Need I Prove More: Why an Adverse Employment Action Prong Has No Place in a Failure to Accomodate Disability Claim

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Perfluorocarbon Enhanced Glasgow Oxygen Level Dependent (GOLD) magnetic resonance metabolic imaging identifies the penumbra following acute ischemic stroke

The ability to identify metabolically active and potentially salvageable ischaemic penumbra is crucial for improving treatment decisions in acute stroke patients. Our solution involves two complementary novel MRI techniques (Glasgow Oxygen Level Dependant (GOLD) Metabolic Imaging), which when combined with a perfluorocarbon (PFC) based oxygen carrier and hyperoxia can identify penumbra due to dynamic changes related to continued metabolism within this tissue compartment. Our aims were (i) to investigate whether PFC offers similar enhancement of the second technique (Lactate Change) as previously demonstrated for the T2*OC technique (ii) to demonstrate both GOLD metabolic imaging techniques working concurrently to identify penumbra, following administration of Oxycyte® (O-PFC) with hyperoxia. Methods: An established rat stroke model was utilised. Part-1: Following either saline or PFC, magnetic resonance spectroscopy was applied to investigate the effect of hyperoxia on lactate change in presumed penumbra. Part-2; rats received O-PFC prior to T2*OC (technique 1) and MR spectroscopic imaging, which was used to identify regions of tissue lactate change (technique 2) in response to hyperoxia. In order to validate the techniques, imaging was followed by [14C]2-deoxyglucose autoradiography to correlate tissue metabolic status to areas identified as penumbra. Results: Part-1: PFC+hyperoxia resulted in an enhanced reduction of lactate in the penumbra when compared to saline+hyperoxia. Part-2: Regions of brain tissue identified as potential penumbra by both GOLD metabolic imaging techniques utilising O-PFC, demonstrated maintained glucose metabolism as compared to adjacent core tissue. Conclusion: For the first time in vivo, enhancement of both GOLD metabolic imaging techniques has been demonstrated following intravenous O-PFC+hyperoxia to identify ischaemic penumbra. We have also presented preliminary evidence of the potential therapeutic benefit offered by O-PFC. These unique theranostic applications would enable treatment based on metabolic status of the brain tissue, independent of time from stroke onset, leading to increased uptake and safer use of currently available treatment options

Contributions for innovative institutional research quality assessment practices and processes

The urge for the achievement of excellence patterns in research has led higher education institutions to become more and more aware of their role in the process by putting their strategic emphasis on the development of assessment tools towards the monitoring and evaluation of research quality. We intend to review the lessons learned from current research assessment experiences and collect good practices and recommendations using semi-directed interviews with evaluation panel members, institutions’ representatives and researchers involved in the last UK’s Research Assessment Exercise. Our major aim is to present and discuss a set of guidelines as a first input for the design of an evaluation framework to evaluate and monitor the quality of research at an institutional level. We seek to add significantly to our understanding of what can be actually done using strategic planning to look forward in the areas of research engagement/resources and institutional culture, productivity/ performance and innovation, quality/merit and impact and sustainability/ support. Overall, the challenges of promoting research are discussed and strategies for its enhancement are included

Can the United States Afford a “No-Fault” System of Compensation for Medical Injury?

One of the key issues separating US critics of a no-fault alternative to the tort system for compensating victims of medical injury from supporters is its anticipated cost. Results from a study are presented that estimate the costs of a no-fault system, one that is similar to the system now in operation in Sweden, within the context of the US health care system

PBStoHTCondor system for campus grids

The campus grid architectures currently available are considered to be overly complex. We have focused on High Throughput Condor HTCondor as one of the most popular middlewares among UK universities, and are proposing a new system for unifying campus grid resources. This new system PBStoCondor is capable of interfacing with Linux based system within the campus grids, and automatically determining the best resource for a given job. The system does not require additional efforts from users and administrators of the campus grid resources. We have compared the real usage data and PBStoCondor system simulation data. The results show a close match. The proposed system will enable better utilization of campus grid resources, and will not require modification in users' workflows

