Recommendations for HER2 testing in the UK

Determining the HER2 status of breast carcinomas is a prerequisite for the use of the monoclonal antibody trastuzumab (Herceptin(R)), which has recently been licensed for the treatment of metastatic disease. This necessitates a test based on archival material. The preferred analyses are immunohistochemistry with fluorescent in situ hybridisation (FISH) as a follow up test for ambiguous results. Guidelines have been developed for standardised, well controlled procedures for the provision of reliable results. A group of three reference laboratories has been established to provide advice, quality assurance, and materials, where needed

An immune response in the bumblebee, Bombus terrestris leads to increased food consumption

BACKGROUND: The concept of a costly immune system that must be traded off against other important physiological systems is fundamental to the burgeoning field of ecological immunity. Bumblebees have become one of the central models in this field. Although previous work has demonstrated costs of immunity in numerous life history traits, estimates of the more direct costs of bumblebee immunity have yet to be made. RESULTS: Here we show a 7.5% increase in energy consumption in response to non-pathogenic immune stimulation. CONCLUSION: This increase in energy consumption along with other results suggests that immunity is one of the most important physiological systems, with other systems being sacrificed for its continuing efficiency. This increased consumption and maintained activity contrasts with the sickness-induced anorexia and reduced activity found in vertebrates

Street railway equipment

Citation: Alexander, Lizzie Bea. Problems of bread making. Senior thesis, Kansas State Agricultural College, 1907.Morse Department of Special CollectionsIntroduction: Alternating current will perhaps in time supplant direct current for traction purposes as it did in lighting, with the advent of the long distance high potential transmission, but as yet the direct current plays a very important part in both power and traction. It has however the disadvantage of being difficult to transmit long distances without great loss. This is due to the inherent limitations in the production of high voltages from the direct current generator. Commutation at voltages sufficiently high to warrant economical transmission over long distances, is extremely difficult. Sparking and other difficulties at once arise which place the voltage within the limitations mentioned. The alternating current generator has not only the advantage of higher voltage, but by means of suitable transformer devices the voltage may be raised to any desired value for economical transmission. It will be readily seen, therefore, that alternating current machinery will supplant the direct current for traction purposes. In this thesis only direct current is treated. Direct current on a small scale and for local distribution fulfills more nearly the requirements demanded for traction purposes such as is needed on railways. The discussions are confined to the electrical equipment of the car only, the mechanical construction being referred to only as needed in line with the electrical connections

Early clinical, radiological and EEG improvement following L-arginine infusion in SMART syndrome

Objectives: To report the clinical, radiological (MRI) and neurophysiological (EEG) changes in a case of SMART (stroke-like migraine attacks after radiation therapy) syndrome following treatment with intravenous L-arginine. Methods: A 60-year-old woman had, ten years prior, been diagnosed with primary CNS diffuse large B cell lymphoma, and was successfully treated with curative chemotherapy and whole brain radiotherapy. She presented acutely with left-sided headache, teichopsia and dysphasia following a chest infection. MRI of the brain showed striking left parieto-occipital gyral swelling, diffusion restriction, leptomeningeal enhancement, and increased cerebral blood volume. Her EEG showed an excess of slow activity diffusely, particularly over the left temporal lobe. A diagnosis of SMART syndrome was made. Intravenous L-arginine (0.5 g/kg) was administered. Results: A few hours post infusion, her migrainous headache subsided and her mentation improved. Her MRI brain performed six days post infusion showed reduced cortical swelling and hyperperfusion, and her EEG showed less temporal slowing. She continued to improve cognitively. Discussion: This is the first report of SMART syndrome with a response to L-arginine, reflected clinically by a measurable improvement in cognition, brain perfusion and EEG parameters, encouraging further clinical studies

Electronic Energy Transfer to the S2 Level of the Acceptor in Functionalised Boron Dipyrromethene Dyes

