin of the South China Sea (SCS) during summer 2014 in order to examine how environmental variability influenced species composition and cellular levels of calcite content. Average coccolithophore abundance and their calcite concentration in the water column were 11.82 cells mL-1 and 1508.3 pg C mL-1, respectively, during the cruise. Water samples can be divided into three floral groups according to their distinct coccolithophore communities. The vertical structure of the coccolithophore community in the water column was controlled by the trophic conditions, which were regulated by mesoscale eddies across the SCS basin. The evaluation of coccolithophore-based calcite in the surface ocean also showed that three key species in the SCS (Emiliania huxleyi, Gephyrocapsa oceanica, Florisphaera profunda) and other larger, numerically rare species made almost equal contributions to total coccolith-based calcite in the water column. For Emiliania huxleyi biometry measurements, coccolith size positively correlated with nutrients (nitrate, phosphate), and it is suggested that coccolith length is influenced by light and nutrients through the regulation of growth rates. Larger-sized coccoliths were also linked statistically to low pH and calcite saturation states; however, it is not a simple cause and effect relationship, as carbonate chemistry was strongly co-correlated with the other key environmental factors (nutrients, light).

  9. Concurrent relations among cigarette smoking status, resting heart rate variability, and erectile response.

    Science.gov (United States)

    Harte, Christopher B

    2014-05-01

    Heart rate variability (HRV) is a marker of sympathovagal balance; it has been implicated in erectile function and is also altered by tobacco use. Furthermore, smoking and erectile health are strongly related, given that smokers are at increased risk for erectile dysfunction. Few studies have explored the interrelationships between smoking, HRV, and erectile function concurrently. The aim of this study was to examine potential mechanisms underlying tobacco's effects on penile hemodynamics by exploring the mediating role of HRV. The sample comprised 119 men (smokers = 64; nonsmokers = 55) (mean age 28.90 years; standard deviation (SD) 11.68; range 18-58) selected from the control conditions of three previously published experiments. Participants were free from a history of cardiovascular disease, myocardial infarct, and/or cardiac/cardiovascular medication use. During a laboratory visit, self-report, anthropometric, cardiovascular, and electrocardiographic data were assessed, as well as sexual arousal responses elicited from viewing an erotic film. Objective sexual arousal indices (circumferential change via penile plethysmography), self-reported erectile function (per the erectile function domain score of the International Index of Erectile Function [IIEF-EF]), and time- (SD of beat-to-beat intervals) and frequency-domain parameters of HRV (ratio of low-frequency [LF] power to high-frequency [HF] power [LF/HF ratio]) were assessed. Being a current long-term cigarette smoker was associated with dysregulated sympathovagal balance (higher LF/HF ratios, indicative of sympathetic nervous system dominance), which in turn showed inverse relations with magnitude of erectile tumescence. HRV did not mediate relations between tobacco use and either IIEF-EF scores or resting penile circumference. Findings suggest that dysfunctional cardiac autonomic tone may be an underlying mechanism by which tobacco exerts its deleterious effects on erectile health. Further research

  10. Developmental models for estimating ecological responses to environmental variability: structural, parametric, and experimental issues.

    Science.gov (United States)

    Moore, Julia L; Remais, Justin V

    2014-03-01

    Developmental models that account for the metabolic effect of temperature variability on poikilotherms, such as degree-day models, have been widely used to study organism emergence, range and development, particularly in agricultural and vector-borne disease contexts. Though simple and easy to use, structural and parametric issues can influence the outputs of such models, often substantially. Because the underlying assumptions and limitations of these models have rarely been considered, this paper reviews the structural, parametric, and experimental issues that arise when using degree-day models, including the implications of particular structural or parametric choices, as well as assumptions that underlie commonly used models. Linear and non-linear developmental functions are compared, as are common methods used to incorporate temperature thresholds and calculate daily degree-days. Substantial differences in predicted emergence time arose when using linear versus non-linear developmental functions to model the emergence time in a model organism. The optimal method for calculating degree-days depends upon where key temperature threshold parameters fall relative to the daily minimum and maximum temperatures, as well as the shape of the daily temperature curve. No method is shown to be universally superior, though one commonly used method, the daily average method, consistently provides accurate results. The sensitivity of model projections to these methodological issues highlights the need to make structural and parametric selections based on a careful consideration of the specific biological response of the organism under study, and the specific temperature conditions of the geographic regions of interest. When degree-day model limitations are considered and model assumptions met, the models can be a powerful tool for studying temperature-dependent development.

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

    Science.gov (United States)

    Fuller, G

    1974-10-01

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

  12. The internal responsiveness of the Oral Health Impact Profile-14 to detect differences in clinical parameters related to surgical third molar removal

    NARCIS (Netherlands)

    Kieffer, J. M.; van Wijk, A. J.; Ho, J. P.; Lindeboom, J. A. H.

    2012-01-01

    Purpose The present study examined the internal responsiveness of the short-form Oral Health Impact Profile (OHIP-14) and its ability to differentiate between patients with and without pre- and postoperative complaints as well as other clinical variables. Methods The sample consisted of 97 patients

  13. Immune and clinical response to honeybee venom in beekeepers

    Directory of Open Access Journals (Sweden)

    Jan Matysiak

    2016-03-01

    The differences in the immune response to a bee sting between the beekeepers and individuals not exposed to bees were probably due to the high exposure of the beekeepers to honeybee venom allergens. This may suggest a different approach to the bee venom allergy diagnostic tests in this occupational group.

  14. Variable Origin of the Superior Laryngeal Artery and Its Clinical Significance

    OpenAIRE

    Soubhagya R. Nayak1*, Ashwin Krishnamurthy2, Latha V. Prabhu2, Bhagath Kumar Potu3, Ishwar B. Bagoji4, Jiji PJ2 and Ganesh Kumar Chettiar2

    2011-01-01

    The superior laryngeal artery (SLA) is the dominant arterial supply of the laryngeal muscles, mucosa and glands. The purpose of the present study was to document the variable origin of the SLA in the carotid triangle. Although the variation in the SLA origin and morphology is important during the partial laryngectomy and reconstruction surgery of the larynx, the description of the SLA in modern literature is vague. The anatomy of SLA was studied in 37 adult South Indian preserved cadavers age...

  15. Recurrent Transmission of a 17q12 Microdeletion and a Variable Clinical Spectrum.

    Science.gov (United States)

    George, A M; Love, D R; Hayes, I; Tsang, B

    2012-01-01

    The relatively rare proximal microdeletion of 17q12 (including deletion of the HNF1B gene) is associated with the renal cysts and diabetes syndrome. Recent reports have suggested that there may also be an association between this microdeletion and learning difficulties/autism. This case report describes one of only a few reported families segregating the 17q12 microdeletion, but which highlights the nonpenetrance and variable expressivity of multiple features of this condition.

  16. Recurrent Transmission of a 17q12 Microdeletion and a Variable Clinical Spectrum

    OpenAIRE

    George, A.M.; Love, D.R.; Hayes, I.; Tsang, B.

    2011-01-01

    The relatively rare proximal microdeletion of 17q12 (including deletion of the HNF1B gene) is associated with the renal cysts and diabetes syndrome. Recent reports have suggested that there may also be an association between this microdeletion and learning difficulties/autism. This case report describes one of only a few reported families segregating the 17q12 microdeletion, but which highlights the nonpenetrance and variable expressivity of multiple features of this condition.

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

    Science.gov (United States)

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

    2015-01-01

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

  18. Do Assault-Related Variables Predict Response to Cognitive Behavioral Treatment for PTSD?

    Science.gov (United States)

    Hembree, Elizabeth A.; Street, Gordon P.; Riggs, David S.; Foa, Edna B.

    2004-01-01

    This study examined the hypothesis that variables such as history of prior trauma, assault severity, and type of assault, previously found to be associated with natural recovery, would also predict treatment outcome. Trauma-related variables were examined as predictors of posttreatment posttraumatic stress disorder (PTSD) severity in a sample of…

  19. Is the algorithm used to process heart rate variability data clinically relevant? Analysis in male adolescents.

    Science.gov (United States)

    Soares, Antonio Henrique Germano; Farah, Breno Quintella; Cucato, Gabriel Grizzo; Bastos-Filho, Carmelo José Albanez; Christofaro, Diego Giulliano Destro; Vanderlei, Luiz Carlos Marques; Lima, Aluísio Henrique Rodrigues de Andrade; Ritti-Dias, Raphael Mendes

    2016-01-01

    To analyze whether the algorithm used for the heart rate variability assessment (fast Fourier transform versus autoregressive methods) influenced its association with cardiovascular risk factors in male adolescents. This cross-sectional study included 1,152 male adolescents (aged 14 to 19 years). The low frequency, high frequency components (absolute numbers and normalized units), low frequency/high frequency ratio, and total power of heart rate variability parameters were obtained using the fast Fourier transform and autoregressive methods, while the adolescents were resting in a supine position. All heart rate variability parameters calculated from both methods were different (padolescentes do gênero masculino. Estudo transversal, que incluiu 1.152 adolescentes do gênero masculino (14 a 19 anos). Componentes de baixa e alta frequência (absolutos e unidades normalizadas), razão componente de baixa frequência/componente de alta frequência e poder total da variabilidade da frequência cardíaca foram obtidos em repouso, na posição supina, usando os métodos transformada rápida de Fourier e autorregressivo. Todos os parâmetros da variabilidade da frequência cardíaca para ambos os métodos foram diferentes (padolescentes masculinos, mas essas diferenças não foram clinicamente significativas.

  20. Predicting Calcium Values for Gastrointestinal Bleeding Patients in Intensive Care Unit Using Clinical Variables and Fuzzy Modeling

    Directory of Open Access Journals (Sweden)

    G Khalili-Zadeh-Mahani

    2016-07-01

    Full Text Available Introduction: Reducing unnecessary laboratory tests is an essential issue in the Intensive Care Unit. One solution for this issue is to predict the value of a laboratory test to specify the necessity of ordering the tests. The aim of this paper was to propose a clinical decision support system for predicting laboratory tests values. Calcium laboratory tests of three categories of patients, including upper and lower gastrointestinal bleeding, and unspecified hemorrhage of gastrointestinal tract, have been selected as the case studies for this research. Method: In this research, the data have been collected from MIMIC-II database. For predicting calcium laboratory values, a Fuzzy Takagi-Sugeno model is used and the input variables of the model are heart rate and previous value of calcium laboratory test. Results: The results showed that the values of calcium laboratory test for the understudy patients were predictable with an acceptable accuracy. In average, the mean absolute errors of the system for the three categories of the patients are 0.27, 0.29, and 0.28, respectively. Conclusion: In this research, using fuzzy modeling and two variables of heart rate and previous calcium laboratory values, a clinical decision support system was proposed for predicting laboratory values of three categories of patients with gastrointestinal bleeding. Using these two clinical values as input variables, the obtained results were acceptable and showed the capability of the proposed system in predicting calcium laboratory values. For achieving better results, the impact of more input variables should be studied. Since, the proposed system predicts the laboratory values instead of just predicting the necessity of the laboratory tests; it was more generalized than previous studies. So, the proposed method let the specialists make the decision depending on the condition of each patient.

  1. Vulnerability of white spruce tree growth in interior Alaska in response to climate variability: dendrochronological, demographic, and experimental perspectives

    Science.gov (United States)

    A.D. McGuire; R.W. Ruess; A. Lloyd; J. Yarie; J.S. Clein; G.P. Juday

    2010-01-01

    This paper integrates dendrochronological, demographic, and experimental perspectives to improve understanding of the response of white spruce (Picea glauca (Moench) Voss) tree growth to climatic variability in interior Alaska. The dendrochronological analyses indicate that climate warming has led to widespread declines in white spruce growth...

  2. Intratesticular and subcutaneous lidocaine alters the intraoperative haemodynamic responses and heart rate variability in male cats undergoing castration

    NARCIS (Netherlands)

    Moldal, E.R.; Eriksen, T.; Kirpensteijn, J.; Nødtvedt, A.; Kristensen, A.T.; Sparta, F.M.; Haga, H.A.

    2013-01-01

    Abstract OBJECTIVE: To evaluate the usefulness of intratesticular and subcutaneous lidocaine in alleviating the intraoperative nociceptive response to castration, measured by pulse rate (PR) and mean arterial pressure (MAP), and to test the applicability of heart rate variability (HRV) analysis in

  3. Effect of weather data aggregation on regional crop simulation for different crops, production conditions, and response variables

    NARCIS (Netherlands)

    Zhao, Gang; Hoffmann, Holger; Bussel, Van L.G.J.; Enders, Andreas; Specka, Xenia; Sosa, Carmen; Yeluripati, Jagadeesh; Tao, Fulu; Constantin, Julie; Raynal, Helene; Teixeira, Edmar; Grosz, Balázs; Doro, Luca; Zhao, Zhigan; Nendel, Claas; Kiese, Ralf; Eckersten, Henrik; Haas, Edwin; Vanuytrecht, Eline; Wang, Enli; Kuhnert, Matthias; Trombi, Giacomo; Moriondo, Marco; Bindi, Marco; Lewan, Elisabet; Bach, Michaela; Kersebaum, Kurt Christian; Rötter, Reimund; Roggero, Pier Paolo; Wallach, Daniel; Cammarano, Davide; Asseng, Senthold; Krauss, Gunther; Siebert, Stefan

    2015-01-01

    We assessed the weather data aggregation effect (DAE) on the simulation of cropping systems for different crops, response variables, and production conditions. Using 13 processbased crop models and the ensemble mean, we simulated 30 yr continuous cropping systems for 2 crops (winter wheat and

  4. Variability of carotid artery measurements on 3-Tesla MRI and its impact on sample size calculation for clinical research.

    Science.gov (United States)

    Syed, Mushabbar A; Oshinski, John N; Kitchen, Charles; Ali, Arshad; Charnigo, Richard J; Quyyumi, Arshed A

    2009-08-01

    Carotid MRI measurements are increasingly being employed in research studies for atherosclerosis imaging. The majority of carotid imaging studies use 1.5 T MRI. Our objective was to investigate intra-observer and inter-observer variability in carotid measurements using high resolution 3 T MRI. We performed 3 T carotid MRI on 10 patients (age 56 +/- 8 years, 7 male) with atherosclerosis risk factors and ultrasound intima-media thickness > or =0.6 mm. A total of 20 transverse images of both right and left carotid arteries were acquired using T2 weighted black-blood sequence. The lumen and outer wall of the common carotid and internal carotid arteries were manually traced; vessel wall area, vessel wall volume, and average wall thickness measurements were then assessed for intra-observer and inter-observer variability. Pearson and intraclass correlations were used in these assessments, along with Bland-Altman plots. For inter-observer variability, Pearson correlations ranged from 0.936 to 0.996 and intraclass correlations from 0.927 to 0.991. For intra-observer variability, Pearson correlations ranged from 0.934 to 0.954 and intraclass correlations from 0.831 to 0.948. Calculations showed that inter-observer variability and other sources of error would inflate sample size requirements for a clinical trial by no more than 7.9%, indicating that 3 T MRI is nearly optimal in this respect. In patients with subclinical atherosclerosis, 3 T carotid MRI measurements are highly reproducible and have important implications for clinical trial design.

  5. Interobserver variability of clinical target volume delineation in supra-diaphragmatic Hodgkin's disease. A multi-institutional experience

    International Nuclear Information System (INIS)

    Genovesi, Domenico; Cefaro, Giampiero Ausili; Vinciguerra, Annamaria

    2011-01-01

    To determine interobserver variability in clinical target volume (CTV) of supra-diaphragmatic Hodgkin's lymphoma. At the 2008 AIRO (Italian Society of Radiation Oncology) Meeting, the Radiation Oncology Department of Chieti proposed a multi-institutional contouring dummy-run of two cases of early stage supra-diaphragmatic Hodgkin's lymphoma after chemotherapy. Clinical history, diagnostics, and planning CT imaging were available on Chieti's radiotherapy website (www.radioterapia.unich.it). Participating centers were requested to delineate the CTV and submit it to the coordinating center. To quantify interobserver variability of CTV delineations, the total volume, craniocaudal, laterolateral, and anteroposterior diameters were calculated. A total of 18 institutions for case A and 15 institutions for case B submitted the targets. Case A presented significant variability in total volume (range: 74.1-1,157.1 cc), craniocaudal (range: 6.5-22.5 cm; median: 16.25 cm), anteroposterior (range: 5.04-14.82 cm; median: 10.28 cm), and laterolateral diameters (range: 8.23-22.88 cm; median: 15.5 cm). Mean CTV was 464.8 cc (standard deviation: 280.5 cc). Case B presented significant variability in total volume (range: 341.8-1,662 cc), cranio-caudal (range: 8.0-28.5 cm; median: 23 cm), anteroposterior (range: 7.9-1.8 cm; median: 11.1 cm), and laterolateral diameters (range: 12.9-24.0 cm; median: 18.8 cm). Mean CTV was 926.0 cc (standard deviation: 445.7 cc). This significant variability confirms the need to apply specific guidelines to improve contouring uniformity in Hodgkin's lymphoma. (orig.)

