Pilot study on developing a decision support tool for guiding re-administration of chemotherapeutic agent after a serious adverse drug reaction

<p>Abstract</p> <p>Background</p> <p>Currently, there are no standard guidelines for recommending re-administration of a chemotherapeutic drug to a patient after a serious adverse drug reaction (ADR) incident. The decision on whether to rechallenge the patient is based on the experience of the clinician and is highly subjective. Thus the aim of this study is to develop a decision support tool to assist clinicians in this decision making process.</p> <p>Methods</p> <p>The inclusion criteria for patients in this study are: (1) had chemotherapy at National Cancer Centre Singapore between 2004 to 2009, (2) suffered from serious ADRs, and (3) were rechallenged. A total of 46 patients fulfilled the inclusion criteria. A genetic algorithm attribute selection method was used to identify clinical predictors for patients' rechallenge status. A Naïve Bayes model was then developed using 35 patients and externally validated using 11 patients.</p> <p>Results</p> <p>Eight patient attributes (age, chemotherapeutic drug, albumin level, red blood cell level, platelet level, abnormal white blood cell level, abnormal alkaline phosphatase level and abnormal alanine aminotransferase level) were identified as clinical predictors for rechallenge status of patients. The Naïve Bayes model had an AUC of 0.767 and was found to be useful for assisting clinical decision making after clinicians had identified a group of patients for rechallenge. A platform independent version and an online version of the model is available to facilitate independent validation of the model.</p> <p>Conclusion</p> <p>Due to the limited size of the validation set, a more extensive validation of the model is necessary before it can be adopted for routine clinical use. Once validated, the model can be used to assist clinicians in deciding whether to rechallenge patients by determining if their initial assessment of rechallenge status of patients is accurate.</p

Chapter 4 Design Options, Implementation Issues and Evaluating Success of Ecologically Engineered Shorelines

Human population growth and accelerating coastal development have been the drivers for unprecedented construction of artificial structures along shorelines globally. Construction has been recently amplified by societal responses to reduce flood and erosion risks from rising sea levels and more extreme storms resulting from climate change. Such structures, leading to highly modified shorelines, deliver societal benefits, but they also create significant socioeconomic and environmental challenges. The planning, design and deployment of these coastal structures should aim to provide multiple goals through the application of ecoengineering to shoreline development. Such developments should be designed and built with the overarching objective of reducing negative impacts on nature, using hard, soft and hybrid ecological engineering approaches. The design of ecologically sensitive shorelines should be context-dependent and combine engineering, environmental and socioeconomic considerations. The costs and benefits of ecoengineered shoreline design options should be considered across all three of these disciplinary domains when setting objectives, informing plans for their subsequent maintenance and management and ultimately monitoring and evaluating their success. To date, successful ecoengineered shoreline projects have engaged with multiple stakeholders (e.g. architects, engineers, ecologists, coastal/port managers and the general public) during their conception and construction, but few have evaluated engineering, ecological and socioeconomic outcomes in a comprehensive manner. Increasing global awareness of climate change impacts (increased frequency or magnitude of extreme weather events and sea level rise), coupled with future predictions for coastal development (due to population growth leading to urban development and renewal, land reclamation and establishment of renewable energy infrastructure in the sea) will increase the demand for adaptive techniques to protect coastlines. In this review, we present an overview of current ecoengineered shoreline design options, the drivers and constraints that influence implementation and factors to consider when evaluating the success of such ecologically engineered shorelines

Comparison of CATs, CURB-65 and PMEWS as Triage Tools in Pandemic Influenza Admissions to UK Hospitals: Case Control Analysis Using Retrospective Data

Triage tools have an important role in pandemics to identify those most likely to benefit from higher levels of care. We compared Community Assessment Tools (CATs), the CURB-65 score, and the Pandemic Medical Early Warning Score (PMEWS); to predict higher levels of care (high dependency - Level 2 or intensive care - Level 3) and/or death in patients at or shortly after admission to hospital with A/H1N1 2009 pandemic influenza. This was a case-control analysis using retrospectively collected data from the FLU-CIN cohort (1040 adults, 480 children) with PCR-confirmed A/H1N1 2009 influenza. Area under receiver operator curves (AUROC), sensitivity, specificity, positive predictive values and negative predictive values were calculated. CATs best predicted Level 2/3 admissions in both adults [AUROC (95% CI): CATs 0.77 (0.73, 0.80); CURB-65 0.68 (0.64, 0.72); PMEWS 0.68 (0.64, 0.73), p<0.001] and children [AUROC: CATs 0.74 (0.68, 0.80); CURB-65 0.52 (0.46, 0.59); PMEWS 0.69 (0.62, 0.75), p<0.001]. CURB-65 and CATs were similar in predicting death in adults with both performing better than PMEWS; and CATs best predicted death in children. CATs were the best predictor of Level 2/3 care and/or death for both adults and children. CATs are potentially useful triage tools for predicting need for higher levels of care and/or mortality in patients of all ages

