Predicting AIDS-related events using CD4 percentage or CD4 absolute counts

BACKGROUND: The extent of immunosuppression and the probability of developing an AIDS-related complication in HIV-infected people is usually measured by the absolute number of CD4 positive T-cells. The percentage of CD4 positive cells is a more easily measured and less variable number. We analyzed sequential CD4 and CD8 numbers, percentages and ratios in 218 of our HIV infected patients to determine the most reliable predictor of an AIDS-related event. RESULTS: The CD4 percentage was an unsurpassed predictor of the occurrence of AIDS-related events when all subsets of patients are considered. The CD4 absolute count was the next most reliable, followed by the ratio of CD4/CD8 percentages. The value of CD4 percentage over the CD4 absolute count was seen even after the introduction of highly effective HIV therapy. CONCLUSION: The CD4 percentage is unsurpassed as a parameter for predicting the onset of HIV-related diseases. The extra time and expense of measuring the CD4 absolute count may be unnecessary

Comparing Rasch Analyses Probability Estimates to Sensitivity, Specificity and Likelihood Ratios when Examining the Utility of Medical Diagnostic Tests

Introduction: Medical diagnostic tests are evaluated based on measures of sensitivity (Sn), specificity (Sp), and likelihood ratios (LR). These procedures are limited in the event of a biased gold standard or missing data. Interpretations of these measures are frequently inappropriate. Purpose: The Rasch Measurement Model (RMM) was examined as a method to provide evidence of diagnostic test utility in order to overcome the limitations of Sn, Sp, and LR. Methods: Patients suspected of a knee ligament tear (n = 825) were studied, by evaluating four diagnostic tests. The RMM probability estimates for each test were compared to estimates of Sn, Sp, and LR. Results: The RMM provided probability estimates for the diagnosis that were comparable to likelihood ratios. These probability estimates correlated with the estimates of Sn, Sp, and LR. The RMM estimates were not affected by missing data. Discussion: The RMM may provide an alternative means to study the utility of medical diagnostic tests to estimate the probability of disease presence/absence

Self-checking method for fault tolerance solution in wireless sensor network

Recently, the wireless sensor network (WSN) has been considered in different application, particularly in emergency systems. Therefore, it is important to keep these networks in high reliability using software engineering techniques in the field of fault tolerance. This paper proposed a fault node detection method in WSN using the self-checking technique according to the rules of software engineering. Then, the detected faulted node is covered employing the reading of nearest neighbor nodes (sensors). In addition, the proposed method sends a message for maintenance to solve the fault. The proposed method can reduce the time between the detection and recovery of a fault to prevent the confusion of adopting wrong readings, in which the detection is making with mistake. Moreover, it guarantees the reliability of the WSN, in terms of operation and data transmission. The proposed method has been tested over different scenarios and the obtained results show the superior efficiency in terms of recovery, reliability, and continuous data transmission

Decreased Prevalence of Autoimmune Connective Tissue Diseases in Type 1 and Type 2 Diabetes

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Opioid Dispensing Practices in the Acute Care Setting: A Retrospective Study

Background: Ohio remains one of the most afflicted states nationally with 46.3 per 100 000 deaths due to drug overdose. Opioids are commonly administered in emergency departments for the management of pain. Given the high volume of patients presenting with pain, emergency clinicians must be cognizant of responsible opioid dispensing practices. Ohio established guidelines in April 2012 to provide a general approach for responsible opioid prescribing practices in the emergency setting. The purpose of this study assesses clinician opioid dispensing before and after the implementation of the Ohio Opioid Prescribing Guidelines. Methods: The study design used retrospective data analysis of opioid medications ordered by emergency clinicians to be administered in the emergency room between January 1, 2007, to December 31, 2017, at the University of Toledo Medical Center. A segmented regression analysis with an interrupted time series was used to determine impact. Results: All opioid medication usage showed a significant decrease after guideline implementation except for morphine and fentanyl which showed statistically significant increases in administration over time (P < 0.05). Conclusion: There was a significant decrease in the use of opioids since the implementation of the Ohio Opioid Prescribing Guidelines, yet morphine and fentanyl use has generally increased across all age groups. Age demographics frequently receiving opioids in the emergency room have seemed to shift over time as well as specific opioid drugs dispensed for the management of pain in certain age groups. Further study is needed to evaluate the use of opioids prescribed by emergency physicians after discharge from the emergency department

Early detection of breast cancer using mammography images and software engineering process

The breast cancer has affected a wide region of women as a particular case. Therefore, different researchers have focused on the early detection of this disease to overcome it in efficient way. In this paper, an early breast cancer detection system has been proposed based on mammography images. The proposed system adopts deep-learning technique to increase the accuracy of detection. The convolutional neural network (CNN) model is considered for preparing the datasets of training and test. It is important to note that the software engineering process model has been adopted in constructing the proposed algorithm. This is to increase the reliably, flexibility and extendibility of the system. The user interfaces of the system are designed as a website used at country side general purpose (GP) health centers for early detection to the disease under lacking in specialist medical staff. The obtained results show the efficiency of the proposed system in terms of accuracy up to more than 90% and decrease the efforts of medical staff as well as helping the patients. As a conclusion, the proposed system can help patients by early detecting the breast cancer at far places from hospital and referring them to nearest specialist center

