205 research outputs found
Ultrasonic locating devices for central venous cannulation: meta-analysis
OBJECTIVES: To assess the evidence for the clinical
effectiveness of ultrasound guided central venous
cannulation.
DATA SOURCES: 15 electronic bibliographic databases,
covering biomedical, science, social science, health
economics, and grey literature.
DESIGN: Systematic review and meta-analysis of
randomised controlled trials.
POPULATIONS: Patients scheduled for central venous
access.
INTERVENTION REVIEWED: Guidance using real time two
dimensional ultrasonography or Doppler needles and
probes compared with the anatomical landmark
method of cannulation.
DATA EXTRACTION: Risk of failed catheter placement
(primary outcome), risk of complications from
placement, risk of failure on first attempt at
placement, number of attempts to successful
catheterisation, and time (seconds) to successful
catheterisation.
DATA SYNTHESIS: 18 trials (1646 participants) were
identified. Compared with the landmark method, real
time two dimensional ultrasound guidance for
cannulating the internal jugular vein in adults was
associated with a significantly lower failure rate both
overall (relative risk 0.14, 95% confidence interval
0.06 to 0.33) and on the first attempt (0.59, 0.39 to
0.88). Limited evidence favoured two dimensional
ultrasound guidance for subclavian vein and femoral
vein procedures in adults (0.14, 0.04 to 0.57 and 0.29,
0.07 to 1.21, respectively). Three studies in infants
confirmed a higher success rate with two dimensional
ultrasonography for internal jugular procedures (0.15,
0.03 to 0.64). Doppler guided cannulation of the
internal jugular vein in adults was more successful
than the landmark method (0.39, 0.17 to 0.92), but the
landmark method was more successful for subclavian
vein procedures (1.48, 1.03 to 2.14). No significant
difference was found between these techniques for
cannulation of the internal jugular vein in infants. An
indirect comparison of relative risks suggested that
two dimensional ultrasonography would be more
successful than Doppler guidance for subclavian vein
procedures in adults (0.09, 0.02 to 0.38).
CONCLUSIONS: Evidence supports the use of two
dimensional ultrasonography for central venous
cannulation
The equation of state of solid nickel aluminide
The pressure-volume-temperature equation of state of the intermetallic
compound NiAl was calculated theoretically, and compared with experimental
measurements. Electron ground states were calculated for NiAl in the CsCl
structure, using density functional theory, and were used to predict the cold
compression curve and the density of phonon states. The Rose form of
compression curve was found to reproduce the ab initio calculations well in
compression but exhibited significant deviations in expansion. A
thermodynamically-complete equation of state was constructed for NiAl. Shock
waves were induced in crystals of NiAl by the impact of laser-launched Cu
flyers and by launching NiAl flyers into transparent windows of known
properties. The TRIDENT laser was used to accelerate the flyers to speeds
between 100 and 600m/s. Point and line-imaging laser Doppler velocimetry was
used to measure the acceleration of the flyer and the surface velocity history
of the target. The velocity histories were used to deduce the stress state, and
hence states on the principal Hugoniot and the flow stress. Flyers and targets
were recovered from most experiments. The effect of elasticity and plastic flow
in the sample and window was assessed. The ambient isotherm reproduced static
compression data very well, and the predicted Hugoniot was consistent with
shock compression data
Impact of social deprivation, demographics and centre on HbA1c outcomes with continuous subcutaneous insulin infusion
Effectiveness and cost-effectiveness of prognostic markers in prostate cancer
This paper demonstrates how economic modelling can be used to derive estimates of the cost-effectiveness of prognostic markers in the management of clinically localised and moderately graded prostate cancer. The model uses a Markov process and is populated using published evidence and local data. The robustness of the results has been tested using sensitivity analysis. Three treatment policies of 'monitoring' (observation), radical prostatectomy, or a selection-based management policy using DNA-ploidy as an experimental marker, have been evaluated. Modelling indicates that a policy of managing these tumours utilising experimental markers has an estimated cost per quality-adjusted life year (QALY) of pound 12 068. Sensitivity analysis shows the results to be relatively sensitive to quality-of-life variables. If novel and experimental markers can achieve specificity in excess of 80%, then a policy of radical surgery for those identified as being at high risk and conservative treatment for the remainder would be both better for patients and cost-effective. The analysis suggests that a radical prostatectomy treatment policy for the moderately graded tumours (Gleason grades -7) modelled in this paper may be inferior to a conservative approach in the absence of reliable prognostic markers, being both more costly and yielding fewer QALYs
Sitagliptin is effective and safe as add-on to insulin in patients with absolute insulin deficiency: a case series
<p>Abstract</p> <p>Introduction</p> <p>It is generally believed that incretin-based therapies are effective in patients possessing certain levels of preserved β-cell function. So far, there are no reports that show the effectiveness of dipeptidyl peptidase-4 inhibitors in patients who absolutely lack the capacity for endogenous insulin secretion.</p> <p>Case presentation</p> <p>This report describes the efficacy of sitagliptin in three Japanese patients (a 91-year-old Japanese woman with type 1 diabetes, a 54-year-old Japanese man with type 2 diabetes and a 30-year-old Japanese man with features of both type 1 and type 2 diabetes) who had no detectable post-meal C-peptide levels. Although they were receiving intensive insulin therapy together with some oral hypoglycemic agents, their glycemic control remained poor. Sitagliptin was added to the ongoing therapeutic regimen to provide better glycemic control. Although these patients had mild hypoglycemia, effective reductions of hemoglobin A1c levels were observed without any adverse events in the liver and kidney during the following 24 weeks. Two of the patients were able to reduce their insulin doses, and one of the patients could discontinue one of the oral hypoglycemic agents. There was no weight gain or gastrointestinal complaints among the three patients. Post-meal C-peptide levels remained undetectable after sitagliptin treatment.</p> <p>Conclusion</p> <p>This report demonstrates that sitagliptin is effective and safe as an add-on therapy to insulin in reducing blood glucose levels in patients who absolutely lack the capacity for endogenous insulin secretion. The improvement seen in glycemic control could not be due to enhanced endogenous insulin secretion, since post-meal C-peptide levels remained undetectable after sitagliptin treatment, but it could be a result of other factors (for example, suppression of glucagon levels). However, the glucagon-suppressive effect of sitagliptin is known to be rather weak and short-lived. Given this background, a novel hypothesis that the glycemic effects of this drug may be caused by mechanisms that are independent of the glucagon-like peptide 1 axis (extra-pancreatic effect) will be discussed.</p
Location Dependent Dirichlet Processes
Dirichlet processes (DP) are widely applied in Bayesian nonparametric
modeling. However, in their basic form they do not directly integrate
dependency information among data arising from space and time. In this paper,
we propose location dependent Dirichlet processes (LDDP) which incorporate
nonparametric Gaussian processes in the DP modeling framework to model such
dependencies. We develop the LDDP in the context of mixture modeling, and
develop a mean field variational inference algorithm for this mixture model.
