Nonsurgical Treatment Options for Basal Cell Carcinoma

Basal cell carcinoma (BCC) remains the most common form of nonmelanoma skin cancer (NMSC) in Caucasians, with perhaps as many as 2 million new cases expected to occur in the United States in 2010. Many treatment options, including surgical interventions and nonsurgical alternatives, have been utilized to treat BCC. In this paper, two non-surgical options, imiquimod therapy and photodynamic therapy (PDT), will be discussed. Both modalities have demonstrated acceptable disease control rates, cosmetically superior outcomes, and short-term cost-effectiveness. Further studies evaluating long-term cure rates and long-term cost effectiveness of imiquimod therapy and PDT are needed

Characterizing the query behavior in peer-to-peer file sharing systems

This paper characterizes the query behavior of peers in a peer-to-peer (P2P) file sharing system. In contrast to previous work, which provides various aggregate workload statistics, we characterize peer behavior in a form that can be used for constructing representative synthetic workloads for evaluating new P2P system designs. In particular, the analysis exposes heterogeneous behavior that occurs on different days, in different geographical regions (i. e., Asia, Europe, and North America) or during different periods of the day. The workload measures include the fraction of connected sessions that are passive (i. e., issue no queries), the duration of such sessions, and for each active session, the number of queries issued, time until first query, query interarrival time, time after last query, and distribution of query popularity. Moreover, the key correlations in these workload measures are captured in the form of conditional distributions, such that the correlations can be accurately reproduced in a synthetic workload. The characterization is based on trace data gathered in the Gnutella P2P system over a period of 40 days. To characterize system-independent user behavior, we eliminate queries that are specific to the Gnutella system software, such as re-queries that are automatically issued by some client implementations to improve system responsiveness

Improving TCP Performance for Multihop Wireless Networks

In this paper, we present a comprehensive performance evaluation of TCP NewReno and TCP Vegas with and without ACK thinning for static multihop wireless IEEE 802.11 networks. Opposed to previous studies, we consider not only IEEE 802.11 operating in ad hoc mode with 2 Mbit/s bandwidth, but also with 5.5 Mbit/s and 11 Mbit/s bandwidths. Simulation results using ns-2 show that TCP Vegas achieves between 15% and 83% more goodput and between 57% and 99% fewer packet retransmissions than TCP NewReno. Considering fairness among multiple TCP flows, we show that using TCP Vegas results in between 21% and 95% fairness improvement compared to TCP NewReno. The reduced amount of packet retransmissions of TCP Vegas also leads to significant savings of energy consumption. The paper gives insight on the particular reasons for such performance advantages of TCP Vegas in comparison to TCP NewReno

Using Intervention Mapping to Develop an Efficacious Multicomponent Systems-Based Intervention to Increase Human Papillomavirus (HPV) Vaccination in a Large Urban Pediatric Clinic Network

Background: The CDC recommends HPV vaccine for all adolescents to prevent cervical, anal, oropharyngeal, vaginal, vulvar, and penile cancers, and genital warts. HPV vaccine rates currently fall short of national vaccination goals. Despite evidence-based strategies with demonstrated efficacy to increase HPV vaccination rates, adoption and implementation of these strategies within clinics is lacking. The Adolescent Vaccination Program (AVP) is a multicomponent systems-based intervention designed to implement five evidence-based strategies within primary care pediatric practices. The AVP has demonstrated efficacy in increasing HPV vaccine initiation and completion among adolescents 10-17 years of age. The purpose of this paper is to describe the application of Intervention Mapping (IM) toward the development, implementation, and formative evaluation of the clinic-based AVP prototype. Methods: Intervention Mapping (IM) guided the development of the Adolescent Vaccination Program (AVP). Deliverables comprised: a logic model of the problem (IM Step 1); matrices of behavior change objectives (IM Step 2); a program planning document comprising scope, sequence, theory-based methods, and practical strategies (IM Step 3); functional AVP component prototypes (IM Step 4); and plans for implementation (IM Step 5) and evaluation (IM Step 6). Results: The AVP consists of six evidence-based strategies implemented in a successful sequenced roll-out that (1) established immunization champions in each clinic, (2) disseminated provider assessment and feedback reports with data-informed vaccination goals, (3) provided continued medical and nursing education (with ethics credit) on HPV, HPV vaccination, message bundling, and responding to parent hesitancy, (4) electronic health record cues to providers on patient eligibility, and (5) patient reminders for HPV vaccine initiation and completion. Conclusions: IM provided a logical and systematic approach to developing and evaluating a multicomponent systems-based intervention to increase HPV vaccination rates among adolescents in pediatric clinics

Comparison of a reduced carbohydrate and reduced fat diet for LDL, HDL, and VLDL subclasses during 9-months of weight maintenance subsequent to weight loss

Objectives: This study compared LDL, HDL, and VLDL subclasses in overweight or obese adults consuming either a reduced carbohydrate (RC) or reduced fat (RF) weight maintenance diet for 9 months following significant weight loss. Methods: Thirty-five (21 RC; 14 RF) overweight or obese middle-aged adults completed a 1-year weight management clinic. Participants met weekly for the first six months and bi-weekly thereafter. Meetings included instruction for diet, physical activity, and behavior change related to weight management. Additionally, participants followed a liquid very low-energy diet of ~2092 kJ per day for the first three months of the study. Subsequently, participants followed a dietary plan for nine months that targeted a reduced percentage of carbohydrate (~20%) or fat (~30%) intake and an energy intake level calculated to maintain weight loss. Lipid subclasses using NMR spectroscopy were analyzed prior to weight loss and at multiple intervals during weight maintenance. Results: Body weight change was not significantly different within or between groups during weight maintenance (p > 0.05). The RC group showed significant increases in mean LDL size, large LDL, total HDL, large and small HDL, mean VLDL size, and large VLDL during weight maintenance while the RF group showed increases in total HDL, large and small HDL, total VLDL, and large, medium, and small VLDL (p 0.05). Conclusion: Some individual lipid subclasses improved in both dietary groups. Large and medium VLDL subclasses increased to a greater extent across weight maintenance in the RF group

Precision and linearity targets for validation of an IFNγ ELISPOT, cytokine flow cytometry, and tetramer assay using CMV peptides

<p>Abstract</p> <p>Background</p> <p>Single-cell assays of immune function are increasingly used to monitor T cell responses in immunotherapy clinical trials. Standardization and validation of such assays are therefore important to interpretation of the clinical trial data. Here we assess the levels of intra-assay, inter-assay, and inter-operator precision, as well as linearity, of CD8+ T cell IFNγ-based ELISPOT and cytokine flow cytometry (CFC), as well as tetramer assays.</p> <p>Results</p> <p>Precision was measured in cryopreserved PBMC with a low, medium, or high response level to a CMV pp65 peptide or peptide mixture. Intra-assay precision was assessed using 6 replicates per assay; inter-assay precision was assessed by performing 8 assays on different days; and inter-operator precision was assessed using 3 different operators working on the same day. Percent CV values ranged from 4% to 133% depending upon the assay and response level. Linearity was measured by diluting PBMC from a high responder into PBMC from a non-responder, and yielded R²values from 0.85 to 0.99 depending upon the assay and antigen.</p> <p>Conclusion</p> <p>These data provide target values for precision and linearity of single-cell assays for those wishing to validate these assays in their own laboratories. They also allow for comparison of the precision and linearity of ELISPOT, CFC, and tetramer across a range of response levels. There was a trend toward tetramer assays showing the highest precision, followed closely by CFC, and then ELISPOT; while all three assays had similar linearity. These findings are contingent upon the use of optimized protocols for each assay.</p