Some demographic characteristics of an autopsied population

The ways in which a series of autopsied hospital patients may or may not differ from other hospital deaths and from deaths in the general population are necessarily of concern to investigators conducting studies based upon postmortem observations, as well as to those concerned with epidemiological and sociological aspects of hospitalization and autopsy. In an effort to investigate this problem, certain demographic characteristics of a population of adults autopsied during a 4-year period at a large general teaching hospital were examined. This population was compared with its parent population, all deaths that occurred at this hospital, and with the population from which the latter, in turn, was derived, all deaths in the northeastern metropolitan county served by this hospital. The variables analyzed were age, sex, nativity, race, marital status, size of residence, place, religious preference, and cause of death.The composition of the autopsied population indicated that it had been significantly affected by various selective factors. Age exhibited perhaps the most striking effects: as age at death decreased, the likelihood increased that a person who died in this county had been hospitalized and autopsied at the institution under study. This trend was especially marked among females. Subsequent analyses were therefore adjusted to control the effects of age and sex.Certified cause of death also was found to be highly subject to selective factors. In particular, the proportions of all deaths in the county from heart disease that occurred and were autopsied at this hospital were strikingly smaller than those of any other of the causal categories employed.With respect to religion, there was suggestive evidence that deceased hospital patients who had indicated a Jewish preference were considerably less likely to be autopsied than those who had designated a Protestant group. Catholics appeared somewhat less likely to be autopsied than Protestants.Other differences found were that the foreign-born were somewhat more likely to be hospitalized at this institution than the native-born, but less likely to be autopsied. Negroes, the divorced, and residents of other states and of places in the state with less than 10,000 inhabitants were more likely to be hospitalized and autopsied at this hospital than those in other categories of race, marital status, and place of residence.In general, deaths at the hospital differed more from deaths in the general population than the autopsied deaths differed from all deaths at the hospital.These findings indicate a few of the kinds of selection that may be found in the composition of autopsied and hospital death populations. They are interpreted as pointing up the need for giving special attention to the effects of selective factors on populations used in autopsy-based research. More specifically, it is hoped that these analyses may illustrate a practicable means by which the extent of selection in a particular autopsy series may be gauged. Usually it should be possible to examine the distributions of variables that may be relevant to a particular study, to compare these with what is known regarding their distributions in other populations, and to control, by special analyses, the effects of such variables as appear to require this with at least sufficient precision to permit extending tentative inferences beyond the immediate study material. Where a unique contribution can be provided by postmortem observations, their use appears justified in the study of many disease problems with the qualification that appropriate care be given to the exploration and control of potential sources of bias.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/32070/1/0000114.pd

Tarantino the cartoonist

In cinema it is not uncommon to see the interrelation of animation and live action but, despite this, the ascription of characteristics of one medium onto the other has been largely one-dimensional: live action upon animation. The films of Quentin Tarantino, however, illustrate an attribution of a cartoon-like aesthetic in live-action sequences, which the author subsequently terms `cartoonism'. `Cartoonism' and its development have been highlighted in Tarantino's work, showing his continual desire to realize this aesthetic in his own work whilst, ironically, only fully achieving this aesthetic in another's film. The conclusions are illuminating with respect to Tarantino's filmic politics and provide a potential mode of inquiry within film theory

Sustained Immune Tolerance Induction in Enzyme Replacement Therapy-Treated CRIM-Negative Patients with Infantile Pompe Disease

BACKGROUND: Cross-reactive immunological material-negative (CRIM-negative) infantile Pompe disease (IPD) patients develop an immune response against enzyme replacement therapy (ERT) with alglucosidase alfa that nullifies ERT efficacy. Prophylactic immune tolerance induction (ITI) with rituximab, methotrexate, and IVIG successfully prevents development of deleterious rhGAA IgG antibodies; however, safety, likelihood of success, and long-term efficacy of ITI in a larger cohort remain unknown. METHODS: Clinical data were analyzed for 19 CRIM-negative IPD patients who received ITI with rituximab, methotrexate, and IVIG in the ERT-naive setting (ERT+ITI) and compared to a historical cohort of 10 CRIM-negative IPD patients on ERT monotherapy. RESULTS: ITI was safely tolerated, although infections were reported in 4 patients. Fourteen (74%) ERT+ITI patients were alive, with a median age of 44.2 months at their final assessment. The eldest survivor was 103.9 months old, with 100.2 months of follow-up after initiation of ERT+ITI. Death (n = 5) occurred at a median age of 29.2 months and was unrelated to the administration of ITI. Fifteen patients either did not seroconvert (n = 8) or maintained low titers (n = 7; defined as titers of /=51,200 at or beyond 6 months on ERT). Left ventricular mass index (LVMI) decreased from a median of 248.5 g/m2 at baseline to 76.8 g/m2 at a median time from ERT+ITI initiation to 59 weeks. ERT+ITI significantly improved overall survival (P = 0.001), eliminated/reduced antibodies at values o

