Standardized approach to extract candidate outcomes from literature for a standard outcome set:a case- and simulation study

Aims: Standard outcome sets enable the value-based evaluation of health care delivery. Whereas the attainment of expert opinion has been structured using methods such as the modified-Delphi process, standardized guidelines for extraction of candidate outcomes from literature are lacking. As such, we aimed to describe an approach to obtain a comprehensive list of candidate outcomes for potential inclusion in standard outcome sets. Methods: This study describes an iterative saturation approach, using randomly selected batches from a systematic literature search to develop a long list of candidate outcomes to evaluate healthcare. This approach can be preceded with an optional benchmark review of relevant registries and Clinical Practice Guidelines and data visualization techniques (e.g. as a WordCloud) to potentially decrease the number of iterations. The development of the International Consortium of Health Outcome Measures Heart valve disease set is used to illustrate the approach. Batch cutoff choices of the iterative saturation approach were validated using data of 1000 simulated cases. Results: Simulation showed that on average 98% (range 92–100%) saturation is reached using a 100-article batch initially, with 25 articles in the subsequent batches. On average 4.7 repeating rounds (range 1–9) of 25 new articles were necessary to achieve saturation if no outcomes are first identified from a benchmark review or a data visualization. Conclusion: In this paper a standardized approach is proposed to identify relevant candidate outcomes for a standard outcome set. This approach creates a balance between comprehensiveness and feasibility in conducting literature reviews for the identification of candidate outcomes.</p

Liquid Xenon Detectors for Positron Emission Tomography

PET is a functional imaging technique based on detection of annihilation photons following beta decay producing positrons. In this paper, we present the concept of a new PET system for preclinical applications consisting of a ring of twelve time projection chambers filled with liquid xenon viewed by avalanche photodiodes. Simultaneous measurement of ionization charge and scintillation light leads to a significant improvement to spatial resolution, image quality, and sensitivity. Simulated performance shows that an energy resolution of <10% (FWHM) and a sensitivity of 15% are achievable. First tests with a prototype TPC indicate position resolution <1 mm (FWHM).Comment: Paper presented at the International Nuclear Physics Conference, Vancouver, Canada, 201

Modeling of [F-18]FEOBV Pharmacokinetics in Rat Brain

Purpose: [18F]Fluoroethoxybenzovesamicol ([18F]FEOBV) is a radioligand for the vesicular acetylcholine transporter (VAChT), a marker of the cholinergic system. We evaluated the quantification of [18F]FEOBV in rats in control conditions and after partial saturation of VAChT using plasma and reference tissue input models and test-retest reliability. Procedure: Ninety-minute dynamic [18F]FEOBV PET scans with arterial blood sampling were performed in control rats and rats pretreated with 10 μg/kg FEOBV. Kinetic analyses were performed using one- (1TCM) and two-tissue compartmental models (2TCM), Logan and Patlak graphical analyses with metabolite-corrected plasma input, reference tissue Patlak with cerebellum as reference tissue, standard uptake value (SUV) and SUV ratio (SUVR) using 60- or 90-min acquisition. To assess test-retest reliability, two dynamic [18F]FEOBV scans were performed 1 week apart. Results: The 1TCM did not fit the data. Time-activity curves were more reliably estimated by the irreversible than the reversible 2TCM for 60 and 90 min as the influx rate Ki showed a lower coefficient of variation (COV, 14–24 %) than the volume of distribution VT (16–108 %). Patlak graphical analysis showed a good fit to the data for both acquisition times with a COV (12–27 %) comparable to the irreversible 2TCM. For 60 min, Logan analysis performed comparably to both irreversible models (COV 14–32 %) but showed lower sensitivity to VAChT saturation. Partial saturation of VAChT did not affect model selection when using plasma input. However, poor correlations were found between irreversible 2TCM and SUV and SUVR in partially saturated VAChT states. Test-retest reliability and intraclass correlation for SUV were good. Conclusion: [18F]FEOBV is best modeled using the irreversible 2TCM or Patlak graphical analysis. SUV should only be used if blood sampling is not possible