The Future of Clinical Trials of Myopia Control

In the field of myopia control, effective optical or pharmaceutical therapies are now available to patients in many markets. This creates challenges for the conduct of placebo-controlled, randomised clinical trials, including ethics, recruitment, retention, selective loss of faster progressors and non-protocol treatments: 1. Ethics: It is valid to question whether withholding treatment in control subjects is ethical. 2. Recruitment: Availability of treatments is making recruitment into clinical trials more difficult. 3. Retention: If masking is not possible, parents may immediately withdraw their child if randomised to no treatment. 4. Selective loss: Withdrawal of fast progressors in the control group leading to a control group biased towards low progression. 5. Non-protocol treatment: Parents may access other myopia treatments in addition to those within the trial. We propose that future trials may adopt one of the following designs: A Non-inferiority trials using an approved drug or device as the control. The choice will depend on whether a regulatory agency has approved the drug or device. B Short conventional efficacy trials where data are subsequently entered into a model created from previous clinical trials, which allows robust prediction of long-term treatment efficacy from the initial efficacy. C Virtual control group trials based on data relating to axial elongation, myopia progression or both, accounting for subject\u27s age and race. D Short-term control data from a cohort, for example, 1 year or less, and applying an appropriate, proportional annual reduction in axial elongation to that population and extrapolating to subsequent years. E Time-to- treatment- failure trials using survival analysis; once a treated or control subject progresses or elongates by a given amount, they exit the study and can be offered treatment. In summary, the future development of new treatments in myopia control will be hampered if significant changes are not made to the design of clinical trials in this area

Hyperglycemia and Death in Cystic Fibrosis–Related Diabetes

OBJECTIVE Diabetes is common in cystic fibrosis and increases the risk of death, yet the role of hyperglycemia remains unproven. An association between glycemia and mortality would provide compelling evidence to support glucose lowering in cystic fibrosis–related diabetes (CFRD). RESEARCH DESIGN AND METHODS Using the U.K. Cystic Fibrosis Registry, we analyzed longitudinal data from 2006 to 2009 in 520 individuals with diabetes. We tested the association between HbA1c and mortality. RESULTS During a median follow-up of 2 years, 36 patients died. The median value of HbA1c was higher in those who died (7.3%) than in those who did not (6.7%). An HbA1c value of ≥6.5% was associated with a threefold increased risk of death (hazard ratio 3.2 [95% CI 1.4–7.3]; P = 0.005) independent of potential confounders. CONCLUSIONS Hyperglycemia trebles the risk of death in patients with CFRD. These findings provide epidemiologic support for continued efforts to improve glycemic control. Diabetes frequently complicates cystic fibrosis. Cystic fibrosis–related diabetes (CFRD) has an incidence in teenagers of up to 6% per year and a prevalence in adults of >30% (1,2). Diabetes further elevates the already high mortality rates in cystic fibrosis (3–5). In individuals without cystic fibrosis, diabetes increases the risk of death, and in individuals with diabetes, hyperglycemia increases the risk of death (6,7). However, no study of CFRD using national data has investigated whether hyperglycemia, per se, increases the risk of death; likewise, no trial has tested whether controlling blood glucose prolongs survival. Proving an association between glycemia and mortality in cystic fibrosis would provide compelling observational evidence to inform clinical practice. Using the U.K. Cystic Fibrosis Registry, we performed longitudinal analyses to test the association between glycemia, as measured by HbA1c, and mortality in individuals with CFRD

Projection of Stabilized Aerial Imagery Onto Digital Elevation Maps for Geo-Rectified and Jitter-Free Viewing

As imagery is collected from an airborne platform, an individual viewing the images wants to know from where on the Earth the images were collected. To do this, some information about the camera needs to be known, such as its position and orientation relative to the Earth. This can be provided by common inertial navigation systems (INS). Once the location of the camera is known, it is useful to project an image onto some representation of the Earth. Due to the non-smooth terrain of the Earth (mountains, valleys, etc.), this projection is highly non-linear. Thus, to ensure accurate projection, one needs to project onto a digital elevation map (DEM). This allows one to view the images overlaid onto a representation of the Earth. A code has been developed that takes an image, a model of the camera used to acquire that image, the pose of the camera during acquisition (as provided by an INS), and a DEM, and outputs an image that has been geo-rectified. The world coordinate of the bounds of the image are provided for viewing purposes. The code finds a mapping from points on the ground (DEM) to pixels in the image. By performing this process for all points on the ground, one can "paint" the ground with the image, effectively performing a projection of the image onto the ground. In order to make this process efficient, a method was developed for finding a region of interest (ROI) on the ground to where the image will project. This code is useful in any scenario involving an aerial imaging platform that moves and rotates over time. Many other applications are possible in processing aerial and satellite imagery