The effectiveness of the proposed modeling framework is shown on an image
segmentation task
Unsupervised Bayesian linear unmixing of gene expression microarrays
Background: This paper introduces a new constrained model and the corresponding algorithm, called unsupervised Bayesian linear unmixing (uBLU), to identify biological signatures from high dimensional assays like gene expression microarrays. The basis for uBLU is a Bayesian model for the data samples which are represented as an additive mixture of random positive gene signatures, called factors, with random positive mixing coefficients, called factor scores, that specify the relative contribution of each signature to a specific sample. The particularity of the proposed method is that uBLU constrains the factor loadings to be non-negative and the factor scores to be probability distributions over the factors. Furthermore, it also provides estimates of the number of factors. A Gibbs sampling strategy is adopted here to generate random samples according to the posterior distribution of the factors, factor scores, and number of factors. These samples are then used to estimate all the unknown parameters. Results: Firstly, the proposed uBLU method is applied to several simulated datasets with known ground truth and compared with previous factor decomposition methods, such as principal component analysis (PCA), non negative matrix factorization (NMF), Bayesian factor regression modeling (BFRM), and the gradient-based algorithm for general matrix factorization (GB-GMF). Secondly, we illustrate the application of uBLU on a real time-evolving gene expression dataset from a recent viral challenge study in which individuals have been inoculated with influenza A/H3N2/Wisconsin. We show that the uBLU method significantly outperforms the other methods on the simulated and real data sets considered here. Conclusions: The results obtained on synthetic and real data illustrate the accuracy of the proposed uBLU method when compared to other factor decomposition methods from the literature (PCA, NMF, BFRM, and GB-GMF). The uBLU method identifies an inflammatory component closely associated with clinical symptom scores collected during the study. Using a constrained model allows recovery of all the inflammatory genes in a single factor
Accuracy of the Neuropad Test for the Diagnosis of Distal Symmetric Polyneuropathy in Type 2 Diabetes
Guidance on the Use of Complex Systems Models for Economic Evaluations of Public Health Interventions
To help health economic modelers respond to demands for greater use of complex systems models in public health. To propose identifiable features of such models and support researchers to plan public health modeling projects using these models. A working group of experts in complex systems modeling and economic evaluation was brought together to develop and jointly write guidance for the use of complex systems models for health economic analysis. The content of workshops was informed by a scoping review. A public health complex systems model for economic evaluation is defined as a quantitative, dynamic, non-linear model that incorporates feedback and interactions among model elements, in order to capture emergent outcomes and estimate health, economic and potentially other consequences to inform public policies. The guidance covers: when complex systems modeling is needed; principles for designing a complex systems model; and how to choose an appropriate modeling technique. This paper provides a definition to identify and characterize complex systems models for economic evaluations and proposes guidance on key aspects of the process for health economics analysis. This document will support the development of complex systems models, with impact on public health systems policy and decision making
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Dynamic response of materials on sub-nanosecond time scales, and beryllium properties for inertial confinement fusion
During the past few years, substantial progress has been made in developing experimental techniques capable of investigating the response of materials to dynamic loading on nanosecond time scales and shorter, with multiple diagnostics probing different aspects of the behavior. these relatively short time scales are scientifically interesting because plastic flow and phase changes in common materials with simple crystal structures--such as iron--may be suppressed, allowing unusual states to be induced and the dynamics of plasticity and polymorphism to be explored. Loading by laser ablation can be particularly convenient. The TRIDENT laser has been used to impart shocks and isentropic compression waves from {approx}1 to 200GPa in a range of elements and alloys, with diagnostics including surface velocimetry (line-imaging VISAR), surface displacement (framed area imaging), x-ray diffraction (single crystal and polycrystal), ellipsometry, and Raman spectroscopy. A major motivation has been the study of the properties of beryllium under conditions relevant to the fuel capsule in inertial confinement fusion: magnetically-driven shock and isentropic compression shots at Z were used to investigate the equation of state and shock melting characteristics, complemented by laser ablation experiments to investigate plasticity and heterogeneous response. These results will help to constrain acceptable tolerances on manufacturing, and possible loading paths, for inertial fusion ignition experiments at the National Ignition Facility. Laser-based techniques are being developed further for future material dynamics experiments, where it should be possible to obtain high quality data on strength and phase changes up to at least 1TPa
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