  6. Radiation-Induced Bystander Response: Mechanism and Clinical Implications

    Science.gov (United States)

    Suzuki, Keiji; Yamashita, Shunichi

    2014-01-01

    Significance: Absorption of energy from ionizing radiation (IR) to the genetic material in the cell gives rise to damage to DNA in a dose-dependent manner. There are two types of DNA damage; by a high dose (causing acute or deterministic effects) and by a low dose (related to chronic or stochastic effects), both of which induce different health effects. Among radiation effects, acute cutaneous radiation syndrome results from cell killing as a consequence of high-dose exposure. Recent advances: Recent advances in radiation biology and oncology have demonstrated that bystander effects, which are emerged in cells that have never been exposed, but neighboring irradiated cells, are also involved in radiation effects. Bystander effects are now recognized as an indispensable component of tissue response related to deleterious effects of IR. Critical issues: Evidence has indicated that nonapoptotic premature senescence is commonly observed in various tissues and organs. Senesced cells were found to secrete various proteins, including cytokines, chemokines, and growth factors, most of which are equivalent to those identified as bystander factors. Secreted factors could trigger cell proliferation, angiogenesis, cell migration, inflammatory response, etc., which provide a tissue microenvironment assisting tissue repair and remodeling. Future directions: Understandings of the mechanisms and physiological relevance of radiation-induced bystander effects are quite essential for the beneficial control of wound healing and care. Further studies should extend our knowledge of the mechanisms of bystander effects and mode of cell death in response to IR. PMID:24761341

  7. Marked variability in clinical presentation and outcome of patients with C1q immunodeficiency

    DEFF Research Database (Denmark)

    van Schaarenburg, Rosanne A; Schejbel, Lone; Truedsson, Lennart

    2015-01-01

    OBJECTIVE: Globally approximately 60 cases of C1q deficiency have been described with a high prevalence of Systemic Lupus Erythematosus (SLE). So far treatment has been guided by the clinical presentation rather than the underlying C1q deficiency. Recently, it was shown that C1q production can...

  8. Variability in Clinical Presentation of Neonatal Stroke: Report of Four Cases

    OpenAIRE

    Joseph, Sonia; Angelis, Dimitrios; Bennett, Robert; Kola, Bhargavi; Hughes, Amanda

    2017-01-01

    Neonatal stroke can be a cause of long term neurodevelopmental disability, seizures, and impaired cognitive function. We present four cases of neonatal stroke, associated with different risk factors and clinical presentations. Two of these newborns were born to mothers with no prenatal care.

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

    Science.gov (United States)

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

    2016-04-30

    Eating disorders (EDs) have been underdiagnosed in many clinical settings. This study investigates the influence of clinical characteristics on presenting symptoms of patients with EDs. Psychiatric outpatients, aged 18-45, were enrolled sequentially and received a two-phase survey for EDs in August 2010-January 2013. Their primary reasons for seeking psychiatric help were obtained at their first encounter with outpatient psychiatrists. Patients' clinical and demographic characteristics were compared according to presenting symptoms with or without eating/weight problems. Of 2140 patients, 348 (16.3%) were diagnosed with an ED (22.6% of women and 6.3% of men). The three most common reasons for seeking psychiatric help were eating/weight problems (46.0%), emotional problems (41.3%), and sleep disturbances (19.3%). The multivariate analyses suggest that when patients with EDs presented symptoms that were less related to eating/weight problems, they were significantly more likely to be those having diagnoses other than anorexia nervosa or bulimia nervosa and less severe degree of binge-eating. Further, patients with EDs who demonstrated more impulsive behaviors and poorer functioning were less likely to report their eating problems when visiting psychiatric clinics. Thus, ED should be assessed routinely in patients with complex psychopathology to facilitate comprehensive treatment. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  10. Clinical benefit response of concurrent chemoradiotherapy with protracted 5-fluorouracil infusion in patients with locally advanced pancreatic cancer

    International Nuclear Information System (INIS)

    Okusaka, Takuji; Okada, Shuichi; Ishii, Hiroshi

    1998-01-01

    Pancreatic cancer is a highly virulent disease with a poor prognosis. Although objective tumor response to chemotherapy and/or radiotherapy is low, some patients show an improvement in their symptoms after treatments, without obvious tumor regression. We assessed the clinical benefit of concurrent chemoradiotherapy with protracted 5-fluorouracil infusion in patients with locally advanced pancreatic cancer. Sixteen patients were enrolled in this study. The clinical benefit response to the chemoradiotherapy was evaluated by 2 indicators, including pain (intensity of pain and consumption of morphine) and performance status. A patient was defined to be a clinical benefit responder if 1 of these 2 variables was positive, and the other variable was positive or stable. Seven patients (44%) responded. Six patients (38%) were classified as stable, and 3 (19%) as nonresponders. The survival period in responders was significantly longer than that in nonresponders and stable patients. Concurrent external-beam radiation therapy, with protracted 5-fluorouracil infusion, may be a meaningful treatment for locally advanced pancreatic cancer. (author)

  11. Response of the mean global vegetation distribution to interannual climate variability

    Energy Technology Data Exchange (ETDEWEB)

    Notaro, Michael [University of Wisconsin-Madison, Center for Climatic Research, Madison, WI (United States)

    2008-06-15

    The impact of interannual variability in temperature and precipitation on global terrestrial ecosystems is investigated using a dynamic global vegetation model driven by gridded climate observations for the twentieth century. Contrasting simulations are driven either by repeated mean climatology or raw climate data with interannual variability included. Interannual climate variability reduces net global vegetation cover, particularly over semi-arid regions, and favors the expansion of grass cover at the expense of tree cover, due to differences in growth rates, fire impacts, and interception. The area burnt by global fires is substantially enhanced by interannual precipitation variability. The current position of the central United States' ecotone, with forests to the east and grasslands to the west, is largely attributed to climate variability. Among woody vegetation, climate variability supports expanded deciduous forest growth and diminished evergreen forest growth, due to difference in bioclimatic limits, leaf longevity, interception rates, and rooting depth. These results offer insight into future ecosystem distributions since climate models generally predict an increase in climate variability and extremes. (orig.)

  12. Vegetation Responses to Climate Variability in the Northern Arid to Sub-Humid Zones of Sub-Saharan Africa

    Directory of Open Access Journals (Sweden)

    Khaldoun Rishmawi

    2016-11-01

    Full Text Available In water limited environments precipitation is often considered the key factor influencing vegetation growth and rates of development. However; other climate variables including temperature; humidity; the frequency and intensity of precipitation events are also known to affect productivity; either directly by changing photosynthesis and transpiration rates or indirectly by influencing water availability and plant physiology. The aim here is to quantify the spatiotemporal patterns of vegetation responses to precipitation and to additional; relevant; meteorological variables. First; an empirical; statistical analysis of the relationship between precipitation and the additional meteorological variables and a proxy of vegetation productivity (the Normalized Difference Vegetation Index; NDVI is reported and; second; a process-oriented modeling approach to explore the hydrologic and biophysical mechanisms to which the significant empirical relationships might be attributed. The analysis was conducted in Sub-Saharan Africa; between 5 and 18°N; for a 25-year period 1982–2006; and used a new quasi-daily Advanced Very High Resolution Radiometer (AVHRR dataset. The results suggest that vegetation; particularly in the wetter areas; does not always respond directly and proportionately to precipitation variation; either because of the non-linearity of soil moisture recharge in response to increases in precipitation; or because variations in temperature and humidity attenuate the vegetation responses to changes in water availability. We also find that productivity; independent of changes in total precipitation; is responsive to intra-annual precipitation variation. A significant consequence is that the degree of correlation of all the meteorological variables with productivity varies geographically; so no one formulation is adequate for the entire region. Put together; these results demonstrate that vegetation responses to meteorological variation are more

  13. Clinical utility and validity of minoxidil response testing in androgenetic alopecia.

    Science.gov (United States)

    Goren, Andy; Shapiro, Jerry; Roberts, Janet; McCoy, John; Desai, Nisha; Zarrab, Zoulikha; Pietrzak, Aldona; Lotti, Torello

    2015-01-01

    Clinical response to 5% topical minoxidil for the treatment of androgenetic alopecia (AGA) is typically observed after 3-6 months. Approximately 40% of patients will regrow hair. Given the prolonged treatment time required to elicit a response, a diagnostic test for ruling out nonresponders would have significant clinical utility. Two studies have previously reported that sulfotransferase enzyme activity in plucked hair follicles predicts a patient's response to topical minoxidil therapy. The aim of this study was to assess the clinical utility and validity of minoxidil response testing. In this communication, the present authors conducted an analysis of completed and ongoing studies of minoxidil response testing. The analysis confirmed the clinical utility of a sulfotransferase enzyme test in successfully ruling out 95.9% of nonresponders to topical minoxidil for the treatment of AGA. © 2014 Wiley Periodicals, Inc.

  14. Demographic, clinical, and quality of life variables related to embarrassment in veterans living with an intestinal stoma.

    Science.gov (United States)

    Mitchell, Kimberly A; Rawl, Susan M; Schmidt, C Max; Grant, Marcia; Ko, Clifford Y; Baldwin, Carol M; Wendel, Christopher; Krouse, Robert S

    2007-01-01

    The study aims were to identify demographic, clinical, and quality of life variables related to embarrassment for people living with ostomies and to determine the experiences and/or feelings of veterans who were embarrassed by their ostomy. This was a cross-sectional, correlational study. A convenience sample of veterans (n = 239) living with ostomies from 3 VA medical centers was studied. The veterans were primarily Caucasian (84%), male (92%), and older (M = 69). The modified City of Hope Quality of Life-Ostomy questionnaire was used. Additionally, an open-ended question related to living with an ostomy was asked. The questionnaire packets were mailed to participants and self-administered. Approximately half of the participants (48%) rated their embarrassment as low, but 26% reported high embarrassment. Participants with high embarrassment were compared to those with low embarrassment on demographic, clinical, and quality of life variables. High embarrassment was associated with poorer total quality of life (P hopefulness were associated with low embarrassment (P < .001). Sources of embarrassment included leakage, odor, and noise. Embarrassment may negatively impact a person's quality of life; therefore, the variables associated with high embarrassment should be recognized and addressed.

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

    Directory of Open Access Journals (Sweden)

    Sen-Kuang Hou

    Full Text Available Ultramarathon is a high endurance exercise associated with a wide range of exercise-related problems, such as acute kidney injury (AKI. Early recognition of individuals at risk of AKI during ultramarathon event is critical for implementing preventative strategies.To investigate the impact of speed variability to identify the exercise-related acute kidney injury anticipatively in ultramarathon event.This is a prospective, observational study using data from a 100 km ultramarathon in Taipei, Taiwan. The distance of entire ultramarathon race was divided into 10 splits. The mean and variability of speed, which was determined by the coefficient of variation (CV in each 10 km-split (25 laps of 400 m oval track were calculated for enrolled runners. Baseline characteristics and biochemical data were collected completely 1 week before, immediately post-race, and one day after race. The main outcome was the development of AKI, defined as Stage II or III according to the Acute Kidney Injury Network (AKIN criteria. Multivariate analysis was performed to determine the independent association between variables and AKI development.26 ultramarathon runners were analyzed in the study. The overall incidence of AKI (in all Stages was 84.6% (22 in 26 runners. Among these 22 runners, 18 runners were determined as Stage I, 4 runners (15.4% were determined as Stage II, and none was in Stage III. The covariates of BMI (25.22 ± 2.02 vs. 22.55 ± 1.96, p = 0.02, uric acid (6.88 ± 1.47 vs. 5.62 ± 0.86, p = 0.024, and CV of speed in specific 10-km splits (from secondary 10 km-split (10th - 20th km-split to 60th - 70th km-split were significantly different between runners with or without AKI (Stage II in univariate analysis and showed discrimination ability in ROC curve. In the following multivariate analysis, only CV of speed in 40th - 50th km-split continued to show a significant association to the development of AKI (Stage II (p = 0.032.The development of exercise

  16. Heart rate variability measurement and clinical depression in acute coronary syndrome patients: narrative review of recent literature

    Directory of Open Access Journals (Sweden)

    Harris PR

    2014-07-01

    Full Text Available Patricia RE Harris,1 Claire E Sommargren,2 Phyllis K Stein,3 Gordon L Fung,4,5 Barbara J Drew6,7 1ECG Monitoring Research Lab, 2Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA; 3Heart Rate Variability Laboratory, School of Medicine, Washington University, St Louis, MO, USA; 4Asian Heart & Vascular Center at Mount Zion, Division of Cardiology, University of California, 5Cardiology Consultation Service, Cardiac Noninvasive Laboratory, and The Enhanced External Counterpulsation Unit, Department of Medicine, University of California, San Francisco Medical Center, 6Division of Cardiology, 7Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA Aim: We aimed to explore links between heart rate variability (HRV and clinical depression in patients with acute coronary syndrome (ACS, through a review of recent clinical research literature. Background: Patients with ACS are at risk for both cardiac autonomic dysfunction and clinical depression. Both conditions can negatively impact the ability to recover from an acute physiological insult, such as unstable angina or myocardial infarction, increasing the risk for adverse cardiovascular outcomes. HRV is recognized as a reflection of autonomic function. Methods: A narrative review was undertaken to evaluate state-of-the-art clinical research, using the PubMed database, January 2013. The search terms “heart rate variability” and “depression” were used in conjunction with “acute coronary syndrome”, “unstable angina”, or “myocardial infarction” to find clinical studies published within the past 10 years related to HRV and clinical depression, in patients with an ACS episode. Studies were included if HRV measurement and depression screening were undertaken during an ACS hospitalization or within 2 months of hospital discharge. Results: Nine clinical studies met the inclusion criteria. The

  17. Modulation of the Interleukin-21 Pathway with Interleukin-4 Distinguishes Common Variable Immunodeficiency Patients with More Non-infectious Clinical Complications.

    Science.gov (United States)

    Desjardins, Marylin; Béland, Marianne; Dembele, Marieme; Lejtenyi, Duncan; Drolet, Jean-Phillipe; Lemire, Martine; Tsoukas, Christos; Ben-Shoshan, Moshe; Noya, Francisco J D; Alizadehfar, Reza; McCusker, Christine T; Mazer, Bruce D

    2018-01-01

    Common variable immunodeficiency (CVID) is characterized by hypogammaglobulinemia and clinical manifestations such as infections, autoimmunity, and malignancy. We sought to determine if responsiveness to interleukin-21 (IL-21), a key cytokine for B cell differentiation, correlates with distinct clinical phenotypes in CVID. CVID subjects were recruited through the Canadian Primary Immunodeficiency Evaluative Survey registry. Peripheral blood mononuclear cells were cultured with anti-CD40 ± interferon-gamma, interleukin-4 (IL-4), IL-21, and/or IL-4+IL-21. B cell subpopulations and IgG production were determined at baseline and day 7 by flow cytometry and ELISA. Clinical complications were compared using contingency tables. CVID subjects exhibited decreased CD27 + B cells and IgG production after 7 days of stimulation with anti-CD40+IL-21 (p  2% class-switched memory B cells at baseline. The IL-4 and IL-21 in vitro assays distinguish two groups of CVID subjects and can be used with baseline B cell subpopulation phenotyping to better identify patients experiencing more vs. fewer clinical non-infectious complications and potentially to modulate therapy.

  18. Stochastic stationary response of a variable-mass system with mass disturbance described by Poisson white noise

    Science.gov (United States)

    Qiao, Yan; Xu, Wei; Jia, Wantao; Han, Qun

    2017-05-01

    Variable-mass systems have received widespread attention and show prominent significance with the explosive development of micro- and nanotechnologies, so there is a growing need to study the influences of mass disturbances on systems. This paper is devoted to investigating the stochastic response of a variable-mass system subject to weakly random excitation, in which the mass disturbance is modeled as a Poisson white noise. Firstly, the original system is approximately replaced by the associated conservative system with small disturbance based on the Taylor expansion technique. Then the stationary response of the approximate system is obtained by applying the stochastic averaging method. At last, a representative variable-mass oscillator is worked out to illustrate the effectiveness of the analytical solution by comparing with Monte Carlo simulation. The relative change of mean-square displacement is used to measure the influences of mass disturbance on system responses. Results reveal that the stochastic responses are more sensitive to mass disturbance for some system parameters. It is also found that the influences of Poisson white noise as the mass disturbance on system responses are significantly different from that of Gaussian white noise of the same intensity.

  19. Responses of runoff to historical and future climate variability over China

    Science.gov (United States)

    Wu, Chuanhao; Hu, Bill X.; Huang, Guoru; Wang, Peng; Xu, Kai

    2018-03-01

    China has suffered some of the effects of global warming, and one of the potential implications of climate warming is the alteration of the temporal-spatial patterns of water resources. Based on the long-term (1960-2008) water budget data and climate projections from 28 global climate models (GCMs) of the Coupled Model Intercomparison Project Phase 5 (CMIP5), this study investigated the responses of runoff (R) to historical and future climate variability in China at both grid and catchment scales using the Budyko-based elasticity method. Results show that there is a large spatial variation in precipitation (P) elasticity (from 1.1 to 3.2) and potential evaporation (PET) elasticity (from -2.2 to -0.1) across China. The P elasticity is larger in north-eastern and western China than in southern China, while the opposite occurs for PET elasticity. The catchment properties' elasticity of R appears to have a strong non-linear relationship with the mean annual aridity index and tends to be more significant in more arid regions. For the period 1960-2008, the climate contribution to R ranges from -2.4 to 3.6 % yr-1 across China, with the negative contribution in north-eastern China and the positive contribution in western China and some parts of the south-west. The results of climate projections indicate that although there is large uncertainty involved in the 28 GCMs, most project a consistent change in P (or PET) in China at the annual scale. For the period 2071-2100, the mean annual P is projected to increase in most parts of China, especially the western regions, while the mean annual PET is projected to increase in all of China, particularly the southern regions. Furthermore, greater increases are projected for higher emission scenarios. Overall, due to climate change, the arid regions and humid regions of China are projected to become wetter and drier in the period 2071-2100, respectively (relative to the baseline 1971-2000).

