Direct-to-Patient Survey for Diagnosis of Benign Paroxysmal Positional Vertigo

Given the high incidence of dizziness and its frequent misdiagnosis, we aim to create a clinical support system to classify the presence or absence of benign paroxysmal positional vertigo with high accuracy and specificity. This paper describes a three-phase study currently underway for classification of benign paroxysmal positional vertigo, which includes diagnosis by a specialist in a clinical setting. Patient background information is collected by a survey on an Android tablet and machine learning techniques are applied for classification. Decision trees and wrappers are employed for their ability to provide information about the question set. One goal of the study is to attain an optimal question set. Each phase of the study presents a unique set and style of questions. Results achieved in the first two phases of the survey indicate that our approach using decision trees with filters or wrappers does a good job of identifying benign paroxysmal positional vertigo

Underemployment: Consequences for the Health and Well-Being of Workers

This paper addresses the question of how the adequacy of a person's employment status influences their health. We draw on and extend the Labor Utilization Framework to distinguish between different forms of underemployment (hours, income, skills, and status) and test their relative effects on a range of physical health and psychological well-being outcomes. Using data drawn from a nationally representative sample ( N =1,429) of adults of working age, we assess the concurrent effects of underemployment through a longitudinal design that controls for prior levels of health and well-being. The results indicate that underemployed workers do report lower levels of health and well-being than adequately employed workers. However, the relationship varies by both types of underemployment and indicator of health and well-being. We conclude by discussing future research to explore the relationship between underemployment and health and well-being.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44065/1/10464_2004_Article_471979.pd

Microscopic-observation drug-susceptibility assay for the diagnosis of TB.

BACKGROUND: New diagnostic tools are urgently needed to interrupt the transmission of tuberculosis and multidrug-resistant tuberculosis. Rapid, sensitive detection of tuberculosis and multidrug-resistant tuberculosis in sputum has been demonstrated in proof-of-principle studies of the microscopic-observation drug-susceptibility (MODS) assay, in which broth cultures are examined microscopically to detect characteristic growth. METHODS: In an operational setting in Peru, we investigated the performance of the MODS assay for culture and drug-susceptibility testing in three target groups: unselected patients with suspected tuberculosis, prescreened patients at high risk for tuberculosis or multidrug-resistant tuberculosis, and unselected hospitalized patients infected with the human immunodeficiency virus. We compared the MODS assay head-to-head with two reference methods: automated mycobacterial culture and culture on Löwenstein-Jensen medium with the proportion method. RESULTS: Of 3760 sputum samples, 401 (10.7%) yielded cultures positive for Mycobacterium tuberculosis. Sensitivity of detection was 97.8% for MODS culture, 89.0% for automated mycobacterial culture, and 84.0% for Löwenstein-Jensen culture (P<0.001); the median time to culture positivity was 7 days, 13 days, and 26 days, respectively (P<0.001), and the median time to the results of susceptibility tests was 7 days, 22 days, and 68 days, respectively. The incremental benefit of a second MODS culture was minimal, particularly in patients at high risk for tuberculosis or multidrug-resistant tuberculosis. Agreement between MODS and the reference standard for susceptibility was 100% for rifampin, 97% for isoniazid, 99% for rifampin and isoniazid (combined results for multidrug resistance), 95% for ethambutol, and 92% for streptomycin (kappa values, 1.0, 0.89, 0.93, 0.71, and 0.72, respectively). CONCLUSIONS: A single MODS culture of a sputum sample offers more rapid and sensitive detection of tuberculosis and multidrug-resistant tuberculosis than the existing gold-standard methods used

Detecting Mutations in the Mycobacterium tuberculosis Pyrazinamidase Gene pncA to Improve Infection Control and Decrease Drug Resistance Rates in Human Immunodeficiency Virus Coinfection.

Hospital infection control measures are crucial to tuberculosis (TB) control strategies within settings caring for human immunodeficiency virus (HIV)-positive patients, as these patients are at heightened risk of developing TB. Pyrazinamide (PZA) is a potent drug that effectively sterilizes persistent Mycobacterium tuberculosis bacilli. However, PZA resistance associated with mutations in the nicotinamidase/pyrazinamidase coding gene, pncA, is increasing. A total of 794 patient isolates obtained from four sites in Lima, Peru, underwent spoligotyping and drug resistance testing. In one of these sites, the HIV unit of Hospital Dos de Mayo (HDM), an isolation ward for HIV/TB coinfected patients opened during the study as an infection control intervention: circulating genotypes and drug resistance pre- and postintervention were compared. All other sites cared for HIV-negative outpatients: genotypes and drug resistance rates from these sites were compared with those from HDM. HDM patients showed high concordance between multidrug resistance, PZA resistance according to the Wayne method, the two most common genotypes (spoligotype international type [SIT] 42 of the Latino American-Mediterranean (LAM)-9 clade and SIT 53 of the T1 clade), and the two most common pncA mutations (G145A and A403C). These associations were absent among community isolates. The infection control intervention was associated with 58-92% reductions in TB caused by SIT 42 or SIT 53 genotypes (odds ratio [OR] = 0.420, P = 0.003); multidrug-resistant TB (OR = 0.349, P < 0.001); and PZA-resistant TB (OR = 0.076, P < 0.001). In conclusion, pncA mutation typing, with resistance testing and spoligotyping, was useful in identifying a nosocomial TB outbreak and demonstrating its resolution after implementation of infection control measures