Taking the high road: Highly efficient electronic energy transfer takes place from a set of appended aryl polycyclic hydrocarbons to an expanded boron dipyrromethene (Bodipy)-based dye (see figure) despite negligible spectral overlap with the lowest-energy excited state localised on the acceptor.A multi-component array has been constructed around an expanded boron dipyrromethene (Bodipy) dye that absorbs and emits in the far-red region. One of the appendages is a perylene-based moiety that is connected to the boron atom of the terminal Bodipy by a 1,4-diethynylphenylene connector. Despite the fact that there is almost negligible spectral overlap between fluorescence from the perylene unit and absorption by the Bodipy residue, electronic energy transfer is rapid and essentially quantitative. It is concluded that at least half of the photons absorbed by perylene are transferred to the upper-lying singlet excited state (S2) associated with the Bodipy-based acceptor. The second appendage is a pyrene unit that is covalently linked to fluorene, through an ethynylene spacer, and to the boron atom of the Bodipy terminus, through a 1,4-diethynylphenylene connector. Pyrene absorbs and emits at higher energy than perylene and there is strong spectral overlap with the Bodipy-based S2 state, and none with the corresponding S1 state. Electronic energy transfer is now very fast and exclusively to the S2 state of the acceptor. It is difficult to compute reasonable estimates for the rates of Coulombic energy transfer, because of uncertainties in the orientation factor, but the principle mechanism is believed to arise from electron exchange. Comparison with an earlier array built around a conventional Bodipy dye indicates that there are comparable electronic coupling matrix elements for the two systems. It is notable that pyrene is more strongly coupled to the Bodipy unit than perylene in both arrays. These new arrays function as highly effective solar concentrators

Reimbursement for Emergency Department Electrocardiography and Radiograph Interpretations: What Is It Worth for the Emergency Physician

Background: Physician reimbursement laws for diagnostic interpretive services require that only those services provided contemporaneously and /or contribute directly to patient care can be billed for. Despite these regulations, cardiologists and radiologists in many hospitals continue to bill for ECG and plain film diagnostic services performed in the emergency department (ED). The reimbursement value of this care, which is disconnected in time and place from the ED patient encounter, is unknown. In a California community ED with a 32,000 annual census, the emergency physicians (EPs) alone, by contract, bill for all ECG readings and plain film interpretations when the radiologists are not available to provide contemporaneous readings.Objectives: To determine the impact of this billing practice on actual EP reimbursement we undertook an analysis that allows calculation of physician reimbursement from billing data.Methods: An IRB-approved analysis of 12 months of billing data cleansed of all patient identifiers was undertaken for 2003. From the data we created a descriptive study with itemized breakdown of reimbursement for radiograph and ECG interpretive services (procedures) and the gross resultant physician income.Results: In 2003 EPs at this hospital treated patients during 32,690 ED visits. Total group income in 2003 for radiographs was $173,555 and$91,025 for ECGs, or $19/EP hour and$6/EP hour respectively. For the average full-time EP, the combined total is $2537/month or$30,444 per annum, per EP. This is $8/ED visit (averaged across all patients).Conclusion: As EP-reimbursement is challenged by rising malpractice premiums, uninsured patients, HMO contracts, unfunded government mandates and state budgetary shortfalls, EPs are seeking to preserve their patient services and resultant income. They should also be reimbursed for those services and the liability that they incur. The reimbursement value of ECGs and plain film interpretations to the practicing EP is substantial. In the ED studied, it represents$30,444 gross income per full-time EP annually. Plain film interpretation services produce three times the hourly revenue of ECG reading at the hospital studied.[WestJEM. 2009;10:178-183.

Neural Level Set Topology Optimization Using Unfitted Finite Elements

To facilitate widespread adoption of automated engineering design techniques, existing methods must become more efficient and generalizable. In the field of topology optimization, this requires the coupling of modern optimization methods with solvers capable of handling arbitrary problems. In this work, a topology optimization method for general multiphysics problems is presented. We leverage a convolutional neural parameterization of a level set for a description of the geometry and use this in an unfitted finite element method that is differentiable with respect to the level set everywhere in the domain. We construct the parameter to objective map in such a way that the gradient can be computed entirely by automatic differentiation at roughly the cost of an objective function evaluation. The method produces optimized topologies that are similar in performance yet exhibit greater regularity than baseline approaches on standard benchmarks whilst having the ability to solve a more general class of problems, e.g., interface-coupled multiphysics.Comment: 16 pages + refs, 10 fig