Improving the cost effectiveness equation of cascade testing for Familial Hypercholesterolaemia (FH)

Purpose of Review : Many International recommendations for the management of Familial Hypercholesterolaemia (FH) propose the use of Cascade Testing (CT) using the family mutation to unambiguously identify affected relatives. In the current economic climate DNA information is often regarded as too expensive. Here we review the literature and suggest strategies to improve cost effectiveness of CT. Recent findings : Advances in next generation sequencing have both speeded up the time taken for a genetic diagnosis and reduced costs. Also, it is now clear that, in the majority of patients with a clinical diagnosis of FH where no mutation can be found, the most likely cause of their elevated LDL-cholesterol (LDL-C) is because they have inherited a greater number than average of common LDL-C raising variants in many different genes. The major cost driver for CT is not DNA testing but of treatment over the remaining lifetime of the identified relative. With potent statins now off-patent, the overall cost has reduced considerably, and combining these three factors, a FH service based around DNA-CT is now less than 25% of that estimated by NICE in 2009. Summary : While all patients with a clinical diagnosis of FH need to have their LDL-C lowered, CT should be focused on those with the monogenic form and not the polygenic form

Development of an improved protective cover/light block for multilayer insulation

The feasibility of using a scrim-reinforced, single metallized, 4-mil Tedlar film as a replacement for the Teflon coated Beta-cloth/single metallized 3-mil Kapton film presently used as the protective cover/light block for multilayer insulation (MLI) on the Orbiter, Spacelab, and other space applications was demonstrated. The proposed Tedlar concept is lighter and potentially lower in cost. Thermal analysis with the proper concept was much simpler than with the present system. Tests have already demonstrated that white Tedlar has low alpha (adsorption) degradation in space from U.V. The proposed concept was 4400 percent cheaper with nominal weight savings of 50 percent

Biases in prime factorizations and Liouville functions for arithmetic progressions

We introduce a refinement of the classical Liouville function to primes in arithmetic progressions. Using this, we discover new biases in the appearances of primes in a given arithmetic progression in the prime factorizations of integers. For example, we observe that the primes of the form $4k+1$ tend to appear an even number of times in the prime factorization of a given integer, more so than for primes of the form $4k+3$. We are led to consider variants of P\'olya's conjecture, supported by extensive numerical evidence, and its relation to other conjectures.Comment: 25 pages, 6 figure

The continued value of disk diffusion for assessing antimicrobial susceptibility in clinical laboratories: Report from the Clinical and Laboratory Standards Institute Methods Development and Standardization Working Group

Expedited pathways to antimicrobial agent approval by the U.S. Food and Drug Administration (FDA) have led to increased delays between drug approval and the availability of FDA-cleared antimicrobial susceptibility testing (AST) devices.</jats:p

Is there an integrative center in the vertebrate brain-stem? A robotic evaluation of a model of the reticular formation viewed as an action selection device

Neurobehavioral data from intact, decerebrate, and neonatal rats, suggests that the reticular formation provides a brainstem substrate for action selection in the vertebrate central nervous system. In this article, Kilmer, McCulloch and Blum’s (1969, 1997) landmark reticular formation model is described and re-evaluated, both in simulation and, for the first time, as a mobile robot controller. Particular model configurations are found to provide effective action selection mechanisms in a robot survival task using either simulated or physical robots. The model’s competence is dependent on the organization of afferents from model sensory systems, and a genetic algorithm search identified a class of afferent configurations which have long survival times. The results support our proposal that the reticular formation evolved to provide effective arbitration between innate behaviors and, with the forebrain basal ganglia, may constitute the integrative, ’centrencephalic’ core of vertebrate brain architecture. Additionally, the results demonstrate that the Kilmer et al. model provides an alternative form of robot controller to those usually considered in the adaptive behavior literature

The Essential Stability of Local Error Control for Dynamical Systems

Although most adaptive software for initial value problems is designed with an accuracy requirement—control of the local error—it is frequently observed that stability is imparted by the adaptation. This relationship between local error control and numerical stability is given a firm theoretical underpinning. The dynamics of numerical methods with local error control are studied for three classes of ordinary differential equations: dissipative, contractive, and gradient systems. Dissipative dynamical systems are characterised by having a bounded absorbing set B which all trajectories eventually enter and remain inside. The exponentially contractive problems studied have a unique, globally exponentially attracting equilibrium point and thus they are also dissipative since the absorbing set B may be chosen to be a ball of arbitrarily small radius around the equilibrium point. The gradient systems studied are those for which the set of equilibria comprises isolated points and all trajectories are bounded so that each trajectory converges to an equilibrium point as t → ∞. If the set of equilibria is bounded then the gradient systems are also dissipative. Conditions under which numerical methods with local error control replicate these large-time dynamical features are described. The results are proved without recourse to asymptotic expansions for the truncation error. Standard embedded Runge–Kutta pairs are analysed together with several nonstandard error control strategies. Both error per step and error per unit step strategies are considered. Certain embedded pairs are identified for which the sequence generated can be viewed as coming from a small perturbation of an algebraically stable scheme, with the size of the perturbation proportional to the tolerance τ. Such embedded pairs are defined to be essentially algebraically stable and explicit essentially stable pairs are identified. Conditions on the tolerance τ are identified under which appropriate discrete analogues of the properties of the underlying differential equation may be proved for certain essentially stable embedded pairs. In particular, it is shown that for dissipative problems the discrete dynamical system has an absorbing set B_τ and is hence dissipative. For exponentially contractive problems the radius of B_τ is proved to be proportional to τ. For gradient systems the numerical solution enters and remains in a small ball about one of the equilibria and the radius of the ball is proportional to τ. Thus the local error control mechanisms confer desirable global properties on the numerical solution. It is shown that for error per unit step strategies the conditions on the tolerance τ are independent of initial data while for error per step strategies the conditions are initial-data dependent. Thus error per unit step strategies are considerably more robust