Age-Related Alteration of Arginase Activity Impacts on Severity of Leishmaniasis

It is well documented that ageing alters many aspects of immune responses; however, a causal relation between impaired immune functions in ageing individuals and the response to infection has not been established. Experimental leishmaniasis is an excellent model to analyse protective and pathological immune responses. Leishmania parasites are obligate intracellular pathogens and invade mainly macrophages, which have dual function: they can kill the parasites or promote their growth. We have recently shown that arginase, an enzyme induced in infected macrophages, is a key factor for parasite survival. Here, we show that ageing reduces the expression levels of arginase in macrophages, resulting in more efficient control of parasite growth. Our results suggest that age-related differences in the metabolism of arginase in macrophages might contribute to the higher susceptibility of children to leishmaniasis

Large-scale silicon quantum photonics implementing arbitrary two-qubit processing

Photonics is a promising platform for implementing universal quantum information processing. Its main challenges include precise control of massive circuits of linear optical components and effective implementation of entangling operations on photons. By using large-scale silicon photonic circuits to implement an extension of the linear combination of quantum operators scheme, we realize a fully programmable two-qubit quantum processor, enabling universal two-qubit quantum information processing in optics. The quantum processor is fabricated with mature CMOS-compatible processing and comprises more than 200 photonic components. We programmed the device to implement 98 different two-qubit unitary operations ( with an average quantum process fidelity of 93.2 +/- 4.5%), a two-qubit quantum approximate optimization algorithm, and efficient simulation of Szegedy directed quantum walks. This fosters further use of the linear-combination architecture with silicon photonics for future photonic quantum processors

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals &lt;1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Impact of various microalgal-bacterial populations on municipal wastewater bioremediation and its energy feasibility for lipid-based biofuel production

The microalgal-bacterial co-cultivation was adopted as an alternative in making microbial-based biofuel production to be more feasible in considering the economic and environmental prospects. Accordingly, the microalgal-bacterial symbiotic relationship was exploited to enhance the microbial biomass yield, while bioremediating the nitrogen-rich municipal wastewater. An optimized inoculation ratio of microalgae and activated sludge (AS:MA) was predetermined and further optimization was performed in terms of different increment ratios to enhance the bioremediation process. The nitrogen removal was found accelerating with the increase of the increment ratios of inoculated AS:MA, though all the increment ratios had recorded a near complete total nitrogen removal (94–95%). In light of treatment efficiency and lipid production, the increment ratio of 0.5 was hailed as the best microbial population size in accounting the total nitrogen removal efficiency of 94.45%, while not compromising the lipid production of 0.241 g/L. Moreover, the cultures in municipal wastewater had attained higher biomass and lipid productions of 1.42 g/L and 0.242 g/L, respectively, as compared with the synthetic wastewater which were only 1.12 g/L (biomass yield) and 0.175 g/L (lipid yield). This was possibly due to the presence of trace elements which had contributed to the increase of biomass yield; thus, higher lipid attainability from the microalgal-bacterial culture. This synergistic microalgal-bacterial approach had been proven to be effective in treating wastewater, while also producing useful biomass for eventual lipid production with comparable net energy ratio (NER) value of 0.27, obtained from the life-cycle analysis (LCA) studies. Thereby, contributing towards long-term sustainability and possible commercialization of microbial-based biofuel production

Thermally drawn advanced functional fibers : New frontier of flexible electronics

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A sugarcane-bagasse-based adsorbent employed for mitigating eutrophication threats and producing biodiesel simultaneously

Eutrophication is an inevitable phenomenon, and it has recently become an unabated threat. As a positive, the thriving microalgal biomass in eutrophic water is conventionally perceived to be loaded with myriad valuable biochemical compounds. Therefore, a sugarcane-bagasse-based adsorbent was proposed in this study to harvest the microalgal biomass for producing biodiesel. By activating the sugarcane-bagasse-based adsorbent with 1.5 M of H2SO4, a highest adsorption capacity of 108.9 ± 0.3 mg/g was attained. This was fundamentally due to the surface potential of the 1.5 M H2SO4 acid-modified sugarcane-bagasse-based adsorbent possessing the lowest surface positivity value as calculated from its point of zero charge. The adsorption capacity was then improved to 192.9 ± 0.1 mg/g by stepwise optimizing the adsorbent size to 6.7–8.0 mm, adsorption medium pH to 2–4, and adsorbent dosage to 0.4 g per 100 mL of adsorption medium. This resulted in 91.5% microalgae removal efficiency. Excellent-quality biodiesel was also obtained as reflected by the fatty acid methyl ester (FAME) profile, showing the dominant species of C16–C18 encompassing 71% of the overall FAMEs. The sustainability of harvesting microalgal biomass via an adsorption-enhanced flocculation processes was also evidenced by the potentiality to reuse the spent acid-modified adsorbent