  20. Variable glacier response to atmospheric warming, northern Antarctic Peninsula, 1988–2009

    Directory of Open Access Journals (Sweden)

    B. J. Davies

    2012-09-01

    Full Text Available The northern Antarctic Peninsula has recently exhibited ice-shelf disintegration, glacier recession and acceleration. However, the dynamic response of land-terminating, ice-shelf tributary and tidewater glaciers has not yet been quantified or assessed for variability, and there are sparse data for glacier classification, morphology, area, length or altitude. This paper firstly classifies the area, length, altitude, slope, aspect, geomorphology, type and hypsometry of 194 glaciers on Trinity Peninsula, Vega Island and James Ross Island in 2009 AD. Secondly, this paper documents glacier change 1988–2009. In 2009, the glacierised area was 8140±262 km2. From 1988–2001, 90% of glaciers receded, and from 2001–2009, 79% receded. This equates to an area change of −4.4% for Trinity Peninsula eastern coast glaciers, −0.6% for western coast glaciers, and −35.0% for ice-shelf tributary glaciers from 1988–2001. Tidewater glaciers on the drier, cooler eastern Trinity Peninsula experienced fastest shrinkage from 1988–2001, with limited frontal change after 2001. Glaciers on the western Trinity Peninsula shrank less than those on the east. Land-terminating glaciers on James Ross Island shrank fastest in the period 1988–2001. This east-west difference is largely a result of orographic temperature and precipitation gradients across the Antarctic Peninsula, with warming temperatures affecting the precipitation-starved glaciers on the eastern coast more than on the western coast. Reduced shrinkage on the western Peninsula may be a result of higher snowfall, perhaps in conjunction with the fact that these glaciers are mostly grounded. Rates of area loss on the eastern side of Trinity Peninsula are slowing, which we attribute to the floating ice tongues receding into the fjords and reaching a new dynamic equilibrium. The rapid shrinkage of tidewater glaciers on James Ross Island is likely to continue because of their low elevations and

  1. Variability in lateralised blood flow response to language is associated with language development in children aged 1-5 years.

    Science.gov (United States)

    Kohler, M; Keage, H A D; Spooner, R; Flitton, A; Hofmann, J; Churches, O F; Elliott, S; Badcock, N A

    2015-01-01

    The developmental trajectory of language lateralisation over the preschool years is unclear. We explored the relationship between lateralisation of cerebral blood flow velocity response to object naming and cognitive performance in children aged 1-5 years. Functional transcranial Doppler ultrasound was used to record blood flow velocity bilaterally from middle cerebral arteries during a naming task in 58 children (59% male). At group level, the Lateralisation Index (LI) revealed a greater relative increase in cerebral blood flow velocity within the left as compared to right middle cerebral artery. After controlling for maternal IQ, left-lateralised children displayed lower expressive language scores compared to right- and bi-lateralised children, and reduced variability in LI. Supporting this, greater variability in lateralised response, rather than mean response, was indicative of greater expressive language ability. Findings suggest that a delayed establishment of language specialisation is associated with better language ability in the preschool years. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Peak expiratory flow variability, bronchial responsiveness, and susceptibility to ambient air pollution in adults

    NARCIS (Netherlands)

    Boezen, M; Schouten, Jan; Rijcken, B; Vonk, J; Gerritsen, J; Hoek, G; Brunekreef, B; Postma, D

    1998-01-01

    Bronchial hyperresponsiveness (BHR) and peak expiratory flow (PEF) variability are associated expressions of airway lability, yet probably reflect different underlying pathophysiologic mechanisms. We investigated whether both measures can be used interchangeably to identify subjects who are

  3. Evaluation of signalment, clinical, and laboratory variables as prognostic indicators in dogs with acute abdominal syndrome

    OpenAIRE

    SIMEONOVA, Galina; DINEV, Dinko; CHAPRAZOV, Tzvetan; ROYDEV, Rumen

    2013-01-01

    The aim of the study was to identify predictors of mortality and to propose a new severity scoring system in dogs with acute abdominal syndrome. A retrospective study was carried out on 58 dogs presented with acute abdominal syndrome with American Society of Anesthesiologists grades III-IV and treated surgically by exploratory laparotomy. Medical records were reviewed and information regarding dog signalment, history, clinical, and laboratory data; surgical findings; and outcome was collected...

  4. THE IMMUNE RESPONSE IN CHAGAS DISEASE AND ITS ROLE IN THE VARIABILITY OF CLINICAL EXPRESSION

    Directory of Open Access Journals (Sweden)

    Dutra Walderez O

    2013-01-01

    Full Text Available Durante los últimos años nuestro laboratorio ha estado interesado en la comprensión de los mecanismos que coordinan el establecimiento de la respuesta inmune protectora frente a patógenos en las enfermedades humanas. Tras la infección con un patógeno, ocurren una serie de eventos dentro del huesped que culminarán con el control del patógeno, lo que a menudo conduce a la curación de la infección o bien a la falta de un control adecuado y la cronificación de la infección. Debido a la alta adaptación del parásito a sus anfitriones, lo que refleja millones de años de coevolución, el resultado de una infección parasitaria es a menudo la cronificación. En este punto, tiene lugar un evento intrigante: a pesar del control de la parasitemia, la cronificación de la infección está aso- ciada con el desarrollo de enfermedad. En las poblaciones endémicas, la gran mayoría de los sujetos desarrollan lo que se puede considerar una forma clínica "leve" de la enfermedad, lo que también refleja la adaptación del parásito a su huesped. Sin embargo, un porcentaje im- portante de los individuos infectados desarrollan lo que se considera formas "graves" de la enfermedad. Esto es cierto para muchas enfermedades parasitarias como la leishmaniasis, la esquistosomiasis y la enfermedad de Chagas, la cual centra esta revisión. En este trabajo vamos a discutir los mecanismos que impulsan el establecimiento de la respuesta inmune protectora frente a patógenos, los cuales están directamente relacionados con el establecimiento de las formas leves o graves de la enfermedad de Chagas, teniendo en cuenta los factores relacionados con el huesped.

  5. Phenotypic variability of the kyphoscoliotic type of Ehlers-Danlos syndrome (EDS VIA): clinical, molecular and biochemical delineation

    Science.gov (United States)

    2011-01-01

    Background The kyphoscoliotic type of Ehlers-Danlos syndrome (EDS VIA) (OMIM 225400) is a rare inheritable connective tissue disorder characterized by a deficiency of collagen lysyl hydroxylase 1 (LH1; EC 1.14.11.4) due to mutations in PLOD1. Biochemically this results in underhydroxylation of collagen lysyl residues and, hence, an abnormal pattern of lysyl pyridinoline (LP) and hydroxylysyl pyridinoline (HP) crosslinks excreted in the urine. Clinically the disorder is characterized by hypotonia and kyphoscoliosis at birth, joint hypermobility, and skin hyperelasticity and fragility. Severe hypotonia usually leads to delay in gross motor development, whereas cognitive development is reported to be normal. Methods We describe the clinical, biochemical and molecular characterisation, as well as electron microscopy findings of skin, in 15 patients newly diagnosed with this rare type of Ehlers-Danlos syndrome. Results Age at diagnosis ranged from 5 months to 27 years, with only 1/3 of the patients been diagnosed correctly in the first year of life. A similar disease frequency was found in females and males, however a broad disease severity spectrum (intra- and interfamilial), independent of molecular background or biochemical phenotype, was observed. Kyphoscoliosis, one of the main clinical features was not present at birth in 4 patients. Importantly we also noted the occurrence of vascular rupture antenatally and postnatally, as well as developmental delay in 5 patients. Conclusion In view of these findings we propose that EDS VIA is a highly variable clinical entity, presenting with a broad clinical spectrum, which may also be associated with cognitive delay and an increased risk for vascular events. Genotype/phenotype association studies and additional molecular investigations in more extended EDS VIA populations will be necessary to further elucidate the cause of the variability of the disease severity. PMID:21699693

  6. Sociodemographic Variables, Clinical Features, and the Role of Preassessment Cross-Sex Hormones in Older Trans People.

    Science.gov (United States)

    Bouman, Walter Pierre; Claes, Laurence; Marshall, Ellen; Pinner, Gill T; Longworth, Julia; Maddox, Victoria; Witcomb, Gemma; Jimenez-Murcia, Susana; Fernandez-Aranda, Fernando; Arcelus, Jon

    2016-04-01

    As referrals to gender identity clinics have increased dramatically over the last few years, no studies focusing on older trans people seeking treatment are available. The aim of this study was to investigate the sociodemographic and clinical characteristics of older trans people attending a national service and to investigate the influence of cross-sex hormones (CHT) on psychopathology. Individuals over the age of 50 years old referred to a national gender identity clinic during a 30-month period were invited to complete a battery of questionnaires to measure psychopathology and clinical characteristics. Individuals on cross-sex hormones prior to the assessment were compared with those not on treatment for different variables measuring psychopathology. Sociodemographic and clinical variables and measures of depression and anxiety (Hospital Anxiety and Depression Scale), self-esteem (Rosenberg Self-Esteem Scale), victimization (Experiences of Transphobia Scale), social support (Multidimensional Scale of Perceived Social Support), interpersonal functioning (Inventory of Interpersonal Problems), and nonsuicidal self-injury (Self-Injury Questionnaire). The sex ratio of trans females aged 50 years and older compared to trans males was 23.7:1. Trans males were removed for the analysis due to their small number (n = 3). Participants included 71 trans females over the age of 50, of whom the vast majority were white, employed or retired, and divorced and had children. Trans females on CHT who came out as trans and transitioned at an earlier age were significantly less anxious, reported higher levels of self-esteem, and presented with fewer socialization problems. When controlling for socialization problems, differences in levels of anxiety but not self-esteem remained. The use of cross-sex hormones prior to seeking treatment is widespread among older trans females and appears to be associated with psychological benefits. Existing barriers to access CHT for older trans

  7. Phenotypic variability of the kyphoscoliotic type of Ehlers-Danlos syndrome (EDS VIA: clinical, molecular and biochemical delineation

    Directory of Open Access Journals (Sweden)

    Kariminejad Ariana

    2011-06-01

    Full Text Available Abstract Background The kyphoscoliotic type of Ehlers-Danlos syndrome (EDS VIA (OMIM 225400 is a rare inheritable connective tissue disorder characterized by a deficiency of collagen lysyl hydroxylase 1 (LH1; EC 1.14.11.4 due to mutations in PLOD1. Biochemically this results in underhydroxylation of collagen lysyl residues and, hence, an abnormal pattern of lysyl pyridinoline (LP and hydroxylysyl pyridinoline (HP crosslinks excreted in the urine. Clinically the disorder is characterized by hypotonia and kyphoscoliosis at birth, joint hypermobility, and skin hyperelasticity and fragility. Severe hypotonia usually leads to delay in gross motor development, whereas cognitive development is reported to be normal. Methods We describe the clinical, biochemical and molecular characterisation, as well as electron microscopy findings of skin, in 15 patients newly diagnosed with this rare type of Ehlers-Danlos syndrome. Results Age at diagnosis ranged from 5 months to 27 years, with only 1/3 of the patients been diagnosed correctly in the first year of life. A similar disease frequency was found in females and males, however a broad disease severity spectrum (intra- and interfamilial, independent of molecular background or biochemical phenotype, was observed. Kyphoscoliosis, one of the main clinical features was not present at birth in 4 patients. Importantly we also noted the occurrence of vascular rupture antenatally and postnatally, as well as developmental delay in 5 patients. Conclusion In view of these findings we propose that EDS VIA is a highly variable clinical entity, presenting with a broad clinical spectrum, which may also be associated with cognitive delay and an increased risk for vascular events. Genotype/phenotype association studies and additional molecular investigations in more extended EDS VIA populations will be necessary to further elucidate the cause of the variability of the disease severity.

  8. Incidence of temonera, sulphuhydryl variables and cefotaximase genes associated with β-lactamase producing escherichia coli in clinical isolates

    Science.gov (United States)

    Isaiah, Ibeh Nnana; Nche, Bikwe Thomas; Nwagu, Ibeh Georgina; Nwagu, Ibeh Isaiah

    2011-01-01

    Background: the occurrence of the different types of Extended spectrum beta Lactamase producing Escherichia coli with the, Sulphurhydryl variable, Temonera and the Cefotaximase have been on the rise Aim: The study was to determine the prevalence of extended spectrum beta lactamase gene resistance across the clinical isolates of hospitalized patients. Materials and Method: Three hundred and fifty isolates of Escherichia coli were received from different clinical specimens. The susceptibility profile of the isolates against 10 different antibiotics was examined, the MICs (Minimum Inhibitory Concentration) for ceftazidime were also determined using micro-broth dilution assay. Isolates showing MIC ≥ 6 μg/ml for ceftazidime were screened for ESBL (PCT)phenotypic confirmatory test and subjected to PCR (polymerase chain reaction) to further. Results: By disk diffusion test, there was resistance to ceftazidime and cefotaxime were 180(51.4%) and 120 (34.2%) respectively. However, all strains were susceptible to imipenem. 250 isolates showed MICs≥ 6 μg/ml for ceftazidime of which 180 (72%) were positive for extended spectrum beta lactamase. The prevalence of Sulphurhydryl variable, Temonera and the Cefotaximase among these isolates were 17.1%, 6.6% and 17%, respectively. Conclusion: For the identification of extended spectrum beta lactamase producing isolates it is recommended that clinical laboratories adopt simple test based on Cinical laboratory standard institute recommendation for confirming extended spectrum beta lactamase production in enterobacteriacea species. PMID:22363078

  9. [Application of three compartment model and response surface model to clinical anesthesia using Microsoft Excel].

    Science.gov (United States)

    Abe, Eiji; Abe, Mari

    2011-08-01

    With the spread of total intravenous anesthesia, clinical pharmacology has become more important. We report Microsoft Excel file applying three compartment model and response surface model to clinical anesthesia. On the Microsoft Excel sheet, propofol, remifentanil and fentanyl effect-site concentrations are predicted (three compartment model), and probabilities of no response to prodding, shaking, surrogates of painful stimuli and laryngoscopy are calculated using predicted effect-site drug concentration. Time-dependent changes in these calculated values are shown graphically. Recent development in anesthetic drug interaction studies are remarkable, and its application to clinical anesthesia with this Excel file is simple and helpful for clinical anesthesia.

  10. Variability in cell response of Cronobacter sakazakii after mild-heat treatments and its impact on food safety

    Directory of Open Access Journals (Sweden)

    Julio eParra-Flores

    2016-04-01

    Full Text Available Cronobacter spp. have been responsible for severe infections in infants associated with consumption of powdered infant formula (PIF and follow-up formulae (FUF. Despite several risk assessments described in published studies, few approaches have considered the tremendous variability in cell response that small micropopulations or single cells can have in infant formula during storage, preparation or post process/preparation before the feeding of infants. Stochastic approaches can better describe microbial single cell response than deterministic models as we prove in this study. A large variability of lag phase was observed in single cell and micropopulations of ≤50 cells. This variability increased as the heat shock increased and growth temperature decreased. Obviously, variability of growth of individual Cronobacter sakazakii cell is affected by inoculum size, growth temperature and the probability of cells able to grow at the conditions imposed by the experimental conditions should be taken into account, especially when errors in bottle-preparation practices, such as improper holding temperatures or manipulation, may lead to growth of the pathogen to a critical cell level. The mean probability of illness from initial inoculum size of 1 cell were below 0.2 in all the cases and for inoculum size of 50 cells the mean probability of illness were, in most of the cases, was above 0.7.

  11. Clinical Response to Ingenol Mebutate in Patients With Actinic Keratoses.

    Science.gov (United States)

    Batalla, A; Flórez, Á; Feal, C; Peón, G; Abalde, M T; Salgado-Boquete, L; de la Torre, C

    2015-12-01

    Cryotherapy is the most common treatment for actinic keratosis, but its effect is limited to individual lesions. Several topical drugs, however, are available that, in addition to treating individual actinic keratoses, target field cancerization and thereby act on subclinical lesions. Examples are 5-fluorouracil, imiquimod, diclofenac, and ingenol mebutate. We report on 17 patients with actinic keratoses treated with ingenol mebutate and describe our findings on treatment effectiveness, adherence, and tolerance. Complete and partial response rates were 35% and 53%, respectively. Ninety-four percent of patients fully adhered to treatment and 18% developed severe local reactions. Ingenol mebutate is an effective treatment for actinic keratosis. Although it has a similar rate of local reactions to other treatments available for actinic keratosis, its short treatment regimen favors better adherence. Copyright © 2014 Elsevier España, S.L.U. y AEDV. All rights reserved.

  12. Shame, honor and responsibility in clinical dialog about lifestyle issues

    DEFF Research Database (Denmark)

    Guassora, A.D.; Reventlow, S.; Malterud, K.

