Use of Colour Duplex Ultrasound as a First Line Surveillance Tool Following EVAR is Associated with a Reduction in Cost Without Compromising Accuracy

CT scanning remains the postoperative surveillance imaging modality of choice following EVAR. Concerns regarding cost, exposure to ionising radiation and intravenous contrast have led to a search for a less expensive, equally efficacious and safer method of monitoring EVAR patients after endograft deployment. This study evaluated the cost saving obtained if CDUS was employed as a first line surveillance tool following EVAR, as well as comparing the two entities in terms of efficacy. Patients & methods: Postoperative surveillance CTs and CDUS scans in the 145 patients who have undergone EVAR from 1st June 2003 to 1st July 2010 were compared for the detection of endoleak and determination of residual sac size. Results: Adopting a protocol where CDUS was employed as the first line surveillance tool following EVAR would result in a reduction in the number of postoperative CTs required in 2010 from 235 to 36. Based on 2010 costings, this would equate to an estimated reduction in expenditure from V117,500 to V34,915 a saving of V82,585. CDUS had a sensitivity of 100% and a specificity of 85% in the detection of endoleaks compared to CT. The positive predictive value was 28% and negative predictive value 100%. The Pearson Coefficient correlation of 0.96 indicates a large degree of correlation between CDUS and CT when measuring residual aneurysm size following EVAR. Conclusion: CDUS can replace CT as the first line surveillance tool following EVAR. This is associated with a significant reduction in the cost of surveillance without any loss of imaging accurac

Use of Colour Duplex Ultrasound as a First Line Surveillance Tool Following EVAR is Associated with a Reduction in Cost Without Compromising Accuracy

CT scanning remains the postoperative surveillance imaging modality of choice following EVAR. Concerns regarding cost, exposure to ionising radiation and intravenous contrast have led to a search for a less expensive, equally efficacious and safer method of monitoring EVAR patients after endograft deployment. This study evaluated the cost saving obtained if CDUS was employed as a first line surveillance tool following EVAR, as well as comparing the two entities in terms of efficacy. Patients & methods: Postoperative surveillance CTs and CDUS scans in the 145 patients who have undergone EVAR from 1st June 2003 to 1st July 2010 were compared for the detection of endoleak and determination of residual sac size. Results: Adopting a protocol where CDUS was employed as the first line surveillance tool following EVAR would result in a reduction in the number of postoperative CTs required in 2010 from 235 to 36. Based on 2010 costings, this would equate to an estimated reduction in expenditure from V117,500 to V34,915 a saving of V82,585. CDUS had a sensitivity of 100% and a specificity of 85% in the detection of endoleaks compared to CT. The positive predictive value was 28% and negative predictive value 100%. The Pearson Coefficient correlation of 0.96 indicates a large degree of correlation between CDUS and CT when measuring residual aneurysm size following EVAR. Conclusion: CDUS can replace CT as the first line surveillance tool following EVAR. This is associated with a significant reduction in the cost of surveillance without any loss of imaging accurac

Epistemic and social scripts in computer-supported collaborative learning

Collaborative learning in computer-supported learning environments typically means that learners work on tasks together, discussing their individual perspectives via text-based media or videoconferencing, and consequently acquire knowledge. Collaborative learning, however, is often sub-optimal with respect to how learners work on the concepts that are supposed to be learned and how learners interact with each other. One possibility to improve collaborative learning environments is to conceptualize epistemic scripts, which specify how learners work on a given task, and social scripts, which structure how learners interact with each other. In this contribution, two studies will be reported that investigated the effects of epistemic and social scripts in a text-based computer-supported learning environment and in a videoconferencing learning environment in order to foster the individual acquisition of knowledge. In each study the factors ‘epistemic script’ and ‘social script’ have been independently varied in a 2×2-factorial design. 182 university students of Educational Science participated in these two studies. Results of both studies show that social scripts can be substantially beneficial with respect to the individual acquisition of knowledge, whereas epistemic scripts apparently do not to lead to the expected effects

QCD Sum Rule Analysis of the Decays B→Kℓ+ℓ−B \to K \ell^+ \ell^- and B→K∗ℓ+ℓ−B \to K^* \ell^+ \ell^-

We use QCD sum rules to calculate the hadronic matrix elements governing the rare decays $B \to K \ell^+ \ell^-$ and $B \to K^* \ell^+ \ell^-$ induced by the flavour changing neutral current $b \to s$ transition. We also study relations among semileptonic and rare $B \to K^{(*)}$ decay form factors. The analysis of the invariant mass distribution of the lepton pair in $B \to K^{(*)} \ell^+ \ell^-$ and of the angular asymmetry in $B \to K^* \ell^+ \ell^-$ provides us with interesting tests of the Standard Model and its extensions.Comment: 26 pages REVTEX + 7 figures. Some typos corrected, figure 5 and 7 modified. This version will appear on Physical Review

Can the Mechanism for π1→ηπ,η′π\pi_1\to \eta\pi,\eta'\pi Hybrid Decays be Detected?

