Protocol for electrophysiological monitoring of carotid endarterectomies.

Near zero stroke rates can be achieved in carotid endarterectomy (CEA) surgery with selective shunting and electrophysiological neuromonitoring. though false negative rates as high as 40% have been reported. We sought to determine if improved training for interpretation of the monitoring signals can advance the efficacy of selective shunting with electrophysiological monitoring across multiple centers, and determine if other factors could contribute to the differences in reports. Processed and raw beta band (12.5-30 Hz) electroencephalogram (EEG) and median and tibial nerve somatosensory evoked potentials (SSEP) were monitored in 668 CEA cases at six surgical centers. A decrease in amplitude of 50% or more in any EEG or SSEP channel was the criteria for shunting or initiating a neuroprotective protocol. A reduction of 50% or greater in the beta band of the EEG or amplitude of the SSEP was observed in 150 cases. No patient showed signs of a cerebral infarct after surgery. Selective shunting based on EEG and SSEP monitoring can reduce CEA intraoperative stroke rate to a near zero level if trained personnel adopted standardized protocols. We also found that the rapid administration of a protective stroke protocol by attending anesthesiologists was an important aspect of this success rate

Power Steering Concept

This senior project was created in conjunction with Edwards Lifesciences. This project was created under an non-disclosure agreement and will not be submitted to any outside sources. The submitted title page will act as proof of completion

Estimated effects of climate change on flood vulnerability of U.S. bridges

We assessed the potential impacts of increased river flooding from climate change on bridges in the continental United States. Daily precipitation statistics from four climate models and three greenhouse gas (GHG) emissions scenarios (A2, A1B, and B1) were used to capture a range of potential changes in climate. Using changes in maximum daily precipitation, we estimated changes to the peak flow rates for the 100-year return period for 2,097 watersheds. These estimates were then combined with information from the National Bridge Inventory database to estimate changes to bridge scour vulnerability. The results indicate that there may be significant potential risks to bridges in the United States from increased precipitation intensities. Approximately 129,000 bridges were found to be currently deficient. Tens of thousands to more than 100,000 bridges could be vulnerable to increased river flows. Results by region vary considerably. In general, more bridges in eastern areas are vulnerable than those in western areas. The highest GHG emissions scenarios result in the largest number of bridges being at risk. The costs of adapting vulnerable bridges to avoid increased damage associated with climate change vary from approximately $140 to$250 billion through the 21st century. If these costs were spread out evenly over the century, the annual costs would be several billion dollars. The costs of protecting the bridges against climate change risks could be reduced by approximately 30% if existing deficient bridges are improved with riprap.United States. Environmental Protection Agency. Office of Atmospheric Programs (Contract #EP-W-07-072

Evaluation of the Reliability of Electronic Medical Record Data in Identifying Comorbid Conditions among Patients with Advanced Non-Small Cell Lung Cancer

Background. Traditional methods for identifying comorbidity data in EMRs have relied primarily on costly and time-consuming manual chart review. The purpose of this study was to validate a strategy of electronically searching EMR data to identify comorbidities among cancer patients. Methods. Advanced stage NSCLC patients (N = 2,513) who received chemotherapy from 7/1/2006 to 6/30/2008 were identified using iKnowMed, US Oncology's proprietary oncology-specific EMR system. EMR data were searched for documentation of comorbidities common to advanced stage cancer patients. The search was conducted by a series of programmatic queries on standardized information including concomitant illnesses, patient history, review of systems, and diagnoses other than cancer. The validity of the comorbidity information that we derived from the EMR search was compared to the chart review gold standard in a random sample of 450 patients for whom the EMR search yielded no indication of comorbidities. Negative predictive values were calculated. Results. The overall prevalence of comorbidities of 22%. Overall negative predictive value was 0.92 in the 450 patients randomly sampled patients (36 of 450 were found to have evidence of comorbidities on chart review). Conclusion. Results of this study suggest that efficient queries/text searches of EMR data may provide reliable data on comorbid conditions among cancer patients

The role of algal organic matter in the separation of algae and cyanobacteria using the novel “Posi” - Dissolved air flotation process