    2014-01-01

    OBJECTIVE: To explore how patients enact presentations of self in consultations dealing with lifestyle in general practice. METHODS: We conducted a qualitative observational study with thematic, cross-case analysis of video-recorded consultations inspired by discourse analysis. RESULTS: Patients ....... Failure to do so could lead to distance and hostility while a strategy to acknowledge the impact of shame could help develop and strengthen the doctor-patient relationship.......OBJECTIVE: To explore how patients enact presentations of self in consultations dealing with lifestyle in general practice. METHODS: We conducted a qualitative observational study with thematic, cross-case analysis of video-recorded consultations inspired by discourse analysis. RESULTS: Patients...... patients shifted attention to another, of which they were more proud. In areas where they were not doing well, some patients revealed shame for not acting responsibly. In such cases, patients spoke of themselves in terms of self-deprecation or admitted not living up to expected standards. CONCLUSION...

  13. Obesity is associated with lack of inhibitory control and impaired heart rate variability reactivity and recovery in response to food stimuli.

    Science.gov (United States)

    Spitoni, Grazia Fernanda; Ottaviani, Cristina; Petta, Anna Maria; Zingaretti, Pietro; Aragona, Massimiliano; Sarnicola, Antonio; Antonucci, Gabriella

    2017-06-01

    Recent theories compare obesity with addiction in terms of lack of inhibitory control in both clinical populations. The present study hypothesized impaired inhibition in obese patients reflected both in executive functions and reduced vagal tone (indexed by a decrease in heart rate variability; HRV) in response to food stimuli. Twenty-four inpatients with obesity (19 women) and 37 controls (24 women) underwent ECG monitoring during baseline, food stimuli viewing, and a recovery phase. Tests and questionnaires assessing inhibitory control and psychopathological dispositions were also administered. As hypothesized, patients were characterized by deficits in all the tests measuring inhibitory capacities. Results also show greater HRV reduction and impaired HRV recovery in response to food stimuli in obese patients compared to controls. The drive to eat experienced by obese patients in the absence of caloric need may rely on impairments in inhibitory and vagal functioning. Results are discussed in terms of implications for therapy. Copyright © 2017. Published by Elsevier B.V.

  14. The Effects of Altitude Training on Erythropoietic Response and Hematological Variables in Adult Athletes: A Narrative Review

    Science.gov (United States)

    Płoszczyca, Kamila; Langfort, Józef; Czuba, Miłosz

    2018-01-01

    Background: One of the goals of altitude training is to increase blood oxygen-carrying capacity in order to improve sea-level endurance performance in athletes. The elevated erythropoietin (EPO) production in hypoxia is a key factor in the achievement of enhanced hematological variables. The level of the EPO increase and acceleration of erythropoiesis depend on the duration of exposure and degree of hypoxia. Furthermore, many other factors may affect the hematological response to altitude training. Aim: The purpose of this narrative review was to: (1) analyze the kinetics of EPO and hematological variables during and after altitude training; (2) summarize the current state of knowledge about the possible causes of individual or cohort differences in EPO and hematological response to altitude training; (3) formulate practical guidelines for athletes to improve the efficiency of altitude training. Methods: A narrative review was performed following an electronic search of the databases PubMed/MEDLINE and SPORTDiscus via EBSCO for all English-language articles published between 1997 and 2017. Results: Complete unification of results from studies on EPO kinetics was difficult due to different time and frequency of blood sampling by different researchers during and after altitude training, but the data presented in the reviewed literature allowed us to detect certain trends. The results of the reviewed studies were divergent and indicated either increase or no change of hematological variables following altitude training. Factors that may affect the hematological response to altitude training include hypoxic dose, training content, training background of athletes, and/or individual variability of EPO production. Conclusions: Despite the potential benefits arising from altitude training, its effectiveness in improving hematological variables is still debatable. Further research and better understanding of factors influencing the response to altitude, as well as factors

  15. The Effects of Altitude Training on Erythropoietic Response and Hematological Variables in Adult Athletes: A Narrative Review.

    Science.gov (United States)

    Płoszczyca, Kamila; Langfort, Józef; Czuba, Miłosz

    2018-01-01

    Background: One of the goals of altitude training is to increase blood oxygen-carrying capacity in order to improve sea-level endurance performance in athletes. The elevated erythropoietin (EPO) production in hypoxia is a key factor in the achievement of enhanced hematological variables. The level of the EPO increase and acceleration of erythropoiesis depend on the duration of exposure and degree of hypoxia. Furthermore, many other factors may affect the hematological response to altitude training. Aim: The purpose of this narrative review was to: (1) analyze the kinetics of EPO and hematological variables during and after altitude training; (2) summarize the current state of knowledge about the possible causes of individual or cohort differences in EPO and hematological response to altitude training; (3) formulate practical guidelines for athletes to improve the efficiency of altitude training. Methods: A narrative review was performed following an electronic search of the databases PubMed/MEDLINE and SPORTDiscus via EBSCO for all English-language articles published between 1997 and 2017. Results: Complete unification of results from studies on EPO kinetics was difficult due to different time and frequency of blood sampling by different researchers during and after altitude training, but the data presented in the reviewed literature allowed us to detect certain trends. The results of the reviewed studies were divergent and indicated either increase or no change of hematological variables following altitude training. Factors that may affect the hematological response to altitude training include hypoxic dose, training content, training background of athletes, and/or individual variability of EPO production. Conclusions: Despite the potential benefits arising from altitude training, its effectiveness in improving hematological variables is still debatable. Further research and better understanding of factors influencing the response to altitude, as well as factors

  16. The Effects of Altitude Training on Erythropoietic Response and Hematological Variables in Adult Athletes: A Narrative Review

    Directory of Open Access Journals (Sweden)

    Kamila Płoszczyca

    2018-04-01

    Full Text Available Background: One of the goals of altitude training is to increase blood oxygen-carrying capacity in order to improve sea-level endurance performance in athletes. The elevated erythropoietin (EPO production in hypoxia is a key factor in the achievement of enhanced hematological variables. The level of the EPO increase and acceleration of erythropoiesis depend on the duration of exposure and degree of hypoxia. Furthermore, many other factors may affect the hematological response to altitude training.Aim: The purpose of this narrative review was to: (1 analyze the kinetics of EPO and hematological variables during and after altitude training; (2 summarize the current state of knowledge about the possible causes of individual or cohort differences in EPO and hematological response to altitude training; (3 formulate practical guidelines for athletes to improve the efficiency of altitude training.Methods: A narrative review was performed following an electronic search of the databases PubMed/MEDLINE and SPORTDiscus via EBSCO for all English-language articles published between 1997 and 2017.Results: Complete unification of results from studies on EPO kinetics was difficult due to different time and frequency of blood sampling by different researchers during and after altitude training, but the data presented in the reviewed literature allowed us to detect certain trends. The results of the reviewed studies were divergent and indicated either increase or no change of hematological variables following altitude training. Factors that may affect the hematological response to altitude training include hypoxic dose, training content, training background of athletes, and/or individual variability of EPO production.Conclusions: Despite the potential benefits arising from altitude training, its effectiveness in improving hematological variables is still debatable. Further research and better understanding of factors influencing the response to altitude, as well

  17. Time variability of C-reactive protein: implications for clinical risk stratification.

    Directory of Open Access Journals (Sweden)

    Peter Bogaty

    Full Text Available C-reactive protein (CRP is proposed as a screening test for predicting risk and guiding preventive approaches in coronary artery disease (CAD. However, the stability of repeated CRP measurements over time in subjects with and without CAD is not well defined. We sought to determine the stability of serial CRP measurements in stable subjects with distinct CAD manifestations and a group without CAD while carefully controlling for known confounders.We prospectively studied 4 groups of 25 stable subjects each 1 a history of recurrent acute coronary events; 2 a single myocardial infarction ≥7 years ago; 3 longstanding CAD (≥7 years that had never been unstable; 4 no CAD. Fifteen measurements of CRP were obtained to cover 21 time-points: 3 times during one day; 5 consecutive days; 4 consecutive weeks; 4 consecutive months; and every 3 months over the year. CRP risk threshold was set at 2.0 mg/L. We estimated variance across time-points using standard descriptive statistics and Bayesian hierarchical models.Median CRP values of the 4 groups and their pattern of variability did not differ substantially so all subjects were analyzed together. The median individual standard deviation (SD CRP values within-day, within-week, between-weeks and between-months were 0.07, 0.19, 0.36 and 0.63 mg/L, respectively. Forty-six percent of subjects changed CRP risk category at least once and 21% had ≥4 weekly and monthly CRP values in both low and high-risk categories.Considering its large intra-individual variability, it may be problematic to rely on CRP values for CAD risk prediction and therapeutic decision-making in individual subjects.

  18. Constant versus variable response signal delays in speed--accuracy trade-offs: effects of advance preparation for processing time.

    Science.gov (United States)

    Miller, Jeff; Sproesser, Gudrun; Ulrich, Rolf

    2008-07-01

    In two experiments, we used response signals (RSs) to control processing time and trace out speed--accuracy trade-off(SAT) functions in a difficult perceptual discrimination task. Each experiment compared performance in blocks of trials with constant and, hence, temporally predictable RS lags against performance in blocks with variable, unpredictable RS lags. In both experiments, essentially equivalent SAT functions were observed with constant and variable RS lags. We conclude that there is little effect of advance preparation for a given processing time, suggesting that the discrimination mechanisms underlying SAT functions are driven solely by bottom-up information processing in perceptual discrimination tasks.

  19. Tramadol effects on clinical variables and the mechanical nociceptive threshold in horses

    OpenAIRE

    Franco,Leandro Guimarães; Moreno,Juan Carlos Duque; Teixeira Neto,Antônio Raphael; Souza,Moisés Caetano e; Silva,Luiz Antônio Franco da

    2014-01-01

    This study assessed the clinical effects and the mechanical antinociceptive potential of intravenous (IV) tramadol in horses.A blinded and randomized study was designed with 7 horses treated with 1 (Tr1), 2 (Tr2) or 3 (Tr3) mg kg-1 of tramadol IV. The heart rate, respiratory rate (fR), arterial pressure, degree of sedation, gastrointestinal motility (GI), behavior changes and the mechanical nociceptive threshold (MNT) were evaluated. The MNT was determined with von Frey device method.Tr3 had ...

  20. Malignant otitis externa: Variability of clinical course and difficulties of diagnostics

    Directory of Open Access Journals (Sweden)

    Janićijević Miloš

    2014-01-01

    Full Text Available This paper shows the case of a 70-year-old diabetic patient who was admitted to the ORL and MFS clinic as an emergency case with the right ear otalgia, in the right mastoid extension, facialis paralysis and the right ear suppuration all of which lasted for a month before the hospitalization. On admission, the initial diagnostics stated canal skin edema of the external hearing canal which made the eardrum impossible to visualize. Granulations at the bottom of the canal were visible. During the admission, the patient was submitted to conservative and surgical treatments which confirmed that it was the case of malignant otitis externa.

  1. The Impact of Clinical and Cognitive Variables on Social Functioning in Parkinson's Disease: Patient versus Examiner Estimates

    Directory of Open Access Journals (Sweden)

    Patrick McNamara

    2010-01-01

    Results. Patients' estimates of their own social functioning were not significantly different from examiners' estimates. The impact of clinical variables on social functioning in PD revealed depression to be the strongest association of social functioning in PD on both the patient and the examiner version of the Social Adaptation Self-Evaluation Scale. Conclusions. PD patients appear to be well aware of their social strengths and weaknesses. Depression and motor symptom severity are significant predictors of both self- and examiner reported social functioning in patients with PD. Assessment and treatment of depression in patients with PD may improve social functioning and overall quality of life.

  2. Changes in the interannual variability of the tropical Pacific as a response to an equatorial Atlantic forcing

    Directory of Open Access Journals (Sweden)

    Marta Martín-Rey

    2012-09-01

    Full Text Available Previous studies have reported that the tropical Atlantic has had an influence on tropical Pacific interannual variability since the 1970s. This variability is studied in the present work, using simulations from a coupled model in the Indo-Pacific but with observed sea surface temperature (SST prescribed over the Atlantic. The interannual variability is compared with that from a control simulation in which climatological SSTs are prescribed over the Atlantic. Differences in the Pacific mean state and in its variability are found in the forced simulation as a response to a warming in the equatorial Atlantic, characterized by a cooler background state and an increase in the variability over the tropical Pacific. A striking result is that the principal modes of tropical Pacific SST interannual variability show significant differences before and after the 1970s, providing new evidence of the Atlantic influence on the Pacific Ocean. Significant cooling (warming in the equatorial Atlantic could have caused anomalous winds in the central-easter Pacific during the summer since 1970s. The thermocline depth also seems to be altered, triggering the dynamical processes involved in the development of El Niño (La Niña phenomenon in the following winter. An increase in frequency of Niño and Niña events favouring the Central Pacific (CP ones is observed in the last three decades. Further analyses using coupled models are still necessary to help us to understand the causes of this inter-basin connection.

  3. Response of piping system with semi-active variable stiffness damper under tri-directional seismic excitation

    International Nuclear Information System (INIS)

    Praveen Kumar; Jangid, R.S.; Reddy, G.R.

    2013-01-01

    Highlights: ► Piping system with semi-active variable stiffness damper is investigated under different seismic excitations. ► Switching control law and modified switching control law are adopted. ► There exist an optimum parameters of the SAVSD. ► Substantial reduction of the seismic response of piping system with SAVSD is observed. ► Good amount of energy dissipation is observed. -- Abstract: Seismic loads on piping system due to earthquakes can cause excessive vibrations, which can lead to serious instability resulting in damage or complete failure. In this paper, semi-active variable stiffness dampers (SAVSDs) have been studied to mitigate seismic response and vibration control of piping system used in the process industries, fossil and fissile fuel power plant. The SAVSD changes its stiffness depending upon the piping response and accordingly adds the control forces in the piping system. A study is conducted on the performance of SAVSD due to variation in device stiffness ratios in the switching control law and modified switching control law, which plays an important role in the present control algorithm of the damper. The effectiveness of the SAVSD in terms of reduction in the responses, namely, displacements, accelerations and base shear of the piping system is investigated by comparing uncontrolled responses under four different artificial earthquake motions with increasing amplitudes. The analytical results demonstrate that the SAVSDs under particular optimum parameters are very effective and practically implementable for the seismic response mitigation, vibration control and seismic requalification of piping systems

  4. Response of piping system with semi-active variable stiffness damper under tri-directional seismic excitation

    Energy Technology Data Exchange (ETDEWEB)

    Praveen Kumar, E-mail: praveen@barc.gov.in [Department of Civil Engineering, Indian Institute of Technology Bombay, Powai, Mumbai 400076 (India); Bhabha Atomic Research Centre, Trombay, Mumbai 400085 (India); Jangid, R.S. [Department of Civil Engineering, Indian Institute of Technology Bombay, Powai, Mumbai 400076 (India); Reddy, G.R. [Bhabha Atomic Research Centre, Trombay, Mumbai 400085 (India)

    2013-05-15

    Highlights: ► Piping system with semi-active variable stiffness damper is investigated under different seismic excitations. ► Switching control law and modified switching control law are adopted. ► There exist an optimum parameters of the SAVSD. ► Substantial reduction of the seismic response of piping system with SAVSD is observed. ► Good amount of energy dissipation is observed. -- Abstract: Seismic loads on piping system due to earthquakes can cause excessive vibrations, which can lead to serious instability resulting in damage or complete failure. In this paper, semi-active variable stiffness dampers (SAVSDs) have been studied to mitigate seismic response and vibration control of piping system used in the process industries, fossil and fissile fuel power plant. The SAVSD changes its stiffness depending upon the piping response and accordingly adds the control forces in the piping system. A study is conducted on the performance of SAVSD due to variation in device stiffness ratios in the switching control law and modified switching control law, which plays an important role in the present control algorithm of the damper. The effectiveness of the SAVSD in terms of reduction in the responses, namely, displacements, accelerations and base shear of the piping system is investigated by comparing uncontrolled responses under four different artificial earthquake motions with increasing amplitudes. The analytical results demonstrate that the SAVSDs under particular optimum parameters are very effective and practically implementable for the seismic response mitigation, vibration control and seismic requalification of piping systems.

  5. Tramadol effects on clinical variables and the mechanical nociceptive threshold in horses

    Directory of Open Access Journals (Sweden)

    Leandro Guimarães Franco

    2014-03-01

    Full Text Available This study assessed the clinical effects and the mechanical antinociceptive potential of intravenous (IV tramadol in horses.A blinded and randomized study was designed with 7 horses treated with 1 (Tr1, 2 (Tr2 or 3 (Tr3 mg kg-1 of tramadol IV. The heart rate, respiratory rate (fR, arterial pressure, degree of sedation, gastrointestinal motility (GI, behavior changes and the mechanical nociceptive threshold (MNT were evaluated. The MNT was determined with von Frey device method.Tr3 had a significant increase in their fR and more pronounced behavioral changes than other treatments.The Tr1 showed a significant increase in arterial pressure. The GI reduced significantly, mainly in Tr2. The tramadol did not change the MNT of the horses.The clinical alterations observed with the different treatments were considered mild and transitory, being most evident in Tr2. However the tramadol did not have any analgesic effect with any of the doses evaluated.