Two mechanisms for the $\pi_1$ ($J^{PC}=1^{-+}$) hybrid meson decay processes $\pi_1\to\eta\pi,\eta'\pi$ are investigated. These mechanisms are applied to $\phi\to\eta\gamma,\eta'\gamma$ and $J/\psi\to\eta\gamma,\eta'\gamma$ decays to illustrate the validity of the decay mechanisms and to obtain independent information on the coupling of $\eta,\eta'$ to quark and gluonic operators. From this information, we find that $\Gamma(\pi_1\to\eta\pi)/\Gamma(\pi_1\to\eta'\pi)$ is substantially different in the two decay mechanisms, and hence future experimental measurements of this ratio will provide valuable information for substantiating the hybrid nature of these states and for determining the mechanism for these hybrid decays.Comment: 5 pages, revtex, 1 eps figure embedded in manuscript. Analysis and references extended in v

Protocol for a feasibility study of a self help cognitive behavioural therapy resource for the reduction of dental anxiety in young people

Background Childhood dental anxiety is very common, with 10–20 % of children and young people reporting high levels of dental anxiety. It is distressing and has a negative impact on the quality of life of young people and their parents as well as being associated with poor oral health. Affected individuals may develop a lifelong reliance on general anaesthetic or sedation for necessary dental treatment thus requiring the support of specialist dental services. Children and young people with dental anxiety therefore require additional clinical time and can be costly to treat in the long term. The reduction of dental anxiety through the use of effective psychological techniques is, therefore, of high importance. However, there is a lack of high-quality research investigating the impact of cognitive behavioural therapy (CBT) approaches when applied to young people’s dental anxiety. Methods/design The first part of the study will develop a profile of dentally anxious young people using a prospective questionnaire sent to a consecutive sample of 100 young people referred to the Paediatric Dentistry Department, Charles Clifford Dental Hospital, in Sheffield. The second part will involve interviewing a purposive sample of 15–20 dental team members on their perceptions of a CBT self-help resource for dental anxiety, their opinions on whether they might use such a resource with patients, and their willingness to recruit participants to a future randomised controlled trial (RCT) to evaluate the resource. The third part of the study will investigate the most appropriate outcome measures to include in a trial, the acceptability of the resource, and retention and completion rates of treatment with a sample of 60 dentally anxious young people using the CBT resource. Discussion This study will provide information on the profile of dentally anxious young people who could potentially be helped by a guided self-help CBT resource. It will gain the perceptions of dental care team members of guided self-help CBT for dental anxiety in young people and their willingness to recruit participants to a trial. Acceptability of the resource to participants and retention and completion rates will also be investigated to inform a future RCT

TNF-induced necroptosis in L929 cells is tightly regulated by multiple TNFR1 complex I and II members

TNF receptor 1 signaling induces NF-κB activation and necroptosis in L929 cells. We previously reported that cellular inhibitor of apoptosis protein-mediated receptor-interacting protein 1 (RIP1) ubiquitination acts as a cytoprotective mechanism, whereas knockdown of cylindromatosis, a RIP1-deubiquitinating enzyme, protects against tumor necrosis factor (TNF)-induced necroptosis. We report here that RIP1 is a crucial mediator of canonical NF-κB activation in L929 cells, therefore questioning the relative cytoprotective contribution of RIP1 ubiquitination versus canonical NF-κB activation. We found that attenuated NF-κB activation has no impact on TNF-induced necroptosis. However, we identified A20 and linear ubiquitin chain assembly complex as negative regulators of necroptosis. Unexpectedly, and in contrast to RIP3, we also found that knockdown of RIP1 did not block TNF cytotoxicity. Cell death typing revealed that RIP1-depleted cells switch from necroptotic to apoptotic death, indicating that RIP1 can also suppress apoptosis in L929 cells. Inversely, we observed that Fas-associated protein via a death domain, cellular FLICE inhibitory protein and caspase-8, which are all involved in the initiation of apoptosis, counteract necroptosis induction. Finally, we also report RIP1-independent but RIP3-mediated necroptosis in the context of TNF signaling in particular conditions

Impact of glucocorticoid receptor density on ligand-independent dimerization, cooperative ligand-binding and basal priming of transactivation: a cell culture model

Glucocorticoid receptor (GR) levels vary between tissues and individuals and are altered by physiological and pharmacological effectors. However, the effects and implications of differences in GR concentration have not been fully elucidated. Using three statistically different GR concentrations in transiently transfected COS-1 cells, we demonstrate, using co-immunoprecipitation (CoIP) and fluorescent resonance energy transfer (FRET), that high levels of wild type GR (wtGR), but not of dimerization deficient GR (GRdim), display ligand-independent dimerization. Whole-cell saturation ligand-binding experiments furthermore establish that positive cooperative ligand-binding, with a concomitant increased ligand-binding affinity, is facilitated by ligand-independent dimerization at high concentrations of wtGR, but not GRdim. The down-stream consequences of ligand-independent dimerization at high concentrations of wtGR, but not GRdim, are shown to include basal priming of the system as witnessed by ligand-independent transactivation of both a GRE-containing promoter-reporter and the endogenous glucocorticoid (GC)-responsive gene, GILZ, as well as ligand-independent loading of GR onto the GILZ promoter. Pursuant to the basal priming of the system, addition of ligand results in a significantly greater modulation of transactivation potency than would be expected solely from the increase in ligand-binding affinity. Thus ligand-independent dimerization of the GR at high concentrations primes the system, through ligand-independent DNA loading and transactivation, which together with positive cooperative ligand-binding increases the potency of GR agonists and shifts the bio-character of partial GR agonists. Clearly GR-levels are a major factor in determining the sensitivity to GCs and a critical factor regulating transcriptional programs