Algae and cyanobacteria frequently require separation from liquid media in both water treatment and algae culturing for biotechnology applications. The effectiveness of cell separation using a novel dissolved air flotation process that incorporates positively charged bubbles (PosiDAF) has recently been of interest but has been shown to be dependent on the algae or cyanobacteria species tested. Previously, it was hypothesised that algal organic matter (AOM) could be impacting the separation efficiency. Hence, this study investigates the influence of AOM on cell separation using PosiDAF, in which bubbles are modified using a commercially available cationic polyelectrolyte poly(N, N-diallyl-N,N-dimethylammonium chloride) (PDADMAC). The separation of Chlorella vulgaris CS-42/7, Mychonastes homosphaera CS-556/01 and two strains of Microcystis aeruginosa (CS-564/01 and CS-555/1), all of which have similar cell morphology but different AOM character, was investigated. By testing the cell separation in the presence and absence of AOM, it was determined that AOM enhanced cell separation for all the strains but to different extents depending on the quantity and composition of carbohydrates and proteins in the AOM. By extracting AOM from the strain for which optimal separation was observed and adding it to the others, cell separation improved from 90%. This was attributed to elevated levels of acidic carbohydrates as well as glycoprotein-carbohydrate conjugations, which in turn were related to the nature and quantity of proteins and carbohydrates present in the AOM. Therefore, it was concluded that process optimisation requires an in-depth understanding of the AOM and its components. If culturing algae for biotechnology applications, this indicates that strain selection is not only important with respect to high value product content, but also for cell separation

Neuromuscular, biochemical, endocrine, and mood responses to small-sided games' training in professional soccer

The 24h responses to small-sided games (SSG) soccer training were characterized. Professional soccer players (n=16) performed SSG’s (4vs4 + goalkeepers; 6x7-min, 2-min inter-set recovery) with performance (peak-power output, PPO; jump height, JH), physiological (blood creatine kinase: CK, lactate; salivary testosterone, cortisol), and mood measures collected before (baseline), and after (immediately; 0h, +2h, +24h). For PPO and JH, possibly small-moderate reductions occurred at 0h (-1.1W·kg-1; ±0.9W·kg-1, -3.2cm; ±1.9cm, respectively), before returning to baseline at +2h (trivial) and declining thereafter (small-moderate effect) at +24h (-0.9W·kg-1; ±0.8W·kg-1, -2.5cm; ±1.2cm, respectively). Lactate increased at 0h (likely-large; +1.3mmol·L-1; ±0.5mmol·L-1), reduced at +2h (likely-small; -0.5mmol·L-1; ±0.2mmol·L-1), and returned to baseline at 24h (trivial). A very-likely small increase in CK occurred at 0h (+97u·L-1; ±28u·L-1), persisting for +24h (very-likely small; +94u·L-1; ±49u·L-1). Possibly-small increases in testosterone (+20pg·ml-1; ±29pg·ml-1) occurred at 0h, before likely-moderate declines at +2h (-61pg·ml-1; ±21pg·ml-1) returning to baseline at +24h (trivial). For cortisol, possibly-small decreases occurred at 0h (-0.09ug·dl-1; -±0.16ug·dl-1), before likely-large decreases at +2h (-0.39ug·dl-1; ±0.12ug·dl-1), which persisted for 24h (likely-small; -0.12ug·dl-1; ±0.11ug·dl-1). Mood was disturbed by SSG’s at 0h (likely-moderate; +13.6AU, ±5.6AU) and +2h (likely-small; +7.9AU; ±5.0AU), before returning to baseline at +24h (trivial). The movement demands of SSG’s result in a bimodal recovery pattern of neuromuscular function and perturbations in physiological responses and mood for up to 24h. Accordingly, when programming soccer training, SSG’s should be periodized throughout the competitive week with submaximal technical/tactical activities

Ozone depletion events observed in the high latitude surface layer during the TOPSE aircraft program