  6. Traumatic event exposure and gambling: associations with clinical, neurocognitive, and personality variables.

    Science.gov (United States)

    Leppink, Eric W; Grant, Jon E

    2015-02-01

    Epidemiological research has shown high comorbidity rates between at-risk/problem (ARP) gambling and trauma. However, few studies have assessed the neurocognitive implications of this comorbidity, and even fewer have been conducted with young adults. The present study sought to determine the neurocognitive, clinical, personality types associated with trauma in ARP gamblers. The present study analyzed young adult gamblers age 18 to 29 drawn from a study investigating impulsivity. Of the 230 gamblers, 52 (22.6%) reported experiencing a traumatic event during their life to which they responded with intense fear, helplessness, or horror. The remaining participants indicated no experience with trauma. ARP gamblers who had experienced trauma showed significant neurocognitive deficits on tasks related to decision-making, risk adjustment, sustained attention, and spatial working memory. We did not detect significant differences in gambling severity. Trauma was associated with lower perceived quality of life and self-esteem, and higher rates of current comorbid diagnoses, suicidality, substance use disorders, and nicotine use. This study suggests that trauma may not exacerbate the severity of gambling in ARP gamblers. However, significant differences in supplemental clinical and neurocognitive measures may indicate that trauma is an important consideration when assessing problems beyond those related directly to gambling severity.

  7. Description, evaluation and clinical decision making according to various fetal heart rate patterns. Inter-observer and regional variability

    DEFF Research Database (Denmark)

    Lidegaard, O; Bøttcher, L M; Weber, Tom

    1992-01-01

    departments, especially between departments far apart. It is concluded that we still need a scientific clarification of which specific heart rate changes are the best predictors of fetal stress. Artificial intelligence programs for interpreting fetal cardiotocograms and ECG signals constitute one promising......At 10 Danish obstetrical departments, 116 residents (42 senior and 74 junior) participated in a study to assess inter-observer and regional variability in the description and evaluation of and clinical decision regarding 11 fetal heart rate patterns. The 11 traces included normal as well...... as pathological patterns, and normal as well as clinically asphyxiated babies. Five antepartum and six intrapartum patterns were included. A total of 1,276 descriptions and evaluations were obtained. The degree of agreement in description of fetal heart rate changes was high regarding the baseline...

  8. Roles and Responsibilities, and Education and Training Requirements for Clinically Qualified Medical Physicists (Russian Edition)

    International Nuclear Information System (INIS)

    2014-01-01

    This publication addresses the shortfall of well trained and clinically qualified medical physicists working in radiation medicine. The roles, responsibilities and clinical training requirements of medical physicists have not always been well defined or well understood by health care professionals, health authorities and regulatory agencies. To fill this gap, this publication provides recommendations for the academic education and clinical training of clinically qualified medical physicists, including recommendations for their accreditation certification and registration, along with continuous professional development. The goal is to establish criteria that support the harmonization of education and clinical training worldwide

  9. Distinguishing spatiotemporal variability of sediment sources in small urbanized catchment as a response to urban expansion

    Science.gov (United States)

    Belyaev, Vladimir; Feoktistov, Artem; Huygens, Dries; Shamshurina, Eugenia; Golosov, Valentin

    2014-05-01

    Understanding hydrological response and geomorphic behavior of small catchments in urban environments, especially those experiencing urban expansion, represents serious and important problem which has not yet been given an adequate research attention. Urbanization exerts profound and diverse impacts on catchment characteristics, particularly by increasing surface runoff coefficients, peak flow discharges and rates of flash flood waves propagation as a result of widespread appearance of buildings and paved surfaces with practically zero infiltration capacities. Another essential influence of urbanization on small catchment hydrological regimes is associated with significant changes of natural topography (from relatively minor modifications such as grading of steeper slopes to complete transformations including total filling of gullies and small valleys, transfer of small streams from surface into underground pipes or collectors, etc.) combined with creation of systems of concrete-protected surface drainages and underground storm flow sewages. Such activities can result in substantial changes of runoff- and sediment-contributing areas for the remaining gullies and small valleys in comparison to the pre-urbanization conditions, causing dramatic increase of fluvial activity in some of those and much lower flow discharges in others. In addition, gullies and small valleys in urban settlements often become sites of dumping for both dry and liquid domestic and industrial wastes, thus being major pathways for dissolved and particle-bound pollutant transfer into perennial streams and rivers. All the problems listed require detailed hydrological and geomorphic investigations in order to provide sound basis for developing appropriate measures aimed to control and decrease urban erosion, sediment redistribution, pollution of water bodies, damage to constructions and communications. Recent advances in sediment tracing and fingerprinting techniques provide promising opportunities

  10. Rapid response predicts 12-month post-treatment outcomes in binge-eating disorder: theoretical and clinical implications

    Science.gov (United States)

    Grilo, C. M.; White, M. A.; Wilson, G. T.; Gueorguieva, R.; Masheb, R. M.

    2011-01-01

    Background We examined rapid response in obese patients with binge-eating disorder (BED) in a clinical trial testing cognitive behavioral therapy (CBT) and behavioral weight loss (BWL). Method Altogether, 90 participants were randomly assigned to CBT or BWL. Assessments were performed at baseline, throughout and post-treatment and at 6- and 12-month follow-ups. Rapid response, defined as ≥70% reduction in binge eating by week four, was determined by receiver operating characteristic curves and used to predict outcomes. Results Rapid response characterized 57% of participants (67% of CBT, 47% of BWL) and was unrelated to most baseline variables. Rapid response predicted greater improvements across outcomes but had different prognostic significance and distinct time courses for CBT versus BWL. Patients receiving CBT did comparably well regardless of rapid response in terms of reduced binge eating and eating disorder psychopathology but did not achieve weight loss. Among patients receiving BWL, those without rapid response failed to improve further. However, those with rapid response were significantly more likely to achieve binge-eating remission (62% v. 13%) and greater reductions in binge-eating frequency, eating disorder psychopathology and weight loss. Conclusions Rapid response to treatment in BED has prognostic significance through 12-month follow-up, provides evidence for treatment specificity and has clinical implications for stepped-care treatment models for BED. Rapid responders who receive BWL benefit in terms of both binge eating and short-term weight loss. Collectively, these findings suggest that BWL might be a candidate for initial intervention in stepped-care models with an evaluation of progress after 1 month to identify non-rapid responders who could be advised to consider a switch to a specialized treatment. PMID:21923964

  11. The cytogenetic damage in gynaecological cancer patients during radiotherapy. The variability of cytogenetic response to irradiation

    International Nuclear Information System (INIS)

    Vyinnyikov, V.A.; Maznik, N.A.; Sipko, T.C.; Pshenyichna, N.D.

    2013-01-01

    The limits of cytogenetic changes in blood lymphocytes of gynecological cancer patients undergoing radiotherapy and assessment the individual variability of the kinetics of chromosome aberration yields depending on treatment schemes was evaluated. Cytogenetic study was carried out in 53 female patients with uterine cancer. For the first time in vivo aberration yields were compared in the representational groups of gynecological cancer patients undergoing telegammatherapy, intracavitary brachytherapy or their combination; the limits of cytogenetic changes were evaluated and the magnitude of the individual variability of kinetics of cytogenetic damage yield was assessed depending on the scheme of therapeutic irradiation

  12. Clinical, pathological and functional characterization of riboflavin-responsive neuropathy.

    Science.gov (United States)

    Manole, Andreea; Jaunmuktane, Zane; Hargreaves, Iain; Ludtmann, Marthe H R; Salpietro, Vincenzo; Bello, Oscar D; Pope, Simon; Pandraud, Amelie; Horga, Alejandro; Scalco, Renata S; Li, Abi; Ashokkumar, Balasubramaniem; Lourenço, Charles M; Heales, Simon; Horvath, Rita; Chinnery, Patrick F; Toro, Camilo; Singleton, Andrew B; Jacques, Thomas S; Abramov, Andrey Y; Muntoni, Francesco; Hanna, Michael G; Reilly, Mary M; Revesz, Tamas; Kullmann, Dimitri M; Jepson, James E C; Houlden, Henry

    2017-11-01

    Drosophila also resulted in severely impaired locomotor activity and reduced lifespan, mirroring patient pathology, and these phenotypes could be partially rescued using a novel esterified derivative of riboflavin. Our findings expand the genetic, clinical and neuropathological features of Brown-Vialetto-Van Laere syndrome, implicate mitochondrial dysfunction as a downstream consequence of riboflavin transporter gene defects, and validate riboflavin esters as a potential therapeutic strategy. © The Author (2017). Published by Oxford University Press on behalf of the Guarantors of Brain.

  13. Bone Mineral Density in Patients with Ankylosing Spondylitis: Incidence and Correlation with Demographic and Clinical Variables

    Directory of Open Access Journals (Sweden)

    Laura MUNTEAN

    2009-12-01

    Full Text Available Objective: To evaluate bone mineral density (BMD in patients with ankylosing spondylitis (AS and determine its correlation with the demographic and clinical characteristics of AS. Patients and Methods: Demographic, clinical and osteodensitometric data were evaluated in a cross-sectional study that included 136 patients with AS. Spine and hip BMD were measured by means of dual energy X-ray absorptiometry (DXA. Using the modified Schober’s test we assessed spine mobility. We examined the sacroiliac, anteroposterior and lateral dorso-lumbar spine radiographs in order to grade sacroiliitis and assess syndesmophytes. Disease activity was evaluated using C-reactive protein (CRP levels and erythrocyte sedimentation rate (ESR. Demographic data and BMD measurements were compared with those of 167 age- and sex-matched healthy controls. Results: Patients with AS had a significantly lower BMD at the spine, femoral neck, trochanter and total hip as compared to age-matched controls (all p<0.01. According to the WHO classification, osteoporosis was present in 20.6% of the AS patients at the lumbar spine and in 14.6% at the femoral neck. There were no significant differences in BMD when comparing men and women with AS, except for trochanter BMD that was lower in female patients. No correlations were found between disease activity markers (ESR, CRP and BMD. Femoral neck BMD was correlated with disease duration, Schober’s test and sacroiliitis grade. Conclusion: Patients with AS have a lower spine and hip BMD as compared to age- and sex-matched controls. Bone loss at the femoral neck is associated with disease duration and more severe AS.

  14. Clinical Variability in Cardiovascular Disease Risk Factor Screening and Management in Adolescent and Young Adult Women with Polycystic Ovary Syndrome.

    Science.gov (United States)

    Baer, Tamara E; Milliren, Carly E; Walls, Courtney; DiVasta, Amy D

    2015-10-01

    To review the clinical presentation, evaluation, and management of normal-weight (NW), overweight (OW), and obese (OB) adolescent and young adult women with polycystic ovary syndrome (PCOS) during a 2-year follow-up. Retrospective chart review. One hundred seventy-three adolescent and young adult women, aged 12-22 years, diagnosed with PCOS. Demographic, health data, and laboratory measures were abstracted from 3 clinic visits: baseline and 1- and 2-year follow-up. Subjects were classified as NW, OW, or OB. Longitudinal data were analyzed using repeated-measures analysis of variance. Body mass index, self-reported concerns, and lifestyle changes. Most patients (73%) were OW or OB. Family history of type 2 diabetes was greater in OW (38%) and OB (53%) patients compared with NW (22%) patients (P = .002). Acanthosis nigricans was identified in OW (62%) and OB (21%) patients but not in NW patients (0%; P insulin (P PCOS were OW or OB. Substantial clinical variability existed in cardiovascular disease (CVD) screening; among those screened, OW and OB patients had greater CVD risk factors. Despite self-reported concerns about weight and diabetes risk among OW and OB patients, no clinically significant change in body mass index percentile occurred. Evidence-based interventions and recommendations for screening tests are needed to address CVD risk in adolescents and young adults with PCOS. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  15. Variability of North Sea pH and CO2 in response to North Atlantic Oscillation forcing

    DEFF Research Database (Denmark)

    Salt, Lesley A.; Thomas, Helmuth; Prowe, Friederike

    2013-01-01

    [1] High biological activity causes a distinct seasonality of surface water pH in the North Sea, which is a strong sink for atmospheric CO2 via an effective shelf pump. The intimate connection between the North Sea and the North Atlantic Ocean suggests that the variability of the CO2 system...... of the North Atlantic Ocean may, in part, be responsible for the observed variability of pH and CO2 in the North Sea. In this work, we demonstrate the role of the North Atlantic Oscillation (NAO), the dominant climate mode for the North Atlantic, in governing this variability. Based on three extensive...... observational records covering the relevant levels of the NAO index, we provide evidence that the North Sea pH and CO2 system strongly responds to external and internal expressions of the NAO. Under positive NAO, the higher rates of inflow of water from the North Atlantic Ocean and the Baltic outflow lead...

  16. Group differences in physician responses to handheld presentation of clinical evidence: a verbal protocol analysis

    Directory of Open Access Journals (Sweden)

    Pavlovic Nada J

    2007-07-01

    Full Text Available Abstract Background To identify individual differences in physicians' needs for the presentation of evidence resources and preferences for mobile devices. Methods Within-groups analysis of responses to semi-structured interviews. Interviews consisted of using prototypes in response to task-based scenarios. The prototypes were implemented on two different form factors: a tablet style PC and a pocketPC. Participants were from three user groups: general internists, family physicians and medicine residents, and from two different settings: urban and semi-urban. Verbal protocol analysis, which consists of coding utterances, was conducted on the transcripts of the testing sessions. Statistical relationships were investigated between staff physicians' and residents' background variables, self-reported experiences with the interfaces, and verbal code frequencies. Results 47 physicians were recruited from general internal medicine, family practice clinics and a residency training program. The mean age of participants was 42.6 years. Physician specialty had a greater effect on device and information-presentation preferences than gender, age, setting or previous technical experience. Family physicians preferred the screen size of the tablet computer and were less concerned about its portability. Residents liked the screen size of the tablet, but preferred the portability of the pocketPC. Internists liked the portability of the pocketPC, but saw less advantage to the large screen of the tablet computer (F[2,44] = 4.94, p = .012. Conclusion Different types of physicians have different needs and preferences for evidence-based resources and handheld devices. This study shows how user testing can be incorporated into the process of design to inform group-based customization.

  17. Plant responses to variable timing of aboveground clipping and belowground herbivory depend on plant age

    NARCIS (Netherlands)

    Wang, Minggang; Bezemer, T. Martijn; van der Putten, W.H.; Brinkman, Pella; Biere, Arjen

    2017-01-01

    Aims Plants use different types of responses such as tolerance and induced defense to mitigate the effects of herbivores. The direction and magnitude of both these plant responses can vary with plant age. However, most studies have focused on aboveground herbivory, whereas important feeding occurs

  18. Variability of IgM response in hepatitis C virus infection

    NARCIS (Netherlands)

    Zaaijer, H. L.; Mimms, L. T.; Cuypers, H. T.; Reesink, H. W.; van der Poel, C. L.; Taskar, S.; Lelie, P. N.

    1993-01-01

    The IgM and IgG antibody response to various hepatitis C virus (HCV) antigens was studied in 8 patients who acquired posttransfusion HCV infection. IgM anti-HCV was detectable in only 4 of these patients, coincident with (1 patient) or later than (3 patients) the IgG anti-HCV response. Seven

  19. Financial liberalisation and political variables: A response to Abiad and Mody

    NARCIS (Netherlands)

    Burgoon, B.; Demetriades, P.; Underhill, G.

    2008-01-01

    We challenge recent findings by Abiad and Mody (2005) which suggest that financial liberalization has little to do with political variables. This analysis is at odds with some of the established literature, and only with difficulty comes to terms with the considerable cross-national variation in the

  20. Light induced intraspecific variability in response to thermal stress in the hard coral Stylophora pistillata

    NARCIS (Netherlands)

    Tilstra, Arjen; Wijgerde, Tim; Dini-Andreote, Francisco; Eriksson, Britas Klemens; Salles, Joana Falcão; Pen, Ido; Osinga, Ronald; Wild, Christian

    2017-01-01

    Recent research suggests that prior exposure of several months to elevated irradiance induces enhanced thermal tolerance in scleractinian corals. While this tolerance has been reported at the species level, individual coral colonies may react differently due to individual variability in thermal

  1. Nitrate and dissolved organic carbon mobilization in response to soil freezing variability

    Science.gov (United States)

    Colin B. Fuss; Charles T. Driscoll; Peter M. Groffman; John L. Campbell; Lynn M. Christenson; Timothy J. Fahey; Melany C. Fisk; Myron J. Mitchell; Pamela H. Templer; Jorge Durán; Jennifer L. Morse

    2016-01-01

    Reduced snowpack and associated increases in soil freezing severity resulting from winter climate change have the potential to disrupt carbon (C) and nitrogen (N) cycling in soils. We used a natural winter climate gradient based on elevation and aspect in a northern hardwood forest to examine the effects of variability in soil freezing depth, duration, and frequency on...

  2. Low voltage RF MEMS variable capacitor with linear C-V response

    KAUST Repository

    Elshurafa, Amro M.; Ho, Pak Hung; Salama, Khaled N.

    2012-01-01

    .2:1 and was achieved at an actuation DC voltage of 8V only. Further, the linear regression coefficient was 0.98. The variable capacitor was created such that it has both vertical and horizontal capacitances present. As the top suspended plate moves towards the bottom

  3. Long-term streamflow response to climatic variability in the Loess Plateau, China

    Science.gov (United States)

    Shenping Wang; Zhiqiang Zhang; Ge Sun; Steven G. McNulty; Huayong Zhang; Jianlao Li; Manliang Zhang

    2008-01-01

    The Loess Plateau region in northwestern China has experienced severe water resource shortages due to the combined impacts of climate and land use changes and water resource exploitation during the past decades. This study was designed to examine the impacts of climatic variability on streamflow characteristics of a 12-km2 watershed near Tianshui City, Gansu Province...