Emergency Medicine Shift Factors Causing the Most Stress Among Emergency Medicine Residents

Introduction: Past studies demonstrate that stress and anxiety affect emergency medicine physicians, but the causal factors identified are usually from sources outside the work shift. We attempt to show the relationship between intrinsic factors of a work shift and anxiety perceived by residents, while also examining differing gender responses. Methods: In 2018, a cross-sectional survey of emergency medicine residents in the United States was distributed anonymously through the Emergency Medicine Residents Association. The survey consisted of demographic questions, novel questions identifying intrinsic factors, and the Generalized Anxiety Disorder 7-item (GAD-7) scale. Spearman correlation, independent t-test, and multivariate analysis of variance were performed. Results: Data from 573 residents found several stressful factors: working with a nurse perceived to be inefficient, working with no inpatient beds available, and working with a colleague perceived to be inefficient. The majority of respondents reported some general anxiety on the GAD-7 assessment. There was no difference on anxiety level as a function of year of residency (p \u3e .05). There was a significant gender difference on anxiety level, t(571) = -4.8689, p \u3c .05, where male residents reported lower anxiety levels (mean=5.15) as compared to female residents (mean=7.02). Lastly, post-hoc analyses revealed that male and female respondents reported differing levels of stress in response to several intrinsic stress factors. Conclusion: We identified several intrinsic factors during a shift that contribute to resident anxiety and analyzed differing gender responses to these factors; this may provide a framework for residency programs to minimize stressors in the future

ABCC5, ERCC2, XPA and XRCC1 transcript abundance levels correlate with cisplatin chemoresistance in non-small cell lung cancer cell lines

BACKGROUND: Although 40–50% of non-small cell lung cancer (NSCLC) tumors respond to cisplatin chemotherapy, there currently is no way to prospectively identify potential responders. The purpose of this study was to determine whether transcript abundance (TA) levels of twelve selected DNA repair or multi-drug resistance genes (LIG1, ERCC2, ERCC3, DDIT3, ABCC1, ABCC4, ABCC5, ABCC10, GTF2H2, XPA, XPC and XRCC1) were associated with cisplatin chemoresistance and could therefore contribute to the development of a predictive marker. Standardized RT (StaRT)-PCR, was employed to assess these genes in a set of NSCLC cell lines with a previously published range of sensitivity to cisplatin. Data were obtained in the form of target gene molecules relative to 10(6 )β-actin (ACTB) molecules. To cancel the effect of ACTB variation among the different cell lines individual gene expression values were incorporated into ratios of one gene to another. Each two-gene ratio was compared as a single variable to chemoresistance for each of eight NSCLC cell lines using multiple regression. In an effort to validate these results, six additional lines then were evaluated. RESULTS: Following validation, single variable models best correlated with chemoresistance (p < 0.001), were ERCC2/XPC, ABCC5/GTF2H2, ERCC2/GTF2H2, XPA/XPC and XRCC1/XPC. All single variable models were examined hierarchically to achieve two variable models. The two variable model with the highest correlation was (ABCC5/GTF2H2, ERCC2/GTF2H2) with an R(2 )value of 0.96 (p < 0.001). CONCLUSION: These results provide markers suitable for assessment of small fine needle aspirate biopsies in an effort to prospectively identify cisplatin resistant tumors

Immune response to pneumococcal polysaccharides 4 and 14 in elderly and young adults. I Antibody concentrations, avidity and functional activity

Streptococcus pneumoniae is a serious worldwide pathogen and the focus of numerous vaccine development projects. Currently the most widely accepted surrogate marker for evaluating the efficacy of a given vaccine is to utilize ELISA. Measurement of antibody concentration by ELISA without reduction in cross-reactive antibodies causes an overestimation of antibody concentration and therefore protection, this is most notable in the aged, an at risk group for this infection. We compared the immune response to the pneumococcal polysaccharides (PPS) 4 and 14 of 20 young to 20 elderly adults. Pre-and post-vaccination IgG antibody concentrations and antibody avidity against PPS4 and PPS14 were measured using two different enzyme-linked immunosorbant assay (ELISA) absorption protocols. All sera were pre-absorbed with either cell-wall polysaccharide (CPS), or CPS and serotype 22F polysaccharide. Pre- and post-vaccination IgG antibody concentrations for serotype 4, but not 14, were significantly lowered with the additional absorption with serotype 22F polysaccharide in both age groups. Young and elderly demonstrated a significant increase from pre- to post-immunization antibody concentration, using either absorption method; and opsonophagocytic antibody titers in response to both PPS4 and PPS14. The correlation coefficients between ELISA and opsonophagocytic assays were improved by additional absorption with serotype 22F in response to serotype 4, but not serotype 14 in all age groups. Opsonophagocytic antibody titers in a sub-group of elderly (>77 years of age) were significantly lower than the opsonophagocytic antibody concentrations in young adults. These results suggest the importance of eliminating cross-reactive antibodies from ELISA measurements by absorption of serum and an age-related impairment in the antibody response to pneumococcal polysaccharides

Calculation of Splicing Potential from the Alternative Splicing Mutation Database

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