A framework and computer system for knowledge-level acquisition, representation, and reasoning with process knowledge

The development of knowledge-based systems is usually approached through the combined skills of software and knowledge engineers (SEs and KEs, respectively) and of subject matter experts (SMEs). One of the most critical steps in this task aims at transferring knowledge from SMEs’ expertise to formal, machine-readable representations, which allow systems to reason with such knowledge. However, this process is costly and error prone. Alleviating such knowledge acquisition bottleneck requires enabling SMEs with the means to produce the target knowledge representations, minimizing the intervention of KEs. This is especially difficult in the case of complex knowledge types like processes. The analysis of scientific domains like Biology, Chemistry, and Physics uncovers: (i) that process knowledge is the single most frequent type of knowledge occurring in such domains and (ii) specific solutions need to be devised in order to allow SMEs to represent it in a computational form. We present a framework and computer system for the acquisition and representation of process knowledge in scientific domains by SMEs. We propose methods and techniques to enable SMEs to acquire process knowledge from the domains, to formally represent it, and to reason about it. We have developed an abstract process metamodel and a library of problem solving methods (PSMs), which support these tasks, respectively providing the terminology for SME-tailored process diagrams and an abstract formalization of the strategies needed for reasoning about processes. We have implemented this approach as part of the DarkMatter system and formally evaluated it in the context of the intermediate evaluation of Project Halo, an initiative aiming at the creation of question answering systems by SMEs

Gender-dependent differences in plasma matrix metalloproteinase-8 elevated in pulmonary tuberculosis.

Tuberculosis (TB) remains a global health pandemic and greater understanding of underlying pathogenesis is required to develop novel therapeutic and diagnostic approaches. Matrix metalloproteinases (MMPs) are emerging as key effectors of tissue destruction in TB but have not been comprehensively studied in plasma, nor have gender differences been investigated. We measured the plasma concentrations of MMPs in a carefully characterised, prospectively recruited clinical cohort of 380 individuals. The collagenases, MMP-1 and MMP-8, were elevated in plasma of patients with pulmonary TB relative to healthy controls, and MMP-7 (matrilysin) and MMP-9 (gelatinase B) were also increased. MMP-8 was TB-specific (p<0.001), not being elevated in symptomatic controls (symptoms suspicious of TB but active disease excluded). Plasma MMP-8 concentrations inversely correlated with body mass index. Plasma MMP-8 concentration was 1.51-fold higher in males than females with TB (p<0.05) and this difference was not due to greater disease severity in men. Gender-specific analysis of MMPs demonstrated consistent increase in MMP-1 and -8 in TB, but MMP-8 was a better discriminator for TB in men. Plasma collagenases are elevated in pulmonary TB and differ between men and women. Gender must be considered in investigation of TB immunopathology and development of novel diagnostic markers

Three-dimensional simulations of internal wave breaking and the fate of planets around solar-type stars

We study the fate of internal gravity waves approaching the centre of a non-rotating solar-type star, by performing 3D numerical simulations using a Boussinesq-type model. These waves are excited at the top of the radiation zone by the tidal forcing of a short-period planet on a circular, coplanar orbit. This extends previous work done in 2D by Barker & Ogilvie. We first derive a linear wave solution, which is not exact in 3D; however, the reflection of ingoing waves from the centre is close to perfect for moderate amplitude waves. Waves with sufficient amplitude to cause isentropic overturning break, and deposit their angular momentum near the centre. This forms a critical layer, at which the angular velocity of the flow matches the orbital angular frequency of the planet. This efficiently absorbs ingoing waves, and spins up the star from the inside out, while the planet spirals into the star. We also perform numerical integrations to determine the linearised adiabatic tidal response throughout the star, for solar-type stellar models with masses in the range 0.5 < m_star/M_sun < 1.1, throughout their main sequence lifetimes. The aim is to study the launching region for these waves at the top of the radiation zone in more detail, and to determine the accuracy of a semi-analytic approximation for the tidal torque on the star, that was derived under the assumption that all ingoing wave angular momentum is absorbed in a critical layer. The main conclusions are that this nonlinear mechanism of tidal dissipation could provide an explanation for the survival of all short-period extrasolar planets observed around FGK stars, while it predicts the destruction of more massive planets. This work provides further support for the model outlined in a previous paper by Barker & Ogilvie, and makes predictions that will be tested by ongoing observational studies, such as WASP and Kepler.Comment: 16 pages, 10 figures, accepted for publication in MNRA

Can three-flavor oscillations solve the solar neutrino problem?

