Systematic review and meta-analysis of the growth and rupture rates of small abdominal aortic aneurysms: implications for surveillance intervals and their cost-effectiveness.

BACKGROUND: Small abdominal aortic aneurysms (AAAs; 3.0-5.4 cm in diameter) are usually asymptomatic and managed by regular ultrasound surveillance until they grow to a diameter threshold (commonly 5.5 cm) at which surgical intervention is considered. The choice of appropriate surveillance intervals is governed by the growth and rupture rates of small AAAs, as well as their relative cost-effectiveness. OBJECTIVES: The aim of this series of studies was to inform the evidence base for small AAA surveillance strategies. This was achieved by literature review, collation and analysis of individual patient data, a focus group and health economic modelling. DATA SOURCES: We undertook systematic literature reviews of growth rates and rupture rates of small AAAs. The databases MEDLINE, EMBASE on OvidSP, Cochrane Central Register of Controlled Trials 2009 Issue 4, ClinicalTrials.gov, and controlled-trials.com were searched from inception up until the end of 2009. We also obtained individual data on 15,475 patients from 18 surveillance studies. REVIEW METHODS: Systematic reviews of publications identified 15 studies providing small AAA growth rates, and 14 studies with small AAA rupture rates, up to December 2009 (later updated to September 2012). We developed statistical methods to analyse individual surveillance data, including the effects of patient characteristics, to inform the choice of surveillance intervals and provide inputs for health economic modelling. We updated an existing health economic model of AAA screening to address the cost-effectiveness of different surveillance intervals. RESULTS: In the literature reviews, the mean growth rate was 2.3 mm/year and the reported rupture rates varied between 0 and 1.6 ruptures per 100 person-years. Growth rates increased markedly with aneurysm diameter, but insufficient detail was available to guide surveillance intervals. Based on individual surveillance data, for each 0.5-cm increase in AAA diameter, growth rates increased by about 0.5 mm/year and rupture rates doubled. To control the risk of exceeding 5.5 cm to below 10% in men, on average a 7-year surveillance interval is sufficient for a 3.0-cm aneurysm, whereas an 8-month interval is necessary for a 5.0-cm aneurysm. To control the risk of rupture to below 1%, the corresponding estimated surveillance intervals are 9 years and 17 months. Average growth rates were higher in smokers (by 0.35 mm/year) and lower in patients with diabetes (by 0.51 mm/year). Rupture rates were almost fourfold higher in women than men, doubled in current smokers and increased with higher blood pressure. Increasing the surveillance interval from 1 to 2 years for the smallest aneurysms (3.0-4.4 cm) decreased costs and led to a positive net benefit. For the larger aneurysms (4.5-5.4 cm), increasing surveillance intervals from 3 to 6 months led to equivalent cost-effectiveness. LIMITATIONS: There were no clear reasons why the growth rates varied substantially between studies. Uniform diagnostic criteria for rupture were not available. The long-term cost-effectiveness results may be susceptible to the modelling assumptions made. CONCLUSIONS: Surveillance intervals of several years are clinically acceptable for men with AAAs in the range 3.0-4.0 cm. Intervals of around 1 year are suitable for 4.0-4.9-cm AAAs, whereas intervals of 6 months would be acceptable for 5.0-5.4-cm AAAs. These intervals are longer than those currently employed in the UK AAA screening programmes. Lengthening surveillance intervals for the smallest aneurysms was also shown to be cost-effective. Future work should focus on optimising surveillance intervals for women, studying whether or not the threshold for surgery should depend on patient characteristics, evaluating the usefulness of surveillance for those with aortic diameters of 2.5-2.9 cm, and developing interventions that may reduce the growth or rupture rates of small AAAs. FUNDING: The National Institute for Health Research Health Technology Assessment programme

Modelling Building Users’ Space Preferences for Group Work: A Discrete-Choice Experiment

Accurate space-use prediction helps architects to optimise space efficiency in buildings, thereby achieving economic and environmental sustainability. However, current space-use prediction models and approaches either disregard or oversimplify the role of building users’ space preferences in spatial-choice behaviour, thereby compromising prediction accuracy. The aim of this study was thus to develop a space-preference model of spatial choice behaviour with a focus on group work-related activities. A total of 2,464 observations of spatial choices were collected using a discrete-choice experiment. The data were modelled using a conditional logit model and then validated in a predictive success test. The resulting model clearly explains space preferences for group work-related activities and predicts spatial-choice behaviour by generating space-use probabilities for given spaces. The model is compared to a space preference model for individual work-related activities. Lastly, the application of the model was demonstrated in a case example.This work was supported by Hong Kong Polytechnic University: [grant number 1-ZE5H]