21nm x-ray laser Thomson scattering of laser-heated exploding foil plasmas

Recent experiments were carried out on the Prague Asterix Laser System (PALS) towards the demonstration of a soft x-ray laser Thomson scattering diagnostic for a laser-produced exploding foil. The Thomson probe utilized the Ne-like zinc x-ray laser which was double-passed to deliver {approx}1 mJ of focused energy at 21.2 nm wavelength and lasting {approx}100 ps. The plasma under study was heated single-sided using a Gaussian 300-ps pulse of 438-nm light (3{omega} of the PALS iodine laser) at laser irradiances of 10{sup 13}-10{sup 14} W cm{sup -2}. Electron densities of 10{sup 20}-10{sup 22} cm{sup -3} and electron temperatures from 200 to 500 eV were probed at 0.5 or 1 ns after the peak of the heating pulse during the foil plasma expansion. A flat-field 1200 line mm{sup -1} variable-spaced grating spectrometer with a cooled charge-coupled device readout viewed the plasma in the forward direction at 30{sup o} with respect to the x-ray laser probe. We show results from plasmas generated from {approx}1 {micro}m thick targets of Al and polypropylene (C{sub 3}H{sub 6}). Numerical simulations of the Thomson scattering cross-sections will be presented. These simulations show electron peaks in addition to a narrow ion feature due to collective (incoherent) Thomson scattering. The electron features are shifted from the frequency of the scattered radiation approximately by the electron plasma frequency {+-}{omega}{sub pe} and scale as n{sub e}{sup 1/2}

Clinical decision modeling system

<p>Abstract</p> <p>Background</p> <p>Decision analysis techniques can be applied in complex situations involving uncertainty and the consideration of multiple objectives. Classical decision modeling techniques require elicitation of too many parameter estimates and their conditional (joint) probabilities, and have not therefore been applied to the problem of identifying high-performance, cost-effective combinations of clinical options for diagnosis or treatments where many of the objectives are unknown or even unspecified.</p> <p>Methods</p> <p>We designed a Java-based software resource, the Clinical Decision Modeling System (CDMS), to implement Naïve Decision Modeling, and provide a use case based on published performance evaluation measures of various strategies for breast and lung cancer detection. Because cost estimates for many of the newer methods are not yet available, we assume equal cost. Our use case reveals numerous potentially high-performance combinations of clinical options for the detection of breast and lung cancer.</p> <p>Results</p> <p>Naïve Decision Modeling is a highly practical applied strategy which guides investigators through the process of establishing evidence-based integrative translational clinical research priorities. CDMS is not designed for clinical decision support. Inputs include performance evaluation measures and costs of various clinical options. The software finds trees with expected emergent performance characteristics and average cost per patient that meet stated filtering criteria. Key to the utility of the software is sophisticated graphical elements, including a tree browser, a receiver-operator characteristic surface plot, and a histogram of expected average cost per patient. The analysis pinpoints the potentially most relevant pairs of clinical options ('critical pairs') for which empirical estimates of conditional dependence may be critical. The assumption of independence can be tested with retrospective studies prior to the initiation of clinical trials designed to estimate clinical impact. High-performance combinations of clinical options may exist for breast and lung cancer detection.</p> <p>Conclusion</p> <p>The software could be found useful in simplifying the objective-driven planning of complex integrative clinical studies without requiring a multi-attribute utility function, and it could lead to efficient integrative translational clinical study designs that move beyond simple pair wise competitive studies. Collaborators, who traditionally might compete to prioritize their own individual clinical options, can use the software as a common framework and guide to work together to produce increased understanding on the benefits of using alternative clinical combinations to affect strategic and cost-effective clinical workflows.</p

Medulloblastoma therapy generates risk of a poorly-prognostic H3 wild-type subgroup of diffuse intrinsic pontine glioma: a report from the International DIPG Registry

Abstract With improved survivorship in medulloblastoma, there has been an increasing incidence of late complications. To date, no studies have specifically addressed the risk of radiation-associated diffuse intrinsic pontine glioma (DIPG) in medulloblastoma survivors. Query of the International DIPG Registry identified six cases of DIPG with a history of medulloblastoma treated with radiotherapy. All patients underwent central radiologic review that confirmed a diagnosis of DIPG. Six additional cases were identified in reports from recent cooperative group medulloblastoma trials (total n = 12; ages 7 to 21 years). From these cases, molecular subgrouping of primary medulloblastomas with available tissue (n = 5) revealed only non-WNT, non-SHH subgroups (group 3 or 4). The estimated cumulative incidence of DIPG after post-treatment medulloblastoma ranged from 0.3–3.9%. Posterior fossa radiation exposure (including brainstem) was greater than 53.0 Gy in all cases with available details. Tumor/germline exome sequencing of three radiation-associated DIPGs revealed an H3 wild-type status and mutational signature distinct from primary DIPG with evidence of radiation-induced DNA damage. Mutations identified in the radiation-associated DIPGs had significant molecular overlap with recurrent drivers of adult glioblastoma (e.g. NRAS, EGFR, and PTEN), as opposed to epigenetic dysregulation in H3-driven primary DIPGs. Patients with radiation-associated DIPG had a significantly worse median overall survival (median 8 months; range 4–17 months) compared to patients with primary DIPG. Here, it is demonstrated that DIPG occurs as a not infrequent complication of radiation therapy in survivors of pediatric medulloblastoma and that radiation-associated DIPGs may present as a poorly-prognostic distinct molecular subgroup of H3 wild-type DIPG. Given the abysmal survival of these cases, these findings provide a compelling argument for efforts to reduce exposure of the brainstem in the treatment of medulloblastoma. Additionally, patients with radiation-associated DIPG may benefit from future therapies targeted to the molecular features of adult glioblastoma rather than primary DIPG.https://deepblue.lib.umich.edu/bitstream/2027.42/145180/1/40478_2018_Article_570.pd