Effect of dopamine D2 receptor antagonists on [18F]-FEOBV binding

The interaction of dopaminergic and cholinergic neurotransmission in, e.g., Parkinson's disease has been well established. Here, D2 receptor antagonists were used to assess changes in [18F]-FEOBV binding to the vesicular acetylcholine transporter (VAChT) in rodents using positron emission tomography (PET). After pretreatment with either 10 mg/kg haloperidol, 1 mg/kg raclopride, or vehicle, 90 min dynamic PET scans were performed with arterial blood sampling. The net influx rate (Ki) was obtained from Patlak graphical analysis, using a metabolite-corrected plasma input function and dynamic PET data. [18F]-FEOBV concentration in whole-blood or plasma and the metabolite-corrected plasma input function were not significantly changed by the pretreatments (adjusted p > 0.07, Cohen's d 0.28-1.89) while the area-under-the-curve (AUC) of the parent fraction of [18F]-FEOBV was significantly higher after haloperidol treatment (adjusted p = 0.022, Cohen's d = 2.51) than in controls. Compared to controls, the AUC of [18F]-FEOBV, normalized for injected dose and body weight, was nonsignificantly increased in the striatum after haloperidol (adjusted p = 0.4, Cohen's d = 1.77) and raclopride (adjusted p = 0.052, Cohen's d = 1.49) treatment, respectively. No changes in the AUC of [18F]-FEOBV were found in the cerebellum (Cohen's d 0.63-0.74). Raclopride treatment nonsignificantly increased Ki in the striatum 1.3-fold compared to control rats (adjusted p = 0.1, Cohen's d = 1.1) while it reduced Ki in the cerebellum by 28% (adjusted p = 0.0004, Cohen's d = 2.2) compared to control rats. Pretreatment with haloperidol led to a nonsignificant reduction in Ki in the striatum (10%, adjusted p = 1, Cohen's d = 0.44) and a 40-50% lower Ki than controls in all other brain regions (adjusted p < 0.0005, Cohen's d = 3.3-4.7). The changes in Ki induced by the selective D2 receptor antagonist raclopride can in part be quantified using [18F]-FEOBV PET imaging. Haloperidol, a nonselective D2/σ receptor antagonist, either paradoxically decreased cholinergic activity or blocked off-target [18F]-FEOBV binding to σ receptors. Hence, further studies evaluating the binding of [18F]-FEOBV to σ receptors using selective σ receptor ligands are necessary

The ππ\pi\pi interaction in nuclear matter from a study of the π+A→π+π±A′\pi^+ A \to \pi^+ \pi^{\pm} A' reactions

The pion-production reactions $\pi^+ A \to \pi^+\pi^{\pm} A'$ were studied on $^{2}H$, $^{12}C$, $^{40}Ca$, and $^{208}Pb$ nuclei at an incident pion energy of $T_{\pi^{+}}$=283 MeV. Pions were detected in coincidence using the CHAOS spectrometer. The experimental results are reduced to differential cross sections and compared to both theoretical predictions and the reaction phase space. The composite ratio $\cal C$$_{\pi\pi}^A$ between the $\pi^{+}\pi^{\pm}$ invariant masses on nuclei and on the nucleon is also presented. Near the $2m_{\pi}$ threshold pion pairs couple to $(\pi\pi)_{I=J=0}$ when produced in the $\pi^+\to \pi^+\pi^-$ reaction channel. There is a marked near-threshold enhancement of $\cal C$$_{\pi^+\pi^-}^A$ which is consistent with theoretical predictions addressing the partial restoration of chiral symmetry in nuclear matter. Furthermore, the behaviour of $\cal C$$_{\pi^+\pi^-}^A$ is well described when the restoration of chiral symmetry is combined with standard P-wave renormalization of pions in nuclear matter. On the other hand, nuclear matter only weakly influences $\cal C$$_{\pi^+\pi^+}^A$, which displays a flat behaviour throughout the energy range regardless of $A$.Comment: 30 pages, 16 figures, PS format, accepted for publication in Nucl. Phys