Effect of B on the microstructure and mechanical properties of mechanically milled TiAl alloys

The present study is concerned with gamma-(Ti52Al48)(100-x)B-x (x = 0, 0.5, 2, 5) alloys produced by mechanical milling/vacuum hot pressing (VHPing) using melt-extracted powders. Microstructure of the as-vacuum hot pressed (VHPed) alloys exhibits a duplex equiaxed microstructure of alpha(2) and gamma with a mean grain size of 200 nm. Besides alpha(2) and gamma phases, binary and 0.5 pet B alloys contain Ti,AIN and Al2O3 phases located along the grain boundaries and show appreciable coarsening in grain and dispersoid sizes during annealing treatment at 1300 degrees C for 5 hours. On the other hand, 2 pet B and 5 pet B alloys contain fine boride particles within the gamma grains and shaw minimal coarsening during annealing. Room-temperature compressing tests of the as-VHPed alloys show low ductility, but very high yield strength > 2100 MPa. After annealing treatment, mechanically milled alloys show much higher yield strength than conventional powder metallurgy and ingot metallurgy processed alloys, with equivalent ductility to ingot metallurgy processed alloys. The 5 pet B alloy with the smallest grain size shows higher yield strength than binary alloy up to the test temperature of 700 degrees C. At 850 degrees C, 5 pet B alloy shows much lower strength than the binary alloy, indicating that the deformation of fine 5 pet B alloy is dominated by the grain boundary sliding mechanism.ope

A self organization approach to goal-directed multimodal locomotion based on Attractor Selection Mechanism

The realization and utilization of multimodal locomotion to enable robots to accomplish useful tasks is a significantly challenging problem in robotics. Related to the challenge, it is crucial to notice that the locomotion dynamics of the robots is a result of interactions between a particular control structure and its body-environment dynamics. From this perspective, this paper presents a simple control structure known as Attractor Selection Mechanism that enables a robot to self organize its multiple locomotion modes for accomplishing a goal-directed locomotion task. Despite the simplicity, the approach enables the robot to automatically explore different body-environment dynamics and stabilize onto particular attractors which corresponds to locomotion modes relevant to accomplish the task. The robot used throughout the paper is a curved-beam hopping robot, which despite its simple actuation method, possesses rich and complex bodyenvironment dynamics.This is the author accepted manuscript. The final version is available from IEEE via http://dx.doi.org/10.1109/ICRA.2015.713990

Interactive ion-mediated sap flow regulation in Olive and Laurel stems: physicochemical characteristics of water transport via the pit structure

Sap water is distributed and utilized through xylem conduits, which are vascular networks of inert pipes important for plant survival. Interestingly, plants can actively regulate water transport using ion-mediated responses and adapt to environmental changes. However, ionic effects on active water transport in vascular plants remain unclear. In this report, the interactive ionic effects on sap transport were systematically investigated for the first time by visualizing the uptake process of ionic solutions of different ion compositions (K+/Ca2+) using synchrotron X-ray and neutron imaging techniques. Ionic solutions with lower K+/Ca2+ ratios induced an increased sap flow rate in stems of Olea europaea L. and Laurus nobilis L. The different ascent rates of ionic solutions depending on K+/Ca2+ ratios at a fixed total concentration increases our understanding of ion-responsiveness in plants from a physicochemical standpoint. Based on these results, effective structural changes in the pit membrane were observed using varying ionic ratios of K+/Ca2+. The formation of electrostatically induced hydrodynamic layers and the ion-responsiveness of hydrogel structures based on Hofmeister series increase our understanding of the mechanism of ion-mediated sap flow control in plants.open1155sciescopu

Genome sequence of strain HIMB30, a novel member of the marine Gammaproteobacteria

Strain HIMB30 was isolated from coastal Hawaii seawater by extinction culturing in seawater-based oligotrophic medium. It is a phylogenetically unique member of the class Gammaproteobacteria that is only distantly related to its closest cultured relatives. Here we present the genome sequence of strain HIMB30, including genes for proteorhodopsin-based phototrophy and the Calvin-Benson-Bassham cycle