Fish Oil Increases the Duodenal Flow of Long Chain Polyunsaturated Fatty Acids and trans-11 18:1 and Decreases 18:0 in Steers via Changes in the Rumen Bacterial Community

Ruminant fat is rich in SFA, partly due to the biohydrogenation of dietary PUFA to SFA in the rumen. This process can be inhibited by the dietary inclusion of fish oil. The only bacteria isolated from the rumen capable of converting PUFA to SFA are closely related to Clostridium proteoclasticum. The aim of this study was to investigate if a correlation could be found in vivo between dietary fish oil inclusions and the composition of the ruminal bacterial community and specifically of C. proteoclasticum. Six Hereford × Friesian steers, prepared with ruminal and duodenal cannulae, received grass silage plus 1 of 3 concentrates resulting in total dietary fish oil contents of 0, 1, or 3% of dry matter. A dual flow marker technique was employed to estimate the relative flow of fatty acids. Steers fed the 3% fish oil diet had 100% increases in trans 18:1 flow, whereas 18:0 flow declined to 39% of steers fed the control diet. 16S ribosomal RNA-based denaturing gradient gel electrophoresis profiles obtained from ruminal digesta showed major changes in the bacterial community within steers fed the 3% fish oil diet. Quantitative PCR indicated only a weak relation between numbers of C. proteoclasticum and 18:0 flow between treatments and in individual steers (P < 0.05, but the percentage variance accounted for only 22.8) and did not provide unambiguous evidence that numbers of C. proteoclasticum in the rumen dictate the ratios of SFA:PUFA available for absorption by the animal. Understanding which microbes biohydrogenate PUFA in the rumen is key to developing novel strategies to improve the quality of ruminant products

Researching Women's Film History

While 1970s/1980s feminist film theory questioned the representability of women within a male-dominated industry, renewed interest in early film history revealed unexpected numbers of women film makers. The international Women Film Pioneers Project (WFPP), an ever-growing database housed at Columbia University, New York, documents research into the pioneering work of women in cinema's first crucial decades as it became a mass and transnational medium. A surge of monographs has followed, focusing on women's diverse careers, the gendering of film studio organization and practices, and the cultural impacts of female audiences, campaigners, journalists, and critics. These discoveries are emerging in festival and film theater programming, film education, and local cultural activity. In Britain, the Women's Film & Television History Network-UK/Ireland, encourages research across the barriers between silence and sound, cinema and television. In what follows, the Network records key issues and figures emerging from the project of women's film history, across the world

Ecophysiology of syntrophic communities that degrade saturated and unsaturated long-chain fatty acids

Syntrophic relationships are the key for biodegradation in methanogenic environments. We review the ecological and physiological features of syntrophic communities involved in the degradation of saturated and unsaturated long-chain fatty acids (LCFA), as well as their potential application to convert lipids/fats containing waste to biogas. Presently, about 14 species have been described with the ability to grow on fatty acids in syntrophy with methanogens, all belonging to the families Syntrophomonadaceae and Syntrophaceae. The principle pathway of LCFA degradation is through β-oxidation, but the initial steps in the conversion of unsaturated LCFA are unclear. Communities enriched on unsaturated LCFA also degrade saturated LCFA, but the opposite generally is not the case. For efficient methane formation, the physical and inhibitory effects of LCFA on methanogenesis need to be considered. LCFA adsorbs strongly to biomass, which causes encapsulation of active syntrophic communities and hampers diffusion of substrate and products in and out of the biomass. Quantification of archaea by real-time PCR analysis suggests that potential LCFA inhibitory effect towards methanogens might be reversible. Rather, the conversion of adsorbed LCFA in batch assays was shown to result in a significant increase of archaeal cell numbers in anaerobic sludge samples.The authors thank J. Prosser for the invitation to write this minireview. We appreciated the critical reading of I.M. Head and of the anonymous reviewers, and we thank them for their constructive comments and suggestions. This work was possible through the financial support provided by the Portuguese Science Foundation (FCT) and European Social Fund (ESF) (grant SFRH/BD/8726/2002), and by the Wageningen Institute for Environmental and Climate Research (WIMEK)