  4. Cortical Response Variability as a Developmental Index of Selective Auditory Attention

    Science.gov (United States)

    Strait, Dana L.; Slater, Jessica; Abecassis, Victor; Kraus, Nina

    2014-01-01

    Attention induces synchronicity in neuronal firing for the encoding of a given stimulus at the exclusion of others. Recently, we reported decreased variability in scalp-recorded cortical evoked potentials to attended compared with ignored speech in adults. Here we aimed to determine the developmental time course for this neural index of auditory…

  5. Quiet Eye Duration Is Responsive to Variability of Practice and to the Axis of Target Changes

    Science.gov (United States)

    Horn, Robert R.; Okumura, Michelle S.; Alexander, Melissa G. F.; Gardin, Fredrick A.; Sylvester, Curtis T.

    2012-01-01

    We tested the hypothesis that quiet eye, the final fixation before the initiation of a movement in aiming tasks, is used to scale the movement's parameters. Two groups of 12 participants (N = 24) threw darts to targets in the horizontal and vertical axes under conditions of higher (random) or lower (blocked) target variability. Supporting our…

  6. The Effects of Delayed Reinforcement on Variability and Repetition of Response Sequences

    Science.gov (United States)

    Odum, Amy L.; Ward, Ryan D.; Burke, K. Anne; Barnes, Christopher A.

    2006-01-01

    Four experiments examined the effects of delays to reinforcement on key peck sequences of pigeons maintained under multiple schedules of contingencies that produced variable or repetitive behavior. In Experiments 1, 2, and 4, in the repeat component only the sequence right-right-left-left earned food, and in the vary component four-response…

  7. The Effect of the Accountability Variables of Responsibility, Openness, and Answerability on Authentic Leadership

    Science.gov (United States)

    Frederick, Heidi R.; Wood, James A.; West, George R.; Winston, Bruce E.

    2016-01-01

    One salient aspect of authentic leadership is the possibility that it can be developed (Walumbwa, Avolio, Gardner, Wernsing, & Peterson, 2008). However, the relative paucity of research on authentic leadership as a dependent variable needs to be addressed. The purpose of this cross-sectional quantitative study is to examine the three factors…

  8. Clinical and molecular characterization of duplications encompassing the human SHOX gene reveal a variable effect on stature.

    Science.gov (United States)

    Thomas, N Simon; Harvey, John F; Bunyan, David J; Rankin, Julia; Grigelioniene, Giedre; Bruno, Damien L; Tan, Tiong Y; Tomkins, Susan; Hastings, Robert

    2009-07-01

    Deletions of the SHOX gene are well documented and cause disproportionate short stature and variable skeletal abnormalities. In contrast interstitial SHOX duplications limited to PAR1 appear to be very rare and the clinical significance of the only case report in the literature is unclear. Mapping of this duplication has now shown that it includes the entire SHOX gene but little flanking sequence and so will not encompass any of the long-range enhancers required for SHOX transcription. We now describe the clinical and molecular characterization of three additional cases. The duplications all included the SHOX coding sequence but varied in the amount of flanking sequence involved. The probands were ascertained for a variety of reasons: hypotonia and features of Asperger syndrome, Leri-Weill dyschondrosteosis (LWD), and a family history of cleft palate. However, the presence of a duplication did not correlate with any of these features or with evidence of skeletal abnormality. Remarkably, the proband with LWD had inherited both a SHOX deletion and a duplication. The effect of the duplications on stature was variable: height appeared to be elevated in some carriers, particularly in those with the largest duplications, but was still within the normal range. SHOX duplications are likely to be under ascertained and more cases need to be identified and characterized in detail in order to accurately determine their phenotypic consequences.

  9. Agreement between clinical estimation and a new quantitative analysis by Photoshop software in fundus and angiographic image variables.

    Science.gov (United States)

    Ramezani, Alireza; Ahmadieh, Hamid; Azarmina, Mohsen; Soheilian, Masoud; Dehghan, Mohammad H; Mohebbi, Mohammad R

    2009-12-01

    To evaluate the validity of a new method for the quantitative analysis of fundus or angiographic images using Photoshop 7.0 (Adobe, USA) software by comparing with clinical evaluation. Four hundred and eighteen fundus and angiographic images of diabetic patients were evaluated by three retina specialists and then by computing using Photoshop 7.0 software. Four variables were selected for comparison: amount of hard exudates (HE) on color pictures, amount of HE on red-free pictures, severity of leakage, and the size of the foveal avascular zone (FAZ). The coefficient of agreement (Kappa) between the two methods in the amount of HE on color and red-free photographs were 85% (0.69) and 79% (0.59), respectively. The agreement for severity of leakage was 72% (0.46). In the two methods for the evaluation of the FAZ size using the magic and lasso software tools, the agreement was 54% (0.09) and 89% (0.77), respectively. Agreement in the estimation of the FAZ size by the lasso magnetic tool was excellent and was almost as good in the quantification of HE on color and on red-free images. Considering the agreement of this new technique for the measurement of variables in fundus images using Photoshop software with the clinical evaluation, this method seems to have sufficient validity to be used for the quantitative analysis of HE, leakage, and FAZ size on the angiograms of diabetic patients.

  10. Local Perceptions and Responses to Climate Change and Variability: The Case of Laikipia District, Kenya

    Directory of Open Access Journals (Sweden)

    Sarah Ayeri Ogalleh

    2012-12-01

    Full Text Available Agricultural policies in Kenya aim to improve farmers’ livelihoods. With projected climate change, these policies are short of mechanisms that promote farmers’ adaptation. As a result, smallholders are confronted with a variety of challenges including climate change, which hinders their agricultural production. Local knowledge can be instrumental in assisting smallholders to cope with climate change and variability. In this paper, we present empirical evidence that demonstrates local knowledge, perceptions and adaptations to climate change and variability amongst smallholders of Laikipia district of Kenya. A Palmer Drought Severity Index (PDSI calculated for one station is compared with smallholders’ perceptions. Data was collected using qualitative and quantitative methods in Umande and Muhonia sub-locations. Qualitative data included 46 transcripts from focus group discussions and key informant interviews. Quantitative data is derived from 206 interviewees. We analyzed qualitative and quantitative data using Atlas-ti and SPSS respectively. According to smallholders’ perceptions, climatic variability is increasingly changing. Local perceptions include decreasing rainfalls, increasing temperatures, increasing frosts and increasing hunger. The PDSI shows a trend towards severe droughts in the last four decades, which is in accordance with farmers’ perceptions. Smallholders use a combination of coping and adaptation strategies to respond to variability, including, among others, diversification of crop varieties, migration and sale of livestock. Significant relationships exist between drought perceptions and some adaptations such as migration and sale of livestock. Farmers have an in-depth knowledge of climatic variability, which they use to inform their coping and adaptation strategies. Knowledge of climatic perceptions and adaptations are vital entry points for decision makers and policy makers to learn how and where to enhance the

  11. Seasonal variability of stream water quality response to storm events captured using high-frequency and multi-parameter data

    Science.gov (United States)

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

    2018-04-01

    The response of stream chemistry to storm is of major interest for understanding the export of dissolved and particulate species from catchments. The related challenge is the identification of active hydrological flow paths during these events and of the sources of chemical elements for which these events are hot moments of exports. An original four-year data set that combines high frequency records of stream flow, turbidity, nitrate and dissolved organic carbon concentrations, and piezometric levels was used to characterize storm responses in a headwater agricultural catchment. The data set was used to test to which extend the shallow groundwater was impacting the variability of storm responses. A total of 177 events were described using a set of quantitative and functional descriptors related to precipitation, stream and groundwater pre-event status and event dynamics, and to the relative dynamics between water quality parameters and flow via hysteresis indices. This approach led to identify different types of response for each water quality parameter which occurrence can be quantified and related to the seasonal functioning of the catchment. This study demonstrates that high-frequency records of water quality are precious tools to study/unique in their ability to emphasize the variability of catchment storm responses.

  12. The Effect of Forging Variables on the Supersolvus Heat-Treatment Response of Powder-Metallurgy Nickel-Base Superalloys

    Science.gov (United States)

    2014-12-01

    AFRL-RX-WP-JA-2015-0160 THE EFFECT OF FORGING VARIABLES ON THE SUPERSOLVUS HEAT-TREATMENT RESPONSE OF POWDER - METALLURGY NICKEL-BASE SUPERALLOYS... POWDER - METALLURGY NICKEL- BASE SUPERALLOYS (POSTPRINT) 5a. CONTRACT NUMBER In-house 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 62102F 6. AUTHOR...treatment (SSHT) of two powder - metallurgy , gamma–gamma prime superalloys, IN-100 and LSHR, was established. For this purpose, isothermal, hot

  13. Hydroxyurea responses in clinically varied beta, HbE-beta thalassaemia and sickle cell anaemia patients of Eastern India.

    Science.gov (United States)

    Chatterjee, Tridip; Chakravarty, Amit; Chakravarty, Sudipa

    2018-05-01

    The haematological and clinical response to hydroxyurea was estimated in HbE-beta, beta thalassaemia and sickle cell anaemia patients of Eastern India, with variable clinical severity and transfusion requirement to determine whether hydroxyurea can help these patients to maintain their steady haemoglobin level without blood transfusions. Three hundred patients (189 HbE-beta thalassaemia, 95 beta thalassaemia and 16 other haemoglobinopathies including sickle cell anaemia) were selected for hydroxyurea therapy and were followed up for 48-60 months. Results suggest significant response to hydroxyurea therapy in 19 beta and 99 HbE-beta patients in the transfusion-dependent group (GR-I). All of them became transfusion-independent while on hydroxyurea therapy. The majority of responding patients were IVS1-5(G-C) in one of their alleles in HbE-beta cases (83 out of 119). Though IVS1-5(G-C) was found to be the commonest mutation in our selected patients, the mutational background of the patients does not found to have any significant correlation with the response category towards hydroxyurea as per the results observed in our study. But, the drug works pretty well in most of the transfusion-dependent patients, as these patients were withdrawn from regular blood transfusion. At the same time, partial or no response to the drug hydroxyurea was also recorded in our study.

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

    Science.gov (United States)

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

    2015-01-01

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

  15. Variability of intraductal papillomas of the mammary gland: Clinical, roentgenologic and morphologic investigations

    International Nuclear Information System (INIS)

    Rummel, W.

    1974-01-01

    The radiodiagnostical method of choice is the galactographic technique. However, a specific X-ray image of the papilloma does not exist. The galactographic technique has to be adapted to the surgical and histologic one. Only by combining these three techniques good results can be achieved. It is not possible to draw conclusions from the colour of the pathologic discharge about the type and character of the pathologic process. Contrary to the findings documented in the literature, we were able to diagnose with our technique not only small tumours, but also tumours situated in the periphery of the lactiferous duct. Because of our investigations it is no longer possible to maintain and keep the strict division of the proliferative changes occurring at the lactiferous duct walls. In this study, the most significant morphologic results are described in detail. In all patients with pathologic discharge of the mammary gland, the so-called papillo-carcinoma was found only in one case. As clinical consequence it has therefore to be demanded that in all women with the symptom of pathologic mamillary discharge first of all the origin of this discharge has to be localised by means of galactography. Only the individual morphologic picture of a proliferative change of the lactiferous duct provides some prognostic value. The prerequisites for such an individual assessment are differentiated roentgenologic, surgical and histological techniques. (orig./MG) [de

  16. Experimental Cowpox Virus (CPXV) Infections of Bank Voles: Exceptional Clinical Resistance and Variable Reservoir Competence.

    Science.gov (United States)

    Franke, Annika; Ulrich, Rainer G; Weber, Saskia; Osterrieder, Nikolaus; Keller, Markus; Hoffmann, Donata; Beer, Martin

    2017-12-19

    Cowpox virus (CPXV) is a zoonotic virus and endemic in wild rodent populations in Eurasia. Serological surveys in Europe have reported high prevalence in different vole and mouse species. Here, we report on experimental CPXV infections of bank voles ( Myodes glareolus ) from different evolutionary lineages with a spectrum of CPXV strains. All bank voles, independently of lineage, sex and age, were resistant to clinical signs following CPXV inoculation, and no virus shedding was detected in nasal or buccal swabs. In-contact control animals became only rarely infected. However, depending on the CPXV strain used, inoculated animals seroconverted and viral DNA could be detected preferentially in the upper respiratory tract. The highest antibody titers and virus DNA loads in the lungs were detected after inoculation with two strains from Britain and Finland. We conclude from our experiments that the role of bank voles as an efficient and exclusive CPXV reservoir seems questionable, and that CPXV may be maintained in most regions by other hosts, including other vole species. Further investigations are needed to identify factors that allow and modulate CPXV maintenance in bank voles and other potential reservoirs, which may also influence spill-over infections to accidental hosts.

  17. Genital tuberculosis in postmenopausal women with variable clinical presentations: A report of 3 cases

    Directory of Open Access Journals (Sweden)

    Ashima Arora

    2018-04-01

    Full Text Available Genital tuberculosis is usually diagnosed in young women being assessed for infertility. After menopause it usually presents with symptoms resembling endometrial malignancy, such as postmenopausal bleeding, persistent vaginal discharge and pyometra. The diagnosis is made by detection of acid-fast bacilli on microscopy or bacteriological culture and/or presence of epithelioid granuloma on biopsy. Anti-tubercular therapy involves the use of rifampicin, isoniazid, pyrazinamide and ethambutol. Surgery is indicated if a pelvic mass and recurrence of pain or bleeding persist after 9 months of treatment. Three cases of genital tuberculosis in postmenopausal women with different clinical presentations are reported. The first woman presented with ascites and weight loss. The second had postmenopausal bleeding with a pipelle biopsy suggestive of endometrial intraepithelial neoplasia. The third presented with weight loss and a palpable abdominal mass. Pelvic malignancy was initially suspected but a diagnosis of tuberculosis was made following pre-operative endometrial biopsy, bacteriological culture and intra-operative frozen section. All three women responded to anti-tubercular therapy. Keywords: Genital tuberculosis, Postmenopausal, Endometrial intraepithelial neoplasia, Anti-tubercular therapy, Endometrial biopsy

  18. Clinical and Individual Variables in Children's Dental Fear: A School-Based Investigation.

    Science.gov (United States)

    Silveira, Ethieli Rodrigues da; Goettems, Marília Leão; Demarco, Flávio Fernando; Azevedo, Marina Sousa

    2017-01-01

    This cross-sectional study evaluated the prevalence of dental fear and associated factors in schoolchildren aged 8 to 12 years old, in Pelotas, southern Brazil. Schoolchildren enrolled in 20 public and private schools were selected using a multi-stage sample design. Sociodemographic characteristics, children's dental visit and oral hygiene habits were assessed by questionnaires. The Dental Anxiety Question was used to measure dental fear prevalence. Children's clinical examination evaluated presence of dental caries (DMFT/dmft index) and gingival bleeding. Data were analyzed using Poisson regression with robust variance (prevalence ratio; 95% confidence interval). One thousand two hundred and two children were included. Dental fear prevalence was 24.6%. After the adjustment, girls [PR=1.71 (CI 95%: 1.31-2.22)], children from poorer families [PR=1.96 (CI 95%: 1.36-2.83)], those who had decayed teeth (D/d index>0)[PR=1.32 (CI 95%: 1.01-1.72), and who had never been at the dentist [PR=1.85 (CI 95%: 1.42-2.41) remained significantly associated with dental fear. The prevalence of dental fear indicates that it is a common problem among schoolchildren. Early dental care and dental caries prevention are important factors to prevent dental fear.

  19. Rebuttal to Nelson et al. 'Response to Bodin and Grote regarding postdoctoral recruitment in clinical neuropsychology'.

    Science.gov (United States)

    Bodin, Doug; Grote, Christopher L

    2016-07-01

    Nelson et al. provided a response to our commentary on the postdoctoral match in clinical neuropsychology. In this brief rebuttal, we will focus on statements from Nelson et al. that we believe are factual inaccuracies or misunderstandings of some of the points we made in our commentary. In addition, we will comment briefly on the proposed guidelines offered in their response.

  20. Seronegative and seropositive autoimmune autonomic ganglionopathy (AAG): Same clinical picture, same response to immunotherapy.

    Science.gov (United States)

    Tijero, Beatriz; Del Pino, Rocio; Pérez-Concha, Tomás; Acera, Maria Angeles; Gabilondo, Iñigo; Berganzo, Koldo; Graus, Frances; Martinez-Alday, Jesus Daniel; Barcena, Joseba; Gómez-Esteban, Juan Carlos

    2018-06-15

    Two patients with a syndrome of pandisautonomia with clinical criteria of AAG are provided. Both patients present a similar clinical picture and response to immunosuppressive treatment. One of them has positive antibodies against the ganglionic nicotinic acetylcholine (gAChr) and the other does not. This brief article serves to reflect the spectrum of AAG, at a clinical level, in laboratory tests and in the response to immunotherapy, independently of the presence of positive gAChr antibodies. Copyright © 2018 Elsevier B.V. All rights reserved.

  1. Accounting for inter-annual and seasonal variability in regionalization of hydrologic response in the Great Lakes basin

    Science.gov (United States)

    Kult, J. M.; Fry, L. M.; Gronewold, A. D.