Remote Detection of Radioactive Material using High-Power Pulsed Electromagnetic Radiation

Remote detection of radioactive materials is impossible when the measurement location is far from the radioactive source such that the leakage of high-energy photons or electrons from the source cannot be measured. Current technologies are less effective in this respect because they only allow the detection at distances to which the high-energy photons or electrons can reach the detector. Here we demonstrate an experimental method for remote detection of radioactive materials by inducing plasma breakdown with the high-power pulsed electromagnetic waves. Measurements of the plasma formation time and its dispersion lead to enhanced detection sensitivity compared to the theoretically predicted one based only on the plasma on and off phenomena. We show that lower power of the incident electromagnetic wave is sufficient for plasma breakdown in atmospheric-pressure air and the elimination of the statistical distribution is possible in the presence of radioactive material.ope

Active Immunization with Extracellular Vesicles Derived from Staphylococcus aureus Effectively Protects against Staphylococcal Lung Infections, Mainly via Th1 Cell-Mediated Immunity

Staphylococcus aureus is an important pathogenic bacterium that causes various infectious diseases. Extracellular vesicles (EVs) released from S. aureus contain bacterial proteins, nucleic acids, and lipids. These EVs can induce immune responses leading to similar symptoms as during staphylococcal infection condition and have the potential as vaccination agent. Here, we show that active immunization (vaccination) with S. aureus-derived EVs induce adaptive immunity of antibody and T cell responses. In addition, these EVs have the vaccine adjuvant ability to induce protective immunity such as the up-regulation of co-stimulatory molecules and the expression of T cell polarizing cytokines in antigen-presenting cells. Moreover, vaccination with S. aureus EVs conferred protection against lethality induced by airway challenge with lethal dose of S. aureus and also pneumonia induced by the administration of sub-lethal dose of S. aureus. These protective effects were also found in mice that were adoptively transferred with splenic T cells isolated from S. aureus EV-immunized mice, but not in serum transferred mice. Furthermore, this protective effect of S. aureus EVs was significantly reduced by the absence of interferon-gamma, but not by the absence of interleukin-17. Together, the study herein suggests that S. aureus EVs are a novel vaccine candidate against S. aureus infections, mainly via Th1 cellular response.111814Ysciescopu

Reducing false-positive biopsies: a pilot study to reduce benign biopsy rates for BI-RADS 4A/B assessments through testing risk stratification and new thresholds for intervention

The aim of this study is to evaluate Breast Imaging Reporting and Data Systems (BI-RADS) 4A/B subcategory risk estimates for ductal carcinoma in situ (DCIS) and invasive cancer (IC), determining whether changing the proposed cutoffs to a higher biopsy threshold could safely increase cancer-to-biopsy yields while minimizing false-positive biopsies. A prospective clinical trial was performed to evaluate BI-RADS 4 lesions from women seen in clinic between January 2006 and March 2007. An experienced radiologist prospectively estimated a percent risk-estimate for DCIS and IC. Truth was determined by histopathology or 4-year follow-up negative for malignancy. Risk estimates were used to generate receiver-operating characteristic (ROC) curves. Biopsy rates, cancer-to-biopsy yields, and type of malignancies missed were then calculated across postulated risk thresholds. A total of 124 breast lesions were evaluated from 213 women. An experienced radiologist gave highly accurate risk estimates for IC, DCIS alone, or the combination with an area under ROC curve of 0.91 (95 % CI 0.84–0.99) (p < 0.001), 0.81 (95 % CI 0.69–0.93) (p = 0.011), and 0.89 (95 % CI 0.83–0.95) (p < 0.001), respectively. The cancer-to-biopsy yield was 30 %. Three hypothetical thresholds for intervention were analyzed: (1) DCIS or IC ≥ 10 %; (2) DCIS ≥ 50 % or IC ≥ 10 %; and (3) IC ≥ 10 %, which translated to 22, 48, and 56 % of biopsies avoided; cancer-to-biopsy yields of 36, 47, and 46 %; and associated chance of missing an IC of 0, 1, and 2 %, respectively. Expert radiologists estimate risk of IC and DCIS with a high degree of accuracy. Increasing the cut off point for recommending biopsy, substituting with a short-term follow-up protocol with biopsy if any change, may safely reduce the number of false-positive biopsies