During the Tropospheric Ozone Production about the Spring Equinox (TOPSE) aircraft program, ozone depletion events (ODEs) in the high latitude surface layer were investigated using lidar and in situ instruments. Flight legs of 100 km or longer distance were flown 32 times at 30 m altitude over a variety of regions north of 58° between early February and late May 2000. ODEs were found on each flight over the Arctic Ocean but their occurrence was rare at more southern latitudes. However, large area events with depletion to over 2 km altitude in one case were found as far south as Baffin Bay and Hudson Bay and as late as 22 May. There is good evidence that these more southern events did not form in situ but were the result of export of ozone-depleted air from the surface layer of the Arctic Ocean. Surprisingly, relatively intact transport of ODEs occurred over distances of 900–2000 km and in some cases over rough terrain. Accumulation of constituents in the frozen surface over the dark winter period cannot be a strong prerequisite of ozone depletion since latitudes south of the Arctic Ocean would also experience a long dark period. Some process unique to the Arctic Ocean surface or its coastal regions remains unidentified for the release of ozone-depleting halogens. There was no correspondence between coarse surface features such as solid ice/snow, open leads, or polynyas with the occurrence of or intensity of ozone depletion over the Arctic or subarctic regions. Depletion events also occurred in the absence of long-range transport of relatively fresh “pollution” within the high latitude surface layer, at least in spring 2000. Direct measurements of halogen radicals were not made. However, the flights do provide detailed information on the vertical structure of the surface layer and, during the constant 30 m altitude legs, measurements of a variety of constituents including hydroxyl and peroxy radicals. A summary of the behavior of these constituents is made. The measurements were consistent with a source of formaldehyde from the snow/ice surface. Median NOx in the surface layer was 15 pptv or less, suggesting that surface emissions were substantially converted to reservoir constituents by 30 m altitude and that ozone production rates were small (0.15–1.5 ppbv/d) at this altitude. Peroxyacetylnitrate (PAN) was by far the major constituent of NOy in the surface layer independent of the ozone mixing ratio

High expression of HMGA2 independently predicts poor clinical outcomes in acute myeloid leukemia

In acute myeloid leukemia (AML), risk stratification based on cytogenetics and mutation profiling is essential but remains insufficient to select the optimal therapy. Accurate biomarkers are needed to improve prognostic assessment. We analyzed RNA sequencing and survival data of 430 AML patients and identified HMGA2 as a novel prognostic marker. We validated a quantitative PCR test to study the association of HMGA2 expression with clinical outcomes in 358 AML samples. In this training cohort, HMGA2 was highly expressed in 22.3% of AML, mostly in patients with intermediate or adverse cytogenetics. High expression levels of HMGA2 (H + ) were associated with a lower frequency of complete remission (58.8% vs 83.4%, P < 0.001), worse 3-year overall survival (OS, 13.2% vs 43.5%, P < 0.001) and relapse-free survival (RFS, 10.8% vs 44.2%, P < 0.001). A positive HMGA2 test also identified a subgroup of patients unresponsive to standard treatments. Multivariable analyses showed that H + was independently associated with significantly worse OS and RFS, including in the intermediate cytogenetic risk category. These associations were confirmed in a validation cohort of 260 patient samples from the UK NCRI AML17 trial. The HMGA2 test could be implemented in clinical trials developing novel therapeutic strategies for high-risk AML

Evaluation of the Reliability of Electronic Medical Record Data in Identifying Comorbid Conditions among Patients with Advanced Non-Small Cell Lung Cancer

Background. Traditional methods for identifying comorbidity data in EMRs have relied primarily on costly and time-consuming manual chart review. The purpose of this study was to validate a strategy of electronically searching EMR data to identify comorbidities among cancer patients. Methods. Advanced stage NSCLC patients (N = 2, 513) who received chemotherapy from 7/1/2006 to 6/30/2008 were identified using iKnowMed, US Oncology&apos;s proprietary oncology-specific EMR system. EMR data were searched for documentation of comorbidities common to advanced stage cancer patients. The search was conducted by a series of programmatic queries on standardized information including concomitant illnesses, patient history, review of systems, and diagnoses other than cancer. The validity of the comorbidity information that we derived from the EMR search was compared to the chart review gold standard in a random sample of 450 patients for whom the EMR search yielded no indication of comorbidities. Negative predictive values were calculated. Results. The overall prevalence of comorbidities of 22%. Overall negative predictive value was 0.92 in the 450 patients randomly sampled patients (36 of 450 were found to have evidence of comorbidities on chart review). Conclusion. Results of this study suggest that efficient queries/text searches of EMR data may provide reliable data on comorbid conditions among cancer patients