    2012-12-01

    Methods for predicting streamflow in areas with limited or nonexistent measures of hydrologic response typically invoke the concept of regionalization, whereby knowledge pertaining to gauged catchments is transferred to ungauged catchments. In this study, we identify watershed physical characteristics acting as primary drivers of hydrologic response throughout the US portion of the Great Lakes basin. Relationships between watershed physical characteristics and hydrologic response are generated from 166 catchments spanning a variety of climate, soil, land cover, and land form regimes through regression tree analysis, leading to a grouping of watersheds exhibiting similar hydrologic response characteristics. These groupings are then used to predict response in ungauged watersheds in an uncertainty framework. Results from this method are assessed alongside one historical regionalization approach which, while simple, has served as a cornerstone of Great Lakes regional hydrologic research for several decades. Our approach expands upon previous research by considering multiple temporal characterizations of hydrologic response. Due to the substantial inter-annual and seasonal variability in hydrologic response observed over the Great Lakes basin, results from the regression tree analysis differ considerably depending on the level of temporal aggregation used to define the response. Specifically, higher levels of temporal aggregation for the response metric (for example, indices derived from long-term means of climate and streamflow observations) lead to improved watershed groupings with lower within-group variance. However, this perceived improvement in model skill occurs at the cost of understated uncertainty when applying the regression to time series simulations or as a basis for model calibration. In such cases, our results indicate that predictions based on long-term characterizations of hydrologic response can produce misleading conclusions when applied at shorter

  2. Predicting beneficial effects of atomoxetine and citalopram on response inhibition in Parkinson's disease with clinical and neuroimaging measures

    Science.gov (United States)

    Ye, Zheng; Rae, Charlotte L.; Nombela, Cristina; Ham, Timothy; Rittman, Timothy; Jones, Peter Simon; Rodríguez, Patricia Vázquez; Coyle‐Gilchrist, Ian; Regenthal, Ralf; Altena, Ellemarije; Housden, Charlotte R.; Maxwell, Helen; Sahakian, Barbara J.; Barker, Roger A.; Robbins, Trevor W.

    2016-01-01

    Abstract Recent studies indicate that selective noradrenergic (atomoxetine) and serotonergic (citalopram) reuptake inhibitors may improve response inhibition in selected patients with Parkinson's disease, restoring behavioral performance and brain activity. We reassessed the behavioral efficacy of these drugs in a larger cohort and developed predictive models to identify patient responders. We used a double‐blind randomized three‐way crossover design to investigate stopping efficiency in 34 patients with idiopathic Parkinson's disease after 40 mg atomoxetine, 30 mg citalopram, or placebo. Diffusion‐weighted and functional imaging measured microstructural properties and regional brain activations, respectively. We confirmed that Parkinson's disease impairs response inhibition. Overall, drug effects on response inhibition varied substantially across patients at both behavioral and brain activity levels. We therefore built binary classifiers with leave‐one‐out cross‐validation (LOOCV) to predict patients’ responses in terms of improved stopping efficiency. We identified two optimal models: (1) a “clinical” model that predicted the response of an individual patient with 77–79% accuracy for atomoxetine and citalopram, using clinically available information including age, cognitive status, and levodopa equivalent dose, and a simple diffusion‐weighted imaging scan; and (2) a “mechanistic” model that explained the behavioral response with 85% accuracy for each drug, using drug‐induced changes of brain activations in the striatum and presupplementary motor area from functional imaging. These data support growing evidence for the role of noradrenaline and serotonin in inhibitory control. Although noradrenergic and serotonergic drugs have highly variable effects in patients with Parkinson's disease, the individual patient's response to each drug can be predicted using a pattern of clinical and neuroimaging features. Hum Brain Mapp 37:1026–1037

  3. The Correlation between Clinical Variables and Sleep Onset Rapid Eye Movement Period Frequencies in Narcoleptic Patients

    Directory of Open Access Journals (Sweden)

    Jin Hwa Jeong

    2010-11-01

    Full Text Available Background and Objective A diagnosis of narcolepsy is defined by less than 8 minutes of mean sleep latency, and two or more sleep onset rapid eye movement periods on the Multiple Sleep Latency Test. This study examined the relationship between the sleep onset rapid eye movement period frequencies during Multiple Sleep Latency Test and narcoleptic symptom severity. Methods From March 2004 to August 2009, 126 patients suffering from excessive daytime sleepiness who visited the Sleep Disorders Clinic of St. Vincent’s Hospital at the Catholic University of Korea were tested by polysomnography and Multiple Sleep Latency Test. Subjects were divided into three groups according to the number of sleep onset rapid eye movement periods that appeared on the Multiple Sleep Latency Test. Symptom severity instruments included the Epworth Sleepiness Scale and the Stanford Center for Narcolepsy Sleep Inventory, and various sleep parameters. In addition, we performed human leukocyte antigen genotyping for human leukocyte antigen-DQB1*0602 on all patients. Results Among the three groups classified by the number of sleep onset rapid eye movement periods during Multiple Sleep Latency Test, we found no significant differences in demographic features, Epworth Sleepiness Scale, and most polysomnographic findings. However, we observed cataplexy, hypnagogic hallucination, sleep paralysis, and human leukocyte antigen-DQB1*0602 positivity more frequently in groups with higher sleep onset rapid eye movement period frequencies. In addition, the proportions of stage II sleep, REM sleep latency from polysomnography, and mean sleep latency and mean REM sleep latency from the Multiple Sleep Latency Test significantly decreased with increasing sleep onset rapid eye movement period frequency. Conclusions In this study, we demonstrated that sleep onset rapid eye movement period frequency during Multiple Sleep Latency Test correlated with sleep architecture, daytime symptom

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

    Science.gov (United States)

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

    2016-01-01

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

  5. Accuracy, calibration and clinical performance of the EuroSCORE: can we reduce the number of variables?

    Science.gov (United States)

    Ranucci, Marco; Castelvecchio, Serenella; Menicanti, Lorenzo; Frigiola, Alessandro; Pelissero, Gabriele

    2010-03-01

    The European system for cardiac operative risk evaluation (EuroSCORE) is currently used in many institutions and is considered a reference tool in many countries. We hypothesised that too many variables were included in the EuroSCORE using limited patient series. We tested different models using a limited number of variables. A total of 11150 adult patients undergoing cardiac operations at our institution (2001-2007) were retrospectively analysed. The 17 risk factors composing the EuroSCORE were separately analysed and ranked for accuracy of prediction of hospital mortality. Seventeen models were created by progressively including one factor at a time. The models were compared for accuracy with a receiver operating characteristics (ROC) analysis and area under the curve (AUC) evaluation. Calibration was tested with Hosmer-Lemeshow statistics. Clinical performance was assessed by comparing the predicted with the observed mortality rates. The best accuracy (AUC 0.76) was obtained using a model including only age, left ventricular ejection fraction, serum creatinine, emergency operation and non-isolated coronary operation. The EuroSCORE AUC (0.75) was not significantly different. Calibration and clinical performance were better in the five-factor model than in the EuroSCORE. Only in high-risk patients were 12 factors needed to achieve a good performance. Including many factors in multivariable logistic models increases the risk for overfitting, multicollinearity and human error. A five-factor model offers the same level of accuracy but demonstrated better calibration and clinical performance. Models with a limited number of factors may work better than complex models when applied to a limited number of patients. Copyright (c) 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

  6. Evaluation of the Effects of Variable Helmet Weight on Human Response During Lateral +Gy Impact

    National Research Council Canada - National Science Library

    Perry, Chris

    2003-01-01

    .... A series of tests was conducted by AFRL/HEPA on a horizontal impulse accelerator using human subjects to investigate the effects of helmet inertial properties on human response to short duration...

  7. DYNAMIC RESPONSE OF THICK PLATES ON TWO PARAMETER ELASTIC FOUNDATION UNDER TIME VARIABLE LOADING

    OpenAIRE

    Ozgan, Korhan; Daloglu, Ayse T.

    2014-01-01

    In this paper, behavior of foundation plates with transverse shear deformation under time variable loading is presented using modified Vlasov foundation model. Finite element formulation of thick plates on elastic foundation is derived by using an 8-noded finite element based on Mindlin plate theory. Selective reduced integration technique is used to avoid shear locking problem which arises when smaller plate thickness is considered for the evaluation of the stiffness matrices. After comparis...

  8. Comparative response of Rangifer tarandus and other northern ungulates to climatic variability

    Directory of Open Access Journals (Sweden)

    Robert B. Weladji

    2002-06-01

    Full Text Available To understand the factors influencing life history traits and population dynamics, attention is increasingly being given to the importance of environmental stochasticity. In this paper, we review and discuss aspects of current knowledge concerning the effect of climatic variation (local and global on population parameters of northern ungu¬lates, with special emphasis on reindeer/caribou (Rangifer tarandus. We also restrict ourselves to indirect effects of climate through both forage availability and quality, and insect activity. Various authors have used different weather variables; with sometime opposite trends in resulting life history traits of ungulates, and few studies show consistent effects to the same climatic variables. There is thus little consensus about which weather variables play the most sig¬nificant role influencing ungulate population parameters. This may be because the effects of weather on ungulate pop¬ulation dynamics and life history traits are scale dependent and it is difficult to isolate climatic effects from density dependent factors. This confirms the complexity of the relationship between environment and ecosystem. We point out limits of comparability between systems and the difficulty of generalizing about the effect of climate change broadly across northern systems, across species and even within species. Furthermore, insect harassment appears to be a key climate-related factor for the ecology of reindeer/caribou that has been overlooked in the literature of climatic effects on large herbivores. In light of this, there is a need for further studies of long time series in assessing effects of climate variability on reindeer/caribou.

  9. Impact of instrumental response on observed ozonesonde profiles: First-order estimates and implications for measures of variability

    Science.gov (United States)

    Clifton, G. T.; Merrill, J. T.; Johnson, B. J.; Oltmans, S. J.

    2009-12-01

    Ozonesondes provide information on the ozone distribution up to the middle stratosphere. Ozone profiles often feature layers, with vertically discrete maxima and minima in the mixing ratio. Layers are especially common in the UT/LS regions and originate from wave breaking, shearing and other transport processes. ECC sondes, however, have a moderate response time to significant changes in ozone. A sonde can ascend over 350 meters before it responds fully to a step change in ozone. This results in an overestimate of the altitude assigned to layers and an underestimate of the underlying variability in the amount of ozone. An estimate of the response time is made for each instrument during the preparation for flight, but the profile data are typically not processed to account for the response. Here we present a method of categorizing the response time of ECC instruments and an analysis of a low-pass filter approximation to the effects on profile data. Exponential functions were fit to the step-up and step-down responses using laboratory data. The resulting response time estimates were consistent with results from standard procedures, with the up-step response time exceeding the down-step value somewhat. A single-pole Butterworth filter that approximates the instrumental effect was used with synthetic layered profiles to make first-order estimates of the impact of the finite response time. Using a layer analysis program previously applied to observed profiles we find that instrumental effects can attenuate ozone variability by 20-45% in individual layers, but that the vertical offset in layer altitudes is moderate, up to about 150 meters. We will present results obtained using this approach, coupled with data on the distribution of layer characteristics found using the layer analysis procedure on profiles from Narragansett, Rhode Island and other US sites to quantify the impact on overall variability estimates given ambient distributions of layer occurrence, thickness

  10. Relative value of clinical variables, bicycle ergometry, rest radionuclide ventriculography and 24 hour ambulatory electrocardiographic monitoring at discharge to predict 1 year survival after myocardial infarction

    NARCIS (Netherlands)

    P.M. Fioretti (Paolo); R.W. Brower (Ronald); M.L. Simoons (Maarten); H.J. ten Katen (Harald); A. Beelen (Anita); T. Baardman (Taco); J. Lubsen (Jacob); P.G. Hugenholtz (Paul)

    1986-01-01

    textabstractThe relative value of predischarge clinical variables, bicycle ergometry, radionuclide ventriculography and 24 hour ambulatory electrocardiographic monitoring for predicting survival during the first year in 351 hospital survivors of acute myocardial infarction was assessed. Discriminant

  11. Clinical Variability in a Family with an Ectodermal Dysplasia Syndrome and a Nonsense Mutation in the TP63 Gene.

    Science.gov (United States)

    Eisenkraft, Arik; Pode-Shakked, Ben; Goldstein, Nurit; Shpirer, Zvi; van Bokhoven, Hans; Anikster, Yair

    2015-01-01

    Mutations in the TP63 gene have been associated with a variety of ectodermal dysplasia syndromes, among which the clinically overlapping Ankyloblepharon-Ectodermal defects-Cleft lip/palate (AEC) and the Rapp-Hodgkin syndromes. We report a multiplex nonconsanguineous family of Ashkenazi-Jewish descent, in which the index patient presented with a persistent scalp skin lesion, dystrophic nails and light thin hair. Further evaluation revealed over 10 affected individuals in the kindred, over four generations, exhibiting varying degrees of ectodermal involvement. Analysis of the TP63 gene from four of the patients and from two healthy individuals of the same family was performed. Gene sequencing of the patients revealed a nonsense mutation leading to a premature termination codon (PTC) (p.Gln16X). The same mutation was found in all tested affected individuals in the family, but gave rise to marked phenotypic variability with minor clinical manifestations in some individuals, underscoring the clinical heterogeneity associated with the recently described PTC-causing mutations.

  12. Attention-deficit/hyperactivity disorder and phonological working memory: Methodological variability affects clinical and experimental performance metrics.

    Science.gov (United States)

    Tarle, Stephanie J; Alderson, R Matt; Patros, Connor H G; Lea, Sarah E; Hudec, Kristen L; Arrington, Elaine F

    2017-05-01

    Despite promising findings in extant research that suggest impaired working memory (WM) serves as a central neurocognitive deficit or candidate endophenotype of attention-deficit/hyperactivity disorder (ADHD), findings from translational research have been relatively underwhelming. This study aimed to explicate previous equivocal findings by systematically examining the effect of methodological variability on WM performance estimates across experimental and clinical WM measures. Age-matched boys (ages 8-12 years) with (n = 20) and without (n = 20) ADHD completed 1 experimental (phonological) and 2 clinical (digit span, letter-number sequencing) WM measures. The use of partial scoring procedures, administration of greater trial numbers, and high central executive demands yielded moderate-to-large between-groups effect sizes. Moreover, the combination of these best-case procedures, compared to worst-case procedures (i.e., absolute scoring, administration of few trials, use of discontinue rules, and low central executive demands), resulted in a 12.5% increase in correct group classification. Collectively, these findings explain inconsistent ADHD-related WM deficits in previous reports, and highlight the need for revised clinical measures that utilize best-case procedures. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  13. Risk estimates for hip fracture from clinical and densitometric variables and impact of database selection in Lebanese subjects.

    Science.gov (United States)

    Badra, Mohammad; Mehio-Sibai, Abla; Zeki Al-Hazzouri, Adina; Abou Naja, Hala; Baliki, Ghassan; Salamoun, Mariana; Afeiche, Nadim; Baddoura, Omar; Bulos, Suhayl; Haidar, Rachid; Lakkis, Suhayl; Musharrafieh, Ramzi; Nsouli, Afif; Taha, Assaad; Tayim, Ahmad; El-Hajj Fuleihan, Ghada

    2009-01-01

    Bone mineral density (BMD) and fracture incidence vary greatly worldwide. The data, if any, on clinical and densitometric characteristics of patients with hip fractures from the Middle East are scarce. The objective of the study was to define risk estimates from clinical and densitometric variables and the impact of database selection on such estimates. Clinical and densitometric information were obtained in 60 hip fracture patients and 90 controls. Hip fracture subjects were 74 yr (9.4) old, were significantly taller, lighter, and more likely to be taking anxiolytics and sleeping pills than controls. National Health and Nutrition Examination Survey (NHANES) database selection resulted in a higher sensitivity and almost equal specificity in identifying patients with a hip fracture compared with the Lebanese database. The odds ratio (OR) and its confidence interval (CI) for hip fracture per standard deviation (SD) decrease in total hip BMD was 2.1 (1.45-3.05) with the NHANES database, and 2.11 (1.36-2.37) when adjusted for age and body mass index (BMI). Risk estimates were higher in male compared with female subjects. In Lebanese subjects, BMD- and BMI-derived hip fracture risk estimates are comparable to western standards. The study validates the universal use of the NHANES database, and the applicability of BMD- and BMI-derived risk fracture estimates in the World Health Organization (WHO) global fracture risk model, to the Lebanese.

  14. Colony-specific investigations reveal highly variable responses among individual corals to ocean acidification and warming.

    Science.gov (United States)

    Kavousi, Javid; Reimer, James Davis; Tanaka, Yasuaki; Nakamura, Takashi

    2015-08-01

    As anthropogenic climate change is an ongoing concern, scientific investigations on its impacts on coral reefs are increasing. Although impacts of combined ocean acidification (OA) and temperature stress (T) on reef-building scleractinian corals have been studied at the genus, species and population levels, there are little data available on how individual corals respond to combined OA and anomalous temperatures. In this study, we exposed individual colonies of Acropora digitifera, Montipora digitata and Porites cylindrica to four pCO2-temperature treatments including 400 μatm-28 °C, 400 μatm-31 °C, 1000 μatm-28 °C and 1000 μatm-31 °C for 26 days. Physiological parameters including calcification, protein content, maximum photosynthetic efficiency, Symbiodinium density, and chlorophyll content along with Symbiodinium type of each colony were examined. Along with intercolonial responses, responses of individual colonies versus pooled data to the treatments were investigated. The main results were: 1) responses to either OA or T or their combination were different between individual colonies when considering physiological functions; 2) tolerance to either OA or T was not synonymous with tolerance to the other parameter; 3) tolerance to both OA and T did not necessarily lead to tolerance of OA and T combined (OAT) at the same time; 4) OAT had negative, positive or no impacts on physiological functions of coral colonies; and 5) pooled data were not representative of responses of all individual colonies. Indeed, the pooled data obscured actual responses of individual colonies or presented a response that was not observed in any individual. From the results of this study we recommend improving experimental designs of studies investigating physiological responses of corals to climate change by complementing them with colony-specific examinations. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. Hospital in the Home nurses' recognition and response to clinical deterioration.