Chiral unitary approach to S-wave meson baryon scattering in the strangeness S=0 sector

We study the S-wave interaction of mesons with baryons in the strangeness S=0 sector in a coupled channel unitary approach. The basic dynamics is drawn from the lowest order meson baryon chiral Lagrangians. Small modifications inspired by models with explicit vector meson exchange in the t-channel are also considered. In addition the pi pi N channel is included and shown to have an important repercussion in the results, particularly in the isospin 3/2 sector.Comment: 23 pages, LaTeX, 21 figure

The two pion decay of the Roper resonance

We evaluate the two pion decay of the Roper resonance in a model where explicit re-scattering of the two final pions is accounted for by the use of unitarized chiral perturbation theory. Our model does not include an explicit $\epsilon$ or $\sigma$ scalar-isoscalar meson decay mode, instead it generates it dynamically by means of the pion re-scattering. The two ways, explicit or dynamically generated, of introducing this decay channel have very different amplitudes. Nevertheless, through interference with the other terms of the model we are able to reproduce the same phenomenology as models with explicit consideration of the $\epsilon$ meson.Comment: 17 latex pages, 11 eps figures. A few misprints corrected. A few new references. Version accepted for publication in Phys. Rev.

NEMA NU 4-2008 Comparison of preclinical PET imaging systems

The National Electrical Manufacturers Association (NEMA) standard NU 4-2008 for performance measurements of smallanimal tomographs was recently published. Before this standard, there were no standard testing procedures for preclinical PET systems, and manufacturers could not provide clear specifications similar to those available for clinical systems under NEMA NU 2-1994 and 2-2001. Consequently, performance evaluation papers used methods that were modified ad hoc from the clinical PET NEMA standard, thus making comparisons between systems difficult. Methods: We acquired NEMA NU 4-2008 performance data for a collection of commercial animal PET systems manufactured since 2000: micro- PET P4, microPET R4, microPET Focus 120, microPET Focus 220, Inveon, ClearPET, Mosaic HP, Argus (formerly eXplore Vista), VrPET, LabPET 8, and LabPET 12. The data included spatial resolution, counting-rate performance, scatter fraction, sensitivity, and image quality and were acquired using settings for routine PET. Results: The data showed a steady improvement in system performance for newer systems as compared with first-generation systems, with notable improvements in spatial resolution and sensitivity. Conclusion: Variation in system design makes direct comparisons between systems from different vendors difficult. When considering the results from NEMA testing, one must also consider the suitability of the PET system for the specific imaging task at hand.This work was funded by the Natural Sciences and Engineering Research Council of Canada under Discovery Grant 341628-2007. No other potential conflict of interest relevant to this article was reported.En prens

System matrix modeling of externally tracked motion

Background and aim In high-resolution emission tomography imaging, even small patient movements can considerably degrade image quality. The aim of this work was to develop a general approach to motion-corrected reconstruction of motion-contaminated data in the case of rigid motion (particularly brain imaging) which would be applicable to any PET scanner in the field, without specialized data-acquisition requirements. Methods Assuming the ability to externally track subject motion during scanning (e.g., using the Polaris camera), we proposed to incorporate the measured rigid motion information into the system matrix of the expectation maximization reconstruction algorithm. Furthermore, we noted and developed a framework to incorporate the additional effect of motion on modifying the attenuation factors. A new mathematical brain phantom was developed and used along with elaborate combined Simset/GATE simulations to compare the proposed framework with the cases of no motion correction. Results and conclusion Clear qualitative and quantitative improvements were observed when incorporating the proposed framework. The method is very practical to implement for any scanner in the field, not requiring any hardware modifications or access to the list-mode acquisition capability