The most promising solution to the solar neutrino problem are neutrino oscillations, which usually are analyzed within the reduced 2-flavor scheme, because the solutions found therein reasonably well reproduce the recent data of Super-Kamiokande about the recoil-electron energy spectrum, zenith-angle and seasonal variations, and the event rate data of all the neutrino detectors. In this work, however, a survey of the complete parameter space of 3-flavor oscillations is performed. Basically eight new additional solutions could be identified, where the best one with \Delta m(12)^2=2.7x10^(-10) eV^2, \Delta m(13)^2=1.0x10^(-5) eV^2, \Theta(12)=23, and \Theta(13)=1.3 (denoted SVO) is slightly more probable than any 2-flavor solution. However, including the results of the atmospheric neutrino problem excludes all 3-flavour solutions apart from the SLMA-solution (\Delta m(12)^2=7.9x10^(-6) eV^2, \Delta m(13)^2=2.5x10^(-4) eV^2, \Theta(12)=1.4, and \Theta(13)=20). Besides, the ability of SNO and Borexino to discriminate the various 2- and 3-flavor solutions is investigated. Only with very good statistics in these experiments the correct solution to the solar neutrino problem can be identified unambiguously.Comment: 22 pages, 19 figures, REVTeX, submitted to Phys.Rev.D, article with better resolved figures available under http://www.mpa-garching.mpg.de/~schlattl/public.htm

Docetaxel-Loaded Pluronic P123 Polymeric Micelles: in Vitro and in Vivo Evaluation

In this work, novel docetaxel (DTX) -loaded Tween 80-free Pluronic P123 (P123) micelles with improved therapeutic effect were developed. The freeze-dried DTX-loaded P123 micelles (DTX-micelles) were analyzed by HPLC, TEM and DLS to determine the DTX loading, micelle morphology, size, respectively. The in vitro cytotoxic activity of DTX-micelles in HepG2, A549 and malignant melanoma B16 cells were evaluated by MTT assay. The corresponding in vivo antitumor efficacy was assessed in Kunming mice bearing B16 tumor after intravenous administration. The DTX-loading and efficiency into the micelles were 2.12 ± 0.09% and 86.34 ± 3.32%, respectively. The DTX-micelles were spherical with a mean particle size of 50.7 nm and size distribution from 22 to 84 nm, which suggested that they should be able to selectively accumulate in solid tumors by means of EPR effect, with a zeta potential of −12.45 ± 3.24 mV. The in vitro release behavior of DTX from DTX-micelles followed the Weibull equation. Compared with Duopafei®, DTX-micelles showed higher cytotoxicity against HepG2 (P < 0.01), A549 (P < 0.05) and B16 (P < 0.01) cells. In addition, DTX-micelles exhibited remarkable antitumor activity and reduced toxicity on B16 tumor in vivo. The tumor inhibition rates (TIR) of DTX-micelles was 91.6% versus 76.3% of Duopafei® (P < 0.01). These results suggested that P123 micelles might be considered as an effective DTX delivery system

The Long-Baseline Neutrino Experiment: Exploring Fundamental Symmetries of the Universe

The preponderance of matter over antimatter in the early Universe, the dynamics of the supernova bursts that produced the heavy elements necessary for life and whether protons eventually decay --- these mysteries at the forefront of particle physics and astrophysics are key to understanding the early evolution of our Universe, its current state and its eventual fate. The Long-Baseline Neutrino Experiment (LBNE) represents an extensively developed plan for a world-class experiment dedicated to addressing these questions. LBNE is conceived around three central components: (1) a new, high-intensity neutrino source generated from a megawatt-class proton accelerator at Fermi National Accelerator Laboratory, (2) a near neutrino detector just downstream of the source, and (3) a massive liquid argon time-projection chamber deployed as a far detector deep underground at the Sanford Underground Research Facility. This facility, located at the site of the former Homestake Mine in Lead, South Dakota, is approximately 1,300 km from the neutrino source at Fermilab -- a distance (baseline) that delivers optimal sensitivity to neutrino charge-parity symmetry violation and mass ordering effects. This ambitious yet cost-effective design incorporates scalability and flexibility and can accommodate a variety of upgrades and contributions. With its exceptional combination of experimental configuration, technical capabilities, and potential for transformative discoveries, LBNE promises to be a vital facility for the field of particle physics worldwide, providing physicists from around the globe with opportunities to collaborate in a twenty to thirty year program of exciting science. In this document we provide a comprehensive overview of LBNE's scientific objectives, its place in the landscape of neutrino physics worldwide, the technologies it will incorporate and the capabilities it will possess.Comment: Major update of previous version. This is the reference document for LBNE science program and current status. Chapters 1, 3, and 9 provide a comprehensive overview of LBNE's scientific objectives, its place in the landscape of neutrino physics worldwide, the technologies it will incorporate and the capabilities it will possess. 288 pages, 116 figure