    Science.gov (United States)

    Gray, Erika; Currey, Judy; Considine, Julie

    2018-05-01

    To obtain an understanding of how Hospital in the Home (HITH) nurses recognise and respond to clinical deterioration in patients receiving care at home or in their usual place of residence. Recognising and responding to clinical deterioration is an international safety priority and a key nursing responsibility. Despite an increase in care delivery in home environments, how HITH nurses recognise and respond to clinical deterioration is not yet fully understood. A prospective, descriptive exploratory design was used. A survey containing questions related to participant characteristics and 10 patient scenarios was used to collect data from 47 nurses employed in the HITH units of three major health services in Melbourne, Australia. The 10 scenarios reflected typical HITH patients and included medical history and clinical assessment findings (respiratory rate, oxygen saturation, heart rate, blood pressure, temperature, conscious state and pain score). The three major findings from this study were that: (i) nurse and patient characteristics influenced HITH nurses' assessment decisions; (ii) the cues used by HITH nurses to recognise clinical deterioration varied according to the clinical context; and (iii) although HITH nurses work in an autonomous role, they engage in collaborative practice when responding to clinical deterioration. Hospital in the Home nurses play a fundamental role in patient assessment, and the context in which they recognise and respond to deterioration is markedly different to that of hospital nurses. The assessment, measurement and interpretation of clinical data are a nursing responsibility that is crucial to early recognition and response to clinical deterioration. The capacity of HITH services to care for increasing numbers of patients in their home environment, and to promptly recognise and respond to clinical deterioration should it occur, is fundamental to safety within the healthcare system. Hospital in the Home nurses are integral to a

  16. Central mechanisms underlying variability in the behavioral and neuroendocrine responses to stress in fish

    DEFF Research Database (Denmark)

    Moltesen, Maria Møller

    of the stress response. In mammals, the hippocampus and amygdala in the telencephalon play central roles in the process of discriminating sensory inputs that, potentially, will threaten the homeostasis of an individual. These regions are part of the limbic system, which interacts with the hypothalamic......-pituitary-adrenal axis (HPA axis). This neuroendocrine stress axis includes corticotropin-releasing factor (CRF), which regulates the release of adrenocorticotropic hormone (ACTH) from the pituitary. A peptide is released to the circulation, inducing release of glucocorticoids from the adrenal cortex....... The neurotransmitter serotonin (5-hydroxytryptamine; 5-HT) also plays an important role in the neuroendocrine stress response by controlling CRF release in hypothalamus. The transmission of 5-HT and CRF are under feedback control of glucocorticoids and interact with the stress response by affecting processes...

  17. Cortisol Stress Response Variability in Early Adolescence Attachment, Affect and Sex

    Science.gov (United States)

    Cameron, Catherine Ann; McKay, Stacey; Susman, Elizabeth J.; Wynne-Edwards, Katherine; Wright, Joan M.; Weinberg, Joanne

    2017-01-01

    Attachment, affect, and sex shape responsivity to psychosocial stress. Concurrent social contexts influence cortisol secretion, a stress hormone and biological marker of hypothalamic–pituitary–adrenal axis activity. Patterns of attachment, emotion status, and sex were hypothesized to relate to bifurcated, that is, accentuated and attenuated, cortisol reactivity. The theoretical framework for this study posits that multiple individual differences mediate a cortisol stress response. The effects of two psychosocial stress interventions, a modified Trier Social Stress Test for Teens and the Frustration Social Stressor for Adolescents were developed and investigated with early adolescents. Both of these protocols induced a significant stress reaction and evoked predicted bifurcation in cortisol responses; an increase or decrease from baseline to reactivity. In Study I, 120 predominantly middle-class, Euro-Canadian early adolescents with a mean age of 13.43 years were studied. The girls' attenuated cortisol reactivity to the public performance stressor related significantly to their self-reported lower maternal-attachment and higher trait-anger. In Study II, a community sample of 146 predominantly Euro-Canadian middle-class youth, with an average age of 14.5 years participated. Their self-reports of higher trait-anger and trait-anxiety, and lower parental attachment by both sexes related differentially to accentuated and attenuated cortisol reactivity to the frustration stressor. Thus, attachment, affect, sex, and the stressor contextual factors were associated with the adrenal-cortical responses of these adolescents through complex interactions. Further studies of individual differences in physiological responses to stress are called for in order to clarify the identities of concurrent protective and risk factors in the psychosocial stress and physiological stress responses of early adolescents. PMID:27468997

  18. Cortisol Stress Response Variability in Early Adolescence: Attachment, Affect and Sex.

    Science.gov (United States)

    Cameron, Catherine Ann; McKay, Stacey; Susman, Elizabeth J; Wynne-Edwards, Katherine; Wright, Joan M; Weinberg, Joanne

    2017-01-01

    Attachment, affect, and sex shape responsivity to psychosocial stress. Concurrent social contexts influence cortisol secretion, a stress hormone and biological marker of hypothalamic-pituitary-adrenal axis activity. Patterns of attachment, emotion status, and sex were hypothesized to relate to bifurcated, that is, accentuated and attenuated, cortisol reactivity. The theoretical framework for this study posits that multiple individual differences mediate a cortisol stress response. The effects of two psychosocial stress interventions, a modified Trier Social Stress Test for Teens and the Frustration Social Stressor for Adolescents were developed and investigated with early adolescents. Both of these protocols induced a significant stress reaction and evoked predicted bifurcation in cortisol responses; an increase or decrease from baseline to reactivity. In Study I, 120 predominantly middle-class, Euro-Canadian early adolescents with a mean age of 13.43 years were studied. The girls' attenuated cortisol reactivity to the public performance stressor related significantly to their self-reported lower maternal-attachment and higher trait-anger. In Study II, a community sample of 146 predominantly Euro-Canadian middle-class youth, with an average age of 14.5 years participated. Their self-reports of higher trait-anger and trait-anxiety, and lower parental attachment by both sexes related differentially to accentuated and attenuated cortisol reactivity to the frustration stressor. Thus, attachment, affect, sex, and the stressor contextual factors were associated with the adrenal-cortical responses of these adolescents through complex interactions. Further studies of individual differences in physiological responses to stress are called for in order to clarify the identities of concurrent protective and risk factors in the psychosocial stress and physiological stress responses of early adolescents.

  19. Grassland Growth in Response to Climate Variability in the Upper Indus Basin, Pakistan

    Directory of Open Access Journals (Sweden)

    Sawaid Abbas

    2015-08-01

    Full Text Available Grasslands in the upper Indus basin provide a resource base for nomadic livestock grazing which is one of the major traditional livelihood practices in the area. The study presents climate patterns, grassland phenology, productivity and spatio-temporal climate controls on grassland growth using satellite data over the upper Indus basin of the Himalayan region, Pakistan. Phenology and productivity metrics of the grasses were estimated using a combination of derivative and threshold methods applied on fitted seasonal vegetation indices data over the period of 2001–2011. Satellite based rainfall and land surface temperature data are considered as representative explanatory variables to climate variability. The results showed distinct phenology and productivity patterns across four bioclimatic regions: (i humid subtropical region (HSR—late start and early end of season with short length of season and low productivity (ii temperate region (TR—early start and late end of season with higher length of season and moderate productivity (iii sub alpine region (SAR—late start and late end of season with very high length of season and the most productive grasses, and (iv alpine region (AR—late start and early end of season with small length of season and least productive grasses. Grassland productivity is constrained by temperature in the alpine region and by rainfall in the humid sub-tropical region. Spring temperature, winter and summer rainfall has shown significant and varied impact on phenology across different altitudes. The productivity is being influenced by summer and annual rainfall in humid subtropical regions, spring temperature in alpine and sub-alpine regions and both temperature and rainfall are contributing in temperate regions. The results revealing a strong relationship between grassland dynamics and climate variability put forth strong signals for drawing more scientific management of rangelands in the area.

  20. Clinical predictors of acute response to transcranial direct current stimulation (tDCS) in major depression.

    Science.gov (United States)

    D'Urso, Giordano; Dell'Osso, Bernardo; Rossi, Rodolfo; Brunoni, Andre Russowsky; Bortolomasi, Marco; Ferrucci, Roberta; Priori, Alberto; de Bartolomeis, Andrea; Altamura, Alfredo Carlo

    2017-09-01

    Transcranial direct current stimulation (tDCS) is a promising neuromodulation intervention for poor-responding or refractory depressed patients. However, little is known about predictors of response to this therapy. The present study aimed to analyze clinical predictors of response to tDCS in depressed patients. Clinical data from 3 independent tDCS trials on 171 depressed patients (including unipolar and bipolar depression), were pooled and analyzed to assess predictors of response. Depression severity and the underlying clinical dimensions were measured using the Hamilton Depression Rating Scale (HDRS) at baseline and after the tDCS treatment. Age, gender and diagnosis (bipolar/unipolar depression) were also investigated as predictors of response. Linear mixed models were fitted in order to ascertain which HDRS factors were associated with response to tDCS. Age, gender and diagnosis did not show any association with response to treatment. The reduction in HDRS scores after tDCS was strongly associated with the baseline values of "Cognitive Disturbances" and "Retardation" factors, whilst the "Anxiety/Somatization" factor showed a mild association with the response. Open-label design, the lack of control group, and minor differences in stimulation protocols. No differences in response to tDCS were found between unipolar and bipolar patients, suggesting that tDCS is effective for both conditions. "Cognitive disturbance", "Retardation", and "Anxiety/Somatization", were identified as potential clinical predictors of response to tDCS. These findings point to the pre-selection of the potential responders to tDCS, therefore optimizing the clinical use of this technique and the overall cost-effectiveness of the psychiatric intervention for depressed patients. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Meta-Analysis of the Effects of Foods and Derived Products Containing Ellagitannins and Anthocyanins on Cardiometabolic Biomarkers: Analysis of Factors Influencing Variability of the Individual Responses

    Science.gov (United States)

    Chambers, Karen; Andrés-Lacueva, Cristina; Konic Ristic, Aleksandra; Hollands, Wendy J.; Kroon, Paul A.; Rodríguez-Mateos, Ana; Istas, Geoffrey; Kontogiorgis, Christos A.; Morand, Christine; Espín, Juan Carlos

    2018-01-01

    Understanding interindividual variability in response to dietary polyphenols remains essential to elucidate their effects on cardiometabolic disease development. A meta-analysis of 128 randomized clinical trials was conducted to investigate the effects of berries and red grapes/wine as sources of anthocyanins and of nuts and pomegranate as sources of ellagitannins on a range of cardiometabolic risk biomarkers. The potential influence of various demographic and lifestyle factors on the variability in the response to these products were explored. Both anthocyanin- and ellagitannin-containing products reduced total-cholesterol with nuts and berries yielding more significant effects than pomegranate and grapes. Blood pressure was significantly reduced by the two main sources of anthocyanins, berries and red grapes/wine, whereas waist circumference, LDL-cholesterol, triglycerides, and glucose were most significantly lowered by the ellagitannin-products, particularly nuts. Additionally, we found an indication of a small increase in HDL-cholesterol most significant with nuts and, in flow-mediated dilation by nuts and berries. Most of these effects were detected in obese/overweight people but we found limited or non-evidence in normoweight individuals or of the influence of sex or smoking status. The effects of other factors, i.e., habitual diet, health status or country where the study was conducted, were inconsistent and require further investigation. PMID:29495642

  2. Meta-Analysis of the Effects of Foods and Derived Products Containing Ellagitannins and Anthocyanins on Cardiometabolic Biomarkers: Analysis of Factors Influencing Variability of the Individual Responses

    Directory of Open Access Journals (Sweden)

    María-Teresa García-Conesa

    2018-02-01

    Full Text Available Understanding interindividual variability in response to dietary polyphenols remains essential to elucidate their effects on cardiometabolic disease development. A meta-analysis of 128 randomized clinical trials was conducted to investigate the effects of berries and red grapes/wine as sources of anthocyanins and of nuts and pomegranate as sources of ellagitannins on a range of cardiometabolic risk biomarkers. The potential influence of various demographic and lifestyle factors on the variability in the response to these products were explored. Both anthocyanin- and ellagitannin-containing products reduced total-cholesterol with nuts and berries yielding more significant effects than pomegranate and grapes. Blood pressure was significantly reduced by the two main sources of anthocyanins, berries and red grapes/wine, whereas waist circumference, LDL-cholesterol, triglycerides, and glucose were most significantly lowered by the ellagitannin-products, particularly nuts. Additionally, we found an indication of a small increase in HDL-cholesterol most significant with nuts and, in flow-mediated dilation by nuts and berries. Most of these effects were detected in obese/overweight people but we found limited or non-evidence in normoweight individuals or of the influence of sex or smoking status. The effects of other factors, i.e., habitual diet, health status or country where the study was conducted, were inconsistent and require further investigation.

  3. Idiotypes as immunogens: facing the challenge of inducing strong therapeutic immune responses against the variable region of immunoglobulins

    International Nuclear Information System (INIS)

    López-Requena, Alejandro; Burrone, Oscar R.; Cesco-Gaspere, Michela

    2012-01-01

    Idiotype (Id)-based immunotherapy has been exploited as cancer treatment option. Conceived as therapy for malignancies bearing idiotypic antigens, it has been also extended to solid tumors because of the capacity of anti-idiotypic antibodies to mimic Id-unrelated antigens. In both these two settings, efforts are being made to overcome the poor immune responsiveness often experienced when using self immunoglobulins as immunogens. Despite bearing a unique gene combination, and thus particular epitopes, it is normally difficult to stimulate the immune response against antibody variable regions. Different strategies are currently used to strengthen Id immunogenicity, such as concomitant use of immune-stimulating molecules, design of Id-containing immunogenic recombinant proteins, specific targeting of relevant immune cells, and genetic immunization. This review focuses on the role of anti-Id vaccination in cancer management and on the current developments used to foster anti-idiotypic B and T cell responses.

  4. Idiotypes as immunogens: facing the challenge of inducing strong therapeutic immune responses against the variable region of immunoglobulins

    Energy Technology Data Exchange (ETDEWEB)

    López-Requena, Alejandro [Molecular Immunology Group, International Centre for Genetic Engineering and Biotechnology, Trieste (Italy); Immunobiology Division, Center of Molecular Immunology, Havana (Cuba); Bioengineering Research Institute, Biotech Pharmaceutical Co., Ltd, Beijing (China); Burrone, Oscar R.; Cesco-Gaspere, Michela, E-mail: cescogaspere@gmail.com [Molecular Immunology Group, International Centre for Genetic Engineering and Biotechnology, Trieste (Italy)

    2012-11-09

    Idiotype (Id)-based immunotherapy has been exploited as cancer treatment option. Conceived as therapy for malignancies bearing idiotypic antigens, it has been also extended to solid tumors because of the capacity of anti-idiotypic antibodies to mimic Id-unrelated antigens. In both these two settings, efforts are being made to overcome the poor immune responsiveness often experienced when using self immunoglobulins as immunogens. Despite bearing a unique gene combination, and thus particular epitopes, it is normally difficult to stimulate the immune response against antibody variable regions. Different strategies are currently used to strengthen Id immunogenicity, such as concomitant use of immune-stimulating molecules, design of Id-containing immunogenic recombinant proteins, specific targeting of relevant immune cells, and genetic immunization. This review focuses on the role of anti-Id vaccination in cancer management and on the current developments used to foster anti-idiotypic B and T cell responses.

  5. Neuronal Intra-Individual Variability Masks Response Selection Differences between ADHD Subtypes—A Need to Change Perspectives

    Directory of Open Access Journals (Sweden)

    Annet Bluschke

    2017-06-01

    Full Text Available Due to the high intra-individual variability in attention deficit/hyperactivity disorder (ADHD, there may be considerable bias in knowledge about altered neurophysiological processes underlying executive dysfunctions in patients with different ADHD subtypes. When aiming to establish dimensional cognitive-neurophysiological constructs representing symptoms of ADHD as suggested by the initiative for Research Domain Criteria, it is crucial to consider such processes independent of variability. We examined patients with the predominantly inattentive subtype (attention deficit disorder, ADD and the combined subtype of ADHD (ADHD-C in a flanker task measuring conflict control. Groups were matched for task performance. Besides using classic event-related potential (ERP techniques and source localization, neurophysiological data was also analyzed using residue iteration decomposition (RIDE to statistically account for intra-individual variability and S-LORETA to estimate the sources of the activations. The analysis of classic ERPs related to conflict monitoring revealed no differences between patients with ADD and ADHD-C. When individual variability was accounted for, clear differences became apparent in the RIDE C-cluster (analog to the P3 ERP-component. While patients with ADD distinguished between compatible and incompatible flanker trials early on, patients with ADHD-C seemed to employ more cognitive resources overall. These differences are reflected in inferior parietal areas. The study demonstrates differences in neuronal mechanisms related to response selection processes between ADD and ADHD-C which, according to source localization, arise from the inferior parietal cortex. Importantly, these differences could only be detected when accounting for intra-individual variability. The results imply that it is very likely that differences in neurophysiological processes between ADHD subtypes are underestimated and have not been recognized because intra